Postoperative Numbness Research Articles

일차성 부갑상선기능항진증으로 수술적 치료를 받은 환자들에 대한 임상적 고찰

Background and Objectives: To evaluate the accuracy of ultrasound (US), computed tomography (CT) and 99Tc sestamibi scan (MIBI) for preoperative localization of solitary parathyroid mass in patients with primary hyperparathyroidism and analyze our surgical outcomes. Materials and Methods: In a retrospective study of 57 consecutive patients with primary hyperparathyroidism, all patients underwent parathyroidectomy from Jan. 2003 through Dec. 2013. Patients were performed ultrasound, computed tomography and Technetium-99m ses-tamibi scan before surgery. We also reviewed serum calcium, serum parathyroid hormone (iPTH), associated symptoms and pathologic results through electronic medical records (EMR). Results: All 57 patients were enrolled and they had single solitary parathyroid mass. In final pathologic results, 45 patients had solitary parathyroid adenoma, 7 patients had nodular hyperplasia and 5 patients were diagnosed as parathyroid cancer. In adenoma and carcinoma as a single nodule, accuracy of US was 95.2% (40/42), CT was 91.7% (44/48), MIBI was 81.5% (31/38). The most common symptoms were general weakness and nausea. Interestingly, asymptomatic hypercalcemia, incidentaloma were over the half patients. Postoperative numbness was observed in 4 patients and they were treated with calcium supplementation but not persisted longer than 4th day postoperatively. Conclusions : Our results show that the combination of US, CT, MIBI has benefits for preoperative localization of parathyroid mass in primary hyperparathyroidism and parathyroidectomy was useful for patients with primary hyperparathyroidism. (J Clinical Otolaryngol 2017;28:205–210)

Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Arthroscopic Iliopsoas Fractional Lengthening Compared With a Matched Control Group Without Iliopsoas Fractional Lengthening

To compare the minimum 2-year outcomes and return to sports in competitive athletes after arthroscopic iliopsoas fractional lengthening (IFL) and treatment for femoroacetabular impingement (FAI) to competitive athletes treated for FAI who did not undergo IFL. Data were prospectively collected and retrospectively reviewed between November 2009 and April 2014. Included patients were high school, collegiate, or professional athletes who underwent arthroscopic IFL, treatment for FAI, and preoperative modified Harris Hip Score, Non-Arthritic Athletic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Exclusion criteria were patients younger than 16years, Tönnis grade >1, microfracture, abductor pathology, and previous hip conditions. A subgroup of athletes were matched to athletes who did not undergo IFL by age ± 5years, sex, and body mass index ±5. There were 75 athletes eligible for inclusion, 60 (80.0%) of whom had minimum 2-year follow-up. All patient-reported outcome (PRO) scores demonstrated significant improvements at latest follow-up (P < .001). Mean satisfaction was 7.9. No patients converted to arthroplasty. Painful snapping was resolved in 55 athletes (91.7%). Nine athletes (15.0%) had nonpainful snapping at follow-up. Thirty-nine (65%) returned to their sport. Forty (66.7%) maintained or improved their competitive abilities. There was one case (1.6%) of temporary postoperative numbness. There were no complaints of weakness in hip flexion. Forty-one IFL athletes were matched to 41 controls. No differences were detected in demographics, follow-up time, intraoperative findings, procedures, mean magnitudes of improvement, or return to sports. In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of 2years postoperatively. Most patients were able to return to sports and maintain or improve their competitive levels. These results were similar to a control group of athletes not requiring IFL. Level III, case-control study.

Correlation of general and oral health-related quality of life in malocclusion patients treated with a combined orthodontic and maxillofacial surgical approach

