Surgical Planning Research Articles

Unilateral two-headed extensor digitorum longus muscle: atypical configuration and clinical implications.

This report describes a new configuration of the extensor digitorum longus (EDL) with two heads and two main tendons divided into four slips. During routine cadaver dissection, unilateral (right) EDL muscle belly and tendon variations were identified. The morphometric measurements of the EDL were conducted using Image J software. Two bellies and two tendons of the EDL muscle were observed in the right leg of an 87-year-old male cadaver. The second belly of the EDL muscle originates 2cm below the first belly. The tendons originate at the ends of the muscle bellies. First and second tendons split into two more slips after passing through the same tunnel below the extensor retinaculum. The first tendon was divided into two tendon slips attached to the extensor expansion of the second and third toes, whereas the second tendon was divided into two tendon slips attached to the extensor expansion of the fourth and fifth toes on the dorsum of the foot. The width of the muscle belly for the tendons of 2nd and 3rd toes was 1.10 ± 0.06cm, while it was 1.39 ± 0.04cm for that of the 4th and 5th toes. The developmental variations in the EDL muscles can be asymptomatic. This variant of the EDL muscle may cause entrapment under the extensor retinaculum, potentially restricting ankle dorsiflexion. This limitation can also affect walking. Consequently, paying attention to this variance is crucial for surgical planning and interpretation of radiological scans.

Concordance between preoperative ultrasound arterial mapping in the femoropopliteal and distal sector and intraoperative angiography.

The present study analyzes the concordance between arterial mapping of this sector using duplex ultrasound and intraoperative angiography. A retrospective, single-center observational study was carried out. The study sample consisted of patients subjected to open or endovascular surgery of the femoropopliteal and distal sector with prior ultrasound arterial mapping from January 2017 to December 2022. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of arterial mapping with duplex ultrasound versus intraoperative angiography were evaluated, the degree of concordance between the two techniques and the correlation between surgical planning and the surgery finally performed. 167 patients were analyzed. A total of 1837 segments were explored, of which 149 (8.1%) were not able to be evaluated. Regarding the global precision of ultrasound in predicting significant arterial lesions (stenosis > 50% or occlusion), sensitivity was 85.26% (95% confidence interval [95%CI]: 82.33-88.19%), specificity 88.57% (95%CI: 86.63-90.51%), PPV 80.41% (95%CI: 77.24-83.58%), and NPV 91.61% (95%CI: 89.89-93.34%). Global concordance assessed by the kappa index was 0.725 (95%CI: 0.691-759). The surgical indications based on arterial mapping coincided with the final surgery performed in 97.6% of the cases. Arterial mapping of the femoropopliteal and distal sector with duplex ultrasound could be considered as the sole preoperative imaging technique for surgical planning.

Integration of cone beam computed tomography for interdisciplinary diagnosis and treatment planning

Cone-beam computed tomography (CBCT) has revolutionized dental imaging by providing precise three-dimensional visualization of hard tissue structures with minimal radiation exposure compared to conventional CT. This review explores the integration of CBCT in interdisciplinary diagnosis and treatment planning across various fields of dentistry. CBCT offers versatile applications including assessment of impacted teeth, airway analysis, temporomandibular joint evaluation, detection of jaw pathologies, and precise diagnosis of dento-maxillofacial fractures. Its ability to generate static and rotational 3D images aids in surgical planning and treatment outcome prediction. Furthermore, CBCT plays a crucial role in orthodontics for localization of impacted teeth and evaluation of craniofacial anomalies such as cleft lip and palate. In periodontics and implantology, CBCT facilitates detailed assessment of periodontal structures, bone defects, and precise implant placement. Additionally, CBCT assists in maxillofacial prosthetics by enabling virtual surgical planning and custom prosthetic fabrication. This paper underscores CBCT as an indispensable tool in modern dental practice, enhancing diagnostic accuracy, treatment precision, and patient outcomes across diverse clinical scenarios.

