Removal Of Soft Tissue Research Articles

Applicability of cone beam computed tomography gray values for estimation of primary stability of dental implants

Objective: To evaluate the relationship between bone density measured by computed tomography (CT) and cone beam computed tomography (CBCT) (Sirona’s Galileos scanner) with primary stability of dental implants. Material and methods: 20 fresh bovine femoral heads were prepared by removal of soft tissue, sectioning of the bone, and placement of markers for location and angulation of implants. Bone density of peri-implant areas was determined preoperatively by CT and CBCT scanning of the prepared bone samples represented by Hounsfield units (HUs) and gray values (GVs), respectively. Then, 60 implants in three sizes (diameter = 4 mm, length = 8, 10, and 12 mm) were inserted into the bones and maximum insertion torque (IT) was recorded. Osstell device was also used for determining the implant stability quotient (ISQ) for each implant. Statistical analysis was performed on the data (alpha = 0.05). Results: Mean ± SD values of GV, HU, and ISQ were 1592.75 ± 231.82, 675.26 ± 115.38 and 61.90 ± 10.14, respectively. Moreover, the most frequent IT limit was 30-35 Ncm (41.4%). Significant relationships were observed between HU and IT, GV and IT, HU and ISQ, GV and ISQ, and IT and ISQ in all implant sizes. Moreover, GV and HU also significantly correlated to each other. Conclusion: Bone density values in CBCT and CT scans are positively associated to primary stability of dental implants. Therefore, GVs obtained from Galileos CBCT scanner can be used for preoperative selection of edentulous sites which allow for better implant stability or locations which require further procedures for enhancing the success rate of dental implants. KEYWORDSComputed tomography; Cone beam computed tomography; Dental implant.

Utilization of surgical treatment for sleep apnea: A study of health disparities.

Barriers to surgical treatment for sleep apnea remain understudied. In this study, we sought to evaluate whether specific demographic and socioeconomic characteristics are associated with whether or not patients receive surgery for sleep apnea management. The National Inpatient Sample (NIS) database was analyzed for 2007-2014. Patients aged 18 or older with primary or secondary diagnoses of sleep apnea were selected. Patients were sub-categorized by whether they received related soft-tissue removal or skeletal modifying procedures. Age, race, gender, region, insurance, comorbidities, procedure type, and procedure setting were analyzed between surgical and nonsurgical groups. A total of 449,705 patients with a primary or secondary diagnosis of sleep apnea were identified, with 27,841 (5.8%) receiving surgical intervention. Compared with the non-surgical group, patients in the surgical cohort were more likely to be younger, male (74.4% vs. 59.0%), Hispanic (10.2% vs. 6.2%), Asian (3.6% vs. 1.0%) (p<0.001), and have less clinical comorbidities. Those receiving surgery were more likely to be in the highest income bracket (36.1% versus 25.1%) and utilize private insurance (76.3% vs. 50.8%). Soft-tissue surgeries comprised 88.5% of total procedures while skeletal modifying procedures constituted 11.5% (p<0.001). This study identified multiple demographic, socioeconomic, and clinical discrepancies in the utilization of surgical versus nonsurgical management of sleep apnea in the United States. Future studies should examine the causes for these health disparities in the ultimate effort to provide more equitable healthcare in the United States.

Anterior chest wall reconstruction for oncologic and non-oncologic pathology: a case series

Background: Utmost malignant, in addition to large benign tumors or deformity/trauma of the chest wall, typically require thoracic surgery to manage the abnormal growth promptly. Chest wall resection encompasses a variety of approaches from partial to full surgical removal of soft tissue, cartilage, sternum, and ribs. The reconstruction, using prosthetic materials may be employed to rebuild the skeletal structure.