PurposeThe aim of the study was to collect information about the oral health-related quality of life (OHRQoL) after combined orthodontic and maxillofacial surgical treatment as well as its influence on health-related quality of life (HRQoL). Materials and methodsThe study includes data from a total of 130 subjects, 65 of whom (21 male, 44 female, mean age at baseline: 24 years, mean age at the time of surgery: 26 years) were compared with control subjects matched on the basis of gender and age. The set of questionnaires used consisted of a questionnaire advanced by the authors including 35 general and treatment-specific questions, and the German version of the validated “Orthognathic Quality of Life Questionnaire” (OQLQ) to analyze the specific OHRQoL, and the SF-36 to measure HRQoL. ResultsThe main reason for treatment was most often a combination of esthetic and functional complaints. In most cases, the treatment results met the expectations of subjects well or very well, particularly in the areas of aesthetics and masticatory function. Postoperative numbness or paresthesia were present in 59% of patients, especially in the chin and lower lip areas. In all, 20% of subjects considered the temporary restriction of mouth opening as very bothersome. A decrease in HRQoL was noted as compared with the control group in the subscales of “role physical” (p < 0.001), “general health” (p = 0.023), and “role emotional” (p = 0.007). No differences were found in the “physical functioning,” “bodily pain,” “vitality,” “social functioning,” and “mental health” subscales. The specific OHRQoL resulted in statistically significant limitations in the patient group for all areas examined. The “oral function” (p < 0.001), “dentofacial aesthetics” (p = 0.005), “social aspects” (p = 0.002), and “awareness of dentofacial aesthetics” (p = 0.004) values were significantly decreased. ConclusionsOverall, patients expressed a high level of satisfaction and approval with regard to the combined orthodontic and maxillofacial surgical treatment. However, even after combined orthodontic and maxillofacial surgical treatment of malocclusion patients, it is possible to detect smaller limitations with regard to the specific OHRQoL, which may have a negative impact on HRQoL. Based on the results, a participatory decision-making process focusing on the individual therapy-related expectations, desires, and psychological factors of the patient concerning the improvements effected by the treatment appears to be advisable.

Incidence and Characterization of Hypoesthesia in the Distribution of the Infrapatellar Branch of the Saphenous Nerve after Anterior Cruciate Ligament Reconstruction: A Prospective Study of Patient-Reported Numbness.

The purpose of this study was to determine the incidence of patient-reported numbness following anterior cruciate ligament reconstruction (ACLR), if postoperative numbness dissipates with time, and how the graft type affects numbness severity. A total of 218 patients undergoing ACLR were prospectively enrolled. At 6 weeks, 6 months, and 1 year postoperatively, patients completed a questionnaire assessing numbness severity and location. Each time, patients rated their sensory deficit from 0 to 10 (0 = no deficit; 10 = complete lack of sensation) and indicated the location of their sensory deficit by marking a picture of a knee divided into nine rectangular segments. A mixed effect linear regression model was used to identify predictors for the patient-reported numbness severity. Overall, 69.8% (150/218) of patients reported numbness at 6 weeks, 50.0% (97/194) at 6 months, and 42.2% (78/185) at 1 year. Allograft patients reported a mean numbness severity of 2.9 ± 0.3 (mean ± standard error), 1.7 ± 0.2, and 1.4 ± 0.3 at 6 weeks, 6 months, and 1 year, respectively. The 6-week, 6-month, and 1-year averages were 4.7 ± 0.4, 2.7 ± 0.4, and 1.7 ± 0.4 for bone-patellar tendon-bone (BTB) autograft patients and 4.3 ± 0.4, 2.9 ± 0.4, and 2.5 ± 0.4 for hamstring autograft patients. The model indicated that the use of hamstring autografts increased patient-reported numbness by an average of 1.4 ± 0.5 across all time points, and the use of a BTB autograft increased patient-reported numbness by 1.2 ± 0.4 across all time points. Time from surgery decreased the severity of patient-reported numbness for all graft types (-1.3 ± 0.2 at 6 months and -1.7 ± 0.2 at 1 year). Hypoesthesia in the distribution of the infrapatellar branch of the saphenous nerve is common after ACLR but is likely to dissipate with time. Patients undergoing ACLR with allograft may be less likely to develop sensory deficits, and these deficits may be less severe.

Straightening the trigeminal nerve axis by complete dissection of arachnoidal adhesion and its neuroendoscopic confirmation for trigeminal neuralgia without neurovascular compression

Abstract Background Microvascular decompression has been used as an effective surgical treatment for typical trigeminal neuralgia with neurovascular compression. Since microvascular decompression cannot be performed in patients with typical trigeminal neuralgia without neurovascular compression, it has recently been suggested that nerve combing or neurolysis (longitudinally splitting the trigeminal nerve from the root entry zone to the pons by microneedle) be used as a primary surgical treatment. However, postoperative numbness and dysesthesia were present in the patients. Case description We present a case of a 57-year-old woman with typical trigeminal neuralgia without neurovascular compression, which was evaluated by magnetic resonance imaging. A neurosurgical operation was performed in a supine-lateral position for the retromastoid approach under monitoring by electrophysiological evoked potentials. Since neurovascular compression could not be found, we performed straightening of the trigeminal nerve axis by complete dissection of the arachnoidal adhesion around the trigeminal nerve. Results were confirmed by a neuroendoscope. The patient demonstrated complete resolution of the trigeminal neuralgia without facial numbness and dysesthesia during the three years after the operation. Conclusions Straightening the trigeminal nerve axis by complete dissection of the arachnoidal adhesion around the trigeminal nerve was effective for typical trigeminal neuralgia without neurovascular compression.

