Preoperative Position Research Articles

Correction of low to moderate corneal astigmatism by steep-axis incision in image-guided cataract surgery

Objective: To explore the corrective effect of cataract extraction surgery combined with a 2.8 mm steep-axis corneal incision under ophthalmic surgical navigation on low-to-moderate corneal astigmatism and different types of corneal astigmatism. Methods: A prospective cohort study was conducted. Patients with age-related cataract who underwent cataract extraction combined with single-focus intraocular lens implantation in the Department of Ophthalmology at the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June to October 2023 and had a total corneal regular astigmatism degree of ≥0.50 D and <1.50 D were continuously collected. Patients were divided into a low-degree group (<1.00 D) and a moderate-degree group (≥1.00 D) according to corneal astigmatism degree. Simultaneously, they were classified into with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism based on preoperative corneal astigmatism axis position. Subjective refraction and anterior segment biometer examination were performed before and 3 months after surgery, respectively. Vector analysis of corneal astigmatism was conducted using the Alpins vector analysis method. The main observational indicators included target induced astigmatism, surgically induced astigmatism, and the correction index. Results: A total of 95 patients (110 eyes) were collected in this study. Thirteen patients (18 eyes) were lost to follow-up, and finally 82 patients (92 eyes) were included. In the low-degree group, there were 14 males (16 eyes) and 26 females (23 eyes), with an age of (69.62±12.22) years. In the moderate-degree group, there were 13 males (15 eyes) and 33 females (35 eyes), with an age of (72.98±8.28) years. The target astigmatism correction amount, surgically induced astigmatism, and deviation vector in the low-degree group were all smaller than those in the moderate-degree group (all P<0.05). Postoperative corneal astigmatism in both groups was undercorrected. The correction index in the low-degree group (0.88±0.44) was greater than that in the moderate-degree group (0.59±0.34) (P=0.001), and the undercorrection proportion in the moderate-degree group (90.00%, 45/50) was much higher than that in the low-degree group (57.14%, 24/42). In the low-degree group, the correction index from high to low was WTR (1.07±0.41), oblique (0.90±0.58), and ATR astigmatism eyes (0.69±0.37). After multiple comparison analysis, the correction index of WTR astigmatism eyes was significantly higher than that of ATR astigmatism eyes (P<0.05). The success index from high to low was oblique (0.82±0.57), ATR (0.74±0.39), and WTR astigmatism eyes (0.68±0.43). In the moderate-degree group, the order of the correction index from high to low was the same as that in the low-degree group, also WTR (0.79±0.33), oblique (0.71±0.50), and ATR astigmatism eyes (0.53±0.30), but there was no statistical significance among the three (P>0.05). In the low-degree group, there were 6 WTR astigmatism eyes undercorrected, fewer than 12 overcorrected eyes; there were 16 ATR astigmatism eyes undercorrected, more than 3 overcorrected eyes. In the moderate-degree group, there were 6 WTR astigmatism eyes undercorrected, more than 2 overcorrected eyes, but there were 2 ATR astigmatism eyes overcorrected, fewer than 34 undercorrected eyes. Conclusions: Cataract extraction surgery combined with a steep-axis corneal incision can achieve a certain astigmatism correction effect in patients with preoperative low-to-moderate corneal astigmatism. Patients with a preoperative corneal astigmatism degree of mild can achieve a better astigmatism correction effect than those with moderate, especially in the WTR astigmatism population. However, for cataract patients with preoperative corneal astigmatism of moderate and WTR astigmatism, a steep-axis corneal incision can also be combined to correct astigmatism as it can achieve the expected postoperative "with-the-rule undercorrection".

CBCT Analysis of the Hyoid and Pharyngeal Airway Changes in Class III Patients With Orthognathic Surgery.