Predictive factors of extremity graft occlusion after endovascular repair of abdominal aortic aneurysm: A 13-year single center experience

Aim: Graft leg thrombosis (GLT) after Endovascular Aortic Repair (EVAR) is an important problem affecting morbidity/mortality. In addition to anatomical factors such as aortic neck angle and diameter in graft leg thrombosis; we aimed to convey the roles of graft extension to the external iliac artery and the effect of graft type selection on the results. Material and Methods: Analysis of 512 patients who underwent EVAR between 2010 and 2023 was performed. The effects of anatomical factors, graft material, underlying diseases, age and gender on the development of graft leg thrombosis were evaluated. Anatomical measurements were evaluated in terms of their predictive power for graft leg thrombosis by Receiver Operating Characteristic (ROC) analysis. Results: The prevalence of graft leg occlusion was significantly associated with some anatomical factors, especially increased aortic neck angle (OR=1.07, p<0.001) and descent to the external iliac artery (OR=13.43, p<0.001). Poliytetrafluoroethylene (PTFE) grafts were associated with a reduced risk of graft leg occlusion (OR=0.26, p=0.002). ROC analysis showed that aortic neck angle had the highest predictive accuracy for GLT (AUC=0.817, p<0.001). There were no significant differences in age, gender, smoking status, diabetes, and hypertension as comorbidities. Peripheral artery disease was shown to increase the risk. Conclusion: Our findings highlight the role of aortic anatomy and graft material selection in the risk of graft leg thrombosis. The use of PTFE grafts appears to be protective against graft leg thrombosis. This information highlights the importance of personalized surgical planning and postoperative management to optimize patient outcomes. Future research should focus on developing models that include these factors.

Effectiveness of Virtual Surgical Planning and Three-Dimensional Anatomical Models in Radiological Reconstruction of Center of Rotation and Pelvic Brim in Patients with Anterior Column Defects Requiring Revision Hip Arthroplasty

Background: The aim of this study was to show that virtual surgical planning (VSP) and printed anatomical models support the reconstruction of the center of rotation (COR) and pelvic BRIM during revision hip surgery using a dual-mobility revision cup system in patients with anterior pelvic column damage and soft tissue envelope deficiency. Methods: Patients with anterior pelvic column damage and soft tissue envelope deficiency underwent revision hip arthroplasty. Virtual planning included assessment of bone segmentation, positioning of the cementless revision cup while maintaining the COR, and the assumed inclination and anteversion angles. Results: The diameter of the planned revision cups was 65.5 ± 2.1 mm, and the diameter of the revision cups used was 65.3 ± 2.1 mm. The difference in COR position in the horizontal axis was 7.8 ± 9.3 mm, in the vertical axis was 4.3 ± 5.9 mm, and in the axial plane was 1.6 ± 3.3 mm. The differences in inclination angle and in the anteversion angle were 12.4° and 8.7°, respectively. Conclusions: The use of VSP and 3D models supports the process of performing RHA surgery in patients with damage to the anterior pelvic column and soft tissue envelope deficiency.

Virtual reality for patient informed consent in skull base tumors and intracranial vascular pathologies: A pilot study.

With the growing demand for shared decision-making and patient-centered care, optimal informed consent (IC) has gained relevance. Virtual reality (VR) has seen significant technological advancements, and its medical applications currently include surgical planning and medical education. This pilot study investigates the feasibility of VR-enhanced informed consent (VR-IC) in neurosurgery to improve preoperative IC and patient satisfaction. We included patients aged 18 to 75years who were scheduled for skull base meningioma or brain aneurysm surgery between May and December 2023. Exclusion criteria were visual/auditory impairments and severe cognitive/psychiatric disorders. Patients received standard IC followed by VR-IC using patient-specific VR models of their pathology. After an initial demonstration by the surgeon, the patients used the VR station independently. A questionnaire with 18 questions on a 5-point Likert scale assessed the subjective impression of VR-IC. Ten patients participated in the study, with six (60%) undergoing aneurysm clipping and four (40%) undergoing skull base meningioma resection. The mean age of the participants was 58years (± 15, range 27 to 75years), with four female patients (40%). Patients overall rated the VR-informed consent (VR-IC) positively with a mean of 4.22 (± 0.84). There was a better understanding of their pathology (mean 4.30 ± 0.92) and the planned procedure (mean 3.95 ± 1.04). Trust in the surgeon was rated with a mean of 3.47 (± 0.94). Only minimal side effects from the VR experience including dizziness or discomfort were noted (mean 4.60 ± 0.22). None of the participants dropped out of the study. VR-enhanced informed consent is feasible and improves patient understanding and satisfaction without significant side effects. These findings will guide the planning of a randomized controlled trial to validate the benefits of VR-IC in neurosurgery further.

Ultra minimally invasive surgical stabilization of Rib fractures (uMI-SSRF): reduction and fixation techniques to minimize the surgical wound.