A Case of Surgical Extraction of the Lower Third Molars in a Cranial Series from the Pucará de Tilcara Fortress (Jujuy Province, Argentina)

This study analyzes the earliest known case of surgical extraction of the lower third molars, observed in a cranial series from Pucará de Tilcara fortress (15th–16th centuries AD), northwestern Argentina, excavated in 1908–1910. Crania were transported to the Kunstkamera in 1910 under an exchange project. Traces of dental surgery were registered in the mandible of a male aged ~40. Both third molars had been extracted after the removal of soft tissues and parts of the alveoli. Teeth were extracted by scraping alveolar walls with semicircular movements. The results of scanning electron microscopy, X-ray fluorescence, and X-ray microanalysis suggest that a stone tool was used. The results of macroscopic and CT analysis suggest that the surgery was motivated by the exacerbation of chronic periodontal disease and probably by caries. The left third molar was extracted without complications 2–3 months before the individual’s death. On the right side, the pathological process continued, culminating in osteomyelitis and its complications. The surgeon’s skill notwithstanding, the extraction of the right third molar did not cure the patient, who died, apparently following the destructive stage of acute osteomyelitis complicated by orofacial phlegmon. Our findings suggest that the level of dental surgery practiced in the Inca Empire was ahead of the diagnostic expertise.

The CUSA Clarity Soft Tissue Removal Study

The CUSA Clarity Soft Tissue Removal Study

3D-structural change of nasopharynx following adenoidectomy: 10-year serial data in a single hospital.

Scar contracture commonly refers to decreased function in the scar area, whereas scar contraction refers to shortening of the scar length compared to the original wound. Wound scar remodeling occurs during months to years of wound healing to form a mature scar. Serial reports about patients who had undergone adenoidectomy are rare. Thus, the objective of this study was to evaluate some parameters of air way passage in patients who had undergone post adenoidectomy. Data of patients who have undergone adenoidectomy between 2000 and 2002 in our hospital were obtained. A total of 154 head and neck CT scans from an adenoidectomy group and a control group were analyzed. We measured lengths of several areas, including the width of posterior wall of nasopharynx, the widest diameter in the upper air way, the length between both Eustachian tubes, the length between both pharyngeal recesses, and the anterior to posterior diameter of the nasopharynx. This study was approved by Institutional Review Board (IRB) of the Department of Otolaryngology Head and Neck Surgery of Catholic University (approval number: UC18RESI0130). There were significant differences in the following parameters between the two groups: the width of posterior wall of nasopharynx and the length between both pharyngeal recesses. Extensive removal of soft tissue or injured muscle layer during surgery might be one of the reasons for the narrowing of airway. Keeping in mind not to make much injury the soft tissue or muscles during adenoidectomy is very important for the long-term outcome of this surgery.

A Cadaveric Study on Lumbar Spinous Process Fusion: Risk Factor for Wrong Level Spinal Surgeries

Introduction: The fusion of Lumbar Spinous Processes (LSP) of adjacent vertebrae may lead to errors in determining the correct spinal level. This may result in wrong level spinal surgeries around the lumbar region. Aim: To determine the prevalence of fusion between adjacent LSP. Materials and Methods: This study was a prospective observational study done in the Department of Anatomy, Smt. B.K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India. The present study had examined the lumbar spines in 30 formalin preserved cadavers. The fusion between the LSP of adjacent vertebrae was recorded after the removal of soft tissue from L1 to S1 vertebrae. Results: The present study found the fusion between the adjacent LSP in 11 (36.67%) cadavers (08 males; 03 females). The fusion between the adjacent LSP, from L4 to S1 vertebrae, was found in 10% of cadavers and was the most common pattern. The fusion between the adjacent LSP was more common in males (53.3%) compared to females (20%). Conclusion: The occurrence of fusion between the adjacent LSP is not uncommon.

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment.

Postoperative surgical site problems (PSSPs) following spinal surgery may lead to patient mortality, increased treatment costs and possible recurrent medical interventions. Despite efforts to reduce spinal surgery-related infection rates, complications are common and significantly increased by patient comorbidities. Since PSSPs occur regardless of deterrent measures, it is essential to distinguish the related risk factors. Different treatment conventions for PSSPs, for example, antibiotic treatment, debridement, soft tissue care and removal of implants have been prescribed with blended outcomes. The utilization of the wound vacuum-assisted closure (VAC) system has gained increasing popularity in the management of deep wound infections after deformity surgery.