This study was designed to investigate the response of the respiratory structures to orthognathic surgery in patients with Class III malocclusion, with a specific emphasis on the vertical placement of the hyoid bone. The correlations of these changes were also analysed, followed by further subgroup analyses based on preoperative conditions. Dolphin software was used to obtain cephalometric landmarks, airway and hyoid bone measurements from pre- and postoperative CBCT scans of 31 patients. Statistical analyses included paired t-tests and Pearson's correlation analysis. Stomatological mandibular values and the nasopharynx height showed significant changes. Pearson's correlation identified significant correlations between changes in B and H horizontal coordinates (p < 0.05), as well as between changes in H longitudinal coordinates and specific airway dynamics (p < 0.05). Patients with a lower preoperative hyoid position experienced a more pronounced decrease in hypopharyngeal airway volume after surgery compared to those with a higher preoperative hyoid position, as evidenced by the significant mean differences and p values (p < 0.01). Class III patients experienced airway constriction following orthognathic surgery, particularly those with a lower preoperative hyoid bone position, who showed a more significant decrease in hypopharyngeal airway volume postsurgery compared to those with a higher preoperative hyoid position. These findings underscored the importance of individualised surgical planning and highlighted the need for further research with dynamic assessments to optimise respiratory outcomes.

Comparing four-hook and double-hook localization needles in preoperative pulmonary nodule positioning: efficacy, safety, and patient perception

BackgroundPrecise preoperative localization is crucial for improving the success rate and reducing the duration of thoracoscopic surgeries. This study aimed to evaluate the efficacy, safety, and patient perception of the four-hook localization needle compared to the traditional double-hook localization needle in the localization of pulmonary nodules.MethodsWe conducted a retrospective analysis of 207 patients who underwent video-assisted thoracoscopic surgery (VATS). Seventy-six patients used a four-hook localization needle preoperatively, while 121 patients used the traditional double-hook needle. Propensity score matching was employed to balance the baseline characteristics of the two groups and minimize confounding bias. We compared the surgery success rate, surgical field success rate, complication rate, and post-localization respiratory pain score between the two groups.ResultsBoth localization methods achieved a 100% success rate. The four-hook needle had a statistically significant shorter localization time (20.00 min vs. 21.00 min, P = 0.046) and a lower preoperative displacement rate (5.81% vs. 17.36%, P = 0.014) compared to the double-hook needle. Both before and after propensity score matching, the postoperative respiratory pain score was significantly lower in the four-hook group compared to the double-hook group (P < 0.001). After balancing baseline characteristics, univariate (P = 0.036) and multivariate (P = 0.039) logistic regression analyses indicated that the four-hook group had a significantly lower risk of localization complications compared to the double-hook group.ConclusionsThe four-hook localization needle outperforms the traditional double-hook needle due to its shorter localization time, lower post-localization respiratory pain score, and reduced displacement rate, making it a simpler and safer option. Furthermore, the four-hook needle effectively reduces the risk of complications, presenting a promising method for preoperative localization of pulmonary nodules.

A case of intraoperative detection of a central venous catheter in azygos vein arch during esophageal cancer surgery

BackgroundCentral venous catheter (CVC) is often used in the perioperative management of esophageal cancer. The position of the CVC tip has been reported to shift with body positioning and, although infrequent, may traverse into the azygos vein arch. Herein, we describe a case where a migrated CVC tip in the azygous vein arch was identified during esophageal cancer surgery, preventing CVC dissection concurrent with azygous vein arch resection.Case presentationA 65-year-old man was diagnosed with advanced esophageal cancer and was referred to our department for surgery after undergoing neoadjuvant chemotherapy. He underwent robot-assisted subtotal esophagectomy, followed by gastric conduit reconstruction via the posterior sternal route. Thoracic manipulation was performed with the patient in the prone position. During the surgery, a foreign body was found in the azygos vein arch, indicating that a central venous catheter had inadvertently entered the azygos vein arch. The catheter was retracted by 5 cm, and after confirming that no catheter remained in the azygos arch, the azygos vein arch was separated using an autosuture device.ConclusionsCentral venous catheter migration can occur in a various vessels. During prone esophageal cancer surgery, elevating the right upper extremity may alter the catheter tip’s position from its the preoperative position. CVC amputation should be observed because the azygos vein arch is often amputated to facilitate upper mediastinal dissection during esophageal cancer surgery.

Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction

To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion(Mis-TLIF) technique combined with preoperative position reduction in the treatment of spondylolisthesis and summarize its advantages. Between July 2016 and July 2022, 60 patients with lumbar isthmic spondylolisthesis were retrospectively analyzed, including 26 males and 34 females, with an average age of (51.32±4.24) years old ranging from 35 to 72 years old. They were divided into observation group and control group according to the operation methods. There were 30 patients in the observation group, including 12 males and 18 females;the age ranged from 35 to 71 years old with an average of(51.80±6.38) years old, the course of disease ranged from 12 to 60 months with an average of (24.17±1.98) months;there were 18 cases of L4 spondylolisthesis and 12 cases of L5 spondylolisthesis;according to Meyerding classification, there were 20 cases of grade Ⅰ spondylolisthesis and 10 cases of gradeⅡ. The observation group was treated with preoperative postural reduction combined with intraoperative reduction assisted minimally invasive transforaminal lumbar fusion via Quadrant channel(Mis-TLIF). There were 30 patients in the control group, including 14 males and 16 females, with an average of (50.00±4.24) years old ranging from 36 to 72 years old;the course of disease ranged from 12 to 60 months with an average of (23.70±1.53) months;there were 16 cases of L4 spondylolisthesis and 14 cases of L5 spondylolisthesis;according to Meyerding classification, there were 19 cases of grade Ⅰ spondylolisthesis and 11 cases of grade Ⅱ. The control group was treated with open transforaminal lumbar interbody fusion(Open-TLIF). The differences of operation time, intraoperative and postoperative blood loss, hospital stay, radiation exposure time and complications between the two groups were analyzed. Visual analogue scale (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical effect. X-ray and CT were followed up to evaluate the interbody fusion. All patients were followed up for 12 months. There was no significant difference in operation time, VAS of low back pain, slip angle and slip rate between two groups (P>0.05). The intraoperative and postoperative blood loss in the observation group (165.50±15.56) ml and (59.17±10.59) ml were less than those in the control group (259.33±35.32) ml and (165.33 ±29.56) ml (P<0.05). The length of hospital stay in the observation group (3.53±0.68) days was less than that in the control group (5.20±0.41) days (P<0.05).The intervertebral space height, slip angle, slip rate, ODI, VAS and JOA scores were significantly improved in the two groups at the final follow-up (P<0.05). There were significant differences in ODI [(9.93±1.11)% vs (10.93±1.11)%] and JOA [ (26.07±1.01) points vs (25.43±1.25) points] between the observation group and the control group at the final follow-up (P<0.05). In the treatment of spondylolisthesis, preoperative position reduction combined with intraoperative reduction assisted Mis-Tlif technique has advantages of less trauma, less bleeding and shorter hospitalization period than traditional open surgery. It is a safe and effective technique.

Analysis of the Effect of Preoperative Eye Position Fixation Training in Patients With Pterygium: A Randomized Controlled Trial.

This study evaluated the effect of preoperative ocular fixation training on patients undergoing pterygium surgery. Before pterygium excision, patients were trained to perform eye position fixation training, which is beneficial for surgeons performing microsurgery. The study analysed the effectiveness of preoperative eye position fixation training in patients with pterygium by randomised controlled experimental design. The number of occurrences of self-turning, operation time, self-rating depression scale scores and self-rating anxiety scale scores of the experimental group (EG) were lower than those of the control group (CG). The recurrence rate and the incidence of conjunctival tear and conjunctival suture loosening in the EG were significantly lower than those in the CG. The use of eye fixation training prior to pterygium surgery can facilitate the activities of the surgeon, reduce the operation time, reduce the occurrence of complications and reduce the recurrence rate after the operation. Eye fixation training is worthy of application in patients with pterygium.

Does Preoperative Virtual Reality Experience Enhance Implant Positioning Accuracy in Total Hip Arthroplasty?

