Surgical Repositioning Research Articles

Patient-Specific Printed Plates Improve Surgical Accuracy In Vitro

It remains unclear to what extent patient-specific printed plates can improve surgical outcomes in orthognathic procedures. This study aimed to quantify the surgical accuracy of patient-specific printed plates invitro and to compare the results with patients' actual surgical outcomes. This invitro study enrolled 20 postoperative orthognathic surgical patients, all treated with inferior maxillary repositioning. The preoperative midfaces were re-created in a 3-dimensionally printed model. The osteotomy and screw holes were placed at prespecified positions using a 3-dimensional guide. The dental segment was repositioned by means of the patient-specific plates. The primary outcome was the mean reposition at 3 dental reference points. The primary predictor variable was the obtained surgical reposition invitro compared with the virtual surgical plan. Confounding variables were gender, age, occlusion, and bimaxillary surgery. The secondary outcome was surgical accuracy, and the secondary predictor was the invitro outcomes versus the patients' surgical outcomes. Surgical accuracy was defined as the difference between the obtained reposition and the virtual surgical plan on a continuous scale. The differences were recorded in 3 dimensions according to the positive valueof the 3 axes: right, anterior, and posterior. The results were analyzed using mixed-model regression and 1-sample t tests. In the 20 patients (age, 18 to 64years; 40% of patients were women), the mean planned reposition was 2.9mm anterior and 1.8mm inferior. In all models, the osteotomy edge was rounded off to position the plate in the predetermined position. Overall, the maxilla was positioned 0.5mm anterior and 0.3mm inferior to the planned position using patient-specific plates. The patient-specific plates positioned the maxilla in close approximation to the planned position without surgically relevant differences. The osteotomy edge must be carefully inspected for interference with the patient-specific plates to avoid displacement of the planned maxillary repositioning.

Coronary artery compression from epicardial leads: More common than we think

A child with an epicardial pacemaker presented with sudden death at our institution, secondary to coronary artery compression. This case prompted enhanced surveillance of all patients with epicardial pacing or defibrillation systems. The purpose of this study was to determine the incidence of coronary artery compression and the diagnostic yield of catheter angiography (CA) and computed tomography (CT). All patients with epicardial leads who underwent CA or cine CT were retrospectively reviewed. A patient with postmortem diagnosis of coronary compression was also included. Coronary compression was noted in 8 of 145 patients (5.5%) with epicardial leads. Median age at diagnosis was 11.4 years (range 3.0-29.6 years). Six patients had compression noted by CA, 6 by CT, and 1 by postmortem analysis. Chest radiography had sensitivity and specificity of 57% and 96%, respectively; CT 100% and 93%, respectively; and CA 86% and 100%, respectively. There was no difference in age or weight at the time of lead implant between those who did and those who did not have compression (age: median 1.3 vs 2.4 years; P = .36; weight: 9.5 vs 11.8 kg; P = .46). Among those with coronary compression, 6 of 8 (75%) had symptoms (1 sudden death, 3 chest pain [2 with associated troponin leak]), 2 unexplained fatigue). Seven patients had surgical repositioning of their lead. We found a higher incidence of coronary artery compression by epicardial leads (5.5%) than previously reported in the literature. Chest radiography can serve as a good surveillance tool, with cine CT scans considered in those with concerning radiographs or with symptoms. Confirmatory CA can be performed before surgical intervention.

Impact of Virtual Planning on Surgical Reposition of the Premaxilla Using an Endonasal Approach and Simultaneous Alveoloplasty.

Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique. A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate. An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability. Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.

Fixation techniques in surgical repositioning of the prognathic pre-maxilla during alveolar bone graft surgery in bi-lateral cleft lip and palate patients

Fixation techniques in surgical repositioning of the prognathic pre-maxilla during alveolar bone graft surgery in bi-lateral cleft lip and palate patients

Extraocular muscle repositioning as the last therapeutic option for a patient with a severe course of Graves\u2019 Ophthalmopathy: a case report

BackgroundGraves’ disease is a common autoimmune inflammatory condition of the thyroid. About one in four of affected patients also develop orbital symptoms like exophthalmos, proptosis and diplopia - called Graves’ Ophthalmopathy. Not all patients respond well to the standard therapy of systemic glucocorticoid administration. The inflammatory swelling of the intraorbital muscles can lead to pressure-induced damage of the optic nerve.Orbital decompression surgery is a therapeutic option for these patients with varying success. Other symptoms like the extreme malposition of the ocular globe are poorly addressed by decompression surgery and demand for different therapeutic approaches.Case presentationPresented is the case of a 46-year old patient with an acute exacerbation of Graves’ ophthalmopathy. Clinically apparent was a convergent strabismus fixus with severe hypotropia of both eyes. The patient suffered from attacks of heavy retrobulbar pain and eyesight deteriorated dramatically. Since neither systemic glucocorticoid therapy nor orbital decompression surgery had helped to halt the progress of the disease, a decision was made in favour of the surgical release and repositioning of the inferior and medial rectus muscle as a final therapeutic option. Surgery of both eyes was performed consecutively within one week. Detailed descriptions and illustrations of the surgical steps and treatment outcome are provided supplemented by a discussion of the current literature.ConclusionsGraves’ Ophthalmopathy is a variant and therapeutically challenging disease. Exceptional courses of the disease call for therapeutic approaches off the beaten track. Surgical extraocular muscle repositioning, which has not been described before in the context of Graves’ Ophthalmopathy, proved to be effective in improving the patient’s eyesight and quality of life. Furthermore, we regard the measurement of extraocular muscle volume as a valuable method to monitor the course of Graves’ Ophthalmopathy.

