Raw Bone Surfaces Research Articles

Use of Generative Adversarial Networks (GAN) for Taphonomic Image Augmentation and Model Protocol for the Deep Learning Analysis of Bone Surface Modifications

Deep learning models are based on a combination of neural network architectures, optimization parameters and activation functions. All of them provide exponential combinations whose computational fitness is difficult to pinpoint. The intricate resemblance of the microscopic features that are found in bone surface modifications make their differentiation challenging, and determining a baseline combination of optimizers and activation functions for modeling seems necessary for computational economy. Here, we experiment with combinations of the most resolutive activation functions (relu, swish, and mish) and the most efficient optimizers (stochastic gradient descent (SGD) and Adam) for bone surface modification analysis. We show that despite a wide variability of outcomes, a baseline of relu–SGD is advised for raw bone surface modification data. For imbalanced samples, augmented datasets generated through generative adversarial networks are implemented, resulting in balanced accuracy and an inherent bias regarding mark replication. In summary, although baseline procedures are advised, these do not prevent to overcome Wolpert’s “no free lunch” theorem and extend it beyond model architectures.

Use of the Buccinator Musculomucosal Flap for Bone Coverage in Primary Cleft Palate Repair

Cleft palate is one of the most common congenital malformations in the maxillofacial region. After a cleft palate repair, surgeons must deal with the transverse growth restriction and palatal fistulas caused by scar tissue on the raw bone surface around the hard palate. This report describes the technique of the buccinator musculomucosal flap procedure performed together with repair of the cleft palate. The objective is to cover exposed bone areas of the hard palate to decrease scar contraction and subsequent transverse maxillary growth restriction, as well as tension at the closure. From August 2009 to February 2012, 15 patients underwent the buccinator musculomucosal flap procedure. First, the cleft palate was repaired by mucoperiosteal flaps, resulting in wide and raw bone surfaces around the hard palate. The outline of the flap was marked on the buccal mucosa. Grounding on the exposed bone areas around the hard palate, the authors designed widths of flaps ranging from 1.5 to 2.5 cm. These flaps were elevated from the buccopharyngeal fascia and turned 90° to cover the raw hard palate bone surfaces. The donor sites were closed by direct suture. The follow-up period was 1-26 months (average, 10 months). No complications were found in any patient who underwent the procedure, and no fistulas occurred in the midline of the palate. No patients experienced complications related to the donor sites. No trismus or other dysfunction related to mouth movement was observed. The buccinator musculomucosal flap is a convenient and safe flap procedure with fewer donor-site complications. This procedure also has significant potential for improving maxilla growth and reducing the secondary complications that often can result from cleft palate repair. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A 2-Screw Fixation Technique for Subtalar Joint Fusion: A Retrospective Case Series Introducing a Novel 2-Screw Fixation Construct with Operative Pearls

A variety of fixation methods are used in fusion of the subtalar joint (STJ) including 1 screw and 2 screw constructs. The rate of union is generally high for STJ fusion, regardless of the fixation method, provided the joint surfaces have been properly prepared and compressed and the patient avoids premature stress on the fusion site. Certain populations are known to have an increased risk of nonunion or delayed union including diabetics, smokers, and those undergoing revision of failed fusion. In this high-risk patient population, we propose that our novel 2-screw construct might have advantages over traditional fixation constructs without identified disadvantages. The technique is simple enough to be used in all primary and revision STJ fusion procedures, and this has become our practice. In the present study, 15 feet in 15 consecutive patients who underwent STJ fusion using a novel 2-screw fixation construct were retrospectively reviewed to assess the fusion outcome and complications. Specifically, we offer a novel 2-screw construct that offers the stability of the traditional parallel 2-screw construct while maintaining a maximum raw bone surface area at the posterior facet achieved by single-screw fixation. A retrospective review of radiographs taken 10 weeks postoperatively indentified a 100% fusion rate (15 of 15). All patients in our series achieved fusion, including several high-risk cases, and no significant complications were identified.