Purpose Total hip arthroplasty (THA) requires precise implant positioning to ensure long-term success. Herein, we evaluated the effect of virtual reality (VR) on the surgical precision of THA, particularly when used by experienced surgeons. Methods In this single-center, prospective, case-control study, 34 patients who underwent primary THA performed by a single experienced surgeon were divided into the control (without VR simulation) and VR (with VR simulation) groups. Preoperative planning involved the creation of three-dimensional models from computed tomography scans using ZedHip® software (Lexi, Tokyo, Japan). The primary outcomes assessed included the accuracy of implant placement, operative time, and intraoperative blood loss. The secondary outcomes included postoperative hospital stay and in-hospital complications. Results A significant improvement in radiographic inclination (RI) was observed in the VR group as compared to controls. Other surgical parameters, such as radiographic anteversion, operation time, blood loss, and postoperative hospital stay, showed no significant differences between the groups. Discrepancies in planned versus actual implant sizes were notedbut were not significantly different between groups. Conclusion VR application in preoperative planning improved the RI accuracy in acetabular cup placement for THA, demonstrating its potential to enhance surgical precision for experienced surgeons. This study highlights the evolving role of VR, from a training tool to an integral part of advanced surgical planning in orthopedics.

Comparing the Efficacy of Landmark-Based Fascia Iliaca Compartment Block and Pericapsular Nerve Group Block for Preoperative Positioning and Postoperative Analgesia in Patients Undergoing Surgery for Hip Fractures: A Randomized Controlled Trial.

Subarachnoid block is the most common anesthetic technique for patients having corrective hip surgeries. However, adequate positioning for a successful subarachnoid block is a major challenge in this particular population of patients, owing to the site of fracture. Regional anesthesia, in the form of nerve blocks, is an effective means of alleviating such constraints and gives an added benefit of prolonged postoperative analgesia. The pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB), under ultrasonography guidance, are a few examples of the commonly performed peripheral nerve blocks in such settings. However, the landmark-based techniques of nerve blockade still hold good in many resource poor settings, given the lack of ultrasonography facilities. To compare the ease of spinal positioning using the patient sitting satisfaction score between the landmark-guided FICBand PENG block. This study was done on 80 patients of the American Society of Anesthesiology (ASA) grade I or II with intertrochantericfractures of the hip joint scheduled for proximal femoral nailing. Patients were allocated into two groups of 40 each through computer generated random numbers, to receive 30 ml of 0.5% ropivacaine via the landmark-guided technique of FICB in Group F and peripheral nerve stimulator assisted landmark-guided PENG block in Group P, 30 minutes prior to spinal positioning. Time to passive leg raise (PLR) to 15 degrees and time to PLR to 30 degrees with a standard goniometer guidance at visual analogue scale (VAS) score < 4 and ease of spinal positioning through the sitting satisfaction score at the 30th minute were assessed. Any adverse effects and events of failure were noted. The duration of postoperative analgesia was measured through the time to the first dose of paracetamol on arrival at the post-anesthesia care unit. Statistical analysis was done using JASP version (0.18.3.0) using the independent samples t-test and significance was taken when p value was < 0.001. The time to PLR to 15 degrees and 30 degrees were achieved faster in the patients who received the PENG block in comparison to the patients who received the FICB, and the average patient sitting satisfaction score was significantly higher in Group P as compared to Group F (p < 0.001). While the overall amount of analgesics used in both groups was similar, the overall period of postoperative analgesia was prolonged in Group F compared to Group P (p < 0.001). The landmark guided PENG block is feasible and superior to the landmark-guided FICB for preoperative positioning and analgesia. The FICB provides a longer duration of postoperative analgesia for patients with intertrochanteric fractures.

The predictive value of anterior segment optical coherence tomography for postoperative corneal edema in cataract patients.