Comparative analysis of supraclavicular nerve injury after clavicle fracture surgery using two different incisions

Objective To compare and analyze supraclavicular nerve injury after mid-section clavicle fracture surgery using two different incisions, and provide solutions for protecting supraclavicular nerve in clavicle fracture surgery. Methods Between August 2010 and October 2013, 73 patients with mid-section clavicle fractures were treated with open reduction and internal fixation surgery by using minimally invasive incision (group A) or conventional incision (group B). In group A, there were 20 males and 18 females, with an average age of 36.7 years. The fractures classified by Robinson included 6 type 2A2, 21 type 2B1 and 11 type 2B2. In group B, there were 18 males and 17 females, with an average age of 38.6 years. There were 7 2A2, 16 2B1 and 12 2B2 fractures. The incidence of postoperative numbness around the incision and the area of the numbness were recorded. Patient satisfaction and shoulder joint function were evaluated by Constant-Murley score and the DASH score in two groups. Results All 73 patients were follow-up for (19.30±4.08) months on average. The numbness incidence and area of group B was significantly higher than group A in 2 weeks, 3 months and 1 year postoperatively (P 0.05). Conclusion The iatrogenic injury of supraclavicular nerves in clavicle fracture surgery impact the patients' quality of life. Surgeons should pay more attention to protect supraclavicular nerves. Using minimally invasive incision can protect supraclavicular nerves effectively in clavicle fracture surgery. Key words: Surgical procedures,minimally invasive; Clavicle; Fractures,bone; Supraclavicular nerve

Modified Lateral Surgical Approach to the Pterygopalatine Fossa.

Oral cancer, especially that originates in the maxillary tuberosity, buccal mucosa, and maxillary alveolus, is apt to invade the pterygopalatine fossa, where an intraoral approach is nearly impossible. There are 2 main types of extraoral approach to the pterygopalatine fossa; the anterior approach and the lateral approach. Although the lateral approach has an advantage compared with the anterior approach in terms of cosmetics, after the operation numbness of the lower lip occurs due to the sacrifice of the mental nerve. In the conventional lateral approach, a vertical incision is made in the center of the lower lip; a lateral flap is then elevated with the sacrifice of the mental nerve. The authors introduce here a new lateral approach to the pterygopalatine fossa with preservation of the mental nerve. In the present technique, a vertical incision was made in the corner of the mouth, and a lateral flap was then elevated with preservation of the mental nerve. This technique could also preserve the marginal mandibular branch of facial nerve in patients without a large metastasis in the submandibular lymph nodes. Additionally, expedient mandibular osteotomy, which is applied in the conventional lateral approach, could be omitted in the present technique, thus helping to prevent postoperative infection. The present approach was applied to 5 patients with oral cancer invading the pterygopalatine fossa. The postoperative numbness of the lower lip was estimated using the current perception threshold. The lesions were successfully resected with little numbness of the lower lip, and no postoperative infection occurred in any of the patients. This technique is available as an approach to the pterygopalatine fossa that preserves the mental nerve and can prevent postoperative infection.

Percutaneous Endoscopic Interlaminar Approach: Medial Foraminal Decompression in Treating Lumbar Disc Herniation or Spinal Stenosis