Fermeture des fistules palatines séquellaires de fentes

Treatment of oronasal fistulae in cleft patients remains a surgical challenge because of its high failure rate. The authors report the results of an aggressive surgical technique using the total elevation of palatal mucoperiosteum, even for small fistulae. This approach was used on twelve consecutive patients, from five to 33 years of age, presenting with a Pittsburgh classification type IV palatal fistulae. The surgical procedure was total elevation of the hard palate mucoperiosteum starting from the dental sulcus combined with sealed double layer sutures. Clinical and photographical control was made at least 6 months after to detect a possible relapse. The success rate was 100%. No relapsing fistula was observed with follow-up ranging from 6 to 36 months. This technique allows wide exposure and safe closure of the nasal layer. It is simple and leaves no raw bone surface exposed and no additional scar. The authors think it can be used in all type IV fistulae less than 1cm wide. Several other surgical techniques have been described to close palatal fistulae: local turnover flaps, pedicled flaps from adjacent oral tissue, tongue flaps, tissue expansion, and even free flaps. Obturator prostheses have also been used. The technique we report, even if more aggressive, seems to be more reliable with fewer relapse and sequelae.

Biomembrana de látex: novo método para o revestimento da cavidade aberta nas timpanomastoidectomia

As neocavidades pós-timpanomastoidectomias de cavidade aberta (TMCA) são normalmente preenchidas por cadarço ou fita cardíaca untados com pomada antibiótica. A remoção deste tampão usualmente causa sangramento e desconforto para o paciente. Propomos para tanto a utilização de uma biomembrana de látex natural para forrar a neocavidade, servindo como uma interface entre o osso cruento e o material de tamponamento. FORMA DE ESTUDO: Clínico prospectivo. OBJETIVOS: Estudar o desempenho da biomembrana como uma interface entre o osso cruento e o material de tamponamento e analisar seu papel na epitelização da neocavidade. MATERIAL E MÉTODO: Foram analisadas 64 orelhas de pacientes submetidos à TMCA e meatoplastia. A biomembrana foi utilizada em 54 das orelhas operadas, sendo que nas outras 10 orelhas o tamponamento da cavidade foi realizado somente com fita cardíaca. RESULTADOS: Na maioria das 54 orelhas onde a biomembrana foi utilizada observou-se maior facilidade na remoção do curativo tampão (sem sangramento ou desconforto para o paciente), menor demanda de tempo para sua retirada, além da epitelização mais precoce da neocavidade. CONCLUSÃO: A utilização da biomembrana de látex revelou-se método eficaz no revestimento da neocavidade, facilitando a remoção do tampão e a epitelização da neocavidade.

Latex biomembrane: A new method to coat the open cavity in tympanomastoidectomies

SummaryThe new cavity created after an open cavity tympanomastoidectomy (OCTM) is filled with an antibiotic impregnated cotton pack (cotton tape, umbilical tape, gauze). The removal of this pack usually causes some bleeding and discomfort for the patient. We propose the use of a latex biomembrane to cover the cavity, which will act as an interface between the raw bone surface and the packing. Study design: clinical prospective. Aim: To study the performance of the latex biomembrane as an interface between the raw bone surface and the pack, and to analyze its role in cavity epithelization. Material and Methods: 64 ears of patients submitted to OCTM were studied. The biomembrane was used in the packing of 54 ears and in the 10 remaining ears the regular cotton tape packing was used. Results: In the majority of the cases where the biomembrane was used the packing was removed much easier with no bleeding or pain for the patient and also showed an earlier cavity epithelization. Conclusion: The use of the latex biomembrane has proven to be an effective method to cover the mastoid cavity facilitating epithelization and removal of mastoid cavity packing.