Rib fractures are common in trauma patients, often leading to complications such as pneumonia and prolonged hospitalization. Surgical Stabilization of Rib Fractures (SSRF) has become increasingly prevalent in treating severe cases. However, traditional approaches, like posterolateral thoracotomy, are invasive and cause significant muscle damage. Recently, muscle-sparing minimally invasive techniques have been introduced, yet they still require advanced reduction and fixation techniques to avoid complications. This study presents an "ultra" minimally invasive SSRF (uMI-SSRF) technique designed to minimize surgical wounds and soft tissue damage while maintaining the benefits of rib fixation. This study involved 76 patients with multiple rib fractures treated using the uMI-SSRF technique between August 2021 and December 2023. Preoperative chest tomography with 3D reconstruction was used for surgical planning. The technique employed small incisions (3-5cm), muscle-sparing approaches, and advanced fixation techniques. Data on patient demographics, intraoperative details, and postoperative outcomes were collected. The mean patient age was 58 years, with 66% being male. On average, patients had 6.4 fractured ribs, and 3.5 ribs with 3.88 plates were fixed per surgery, achieving a fixation/fracture ratio of 59%. The average wound length was 4.2cm, with a mean operation time of 122min. Most patients required only one incision (74%). The median hospital length of stay was 7 days, with a pneumonia rate of 5%. No wound infections or implant-related complications were observed. The uMI-SSRF technique effectively reduces wound size and soft tissue damage in rib fracture stabilization while maintaining high fixation quality. This method shows promise for improving patient outcomes, reducing recovery time, and minimizing complications. Further studies with larger sample sizes and comparisons with other methods are warranted to verify the advantages of uMI-SSRF.

Virtual surgical plan with custom surgical guide for orthognathic surgery: systematic review and meta-analysis.

The shift from traditional two-dimensional (2D) planning to three-dimensional (3D) virtual surgical planning (VSP) has revolutionized orthognathic surgery, offering new levels of precision and control. VSP, combined with computer-aided design/computer-aided manufacturing (CAD/CAM) technology, enables the creation of patient-specific surgical guides and implants that translate preoperative plans into more precise surgical outcomes. This review examines the comparative accuracy and operative efficiency of VSP, especially when used with custom surgical guides, against conventional 2D planning in orthognathic surgery. The study systematically reviewed and analyzed published literature comparing the accuracy and operative time between VSP and conventional planning methods. The meta-analysis included clinical trials, controlled trials, and observational studies on patients undergoing orthognathic surgery, focusing on the degree of alignment between planned and postoperative bone positions and total surgery time. Results indicate that VSP consistently reduces discrepancies between planned and actual surgical outcomes, particularly when integrated with custom surgical guides. Additionally, while VSP demonstrated potential time-saving advantages over conventional planning, these differences were not statistically significant across studies, likely due to high variability among study protocols and designs. VSP with custom surgical guides enhances surgical accuracy in orthognathic procedures, marking a significant advancement over traditional methods. However, the reduction in operative time was not conclusively significant, underscoring the need for further studies to evaluate time efficiency. These findings emphasize VSP's role in improving surgical precision, which holds substantial implications for future orthognathic surgical practices.

VS 04 - HPB Laparoscopic trans-vesical approach is safe management for cholecystoduodenal fistula

Abstract Background A 71 year old female initially presented cholangitis. Her MRCP showed a distal common bile duct (CBD) stone. An ERCP was then performed which was not successful due to anatomical challenge in the form of a large diaphragmatic hernia. An elective laparoscopic cholecystectomy with IOC was performed. An incidental cholecystoduodenal fistula was found therefore the clinical decision was made to perform a trans-vesical approach to fistulogram. This showed a fistula was present and that it was not complicated further. This case shows that this approach avoided iatrogenic injury by confirming presence of the fistula and aided further surgical planning. Method Standard four-port technique with 10mm, 30-degree laparoscope. Blunt, sharp, energised and hydro-dissection were employed. The duodenum was adherent to the gallbladder body therefore a trans-vesical enterotomy was performed. Fistulogram confirmed presence of a cholecystoduodenal fistula but nil further pathology. The fistula was dissected from the gallbladder and stapled with the GIA endo- tri-staple 45 Purple. Further dissection to gallbladder to ensure clear visualisation of calot’s triangle. Basket trawl of the CBD was performed and repeat cholangiogram was clear. The gallbladder was dissected from gallbladder fossa, all gallstones were removed and 3L of wash was used to irrigate the intra-abdominal cavity. Results The patient was admitted following the procedure and was discharged on day two with PPI. She was reviewed post-operatively at 12 weeks and had no further issues. She remains well and has had no further episodes of cholangitis or hospital admissions in almost four years since the procedure. Conclusion This case shows an unexpected finding of cholecystoduodenal fistula in a planned laparoscopic cholecystectomy with IOC. It is important to note that some gas was seen in the gallbladder on initial imaging therefore indicating a possible cholecystoduodenal fistula. This trans-vesical approach with fistulogram confirmed a simple fistula and no further pathology and aided safe surgical planning. This improved patient outcomes and avoided iatrogenic injury thus providing a safer way to manage cholecystoenteric fistula. This novel approach to cholecystoduodenal fistula repair improves patient safety, length of stay and by aiding intra-operative planning and avoiding iatrogenic injury.