Background: The technique of transforaminal endoscopic spine surgery is being widely used for lumbar degenerative diseases. But the interlaminar endoscopic surgery, which is more familiar and easier to be operated for spine surgeons, is more easily applied by traditionally trained surgeons. Objective: We propose the technique of percutaneous endoscopic medial foraminal decompression through interlaminar approach for the treatment of lumbar disc herniation (LDH) and spinal stenosis (LSS), and to explore the safety and efficacy of using this technique clinically. Methods: Thirty-two LDH and eleven LSS patients received medial foraminal decompression surgery with 22.6 ± 7.9 months follow-up. Through interlaminar space, we are able to perform discectomy and lateral recess decompression to decompress the medial foraminal area. Clinical efficacy was assessed by calculating the scores of VAS, SF-36, and lumbar disease JOA and ODI respectively at preoperative, postoperative and the discharge period, 3-6 months postoperatively and the final follow-up time point when patients were considered having received maximum surgical benefit. Follow-up time period varied because of the patients' follow-up logistics in China serving a large referral area made it difficult for rural patients to return at established intervals for the study. Results: For both LDH and LSS patients, the observational indexes of the follow-up time points showed significant differences compared with those preoperatively (P<0.01). Surgical results were assessed according to JOA scores: 22 cases were excellent, 16 cases were good, and 5 cases were fair by modified MacNab criteria. The satisfaction rate of PEMFD was 88.37% during the follow-up period with the improvement of daily life quality. One patient had postoperative radiation calf pain and foot numbness, and another one had the dorsal remnant of the dural sac without symptom. Conclusion: The treatment for LDH and LSS with medial foraminal decompression is safe and effective with minimal tissue trauma, less surgical morbidity to the lumbar canal, with full decompression of nerve roots and the cauda equina. It is more similar to traditional open surgery and easier to achieve adequate canal decompression, especially for LSS.

Reshaping of the Anterior Nasal Spine: An Important Step in Rhinoplasty.

Background:The importance of analysis of the nasal spine should not be underestimated in the correct planning of rhinoplasty. Deformations in position with respect to the midline and/or in size are often present, and their correction to ensure harmony between the spine and the other components of the nasal pyramid constitutes a key step in rhinoplasty that can lead to excellent results.Methods:The study includes 160 patients who underwent surgical treatment of the anterior nasal spine with or without other techniques of nasal reshaping. Eighty-seven of these patients presented with hyperplasia of the nasal spine, 43 with hypoplasia, and 30 with deviation. A combination of deviation and hyperplasia was present in 15 cases.Results:No patients developed postoperative complications. Five patients who underwent anterior nasal spine reduction reported postoperative numbness in the premaxillary area, but sensitivity was fully regained within 4 months after surgery in these patients. All the patients reported postoperative improvement of nasal airflow. A total of 142 patients considered their postoperative aesthetic result as excellent and 18 as good.Conclusion:The simplicity of the surgical procedures performed on the nasal spine and the marked aesthetic improvements thus achieved suggest that greater attention should be paid to this anatomical region.

Forehead lipoma excision: a comparative study of open versus endoscopic technique

Endoscopic excision of forehead lipoma is increasingly utilized for its inconspicuous scarring, good intraoperative visualization and low complication rates. Currently, studies comparing outcomes from endoscopic and open excision of forehead lipomas are lacking. This retrospective study compares the surgical outcomes of the two techniques. The authors retrospectively reviewed medical records of all patients who had undergone forehead lipoma excision at a single institution between 2010 and 2015. Data collected included patient demographics, lesion size, mean operative time and postoperative complications. A comparison was made between the two groups of patients. Sixty-two patients underwent excision of their forehead lipoma (38 endoscopic and 24 open excisions). Patient groups were similar in terms of sex ratios, size of lesion, choice of anaesthesia, mean operative time and duration of follow-up. Swelling beyond 1 week in the endoscopic group was 1/38 (2.6 %) compared to 4/24 (16.7 %) in the open excision group (p = 0.07). Postoperative scalp numbness in the endoscopic group was 2/38 (5.2 %) versus 2/24 (8.3 %) in the open excision group (p = 0.64). Incidence of haematoma in the endoscopic group was 1/38 (2.6 %) compared to 2/24 (4.2 %) in the open excision group (p = 1). All 38 patients in the endoscopic group were satisfied with their scars compared with 4/24 (16.7 %) in the open excision group who reported dissatisfaction (p = 0.02). Complication rates of both surgical techniques are similar. Given that the endoscopic technique results in cosmetically superior outcomes, with no increase in morbidity, the authors recommend the use of endoscopic technique for forehead lipoma excision. Level of Evidence: Level III, therapeutic study.