Cold-Plasma Ablation Use in Endoscopic Endonasal Dacryocystorhinostomy

The aim is to evaluate efficacy of the method of cold-plasma ablation when performing endonasal of dacryocystorhinostomy. Patients and Methods. With the use of the equipment Coblator II were 31 unilateral dacryocystorhinostomy patients with obstruction of the lacrimal ducts at the level of the lacrimal-nasal duct. After a full examination, including color samples, rinsing and probing of lacrimal ducts, radiographic, and, in some cases, transcanalicular endoscopy, when indicated, was performed endonasal dacryocystorhinostomy with the use of cold-plasma ablation. Using a set of equipment Coblator II performed 31 unilateral cerebral PALSY patients with obstruction of the lacrimal duct at the level of the lacrimal duct. In the postoperative period, antibacterial therapy, lacrimal lavage, full volume washing of the nasal cavity, inhalation of mucolytics and antibiotics with a nebulizer were carried out, lubricants were also used. Results . In the early postoperative period and 1 month after surgery, all patients reported no complaints of lacrimation and purulent discharge. In endorinoscopy, healing was observed by the type of predominant epithelialization, the stoma functioned, when washing the stagnant content in the lacrimal SAC was not. There was a small bleeding intraoperatively and in the early postoperative period. Conclusion . Endoscopic endonasal dacryocystorhinostomy with the use of the method co-ablation is a safe and effective alternative to other methods of holding the endonasal dacryocystorhinostomy. The advantages are the ease of implementation, no need for additional, including power tools (pliers, cutting head of a shaver, rasp, etc.) for removal of soft tissue in the area formed dacryocystectomy, good visualization due to the coagulating effect of the cold-plasma ablation, the possibility of gentle removal of even the hypertrophied wall of the lacrimal SAC. The main drawbacks are the high cost of equipment and consumables.

Amlodipine induced gingival overgrowth- A case report

Patients on anticonvulsants, calcium channel blockers and immuno-suppressants therapy often experience gingival overgrowth. Oral functions like mastication, speech, tooth eruption and aesthetics is hampered by gingival overgrowth. It impacts routine oral hygiene procedures which leads to increased plaque retention and resultant inflammatory overgrowth. Similar clinical and microscopic features of overgrowth are seen with the use of different drugs. Gingival overgrowth is treated by thorough oral prophylaxis i.e. scaling and polishing, drug substitution is done only if new drug has fewer adverse effects and if overgrowth persists surgical removal of excess soft tissue is advised. This article is a case report of commonly used calcium channel blocker Amlodipine which induces gingival overgrowth in few cases. It is treated by a combination of a rigorous oral hygiene regime, and in cases where aesthetics, function or speech are compromised surgery is advised. Keywords: Gingival overgrowth, Drug, Management, Hyperplasia.

Spatial changes in soil stable isotopic composition in response to carrion decomposition

Abstract. Decomposition provides a critical mechanism for returning nutrients to the surrounding environment. In terrestrial systems, animal carcass, or carrion, decomposition results in a cascade of biogeochemical changes. Soil microbial communities are stimulated, resulting in transformations of carbon (C) and nitrogen (N) sourced from the decaying carrion soft tissues, changes to soil pH, electrical conductivity, and oxygen availability as microbial communities release CO2 and mineralize organic N. While many of the rapid changes to soil biogeochemistry observed during carrion decomposition return to background or starting conditions shortly after soft tissues are degraded, some biogeochemical parameters, particularly bulk soil stable δ15N isotopic composition, have the potential to exhibit prolonged perturbations, extending for several years. The goal of this study was to evaluate the lateral and vertical changes to soil stable isotopic composition 1 year after carrion decomposition in a forest ecosystem. Lateral transects extending 140 cm from three decomposition “hotspots” were sampled at 20 cm intervals, and subsurface cores were collected beneath each hotspot to a depth of 50 cm. Bulk soil stable isotopic composition (δ15N and δ13C) indicated that 1 year after complete soft tissue removal and decay, soils were significantly 15N enriched by 7.5±1.0 ‰ compared to control soils up to 60 cm from the hotspot center, and enrichment extended to a depth of 10 cm. Hotspot soils also contained 10 % more N compared to control soils, indicating that decomposition perturbs N pools. Our results demonstrate that carrion decomposition has the potential to result in long-term changes to soil biogeochemistry, up to at least 1 year after soft tissue degradation, and to contribute to bulk soil stable isotopic composition.