Three-dimensional automated measurements of femoral angles for the preoperative planning in dogs with patellar luxation

ObjectivesTo report the surgical outcomes of treating patellar luxation (PL) in dogs with surgical planning based on three-dimensional (3D) automated measurement of femoral angles.Study designMulticenter retrospective study.MethodsForty-one dogs with PL underwent preoperative computed tomography (CT). Three-dimensional femur models were exported as stereolithographic files, and imported into computer-aided design (CAD) software where 3D measurements were performed. The anatomical laterodistal femoral (aLDFA), femoral neck (FNA), and femoral torsion (FTA) angles were recorded. Surgical records, complications, radiographic femoral postoperative alignment, preoperative and postoperative lameness evaluation, and patellar position were reviewed. The success of the surgical outcome was based on the presence of normal patellar tracking at the last clinical recheck.ResultsForty-seven limbs were included; 46% of the cases (22/47) were affected by grade 3 PL. Mean (±SD) 3D aLDFA, FNA, and FTA measurements were 101.4° (±3.6), 132.5° (±2.6), and 17.6° (±4.3) in dogs with medial patellar luxation (MPL) and 89.3° (±7.6), 134.8° (±2.9), 36.9° (±5.3) with lateral patellar luxation (LPL), respectively. Based on the 3D preoperative planning, corrective osteotomies were performed in 34 of 47 cases. The mean radiographic follow-up was 4.7 months. At the final follow-up, PL was successfully treated in 45 of 47 cases. Patella reluxated in five cases. In three of five cases, the 3D automated plan was not followed by the surgeon.DiscussionSurgical treatment of PL based on 3D femoral measurements successfully corrected PL in 45 of 47 cases (96%). This is the first study reporting the use of 3D automated femoral angle measurement in clinical cases affected by PL.

Proposal for a new classification of intrauterine adhesions bysites.

The authors propose a new classification of intrauterine adhesions (IUAs) to facilitate understanding for both the gynecologist and the patient, documenting the location and characteristics of the adhesions in a single image. This tool significantly improves surgical planning and patient outcomes in the treatment of intrauterine adhesions. In addition, having a simple and consistent method of describing IUAs will facilitate longitudinal studies tracking the outcomes of various surgical techniques, adhesion barriers and the impact of hormonal treatment. The proposed new classification system may represent a significant advancement in the field of gynecology. Its adoption may facilitate and simplify the representation of intrauterine adhesion sites, allowing for better communication between doctors and more effective management of intrauterine adhesions.

Innovative 3D Imaging in Pre-Operative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: A Pilot Study.

The efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While 3D imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modeling in SCS preparation. A retrospective analysis was undertaken at a university affiliated tertiary medical center, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into two cohorts: those with pre-operative CT-based 3D imaging (Group A) and those without (Group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. Among the 76 identified patients, 18 were deemed suitable for surgery, with 7 in Group A undergoing preoperative 3D modeling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in Group B. Although operative metrics and collaborative endeavors exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in Group A (100%) compared to Group B (54%), with a significance level of P = 0.05. CT-based 3D modeling in the preoperative phase of secondary cytoreductive surgery for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate impact.

A Randomized Pilot Trial of Virtual Reality Surgical Planning for Head and Neck Oncologic Resection.