Does Liposomal Bupivacaine (Exparel) Significantly Reduce Postoperative Pain/Numbness in Symptomatic Teeth with a Diagnosis of Necrosis? A Prospective, Randomized, Double-blind Trial

IntroductionMedical studies have shown some potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA), a slow-release bupivacaine solution, to extend postoperative benefits of numbness/pain relief for up to several days. Because the Food and Drug Administration has approved Exparel only for infiltrations, we wanted to evaluate if it would be effective as an infiltration to control postoperative pain. The purpose of this study was to compare an infiltration of bupivacaine with liposomal bupivacaine for postoperative numbness and pain in symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain. MethodsOne hundred patients randomly received a 4.0-mL buccal infiltration of either bupivacaine or liposomal bupivacaine after endodontic debridement. For postoperative pain, patients were given ibuprofen/acetaminophen, and they could receive narcotic pain medication as an escape. Patients recorded their level of numbness, pain, and medication use the night of the appointment and over the next 5 days. Success was defined as no or mild postoperative pain and no narcotic use. ResultsThe success rate was 29% for the liposomal group and 22% for the bupivacaine group, with no significant difference (P = .4684) between the groups. Liposomal bupivacaine had some effect on soft tissue numbness, pain, and use of non-narcotic medications, but it was not clinically significant. There was no significant difference in the need for escape medication. ConclusionsFor symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain, a 4.0-mL infiltration of liposomal bupivacaine did not result in a statistically significant increase in postoperative success compared with an infiltration of 4.0 mL bupivacaine.

The therapeutic effect of percutaneous transforaminal endoscopic discectomy through interlaminar approach for treating lumbar disc herniation

Objective To evaluate the therapeutic efficacy of percutaneous transforaminal endoscopic discectomy (PTED) through interlaminar approach in the treatment of lumbar disc herniation (LDH). Methods From October 2013 to January 2015, 54 LDH patients underwent PTED by using transforaminal endoscopic spine system (TESSYS) in our hospitial. CT or MRI indicated L 4-5 disc herniation in 13 patients and L 5 -S 1 disc herniation in other 41 patients. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of pain in the low back and leg before operation, one day, 3 months and one year after operation. MRI was performed after operation to assess if the nucleus pulposus was removed completely and whether there was a relapse. Results The success rate of operations was 96.30% (52/54). Two patients suffered from rupture of spinal dura mater during the surgery, and underwent fenestration laminectomy in turn. The average operation time was 58.35 min and median hospital stay was 3 d. At discharge, pain was disappeared in 52 patients and relieved in 2 patients, however, 5 patients presented worsened numbness of lateral lower leg. Compared with preoperation, VAS and ODI scores decreased significantly one day, 3 months and one year after operation ( P = 0.000, for all). Lumbar MRI one day after operation revealed nucleus pulposus had been completely removed and the compression of nerve root had been relieved in all cases. There was no relapse in MRI findings 3 months and one year after operation. No surgical complication, such as infection, was found. One patient with L 5 -S 1 disc herniation presented postoperative numbness of S 1 nerve root region caused by heavy stretching of nerve root during the operation, and was improved one month later. Conclusions Percutaneous transforaminal endoscopic discectomy through interlaminar approach in the treatment of lumbar disc herniation is effective and safe. DOI: 10.3969/j.issn.1672-6731.2016.04.006

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

BackgroundAdductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients' physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation.MethodsWe conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status.ResultsData from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th–90th percentiles]) compared to femoral patients (0 [0–5] vs. 4 [0–10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = –2.6; 95% CI: –4.5, –0.8, P = 0.01) with R2 = 0.1.ConclusionsAdductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.

Role of pronator release in revision carpal tunnel surgery.

Introduction: The purpose of this study was to compare the result of treatment of patients with failed primary carpal tunnel surgery who suspected pronator teres syndrome (PTS) by performing revision carpal tunnel release (CTR) with pronator teres release (PTR) and revision CTR alone. Methods: Retrospective chart review in patients who required revision CTR and suspected PTS. Group 1, treated by redo CTR with PTR and group 2, treated by redo CTR alone. Intraoperative findings, pre and postoperative numbness (2-PD), pain (VAS score), and grip strength were studied. Results: There were 17 patients (20 wrists) in group 1 and 5 patients (5 wrists) in group 2. Patients in group 1 showed more chance of fully recovery of numbness and pain than group 2 (60% vs. 0%, p < 0.05 and 55.0% vs. 0%, p < 0.05, respectively). Mean grip strength was increased 16.0% in group 1 and increase 11.7% in group 2. Most common pathology at the elbow were deep head of pronator teres 90% (18/20 elbows) and lacertus fibrosus 50% (10/20 elbows). The most common finding at carpal tunnel was the reformed transverse carpal ligaments (80%, 20/25 wrists) and scar adhesion around the median nerve (40%, 10/25 wrists). Discussion: Intraoperative findings from our study confirmed that there were pathology in both carpal tunnel and pronator area in failed primary CTR with suspected PTS. Our study showed that combined PTR with revision CTR provided higher chance of completely recovery from numbness and pain more than redo CTR alone.