Design of a Lumbar Interspinous Fixation Device for Minimally Invasive Surgery and Spine Motion Stabilization

Intervertebral fusion removes a considerable region of lumbar ligaments and muscles and increases degenerative diseases in adjacent segments. Therefore, an interspinous fixation device must be developed to overcome these drawbacks. The purpose of the present study is to design a lumbar spine interspinous fixation device that minimizes both tissue removal during interspinous fixation surgery and degenerative changes of adjacent lumbar segments after the surgery. The lumbar interspinous fixation device was designed by employing spike and ratchet structures in the device fixation part to minimize the removal of soft tissue during interspinous fixation surgery and to reduce the stress concentration after the surgery. The part connecting two spinous processes was designed as spring element to allowing normal lumbar behavior after the surgery. Finite element analysis was performed to design spring elements, confirm the structural stability of the fixation device, and compute the intervertebral disc pressure and flexion–extension motions of intact and defect lumbar vertebrae models that were validated in this study. The structural stability of the currently designed interspinous fixation device was confirmed. Under physiological loading conditions, the maximum displacement is 0.4 mm and the maximum stress is 173.5 MPa under the maximum load of 250 N, which accounts for 18.3% of the yield strength of the LIFD material (950 MPa). When the interspinous fixation device was inserted, the intervertebral disc pressure was reduced by 80–92% compared with the defect model that mimics intervertebral fusion. Both a significant reduction in the flexion motion (from 10.7° to 6.0°) up to the normal behavior and a minimal reduction in the extension motion (from − 4.6° to − 3.1°) were achieved, which is consistent with the main role of the LIFD reported in the literature. The interspinous fixation device designed in this work, which is structurally stable and can minimize the tissue removal during interspinous fixation surgery, can reduce the intervertebral disc pressure and maintain the normal lumbar behavior. Therefore, the device can minimize degenerative diseases in adjacent lumbar segments of lumbar vertebrae after the surgery.

Clinical value analysis of limited debridement for the treatment of incomplete gangrenous diabetic foot osteomyelitis

Objective To investigate the clinical value of limited debridement in treating diabetic foot osteomyelitis with incomplete foot gangrene. Methods Retrospective analysis of traditional surgery (complete removal of diseased bone and soft tissue) and limited debridement (limited removal of diseased bone and soft tissue) in patients with incomplete foot gangrenuria foot osteomyelitis from February 2015 to March 2017, There were 38 cases in the traditional operation group and 76 cases in the limited debridement group. Between the two groups, the sex ratio (20/18 vs 41/35), age (64.90±8.40 vs 68.1±8.10), Wagner 3/4 grading ratio (12/26 vs 26/50), the ratio of nerve ulcers/ischemic neurotic ulcers (13/25 vs 24/52), the ulceration ratio of forefoot/middle foot+hind foot (33/5 vs 68/8) , arterial ABI (0.71±0.39 vs 0.67±0.33) , and lower extremity arterioplasty ratio (52.63% vs 59.21%), combined with hypertension (78.95% vs 77.63%), coronary heart disease (71.05% vs 69.74%), cardiac insufficiency (10.53% vs 9.21%), renal failure rate (21.05% vs 22.37%), incidence of hypoproteinemia (10.53% vs 10.53%), anaemia (15.79% vs 19.74%) and drug resistance of drug resistant bacteria (26.32 vs 23.68%) had no statistical difference. All the patients received antibiotic after surgery. The incidence of antibiotic related complications, the rate of amputation on the ankle, the average length of hospitalization, the average healing time of the ulcer/wound, the rate of readmission in one year, the rate of recurrent ulcer, the rate of new ulceration, the rate of ulceration and the death rate were collected to evaluate the clinical effects. Results The duration of antibiotic use in the traditional operation group (25.2±12.3 d) and the average hospitalization time (16.9±7.6 d). The average healing time of ulcer/wound (121.6 ±23.7 d) was shorter than that of limited debridement group (32.5±16.8 d, 24.7±12.5 d, 153.2±27.8 d). The amputation rate (1.32%), re-admission rate (1.32%), ulcer recurrence rate (2.63%) and ulcer recurrence rate (1.32%) in the limited debridement group were significantly lower than those in the traditional operation group (10.53%, 31.58%, 21.05%, 28.95%). There was no significant difference in the incidence of antibiotic-related complications and all-cause mortality between the two groups. Conclusion Conservative surgery for diabetic foot osteomyelitis of incomplete foot gangrene is scientific and reasonable, and the quality of life of patients can be improved. The clinical benefit is obvious. It is worth of clinical promotion. Key words: Diabetic foot; Debridement; Osteomyelitis