Application of virtual reality (VR) for surgical planning may improve clinical outcomes for head and neck cancer (HNC) resection. There is a lack of randomized trials and meaningful metrics to assess such technological applications. Our objective was to evaluate the feasibility of a VR protocol for oncologic surgical planning and assess the impact on surgical outcomes. A randomized controlled trial utilizing a VR Case Enhancement Protocol (VRCEP) versus standard of care (SOC) surgical planning was conducted. The primary endpoint was feasibility, defined as >80% successful VRCEPs. Metrics included surgeon task-load burden (TLB) using the NASA Task-Load Index and "margin events," defined as "the need for defect-driven margins, positive frozen margins, and/or positive final margins." Margin events were used to calculate a margin event score (MES) per case and margin event rate (MER) per cohort. Thirty-four patients were included in the final analysis (17 VRCEP, 17 SOC) with 94.4% of eligible VRCEP cases completed (17/18). Surgeon TLB was unchanged with VRCEP. Cases undergoing VRCEP were associated with a lower mean MES (0.27 vs. 0.94, p = 0.014) and MER (11.6% vs. 35.6%, p = 0.0041). VRCEP was associated with decreased defect-driven margins (10% vs. 53.3%, p = 0.032). Although not statistically significant, positive frozen and final margin rates were lower in VRCEP. Completion of the VRCEP was feasible with no significantincrease in surgeon TLB appreciated. VRCEP yielded fewer MEs. Further investigation into the benefit of VR in HNC resection is warranted. Margin events may represent useful metrics for assessing novel surgical technologies. 2 Laryngoscope, 2024.

The Pan-African Surgical Healthcare Forum: An African qualitative consensus propagating continental national surgical healthcare policies and plans.

Access to equitable, safe, affordable, timely, and quality surgical healthcare in Africa remains limited. Few African countries have surgical healthcare plans or policies. Where these exist, there are significant gaps in dissemination, funding, and implementation. A Pan-African Surgical Healthcare Forum (PASHeF) was initiated to address this. The inaugural forum was a two-day consensus conference of technocrats from African Ministries of Health hosted by the Honorable Minister for Health of Rwanda in Kigali. Through coordinated discussions, plenary sessions, working groups, and technocrat networking, they charted the path forward for national surgical healthcare policies and plans. Discussions were sparked by country experiences, and working groups focused on curated context-specific, face-validated questions. Documentation involved field notes, audio recordings, and artificial intelligence transcription. Data was coded using a constant comparative method to itemize delegates' observations, declarations, and recommendations, with member checking. A consensus statement was generated using an inclusive decision-making model. Thirty-two Ministries of Health were represented by 42 delegates who drafted and unanimously adopted the PASHeF 2023 Consensus Statement. This was a 50-point consensus addressing country commitment, leadership, financing, stakeholder mobilization, monitoring and evaluation, partnerships, and other aspects of national surgical healthcare planning in Africa. This consensus is the African roadmap and emphasizes implementation, the need for flexibility in policy development, and current opportunities and barriers. It emphasizes that community involvement and sustainability should undergird this planning, in addition to a focus on the entire spectrum of surgical healthcare, including prevention and rehabilitation. Delegates endorsed PASHeF as an annual event with a secretariat and recommended the creation of a Pan-African Surgical Healthcare Policy monitoring system, and that issues of surgical healthcare should be escalated as an agenda item on African Union and sub-regional ministerial meetings. African nations have embraced surgical healthcare policy as an imperative on their journey towards Universal Health Coverage.

Optimizing Surgical Outcomes: A Case Series on BREAST-V for Treating Breast Asymmetries.

Breast asymmetry occurs when there is a discrepancy in the shape, volume, or positioning of the breasts. Various factors, including unequal development of breast buds, endocrine disorders, chest wall deformities, and surgical or posttraumatic sequelae, can contribute to this condition. Although breast asymmetry is common, clinically severe cases are rare and often require surgical correction because of potential postural, aesthetic, and psychological issues. Accurate assessment of the breast volume is crucial for planning and evaluating surgical interventions. This prospective, non-randomized, interventional study was conducted between 2019 and 2024 at the Breast Reconstruction Section of the Federal University of São Paulo, Brazil. Forty patients with breast asymmetry were evaluated using the BREAST-V, which calculates the breast volume based on three linear measurements. Patients underwent various surgical procedures, including augmentation, reduction mammoplasty, and mastopexy, tailored to their specific type of asymmetry. Preoperative and postoperative breast volumes were compared to assess the effectiveness of surgical correction RESULTS: The study included 40 participants, with an average age of 25.2 years. The mean preoperative breast volumes were 469.6g (right) and 448.8g (left). The postoperative volumes decreased to 338.3g (right) and 331.1g (left), showing an average reduction in asymmetry of 72.9%. The minimal clinically important difference (MCID) for pre-treatment asymmetry was 65.4g. The BREAST-V tool has significant potential for the objective assessment of breast asymmetry. Reliable volumetric measurements can aid in surgical planning and postoperative evaluation, ultimately enhancing the clinical outcomes. 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 .