Modified Baha Punch Technique: Least Invasive, Shortest Time and No Suturing.

To describe a new Baha surgical procedure (Modified Punch Technique) with a smaller punch hole, a minimal incision and the use of the hydroxyapatite-coated abutment (BIA400). Retrospective chart review. Patients were implanted between 2012 and 2013 at King Abdulaziz University Hospital (Kingdom of Saudi Arabia). Eligible for initial or replacement bone-anchored hearing system; includes six patients (four adults, two children). Baha surgery using the Punch Method is described. The mean surgical time was 12.33min (range 6-30), without the single outlier, it was 8.8min. Bleeding was significant but easily controlled in two patientsonly. Depending on the postauricular subcutaneous thickness, the sizes of abutment used were 6, 8, 10 or 12mm. None of the patients experienced severe pain. The postoperative follow-up period was 7months for one patient, 5months for three patients, and 3months for two patients. First report of combined Modified Punch Technique with the BIA400 abutment is minimally invasive, reduces surgical time and results in faster healing and reduced likelihood of postoperative numbness.

Infrapectineal plating for senile acetabular fractures with displaced medial wall

Objective To evaluate the clinical outcomes of infrapectineal plating for acetabular fractures with displaced medial wall in senior patients. Methods A retrospective study was conducted on 26 senior patients who had been treated for acetabular fracture with open reduction and infrapectineal buttress plating from August 2009 to January 2013. They were 16 males and 10 females, 65 to 85 years of age (mean, 72.5 years). According to Judet-Letournel classification, 14 patients had anterior + posterior hemitransverse fracture, 10 both-column fracture, and 2 T-shaped facture. The time between injury to surgery ranged from 3 to 25 days (average, 7.2 days). Matta criteria were used to evaluate fracture reduction and Merle d'Aubigne & Postel scores to assess the hip function at the final follow-ups. Results The operation time ranged from 120 to 250 min (average, 180 min); the intraoperative bleeding ranged from 200 to 700 mL (average, 400 mL). By Matta criteria, reduction was excellent in 14 cases, good in 10, and poor in 2 (with an excellent to good rate of 92.3%). Twenty-six patients were followed up for 24 to 36 months (mean, 28 months). Fractures healed after 14 to 20 weeks (mean, 16.5 weeks). Merle d'Aubigne & Postel scores ranged from 9 to 18 points (average, 15 points). Six cases were excellent, 13 good, 5 fair and 2 poor, giving an excellent to good rate of 73.1%. Of the 2 patients who had to undergo total hip arthroplasty because of posttraumatic arthritis, one had delayed wound healing because of fat liquefaction and one had postoperative numbness at the ipsilateral medial thigh which disappeared 3 months later. No infection or heterotopic ossification was observed in this series. Conclusion In the treatment of senile acetabular fractures with displaced medial wall, infrapectineal buttress plating can achieve congruency and stability of the hip joint which allows the patient to do weight-bearing earlier and leads to satisfactory clinical outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Aged

Impact of Starting Point and C2 Nerve Status on the Safety and Accuracy of C1 Lateral Mass Screws

Literature review and meta-analysis. To compare clinical and radiographic outcomes of patients treated with C1 lateral mass screws (C1LMS), analyzing the impact of screw starting point and C2 nerve sectioning on malposition, vertebral artery injury (VAI), and C2 neuralgia and numbness. Various starting points have been suggested for C1LMS insertion. Some advocate sectioning the C2 nerve root to ease placement. Online databases were searched for English language articles between 1994 and 2012 reporting on C1LMS. Forty-two studies describing 1471 patients instrumented with 2905 C1LMS met inclusion criteria. Three surgical techniques included posterior arch starting point and center of lateral mass with nerve root preservation or sacrifice. All studies provided class III evidence. Three injuries to the vertebral artery occurred secondary to C1LMS insertion (0.1%) and 5 instances of clinically significant screw malpositions (0.2%). Postoperative imaging revealed 45 malpositioned screws (1.6%) without clinical consequences. Meta-analysis techniques demonstrated that sacrifice of the C2 nerve root caused greater postoperative numbness but less neuralgia and fewer screw malpositions. Similar rates of screw malposition and VAI arose with posterior arch screws and those starting below the arch with C2 nerve preservation, but the latter had greater numbness and pain. A thorough understanding of atlantoaxial anatomy and modern surgical techniques renders the insertion of C1LMS safe and accurate. The incidence of clinically significant malpositioned screws or VAI is <0.5%. Sacrifice of the C2 nerve root did result in fewer malpositioned screws. Numbness occurred in 11% of patients, an outcome that may be unacceptable to certain patient populations, but neuropathic pain was nearly absent with nerve sectioning. C2 nerve preservation and retraction for C1 screw placement may have higher incidence of neuropathic pain. Posterior arch screws are a viable option for patients with arches that are of adequate height.