To evaluate the predictive value of anterior segment optical coherence tomography (AS-OCT) for postoperative corneal edema in cataract patients. A retrospective cohort study of 144 cataract patients from December 2020 to December 2021 was conducted. Patients were divided into edema eyes (84 cases) and observation (60 cases) group based on postoperative corneal edema occurrence. Relevant indicators were compared between groups. Logistic regression identified risk factors for postoperative corneal edema. Receiver operating characteristic curves evaluated the predictive value. The edema eyes group had significantly higher postoperative central corneal thickness (CCT) and lower postoperative endothelial cell density (ECD) than the observation group (P < 0.05). The edema eyes group also had significantly lower preoperative ECD, anterior chamber depth (ACD), anterior chamber angle (ACA), and preoperative lens position (LP) than the observation group (P < 0.05). Logistic regression analysis showed that preoperative ECD, ACD, ACA, and LP were independent risk factors for postoperative corneal edema (P < 0.05), all of which also showed good predictive value for postoperative corneal edema, with areas under the curve (AUCs) of 0.854, 0.812, 0.791, and 0.778, respectively, under the ROC curve analysis. AS-OCT can provide useful information for predicting postoperative corneal edema in cataract patients. Preoperative ECD, preoperative ACD, preoperative ACA, and preoperative LP are important parameters that can be measured by AS-OCT and used as risk factors for postoperative corneal edema.

Incisor Show Based Selection of Tip Augmentation Rhinoplasty Technique.

Our recent studies show that the majority of patients seeking rhinoplasty have inadequate incisor show. Furthermore, that some rhinoplasty maneuvers, such as a columella strut can alter the lip position and consequently the incisor show. We report the senior author's algorithm for tip augmentation technique based on our prior studies and 44 years of rhinoplasty keen observations. The five most common scenarios are described. When there is a short columella with inadequate incisor show, bilateral extended spreader grafts and columella strut with a tapered posterior portion are recommended, serving as a reliable midline septal extension graft supporting the medial crura in a more anterior position with sutures and a positive effect on incisor show. When there is optimal lip/incisor relationship, a columella strut with a tapered posterior end fixed to the septum, with or without extended spreader grafts is a better choice to prevent a change in smile. If there is excessive gum show, the optimal tip augmentation technique is a columella strut without tapering or even wider posterior end, with fixation of the columella strut to the septum, with or without extended spreader grafts which will push the upper lip caudally. The remaining scenarios are described in detail. Tip augmentation maneuvers in rhinoplasty can have a significant influence on upper lip position, which is often detrimental to the smile. The pre-operative position of the upper lip during smile should play an integral role in the selection of tip augmentation technique.

Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices.

Robotic systems have emerged as a significant advancement in the field of spine surgery. They offer improved accuracy in pedicle screw placement and reduce intraoperative complications, hospital length of stay, blood loss, and radiation exposure. As the use of robotics in spine surgery continues to grow, it becomes imperative to understand common errors and challenges associated with this new and promising technology. Although the reported accuracy of robot-assisted pedicle screw placement is very high, the current literature does not capture near misses or incidental procedural errors that might have been managed during surgery or did not alter treatment of patients. We evaluated errors that occur during robot-assisted pedicle screw insertion and identify best practices to minimize their occurrence. In this systematic review, we characterized 3 types of errors encountered during robot-assisted pedicle screw insertion-registration errors, skiving, and interference errors-that have been reported in the literature. Our search yielded 13 relevant studies reporting robot-assisted screw errors. Nine studies reported registration errors, with 60% of failed screws in those studies caused by registration issues. Seven studies highlighted skiving errors; 26.8% of the failed screws in those studies were caused by skiving. Finally, interference errors were reported in 4 studies, making up 19.5% of failed screws. On the basis of these findings, we suggest best practices-including close attention to preoperative planning, patient positioning, image registration, and equipment selection-to minimize the occurrence of these errors. Awareness of how errors occur may increase the safety of this technology.

Changes in the anteroposterior position of the femur relative to the tibia impact patient satisfaction in total knee arthroplasty