ANGLED DENTAL IMPLANTS: IMPLICATIONS FOR CLINICAL PRACTICE AND BIOMECHANICAL CONSIDERATIONS

Angled dental implants have emerged as an effective solution in clinical settings where the placement of straight implants is constrained by unfavorable bone positions or the presence of adjacent anatomical structures. The angulation of implants significantly influences stress distribution around the implant, impacting its stability and longevity. Research highlights that the direction of applied loads is critical, as angled implants can generate greater bending and shear forces compared to straight implants, potentially leading to stress concentrations in surrounding bone. Finite element analysis (FEA) is commonly used to model these conditions, offering insights into stress zones and predicting potential failure areas. Bone quality plays a vital role in how implants respond to applied forces, with denser bones effectively dissipating forces while more porous bones are at higher risk of resorption and integration failure. Studies indicate that excessive stresses on angled implants can lead to bone resorption, compromising long-term stability. Therefore, careful consideration of implant angulation, connection type, bone quality, and thorough surgical planning is essential. Recent studies, including those investigating the effects of implant design and bone density on stress distribution, have demonstrated that varying implant threads and angulated abutments affect the stresses experienced by surrounding bone and implants. The findings emphasize the need for appropriate implant selection and a detailed assessment of bone anatomy and patient-specific clinical conditions. By incorporating advanced technologies like FEA, clinicians can enhance their understanding of biomechanical interactions, ultimately leading to improved clinical outcomes and patient satisfaction. Continuous education and the implementation of best practices in dentistry remain vital for the successful application of angled dental implants.

Clinical outcomes after extra-articular resection of hip joint tumour using a custom-made osteotomy guide and 3D-printed endoprosthesis with posterior column preserved.

For rare cases when a tumour infiltrates into the hip joint, extra-articular resection is required to obtain a safe margin. Endoprosthetic reconstruction following tumour resection can effectively ensure local control and improve postoperative function. However, maximizing bone preservation without compromising surgical margin remains a challenge for surgeons due to the complexity of the procedure. The purpose of the current study was to report clinical outcomes of patients who underwent extra-articular resection of the hip joint using a custom-made osteotomy guide and 3D-printed endoprosthesis. We reviewed 15 patients over a five-year period (January 2017 to December 2022) who had undergone extra-articular resection of the hip joint due to malignant tumour using a custom-made osteotomy guide and 3D-printed endoprosthesis. Each of the 15 patients had a single lesion, with six originating from the acetabulum side and nine from the proximal femur. All patients had their posterior column preserved according to the surgical plan. Postoperative pathological assessment revealed a negative surgical margin was achieved in all patients. At final follow-up, 13.3% (2/15) died and no recurrence occurred. The overall survival was 81.7% at five years. None of the patients showed any signs of aseptic loosening, and no wound healing issues were observed. In total, 20% (3/15) developed complications, with two cases of early hip dislocation and one case of deep infection. The cumulative incidence of mechanical and non-mechanical failure in this series was 13.7% and 9.3%, respectively, at five years. In this cohort, the mean time to full weightbearing was 5.89 (SD 0.92) weeks and the mean Musculoskeletal Tumor Society score was 24.1 (SD 4.4). For patients with a hip joint tumour who met the inclusion criteria and were deemed suitable for posterior column preservation, a custom-made osteotomy guide combined with 3D-printed endoprosthesis is worth performing when treating patients who require extra-articular resection of the hip joint, as it can achieve adequate margin for local control, maximize bone preservation to maintain pelvic ring integrity, reduce the risk of complications by simplifying the surgical procedure, and allow for more precise reconstruction for better function.

