Surgical Repositioning Research Articles

Harmonizing soft tissue subnasale and chin position in a forehead-based framework: interracial commonalities and differences between Asian and Caucasian females.

To establish a reference system for assessing the anteroposterior (A-P) position of the subnasal and lower-facial soft tissues for whole facial harmony. Forty Asian and 40 Caucasian females with attractive profiles were selected as the "attractive" samples, with "ordinary" samples for comparison. Each profile was analyzed, and comparisons were made to reveal the interracial commonalities and differences. Esthetically essential parameters were established. An averaged attractive profile for each race was created by digital morphing and then modified into 30 variations based on combined variations of the esthetically essential parameters. Assessments were performed to investigate the esthetic ranges. A-P position of the subnasal and lower-facial landmarks harmonized with the forehead for female profile esthetics. In addition to balanced soft tissue subnasale (sSn)- and soft titssue pogonion (Pos)-to-forehead A-P relations, harmonizing lower-facial soft tissues to sSn was indispensable for profile attractiveness. sSn-to-glabella, Pos-to-glabella, and Pos-to-sSn A-P relations were esthetically essential. Perceived by orthodontists, the attractive Asian female profiles had sSn-to-glabella A-P relations ranging from 0.5 mm to 4.5 mm, Pos-to-sSn from -9.0 mm to -5.5 mm, and Pos-to-glabella from -8.5 mm to -1.0 mm. Compared with Asians, the attractive Caucasian female profiles had more anteriorly and widely distributed sSn relative to the forehead, wider ranges of Pos-to-sSn A-P relations, and more prominent chins. A reference system comprising sSn-glabella, Pos-sSn, and Pos-glabella horizontal distances was constructed for facial profile analysis. This system could aid treatment planning for surgical or orthopedic repositioning of the maxilla and chin.

Anterior Nasal Superior Oblique Tendon Syndrome: A Case Series

PurposeTo evaluate the clinical characteristics and management of patients with an anteriorly and nasally inserted superior oblique tendon. DesignRetrospective interventional case series. MethodsInstitutional clinical records between 2020 and 2024 were retrospectively reviewed for 9 consecutive patients in whom the superior oblique (SO) tendon was inserted anterior to the equator and nasal to the superior rectus muscle. Information collected included age, sex, ocular and surgical history, preoperative and postoperative data (ophthalmologic examinations, strabismus measurements, ductions and versions), intraoperative findings, need for additional surgery, and follow-up time. ResultsAll nine patients were found to have an anomalous insertion of the SO tendon. Three were of congenital origin and six were acquired following ocular surgery. Among the acquired cases, all but one resulted from incarceration of the tendon from post-surgical scar tissue formation. The remaining acquired case was due to a prior deliberate anterior and nasal transposition of the superior oblique. This case series demonstrated varying degrees of vertical deviations, lateral incomitance, and limited depression. Repositioning the SO to its normal insertion site yielded equivocal improvement in ocular alignment. ConclusionAnterior nasal superior oblique tendon syndrome is a rare clinical entity characterized by an anti-depressor effect. Vertical deviations, hypertropia worse in downgaze, limited depression worse in adduction for congenital cases and in abduction for acquired cases, and lateral incomitance may be indicative of this anomaly. In acquired cases following surgery, additional findings may include limited depression worse in abduction, esotropia in abduction, V-pattern esotropia, and enophthalmos in downgaze. Surgical repositioning of the SO along its normal anatomical trajectory is recommended for treatment. However, outcomes may be variable and achieving a complete resolution of this syndrome can be challenging.

Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

Surgical Premaxilla Reposition and Secondary Bone Grafting in a Children with Complete Bilateral Trans-Foramen Cleft Lip and Palate: a Case Report

The objective of this study is to report the clinical case of a child with complete bilateral trans-foramen CLP who underwent surgical repositioning of the premaxilla with internal rigid fixation and a secondary bone grafting. The boy was following by different specialists since five days of life, being subjected to the entire surgical protocol to close the lip and palate. At 9 years old it was proposed surgical premaxilla reposition and, in a second surgery, a bone grafting in the alveolar process. After a virtual planning, surgery was performed under general anesthesia. The access was performed maintaining the vestibular pedicle of premaxilla, and after remove the interferences at the vomer and maxilla, premaxilla was fixed with titanium plates and screws. Six months after, fixation material was removed and the remaining gaps were grafted with iliac bone. After 21 months of the first surgery, the patient presents a good anteroposterior positioning of the maxilla and lip seal and, those responsible for the patient, reported an improvement in the patient's quality of life, with improvements mainly in speech, chewing and the patient's social life.

Combined therapy of laser puncture and surgical repositioning of rectal prolapse accompanied by rupture in goats

Rectal prolapse occurs when the rectum protrudes from the anus. This article reports a case of a male goat named Jimmy, presented to the Cimanggu Animal Clinic with a mass protruding from his anus. Physical examination revealed diarrhea, and the mass was a rectal prolapse with three ruptures in the rectal wall accompanied by swelling and bleeding. Jimmy was diagnosed with rectal prolapse with ruptures. Treatment involved suturing the ruptures and performing laser puncture at the suture sites and prolapsed rectum at the Lian Hua point, followed by repositioning. Additional laser puncture was performed after repositioning at the GV-1, GV-20, ST-36, and Gang Tuo acupuncture points using 0.5 Joules of energy and 50 mW of power. Metronidazole was administered intravenously at 75 mg/kg body weight for 3 days to manage the diarrhea. Improvement was noted on the third day post-surgery, with the goat's feces forming pellets and the anal sphincter condition improved. One month after surgery, the goat was discharged with pellet-shaped feces, good appetite, strong anal and sphincter condition, and no recurrence of prolapse. This case highlights the successful management of rectal prolapse in goats by using a combination of surgical intervention, laser puncture, and antibiotic therapy.

Effect of Different Treatment Modalities for Condylar Fractures in Childhood on Mandibular Symmetry and Temporomandibular Joint Function: A Retrospective Study.

In a retrospective study of the effects of different treatment modalities of condylar fractures in childhood on mandibular symmetry and temporomandibular function, the cases selected for this article were adult patients who had sustained a condylar fracture in childhood. The aim was to investigate the effects of condylar fractures in children on the development and function of the mandible and their specific manifestations after the completion of mandibular development. According to the different treatment modalities, the patients were divided into the conservative treatment group and the open surgical treatment group, and the effects of the 2 treatment modalities on the patients' condylar healing, the difference in growth ability, and the symmetry of the jaws were evaluated. The effects of different treatment modalities of children's condylar fracture on the growth, development, and function of the mandible were investigated using the Ai and Di, the grading of the imaging results, and the 3-dimensional CT fixation measurements from the aspects of both clinical examination and imaging examination. The 2 groups had condylar malalignment and condylar morphology abnormality, and there was one case of joint ankylosis in the surgical treatment group. There was a statistical difference in the evaluation of condylar reconstruction between the 2 groups, and the condylar reconstruction in the surgical treatment group was better than that in the conservative treatment, and there was a statistical difference between the condylar length, condylar width, condylar height, and depth of TMJ fossa between the healthy side and the affected side in the closed treatment group. There was a statistical difference in the height of the mandibular ascending branch between the healthy side and the affected side, and the unilateral condylar fracture was treated conservatively; the difference in the bony chin point deviation between the 2 groups was not statistically significant. In children, after conservative treatment of condylar fracture, the growth of condylar process is poor, and the condylar shape and position are not as good as surgical repositioning, but through the proliferation of temporomandibular joint fossa, it can make up for the insufficient height of condylar process, which has no effect on the symmetry of the mandible, and the surgical treatment can achieve good anatomical repositioning, which has a greater effect on the symmetry of the mandible than the conservative treatment.

Does artificial intelligence predict orthognathic surgical outcomes better than conventional linear regression methods?