BackgroundIn this study, we aimed to investigate the preoperative and postoperative anteroposterior position (AP) of the femur relative to the tibia in total knee arthroplasty (TKA) and assess the influence of change in the AP position on clinical outcomes.MethodsWe evaluated 49 knees that underwent bi-cruciate-substituted TKA using a navigation system. The preoperative and postoperative AP position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60°, 90°, 105°, and 120° and maximum flexion angles were calculated. The 2011 Knee Society Score was evaluated preoperatively and 1 year postoperatively. The Wilcoxon signed rank and Spearman’s rank correlation tests were performed, with statistical significance set at P < 0.05.ResultsThe postoperative AP position was significantly correlated with the preoperative AP position at each measured angle. The postoperative AP positions were statistically more anterior than those preoperatively. Furthermore, the changes in the AP position after TKA negatively correlated with the symptom (P = 0.027 at 30°, P = 0.0018 at 45°, P = 0.0003 at 60°, P = 0.01 at 90°, and P = 0.028 at 105°) and patient satisfaction (P = 0.018 at 60° and P = 0.009 at 90°) scores at 1 year postoperatively.ConclusionThe postoperative AP position of the femur relative to the tibia was strongly influenced by the preoperative those in TKA. Postoperative anterior deviation of the femur relative to the tibia from mid-flexion to deep flexion could worsen clinical outcomes.

Orthopedic Surgical Treatment of Patients with Tumor-induced Osteomalacia Located in the Hip Bones: A Retrospective Analysis of 10 Years in a Single Center.

The orthopedic surgical treatment strategies for patients with tumor-induced osteomalacia (TIO) require improvement, especially for patients where the causative tumors are located in surgically challenging areas, requiring a greater degree of in-depth investigation. This work aims to summarize and investigate clinical features and orthopedic surgical treatment effects of patients with tumor-induced osteomalacia (TIO), whose causative tumors are located in the hip bones. A retrospective analysis was conducted on the clinical data of all patients diagnosed with culprit tumors located in the hip bones who underwent surgical treatment at the orthopedic bone and soft tissue tumor sub-professional group of Peking Union Medical College Hospital from January 2013 to January 2023. This retrospective study summarized the clinical data, preoperative laboratory test results, imaging findings, surgery-related data, perioperative changes in blood phosphorus levels, and postoperative follow-up data of all patients who met the inclusion criteria. Normally distributed data are presented as mean and standard deviation, while non-normally distributed data are shown as the means and 25th and 75th interquartile ranges. The clinical diagnostic criteria for TIO were met by all 16 patients, as confirmed by pathology after surgery. Among the 16 patients, we obtained varying degrees of bone pain and limited mobility (16/16), often accompanied by difficulties in sitting up, walking, and fatigue. An estimated 62.5% (10/16) of patients had significantly shorter heights during the disease stages. All 16 patients underwent surgical treatment for tumors in the hip bones, totaling 21 surgeries. In the pathogenic tumor, there were 16 cases of skeletal involvement and none of pure soft tissue involvement. Out of the 16 patients, 13 cases had a gradual increase in blood phosphorus levels following the latest orthopedic surgery, which was followed up for 12 months to 10 years. Due to unresolved conditions after the original surgery, four patients received reoperation intervention. Two cases of refractory TIO did not improve in their disease course. In summary, the location of the causative tumor in the hip bone is hidden and diverse, and there is no defined orthopedic surgical intervention method for this case in clinical practice. For patients with TIO where the tumors are located in the hip bones, surgical treatment is difficult and the risk of postoperative recurrence is high. Careful identification of the tumor edge using precise preoperative positioning and qualitative diagnosis is crucial to ensure adequate boundaries for surgical resection to reduce the likelihood of disease recurrence and improve prognosis.

Lower Eyelid Position Changes Following Müller's Muscle-Conjunctival Resection Blepharoptosis Surgery.

Asymmetry of the lower eyelids and a lower position of the lower eyelid on the ptotic side are common issues in patients with upper lid ptosis. Understanding the relationship between upper lid ptosis correction and lower eyelid position will facilitate better treatment strategies for ptosis. The aim of this study was to assess the lower eyelid position before and after Müller's muscle-conjunctival resection (MMCR) in unilateral myogenic ptosis (MP) and aponeurotic ptosis (AP). This prospective interventional before-and-after study included adults with blepharoptosis. Measurements were taken before and 6 months after the surgery. A total of 47 patients were included, with 29 having MP and 18 having AP. The mean [standard deviation] ages were 31.55 [5.30] years and 50.11 [6.45] years, respectively. In the MP group, there was a significant association between baseline margin reflex distance 2 (MRD2) and the severity of ptosis (MRD1) (β = -0.739, P = .004, multivariate regression analysis). After MMCR, significant decreases were observed in MRD2 for both the MP (-0.38 [0.48] mm, P < .001) and AP (-0.39 [0.47] mm, P = .003) groups. The symmetry of MRD2 remained stable at 41.4% in the MP group, while it decreased from 44.4% to 16.7% in the AP group. The baseline MRD2 was the only factor associated with postoperative MRD2 in the MP group. Patients with MP and AP often exhibit a lower position of the lower eyelid, which typically elevates after posterior upper lid ptosis surgery. In myogenic cases, the severity of preoperative lower eyelid position correlates with the severity of upper lid ptosis and predicts postoperative elevation of the lower lid.