Surgical Technique for the Correction of Postpalatoplasty Fistulae of the Hard Palate

Ortak, Turgut M.D.; Kerem, Metin M.D.; Uraloğlu, Muhammet M.D.; Ünlü, Ramazan Erkin M.D.; İnözü, Emre M.D.; Şensöz, Ömer M.D. Author Information

Surgical Technique for the Correction of Postpalatoplasty Fistulae of the Hard Palate

Postpalatoplasty fistulas of the hard palate remain challenging. The reported recurrence rate after surgical correction ranges between 33 and 37 percent. The authors describe a surgical technique for the correction of postpalatoplasty fistulas by total elevation of the palatal gingivoperiosteum starting at the dental sulcus, excision of the fistula, and watertight separate closure of the nasal and palatal mucosa by means of the transoral approach. This technique has the advantages of providing adequate exposure for closure of the nasal mucosal gap and allowing closure of the palatal defect under minimal tension. Placement of interdental sutures leaves no raw bone surfaces exposed. The authors have used this technique on 60 consecutive patients with fistulas of the primary and secondary hard palate between 1998 and 2003. Their overall success rate of fistula closure was 90 percent. The success rate for previously unoperated postpalatoplasty fistulas was 96.9 percent. All of the failures occurred in patients who had bilateral cleft lip and palate. No complications of tooth loss or gingival recession were observed. A detailed description of the technique with illustrations is provided.

The use of a pedicled buccal fat pad graft for bone coverage in primary palatorrhaphy: A case report

Although the buccal fat pad graft (BFPG) has been used as an alternative method for the reconstruction of small- to medium-sized intraoral defects, it has rarely been used in primary cleft palate surgery. It is difficult to completely close the wide cleft palate without complications. Even though the surgeon performs complete closure, secondary oronasal fistulas and severe scar contracture can develop because of the large lateral raw bone surfaces. This report describes a patient in whom these surfaces were covered with bilateral pedicled BFPGs.

Methylmethacrylate induces pulmonary hypertension and increases lung vascular permeability in sheep.

Methylmethacrylate (MMA) is a bone cement used to attach prosthetic joints to raw bone surfaces. Occasional reports of pulmonary complications following total hip replacement suggest that MMA may induce pulmonary microvascular abnormalities. We studied the hemodynamic and pulmonary edemagenic effects of 2 mg/kg and 12 mg/kg MMA in 23 sheep. After the 12 mg/kg dose there was a marked fall in mean systemic blood pressure (SBP) within 30 s from 92 +/- 7 to 59 +/- 3 mmHg (p less than 0.05). The SBP returned to normal and then decreased, again becoming significantly lower than baseline at 120 min. Mean pulmonary artery pressure (PAP) increased from 16.8 +/- 1.2 to 27.0 +/- 1.5 mmHg at 0.5 min (p less than 0.01 then slowly returned to normal over 1 h. Despite the transient changes in pulmonary hemodynamics, baseline lymph flow (QL) doubled at 30 min and tripled at 120 min to 3.0 +/- 0.4 and 4.4 +/- 0.6, respectively (p less than 0.01). Lymph/plasma ratio for albumin was 0.83 +/- 0.03 at baseline and was unchanged throughout the study. Lung tissue water/blood free dry weight ratio was 5.4 +/- 0.4 compared to 3.6 +/- 0.3 for normal sheep (p less than 0.05). After the low dose there was no change in SBP or PAP, and QL only doubled (1.0 +/- 0.3 to 2.3 +/- 0.7). The L/P albumin was unchanged. We found no evidence of polymorphonuclear leukocyte (PMN) trapping in the pulmonary parenchyma by lung biopsy or by counts of PMNs in pulmonary artery and aortic blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular effects of methylmethacrylate cement.

Experiments were carried out on dogs in an attempt to identify the mechanisms underlying the systemic hypotension associated with the application of acrylic cement substances to raw bone surfaces, as in reconstructive hip surgery. Intravenous injection of the liquid component of such cements (monomeric methylmethacrylate) into six dogs produced a significant fall in blood pressure together with an increase in heart rate and cardiac output. This seemed to be due to peripheral vasodilatation caused directly by the monomer and not through the release of histamine. Absorption of free monomer from the mixed cement into the systemic circulation at operation is likely to have the same effect. Precautionary measures can be taken and groups of patients who are especially at risk can be identified, thus reducing the hazards of total hip replacement.

CORRECTION OF DEFORMITY AND PREVENTION OF ASEPTIC NECROSIS IN LATE CASES OF SLIPPED FEMORAL EPIPHYSIS

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