Prosthodontic approach to manage maxillary flabby ridge and severely resorbed mandibular residual ridge – a case report

Brief Background Fabrication of any dental prosthesis over a compromised residual alveolar ridge is really a challenge for prosthodontists. Fibrous or flabby ridge and highly resorbed residual alveolar ridge are two clinical situations that require special considerations during construction of any prosthesis. Mobile soft tissue and flattened alveolar ridge significantly compromise denture stability and support. There are different treatment modalities to manage these clinical conditions like surgical excision of soft tissue, ridge augmentation, modification in impression technique, etc. Materials and Methods This case report is about an old completely edentulous male patient who reported with a complaint of difficulty in chewing with his present denture. Discussion Prosthodontic management of a patient with compromised residual alveolar ridges needs special consideration . Selection of treatment modality depends on patients general health ,clinical condition of residual alveolar ridges , financial capacity and skill of the clinician A modification from conventional impression procedure was used to record maxillary flabby anterior ridge and neutral zone concept was applied for teeth arrangement to improve denture stability in atrophied lower alveolar ridge. Summary and Conclusions Surgical removal of soft tissue and implant supported prosthesis may not be possible in all situations. In that case a conservative approach using modified impression technique, neutral zone concept provides the basic triad of a successful denture prosthesis that is retention, stability and support. Key Words Flabby tissue, Window technique, Resorbed ridge, Neutral zone.

ESTUDO DESCRITIVO E MORFOMÉTRICO DO CRÂNIO DO Ramphastos toco (AVES: PICIFORMES)

Resumo O estudo de caracteres morfológicos e suas funções biomecânicas na estrutura craniana das aves levanta debates de cunho filogenético, taxonômico e morfofuncional. O objetivo deste trabalho foi descrever e analisar caracteres morfológicos e morfométricos do esqueleto do Ramphastos toco e confrontá-los com a bibliografia disponível. Foram analisados 13 crânios de indivíduos adultos e de um espécime dissecado fixado em formol (4%). As carcaças foram submetidas à técnica de maceração para o preparo dos esqueletos, com a retirada dos tecidos moles, desengorduramento e clareamento em água oxigenada (50%) e hipoclorito de sódio (50%). O formato e amplitude da sutura naso-frontal e zona flexora craniofacial, a presença dos sesamóides intracapsulares rostral e caudal na articulação quadrática e a presença do ligamento pós-orbital foram fatores que desafiaram a bibliografia existente e os modelos de transferência de força propostos durante estudos da cinética craniana da espécie. A discussão que emerge é a possibilidade dessas características limitadoras da cinética craniana descritas nos espécimes possuírem, em conjunto, a função de promover estabilidade funcional para uma estrutura cuja natureza dimensional, em si, gera instabilidade. Os resultados morfométricos também apresentaram divergências significativas quando comparados à bibliografia disponível, o que pode estar relacionado a variáveis como especiação alopátrica, hibridização e amostragem.

Soft Tissues Deformation and Removal Simulation Modeling for Virtual Surgery

Major advances in the area of virtual reality have paved the way to an important application called surgical simulators. These are safe methods to carry out surgical planning and training. Surgical simulators are expected to replace conventional surgery training methods in the near future. Achieving soft tissue deformations in real time is a challenging task in virtual surgery. The most commonly used methods for deformation simulation are finite element method and mass spring method. The proposed method makes use of Delaunay triangulated mesh model to depict multiple layers of skin. This paper presents simple method of 3D soft tissue deformation and removal simulation using visualisation toolkit. The presented framework is able to simulate: collision detection, deformation and removal of soft tissues for real time computation. Multilayered model of human skin using Delaunay triangulated approach is developed as a pre-process step. The same interactive model is considered for deformation and removal simulation approach. Necessary meshing algorithms are used based on Delaunay criteria to obtain qualitative results.