Anatomical Measurements of the Malar Bone for Safe Zygomatic Implant Placement: A Study on Donated Bodies

Background: The malar bone provides an anchorage point for zygomatic implants, avoiding invasive reconstructive surgeries in the fixed rehabilitation of fully edentulous and severely atrophic maxillae. The limited bone volume, however, requires precise implant placement to prevent complications related to nearby anatomical structures. This observational cross-sectional study aims to measure the malar and zygomatic arch bones and their distances from critical anatomical landmarks to guide surgeons in safe zygomatic implant placement. Methods: Dissections were performed bilaterally on 29 heads from human donated bodies in a cross-sectional observational study. Key landmarks evaluated include the infraorbital foramen (IF), pyriform nasal aperture (PNA), infraorbital margin (IM), zygomaticofacial foramen (ZFF), anterior end (A), and the most protruding point of the zygomatic arch (B). Measurements included IF-PNA, IF-IM, IF-ZFF, ZFF-IM, A-B, and orbital floor depth (OFD). Results: Significant findings showed IF-PNA was greater in males (18.66 ± 2.63 mm, p = 0.001), and IF-ZFF varied between sides (26.72 ± 8.7 mm, p = 0.002). ZFF-IM was larger in males (7.43 ± 2.09 mm, p < 0.001). Heights and thicknesses were also assessed, with significant side differences observed. Conclusions: These findings underscore the importance of understanding precise anatomical distances for successful implant placement. The study provides essential data to enhance surgical planning and training, ensuring safer procedures and minimizing the risk of complications.

Leiomyosarcoma of the inferior vena cava: case report

Introduction and Importance: Leiomyosarcomas of the inferior vena cava are exceedingly rare tumors, presenting diagnostic dilemmas due to their nonspecific clinical features. This case report aims to shed light on the challenges associated with diagnosing and managing such tumors, emphasizing the importance of a multidisciplinary approach. This article uses SCARE2023 criteria as a framework to sort out a case report in order[1]. Case Presentation: We present a case of leiomyosarcoma of the inferior vena cava in a patient presenting with abdominal pain. Initial clinical signs, supported by computed tomography (CT) and magnetic resonance imaging (MRI), led to the suspicion of the tumor. Histological analysis confirmed the diagnosis, prompting surgical intervention. Clinical Discussion: The diagnosis of tumors within the inferior vena cava is often challenging due to their nonspecific presentation. Imaging modalities such as CT and MRI play an important role in describing the extent of the tumor and guiding surgical planning. Histological analysis remains supreme for definitive diagnosis. Surgical resection, aimed at complete excision, is the keystone of treatment to minimize the risk of recurrence. Conclusion: Leiomyosarcomas of the inferior vena cava pose diagnostic and therapeutic challenges due to their rarity and nonspecific clinical presentation. A comprehensive approach integrating clinical assessment, imaging, and histological analysis is essential for accurate diagnosis and optimal management. Multidisciplinary collaboration is key for navigating the complexities associated with these rare vascular neoplasms, ensuring positive patient outcomes.

Orthodontic-orthognathic combined case management in postgraduate orthodontic and oral maxillofacial surgery programs.

With the development of three-dimensional (3D) image, the 3D virtual surgical planning (VSP) system has been broadly used in the treatment planning of orthodontic-orthognathic cases. This study aimed to understand the current education status regarding the use of orthodontic-orthognathic surgical planning tools in the postgraduate orthodontic and oral and maxillofacial surgery (OMFS) programs in North America. An electronic multiple-choice survey was sent via email with 2-week and 1-month follow-ups, requesting anonymous participation of program directors/department chairs from all postgraduate orthodontic and OMFS programs in North America. Responses were collected directly on Qualtrics for analysis. The response rate was 25.68% for orthodontic and 34.34% for OMFS programs. Two-dimensional traditional surgical planning (TSP) at initial treatment planning and 3D VSP right before surgery were most commonly utilized in both specialty programs. All responded postgraduate OMFS programs utilized VSP, yet 26.32% of responded orthodontic programs did not utilize VSP. For the surgical outcomes, fewer orthodontic programs were highly satisfied than OMFS programs. More orthodontic programs warranted secondary surgery at a higher rate due to the unsatisfied outcome. Additionally, the orthodontic programs that did not use VSP showed higher unsatisfied surgical outcomes than the programs that used VSP. Moreover, there were discrepancies between orthodontic and OMFS programs regarding the perceived level of collaboration of each other on the surgical planning for the patients. There were discrepancies between orthodontic and OMFS programs regarding the utilization of VSP, treatment outcomes satisfaction, and perceived level of collaboration on surgical planning for the patients.