To evaluate the performance of an artificial intelligence (AI) model in predicting orthognathic surgical outcomes compared to conventional prediction methods. Preoperative and posttreatment lateral cephalograms from 705 patients who underwent combined surgical-orthodontic treatment were collected. Predictors included 254 input variables, including preoperative skeletal and soft-tissue characteristics, as well as the extent of orthognathic surgical repositioning. Outcomes were 64 Cartesian coordinate variables of 32 soft-tissue landmarks after surgery. Conventional prediction models were built applying two linear regression methods: multivariate multiple linear regression (MLR) and multivariate partial least squares algorithm (PLS). The AI-based prediction model was based on the TabNet deep neural network. The prediction accuracy was compared, and the influencing factors were analyzed. In general, MLR demonstrated the poorest predictive performance. Among 32 soft-tissue landmarks, PLS showed more accurate prediction results in 16 soft-tissue landmarks above the upper lip, whereas AI outperformed in six landmarks located in the lower border of the mandible and neck area. The remaining 10 landmarks presented no significant difference between AI and PLS prediction models. AI predictions did not always outperform conventional methods. A combination of both methods may be more effective in predicting orthognathic surgical outcomes.

Modified semitendinosus muscle transposition to repair bilateral perineal hernias in dogs

Perineal hernia (PH) resulting from a weakness and tear of the pelvic muscles of the diaphragm. Repair of the pelvic muscles by surgical repositioning is the curative treatment. To report a modified technique of semitendinosus muscle transposition for perineal hernias treatment. Eleven male dogs were prospectively enrolled to repair perineal hernias incorporating contralateral semitendinosus muscle transposition. The transected muscle was rotated medially through the subcutaneous tunnel ventral to the anus up to the opposite lateral perineum. Ten dogs were neutered and 01 was intact. The mean age was 10.45 years and the mean body weight was 18.52 kg. Five dogs had been previously submitted to perineal herniorrhaphy. Partial wound dehiscence occurred in two dogs. Postoperative complications related to the technique were presented in 7 of 11 dogs. Unilateral recurrence was detected in 8 of 11 dogs. The small number of samples, the absence of a control group and the heterogeneity of breeds make it difficult to reach significant conclusions. The transposition of the semitendinosus muscle through the subcutaneous tunnel is feasible to repair perineal hernias. The technique was unable to reduce complications and recurrence rates. However, provides evidence that can be used to repair cases of bilateral and ventral perineal hernias in dogs.

Re-descemet membrane endothelial keratoplasty (DMEK) with preservation of the original graft after free roll in anterior chamber: A case report

IntroductionLamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as Descemet Membrane Endothelial Keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management. Clinical caseAn 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber.She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble.24 h after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9. ConclusionThe discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.

Dental Auto Transplantation: A Promising Treatment for Public Health System

Introduction: Tooth autotransplantation is a biological and innovative technique for the rehabilitation of compromised or missing teeth. It involves the surgical repositioning of healthy teeth in the dental arch to restore the functions of the stomatognathic system. Despite being a promising technique, few professionals have performed dental autotransplantation in clinical practice. Aim: To review the literature and evaluate the clinical success rate and factors associated with the technique of dental autotransplantation, focusing on its application especially in the Brazilian public health system. Methods: Articles were searched in PubMed (Medline), Scielo and Google Scholar databases for a period of 10 years (2012- 2022) by two independent authors. Clinical studies and case series about dental autotransplantation presenting more than 10 patients older than eight years, and a follow-up longer than one year were included. Results: A total of 320 articles were eligible for inclusion, of which 57 were selected for full-text evaluation. Fifteen articles were included in this review. A total of 1048 patients were reported in the articles, with an age range of 8 to 58 years and a followup of 1 to 29 years. The mean success rate was 86.79%. Molars were the most commonly used teeth for autotransplantation. Conclusion: Dental autotransplantation has high success rates and proves to be an excellent, low-cost therapeutic option that should be promoted in clinical practice, especially in the public service.

Surgical Versus Noninvasive Manual Repositioning After Cochlear Implant Partial Magnet Dislocation.