Does Sensation Return to the Nasal Tip After Microfat Grafting?

Patients usually complain about numbness in the nasal tip after microfat injections. The present study evaluated the severity of the numbness in the nasal tip after the procedure. To address the research question, a prospective study of young women was designed and performed at the Beijing Anzhen Hospital. Time was the primary predictor variable. The nasal tip sensation, which was evaluated using objective and subjective assessments, was used as the primary outcome variable. The McNemar-Bowker test (time vs nasal tip sensation) was used to detect statistical significance. A total of 30 young women (age 20.04 ± 3.63 years) were recruited for the present study. The preoperative mean touch threshold value was 3.60 units. One week after the injection, the women experienced a decrease in the touch threshold value by 2.50 units. However, the sensation recovered gradually during the follow-up period (1.51 units at week 2, 2.39 units at week 4, 3.01 units at week 8, and 3.35 units at week 12). Significant differences were detected between multiple different measurement points (P < .05). The percentage of those experiencing paresthesia after the microfat injections also gradually diminished to none. Postoperative numbness occurs in most patients receiving nasal microfat injections. Partial to complete recovery of nasal tip sensation can be expected to occur over a 3-month period.

Mini invasive transoral approach to the glenoid fossa: Benign lesion removal using endoscopy.

We describe an endoscopic transoral approach for treating benign lesions of the glenoid fossa with or without infratemporal fossa involvement. Description and validation of surgical technique on living humans. Excision of benign lesions arising from the glenoid fossa was achieved in five patients through a transoral endoscopic approach. Using 0- and 45-degree angled 4-mm optics, the entire middle skull base and infratemporal fossa were explored without damaging the nearby neurovascular structures. Three of the five patients had complete removal of osteochondroma. In the remaining two patients, the lesion removed was diagnosed as osteoma. In one patient, postoperative numbness of the alveolar nerve was observed. No infections were reported. The surgical approach utilized was determined to be valid not only for glenoid fossa exposure but also for management of the middle skull base and infratemporal fossa. The described approach to the glenoid fossa offers direct and minimally invasive access to benign lesions within this region. Further use of this approach will allow us to determine its potential in treating malignancies. 4.

Schwannoma of the Orbit.

BackgroundA schwannoma is a benign, slow-growing peripheral nerve sheath tumor that originates from Schwann cells. Orbital schwannomas are rare, accounting for only 1% of all orbital neoplasms. In this study, we retrospectively review orbital schwannomas and characterize clinical, radiologic, and histologic features of this rare entity.MethodsA retrospective review was performed to identify patients with histologically confirmed orbital schwannoma, among a list of 437 patients who had visited our hospital with soft tissue masses within the orbit as the primary presentation between 2010 and 2014. Patient charts and medical records were reviewed for demographic information, relevant medical and family history, physical examination findings relating to ocular and extraocular sensorimotor function, operative details, postoperative complications, pathologic report, and recurrence.ResultsFive patients (5/437, 1.1%) were identified as having histologically confirmed orbital schwannoma and underwent complete excision. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies were not consistent in predicting histologic diagnosis. There were no complications, and none of the patients experienced significant scar formation. In two cases, patients exhibited a mild postoperative numbness of the forehead, but the patients demonstrated full recovery of sensation within 3 months after the operation. None of the five patients have experienced recurrence.ConclusionOrbital schwannomas are relatively rare tumors. Preoperative diagnosis is difficult because of its variable presentation and location. Appropriate early assessment of orbital tumors by CT or MRI and prompt management is warranted to prevent the development of severe complications. Therefore, orbital schwannomas should be considered in the differential diagnosis of slow-growing orbital masses.