Radix's Importance for Plastic Surgeons: A Descriptive Cross-Sectional Study.

Considering the importance of the nose in the beauty of the face, accurate and systematic three-dimensional nasal analysis of the nose before the procedure is essential. The radix, and so the nasofrontal and nasofacial angles, play an essential role in forming an aesthetically pleasing nose because they influence the length and projection of the nose. We aimed to measure information about the pre-operative radix position in our region. Pre-operative images were taken from our cases in the profile view. A checklist including radix location and projection, nasofrontal angle, and nasofacial angle were extracted from these images. Overall, 200 (100 males and 100 females) cases were enrolled. Thirty-two male cases and 48 females had abnormal radix position. Radix projection were normal in only 36 male cases and 18 females. The mean nasofrontal angle in the male and female groups was 119.2 and 128.2 respectively. The mean nasofacial angle was 29.8 in the female groups and 32.6 in the male group. The reality of the current society of Iranian patients can be very different from the predictions of surgeons and can be far away from the statistics mentioned in western books. We tried to notify surgeons to thoroughly examine the patients prior to surgical operation by measuring parameters such as projection and position of the radix and nasofrontal and nasofacial angles.

Upper extremity contact pressure measurement in robot-assisted pelvic surgery

Upper extremity complications are often a problem in robot-assisted pelvic surgery (RAPS) with the lithotomy-Trendelenburg position (LT-position). This study focused on upper extremity contact pressure (UEP) and examined the relationship between UEP and upper extremity complications. From May 2020 to April 2022 at the University of Tokyo Hospital, UEP was measured in 155 patients undergoing RARP and 20 patients undergoing RARC. A total of 350 sets of UEP were investigated in this study. UEP was measured using a portable interface pressure sensor (Palm Q, Cape CO., Kanagawa, Japan) in the preoperative lithotripsy position (L-position), preoperative LT-position, and postoperative L-position. UEP was increased in the preoperative LT-position than in the preoperative L-position (right side 5.2 mmHg vs. 17.1 mmHg, left side 5.3 mmHg vs. 17.1 mmHg, P < 0.001, respectively), and was decreased in the postoperative L-position than in preoperative LT-position (right side 17.1 mmHg vs. 10.8 mmHg, left side 17.1 mmHg vs. 10.6 mmHg, P < 0.001, respectively). Eleven upper extremities developed shoulder pain. UEP of the preoperative LT-position tended to be higher in the upper extremity exhibiting shoulder pain (25.6 mmHg (15.4–30.3) vs. 17.1 mmHg (12.0–24.4) P = 0.0901). UEP measurements may help prevent postoperative shoulder pain.

Comparison of condylar position after free fibular flap mandibular reconstruction using computer-assisted and traditional techniques