Objectives: To compare surgical magnet repositioning (SMR) and noninvasive manual magnet repositioning (MMR) as treatments for partial magnet dislocation (PMD) of the internal magnet in a cochlear implant (CI) caused by magnetic resonance imaging (MRI). The primary objective was the success rate, while the secondary objectives were total postinterventional CI downtime and complications. Methods: This single-center retrospective study was conducted at a tertiary referral medical center. Patients with CI treated for PMD between January 1, 2007 and September 30, 2022 were included. SMR served as primary treatment until June 2019 and as secondary treatment after the introduction of MMR. Results: A total of 51 cases of PMD were observed in 42 patients and 43 devices (18 ♀; 24 ♂; 12 with bilateral CI). MMR was performed successfully in 19 out of 20 cases (95%), while 32 cases were managed successfully by SMR. The median age at first magnet repositioning was 53.8 years (minimum 19 years, maximum 93 years). When MMR was performed, the mean time from diagnosis to treatment (0.5 ± 1.5 days vs 9.8 ± 7.6 days; P < .01), the mean time from repositioning to CI reactivation (1.4 ± 4.3 days vs 13.1 ± 6.7 days; P < .01), and the mean total CI downtime (1.9 ± 4.8 days vs 22.9 ± 11.9 days; P < .01) were significantly shorter compared to SMR. Significantly fewer complications were experienced with MMR [n = 0 (0%) vs n = 8 (25%); P = .04]. Conclusion: In case of PMD caused by MRI, noninvasive MMR shows a high success rate with a shorter total CI downtime as well as a lower complication rate compared to SMR. Therefore, MMR should be considered as first line treatment with SMR as a second option in case of failure.

Наш опыт имплантации торических интраокулярных линз

Рurpose. To analyze the results of cataract phacoemulsification with implantation of toric intraocular lenses. Methods. We conducted a retrospective analysis of the results of cataract phacoemulsification with concomitant regular corneal astigmatism of 1.5 D or more. 32 patients (42 eyes) were implanted with toric intraocular lenses: 11 MX 60T lenses (BAUSCH+LOMB) and 31 Torica aAY lenses (HumanOptics). Results. Intraocular lens rotation less than 5 ° was recorded in 40 eyes (95.2 %). In 2 patients, the deviation of Torica aAY lenses was 10–15 °, which required their surgical reposition. All patients achieved an increase in uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). UCVA after surgery increased by an average of 0.5 (from 0.13±0.03 to 0.63±0.08), and then remained stable. BCVA increased by 0.33 (from 0.37±0.06 to 0.7±0.06) in the early postoperative period, and by another 0.09 (0.79±0.04) in the late period. Mean value of the spherical component of refraction decreased in the early postoperative period by 4.1 D (from 5.05±0.45 to 0.94±0.22), in the late period a slight increase by 0.09 D was recorded. The value of the cylindrical component decreased after the operation by an average of 2.24 D (from 3.31±0.22 to 1.07±0.37), further a decrease by another 0.1 D was observed. Conclusion. The implantation of toric intraocular lenses is a relatively inexpensive, technically uncomplicated, effective and safe method of cataract surgery and associated corneal astigmatism correction. Key words: phacoemulsification; astigmatism; toric intraocular lens.

Surgical Repositioning Following a Severe Traumatic Intrusion of Maxillary Permanent Incisors: A Case Report

: Intrusion is the most severe luxation injury, resulting in soft and hard tissue damage. Treatment depends on the root development stage and tooth intrusion degree. Lateral luxation describes tooth displacement in any direction other than axial. The prognosis of luxated teeth depends on the emergency treatment and elapsed time. This paper reports an 11-year-old boy who sustained displacement of central and lateral incisors into the nasal cavity, and his left canine had lateral luxation. Surgical repositioning was undertaken for intruded teeth, and a splint was placed. The canine could not be repositioned due to the delay, but its position improved toward the force of the cheek after several sessions. This study contains the data obtained from a one-year follow-up.