Crown Lengthening for Aesthetic Purposes from the Islamic Perspective: a Case Discussion

The aim of dental treatment is to restore function and improve oral health condition. It is an advantage if the treatment conducted can also improve aesthetic. However, current trend of patient’s demand for aesthetic treatment is challenging. This alarming scenario sometimes does not comply with Shariah and Islamic jurisprudence. Crown lengthening is a procedure to facilitate restoration in certain clinical conditions simultaneously improves the aesthetic in anterior region. It involves manipulation of gingiva which requires removal of soft tissue and/or hard tissue. This paper was aimed to discuss the management of missing teeth with crown lengthening surgery from Islamic perspective. In the selected case, a lady requested to replace her denture with a fixed prosthesis that requires surgery. Initially, the surgical procedure was only planned on the right anterior region. However, during the preliminary stage of determining the treatment outcome; crown lengthening on both sides is advice to harmonize the gingival line. The final decision was to carry out surgical procedure on the site of complaint and crown lengthening surgery on both sides. As expected, the outcome of the treatment significantly improved the aesthetic of the patient. This study employs mainly the comparative case study approach where the detail description of the selected case is mapped to the Shariah principles and guidelines related to aesthetic treatment. The selected Shariah principles and guidelines are based on the commonly accepted school of law. In conclusion, this study found that the treatment proposed by the specialist that is based on function first, followed by correction of aesthetics is in line with the guidelines and principles of Shariah as well as legal maxim that falls under acts are judged by their goals and purpose (al-’Umur-bimaqasidiha). Therefore, basic knowledge on Islamic principle is favourable for dentist and patient in deciding the final treatment plan. &#x0D;

Stereovision Co-Registration in Image-Guided Spinal Surgery: Accuracy Assessment Using Explanted Porcine Spines.

Current methods of spine registration for image guidance have a variety of limitations related to accuracy, efficiency, and cost. To define the accuracy of stereovision-mediated co-registration of a spinal surgical field. A total of 10 explanted porcine spines were used. Dorsal soft tissue was removed to a variable degree. Bone screw fiducials were placed in each spine and high-resolution computed tomography (CT) scanning performed. Stereoscopic images were then obtained using a tracked, calibrated stereoscopic camera system; images were processed, reconstructed, and segmented in a semi-automated manner. A multistart registration of the reconstructed spinal surface with preoperative CT was performed. Target registration error (TRE) in the region of the laminae and facets was then determined, using bone screw fiducials not included in the original registration process. Each spine also underwent multilevel laminectomy, and TRE was then recalculated for varying amounts of bone removal. The mean TRE of stereovision registration was 2.19 ± 0.69 mm when all soft tissue was removed and 2.49 ± 0.74 mm when limited soft tissue removal was performed. Accuracy of the registration process was not adversely affected by laminectomy. Stereovision offers a promising means of registering an open, dorsal spinal surgical field. In this study, overall mean accuracy of the registration was 2.21 mm, even when bony anatomy was partially obscured by soft tissue or when partial midline laminectomy had been performed.

Threatened species drive the strength of the carbonate pump in the northern Scotia Sea

The efficiency of deep-ocean CO2 sequestration is regulated by the relative balance between inorganic and organic carbon export respectively acting through the biological carbon pump (BCP) and the carbonate counter pump (CCP). The composition and abundance of calcifying species in the prevailing oceanic plankton community plays a major role in driving the CCP. Here we assess the role of these calcifying organisms in regulating the strength of the CCP in a Southern Ocean region (northern Scotia Sea) known to be a major hotspot for the drawdown of atmospheric CO2. We show that, when shelled pteropods dominate the calcifying community, the total annual reduction of CO2 transferred to the deep ocean doubles (17%) compared to when other plankton calcifiers dominate (3–9%). Furthermore, predation enhances their contribution through the removal of organic soft tissue. Pteropods are threatened in polar regions by ocean warming and acidification. We determine that their potential decline would have major implications to the comparative strengths of the BCP and CCP.

Should clinicians integrate the findings of The Lancet’s 2018 placebo-controlled subacromial decompression trial into clinical practice?

Earlier this year, Beard et al 1 published the outcomes of a multicentre, placebo-controlled randomised surgical trial in The Lancet , in which they concluded that arthroscopic subacromial decompression has...