ObjectivesTo compare the changes in condylar position after mandibular reconstruction with free fibular flap(FFF) and the differences between computer-assisted techniques and traditional methods on CT images.MethodsThirty-four patients who underwent mandibular reconstruction with free fibular flap were selected according to the inclusion and exclusion criteria. In the 3D group, virtual surgical planning (VSP) with osteotomy cutting plate and placement guiding plate were used, while the traditional group underwent freehand reconstruction. The CT data of 68 temporomandibular joints (TMJs) were recorded before and immediately after surgery. The condylar position was evaluated by measuring the anterior space (AS), posterior space (PS) and superior space (SS), and the ln (PS/AS) was calculated according to the method proposed by Pullinger and Hollender.ResultsIn the patients included in the 3D group, the condyle on the ipsilateral side moved slightly backward; however, in the patients in the traditional group, the ipsilateral side moved considerably anteroinferior. No obvious changes on the contralateral side were noted. In the 3D group, 33% of ipsilateral condyles were in the posterior position postoperatively when compared with the preoperative position (13%). In the traditional group, the number of ipsilateral condyles in the anterior position increased from 4 to 10, accounting for 53% postoperatively. Contrary to the traditional group, the 3D group presented less condylar displacement on the ipsilateral side postoperatively.ConclusionsThis study showed a decreased percentage of change in condylar position postoperatively when VSP was used. Virtual surgical planning improved the accuracy of FFF mandibular reconstruction and made the condylar position more stable.

Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study.

The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling.

Accuracy of correction of a hexapod frame, patient-specific osteotomy and reduction guides, and hinged circular external fixation in a 3D-printed canine antebrachial deformity model.

This study aimed to objectively define whether human hexapod fixation (Maxframe), with or without the use of 3D-printed positioning guides, can correct a canine antebrachial deformity with greater accuracy than the clinically established techniques of 3D patient-specific osteotomy and reduction guides (3D-PSORG) or hinged circular external skeletal fixation (CESF). CT of a canine antebrachium was manipulated to induce distal radial deformity of the valgus, external torsion, and procurvatum, each of magnitude 20o. Five experiments were performed to correct the deformity via a distal radial and ulna opening osteotomy using: (1) A 3D-PSORG with the application of a locking plate, (2) hinged CESF, (3) Maxframe standard protocol, (4) Maxframe applied with patient-specific positioning guides (PSPGs), and (5) Maxframe with frame adjustment calculated from post-application CT. Following correction, all constructs were optically scanned, and objective measurement of the correction achieved was performed. No construct returned the distal bone segment to its preoperative position in all planes. Translational malalignment in the sagittal plane had the highest magnitude of error for all constructs, with the Maxframe standard protocol showing the greatest error. Maxframe (PSPGs) showed the minimum error of all constructs in the frontal and sagittal planes. In this 3D-printed model of antebrachial deformity correction, the hexapod frame with the use of PSPGs achieved better accuracy than 3D-PSORG and hinged CESF and may be a technique of future interest and development in the management of canine antebrachial limb deformity.

Comparison of the safety and effectiveness of the four-hook needle and hook wire for the preoperative positioning of localization ground glass nodules

BackgroundWith the implementation of lung cancer screening programs, an increasing number of pulmonary nodules have been detected.Video-assisted thoracoscopic surgery (VATS) could provide adequate tissue specimens for pathological analysis, and has few postoperative complications.However, locating the nodules intraoperatively by palpation can be difficult for thoracic surgeons. The preoperative pulmonary nodule localization technique is a very effective method.We compared the safety and effectiveness of two methods for the preoperative localization of pulmonary ground glass nodules.MethodsFrom October 2020 to April 2021, 133 patients who underwent CT-guided single pulmonary nodule localization were retrospectively reviewed. All patients underwent video-assisted thoracoscopic surgery (VATS) after successful localization. Statistical analysis was used to evaluate the localization accuracy, safety, information related to surgery and postoperative pathology information. The aim of this study was to evaluate the clinical effects of the two localization needles.ResultsThe mean maximal transverse nodule diameters in the four-hook needle and hook wire groups were 8.97 ± 3.85 mm and 9.00 ± 3.19 mm, respectively (P = 0.967). The localization times in the four-hook needle and hook wire groups were 20.58 ± 2.65 min and 21.43 ± 3.06 min, respectively (P = 0.09). The dislodgement rate was significantly higher in the hook wire group than in the four-hook needle group (7.46% vs. 0, P = 0.024). The mean patient pain scores based on the visual analog scale in the four-hook needle and hook wire groups were 2.87 ± 0.67 and 6.10 ± 2.39, respectively (P = 0.000). All ground glass nodules (GGNs) were successfully resected by VATS.ConclusionsPreoperative pulmonary nodule localization with both a four-hook needle and hook wire is safe, convenient and effective.