Bilateral Condylar Fracture: A 10-Year Case Report Follow-Up after a Conservative Myofunctional Approach

Mandibular condylar fractures can be approached with invasive techniques, such as surgical repositioning and fixation of the fractured condyle, or with conservative techniques using myofunctional appliances. Recent publications recommend non-invasive or conservative approaches when treating mandibular condylar fractures, as they may produce more stable results and fewer consequences. However, to the knowledge of the authors, there is no long-term follow up publications of clinical cases treated with a conservative approach. This report presents a ten-year follow-up of a case report published two years ago by the same authors. In the previous report, the authors showed an eleven year-old girl treated with a myofunctional appliance due to a bilateral mandibular condylar fracture. The treatment produced a stable result over the following ten years with the patient not using any appliance after the myofunctional treatment was completed. The benefits of a conservative treatment, as well as the consequences of mandibular condylar fracture, such as a heart shaped mandibular condyle, are discussed here by the authors.

Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design

To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL). Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier. Single-center retrospective study. This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery. Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was≤6̊ (1 month) and≤10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D. The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

Treatment of Horizontally Impacted Mandibular Second Molar: Report of Two Cases with Proposal of a Biomechanical Option

Horizontally impacted mandibular second molar is a rare but challenging situation for clinicians. Many treatment modalities were proposed and presented in articles that include use of surgical repositioning, orthodontic traction and uprighting, autotransplantation, extraction and etc. The proper treatment method decision is upon case-by-case observation as like other orthodontic decisions. This case report is aimed to present another biomechanical option utilizing TMA spring attached to the mandibular main archwire to provide distal uprighting force to the horizontally impacted mandibular second molar. Two successfully treated cases are presented treated with the proposed treatment modality.

Long-Term Survival Rate of ATOMS Implant for Male Stress Urinary Incontinence and Management of Late Complications

stress urinary incontinence (SUI) still represents a major drawback of prostate surgery. The aim of this study is to evaluate long term efficacy, safety and survival of ATOMS system implant in a single center. we retrospectively included al consecutive patients treated with ATOMS implant for SUI from October 2014 to July 2019. Patients received anamnesis, urodynamic evaluation, pre- and postoperative 24 h pad test and count. Patients were considered "continent" when dry or when wearing a security pad (social continence). we treated99 patientswith median age 77.98 years (IQR 72.7-82.52). Most of the patients had undergone radical prostatectomy. Median follow-up was 62.9 months (IQR 47.5-75.9). At last follow-up 74 (74.7%) patients reported continence. We had 21 early (<30 days) postoperative complications, all Clavien-Dindo (CD) grade 1 [11 temporary perineal pain, 4 urinary retention, 3 scrotal edema, 2 superficial wound dehiscence, 1 dysuria]. We had late postoperative complications in 28 patients [7 port dislocations requiring surgical repositioning (CD 3a), 6 device removals (CD 3a) due to port erosion (2), inefficacy (2), cushion leakage (1), mesh detachment (1), perineal pain (5), 2 cases of port extrusion solved with port removal leaving the device in place (CD 3a), 2 superficial wound dehiscence (CD 1), 2 UTI (CD 1), 1 scrotal edema (CD 1), 1 cushion deflate (CD 1), 1 dysuria (CD 1), 1 perineal pain (CD 1)]. The survival of the device was 97% at 12 months, 93% at 24 months, 91% at 36 months, 90% at 48 months and 87.9% at 60 months. This study demonstrates the good safety and efficacy of ATOMS implant for the treatment of SUI.

A Study on Laryngeal Trauma Caused by External Damage

Objectives: Laryngeal trauma caused by external factors is rare. The treatment strategies for laryngeal trauma, including the optimal surgical approaches, airway management methods, and fixation materials to be used still remain under debate.Methods: We retrospectively analyzed the details of the management and clinical course of 16 patients with fresh laryngeal trauma treated between April 2000 and March 2020 at the Hiroshima University Hospital.Results: The causes of the laryngeal trauma included sports accident (n = 6), fall (n = 3), suicidal behavior (n = 2), labor accident (n = 2), and other (n = 3). Categorization of the severity and the treatment policy, including the surgical indications, were in accordance with the classification proposed by Umeno et al. We performed surgical repositioning of the fractured thyroid cartilage in 7 cases and repositioning or correction of arytenoid cartilage dislocation in 2 cases under general anesthesia. The fixation materials used varied depending on the need.Conclusion: The clinical features of laryngeal trauma were examined. Further studies on fixation methods, methods to restore the phonation ability, and appropriate surgical timing are required.

Role of surgical hyoid bone repositioning in modifying upper airway collapsibility.

Background: Surgical hyoid bone repositioning procedures are being performed to treat obstructive sleep apnea (OSA), though outcomes are highly variable. This is likely due to lack of knowledge regarding the precise influence of hyoid bone position on upper airway patency. The aim of this study is to determine the effect of surgical hyoid bone repositioning on upper airway collapsibility. Methods: Seven anaesthetized, male, New Zealand White rabbits were positioned supine with head/neck position controlled. The rabbit's upper airway was surgically isolated and hyoid bone exposed to allow manipulation of its position using a custom-made device. A sealed facemask was fitted over the rabbit's snout, and mask/upper airway pressures were monitored. Collapsibility was quantified using upper airway closing pressure (Pclose). The hyoid bone was repositioned within the mid-sagittal plane from 0 to 5mm (1mm increments) in anterior, cranial, caudal, anterior-cranial (45°) and anterior-caudal (45°) directions. Results: Anterior displacement of the hyoid bone resulted in the greatest decrease in Pclose amongst all directions (p = 0.002). Pclose decreased progressively with each increment of anterior hyoid bone displacement, and down by -4.0 ± 1.3cmH2O at 5mm. Cranial and caudal hyoid bone displacement did not alter Pclose (p > 0.35). Anterior-cranial and anterior-caudal hyoid bone displacements decreased Pclose significantly (p < 0.004) and at similar magnitudes to the anterior direction (p > 0.68). Conclusion: Changes in upper airway collapsibility following hyoid bone repositioning are both direction and magnitude dependent. Anterior-based repositioning directions have the greatest impact on reducing upper airway collapsibility, with no effect on collapsibility by cranial and caudal directions. Findings may have implications for guiding and improving the outcomes of surgical hyoid interventions for the treatment of OSA.

Change in functional biomechanics following a targeted exercise intervention in patients with acetabular retroversion and femoroacetabular impingement syndrome

BackgroundAcetabular retroversion is a form of hip dysplasia that may cause femoroacetabular impingement syndrome (FAIS), leading to pain and restricted hip range of motion. An exercise intervention aiming at altering pelvis tilt and related functional biomechanics may be a useful first-line intervention for patients who are not eligible for surgical repositioning. Research questionDoes squat and gait biomechanics change following an 8-week targeted exercise program in individuals with symptomatic acetabular retroversion and FAIS? MethodsThis prospective intervention study used participants as their own controls. Examinations were conducted at three time-points: T1 baseline; T2 following an 8-week control period; T3 after 8 weeks’ intervention. At each time-point, three-dimensional motion analysis of a deep squat and level gait was performed, and pain intensity was recorded using a numerical rating scale (NRS 0–10). The intervention consisted of a home-exercise program to improve core stability and pelvic movement. Differences in waveforms between time-points across pelvis and lower-limb biomechanics were evaluated using statistical parametric mapping. Delta (Δ, differences between T1-T2 and T2-T3) was used to evaluate changes in spatiotemporal gait parameters and pain. ResultsNineteen patients (18 females), mean age 22.6 (SD 4.5) years, BMI (kg/m2) 23.0 (SD 4.1), were included. Changes (Δ T1-T2 vs. Δ T2-T3) in squat biomechanics were observed as: (i) decreased anterior pelvic tilt, (ii) deeper vertical pelvis position, and (iii) increased knee flexion angle. Contrary, no significant changes in gait biomechanics, Δ walking speed, Δ step length, or NRS for pain were found. SignificanceFollowing a targeted exercise intervention, participants were able to squat deeper, potentially allowing better hip function. The deepened squat position was accompanied by increased knee flexion and reduced anterior pelvic tilt. Gait biomechanics and patient-reported pain remained unchanged post-intervention. These findings are important for future design of exercise interventions targeting pelvic tilt in symptomatic individuals.