Rupture of the Short Head of the Biceps and Coracoid Fractures: Mechanism and Refixation

Injuries of the short head of the biceps are rarely seen in clinics as seen by a lack of published articles. Most of the literature report on coracoid fractures, whereas these scapula process fractures remain less common in the upper extremity. They are caused by direct impact or are associated with acromioclavicular or anterior shoulder dislocation as it may occur in sports. The attached biceps short head, coracobrachialis and pectoral minor tendon are likely to tension an avulsion and displace a fragment. The most favorable treatment is a non-operative therapy, especially if the displacement of fragments is little and the coracoclavicular ligaments maintain the fragments in position. Widely displaced fractures cause a high nonunion rate and surgical reposition and fixation is recommended in such cases. Different fixation techniques are present due to its rare and heterogenic occurrence. However, surgically treated fractures are likely to heal and patients gain full range of motion after three months. We present a case report from our department and demonstrate different operative techniques in a cadaver model.

Surgical Repositioning of the Premaxilla Using a Minimally Invasive Endonasal Approach.

The aim of this study was to evaluate a technique for the surgical repositioning of the premaxilla using a minimally invasive endonasal approach. Retrospective review of clinical records. Tertiary care, University Hospital, pediatric maxillofacial surgery unit. Twenty-one patients (12 boys and 9 girls), ages ranging from 6 to 21 years, with BCLP+A and premaxillary malposition (PM). Surgical repositioning of the premaxilla (SRP) using a minimally invasive endonasal approach, from November 2007 to November 2015. Achieving maxillary arch alignment and premaxillary stability was defined as treatment success. Intraoperative and postoperative complications were also recorded. In all cases (100%), the treatment was successful either at first surgery or after reoperation. Two patients (9.5%) were reoperated-one due to premaxillary instability and one due to PM relapse. There were no perioperative complications. SRP using a minimally invasive endonasal approach is a safe and effective technique that levels and aligns the maxillary arch in preparation for SABG, which minimizes the risk of wound infection and premaxillary vascular compromise. The endonasal approach improves tissue quality of the mucoperiosteal flaps when performing the SABG procedure. Further prospective studies are needed to elucidate the best protocols and techniques for the management of PM in patients with BCLP+ A.

Autotransplantation, Surgical Repositioning of Retained Canine, and Apical Filling of Two Incisors with Root Resorption.

The purpose is to show the autotransplantation and surgical repositioning of a retained canine, and the apical filling of central and lateral resorbed incisors from a 12-year-old female patient, healthy and with clinical absence of left maxillary canine. Radiographically, the retained canine between the resorbed central and lateral incisors was observed. Root canal treatment of the canine was performed after 8 weeks; apical curettage and placement of bovine graft in inter-incisal zone was done after 4 months. During 6 months, orthodontic traction of the canine was carried out with no positive results, and 12 months after the autotransplantation, surgical repositioning was performed. Clinical-radiographic control at 30 days and 24 months showed absence of inflammation, restoration and integration of the tooth-supporting structures. Autotransplantation combined with surgical repositioning of the retained canine and the apical filling of two incisors achieved the harmonious, aesthetic, functional, dental and psychological preservation of the patient.

Lip repositioning for the treatment of excess gingival display: A systematic review

Lip repositioning is a conservative surgical technique used to treat excess gingival display. An array of modifications has been introduced to the technique over time and as studies show the technique and its modifications to be successful, there is little standardized information for clinicians to make informed decisions when choosing this technique for the treatment of patients with excessive gingival display (EGD). To review the current literature on the topic of lip repositioning for the treatment of excessive EGD, exploring outcome, and result longevity. A structured systematic search was carried out using the Ovid database and Web of Science to identify published studies on lip repositioning technique. Search was restricted to studies in the English language, describing a surgical intervention. Case reports were included as the number of published studies was limited. The electronic search identified 93 articles, hand search identified 1 article, and reference search identified 1 article. After excluding duplicates and screening articles, a total of 22 articles met the inclusion criteria. An estimated mean improvement of 3.4mm (95% confidence interval, 3.0-3.8mm) was found possible with lip repositioning. Data analysis was performed using only 4 studies, amounting to a total of 33 patients. Potential risk of bias was identified in some of the studies included. Despite the limited available studies on lip repositioning, an estimated mean improvement of 3.4mm was found to be possible with surgical lip repositioning, suggesting that the technique could be used successfully to treat EGD. However, more studies are necessary to properly evaluate the treatment approach and stability of the technique. Recently, the demand for esthetics has significantly increased, driven by increased patient awareness and the search for an ideal smile. Creating the perfect smile is an intricate process that requires a multidisciplinary approach, with careful consideration of the lips and the gingival outline. Excess gingival display results in an unaesthetic smile, lip repositioning offers a comparatively simple solution for this problem. While the quality literature on this topic is limited statistical analysis of collected studies show that an estimated mean improvement of 3.4mm can be achieved with surgical lip repositioning.

Spontaneous re-eruption, surgical or orthodontic extrusion: What is the choice for intrusive luxation in permanent teeth?

Data sourcesMedline, Embase, the US Clinical Trials and ISRCTN Registry databases.Study selectionTwo reviewers independently selected studies. Interventional and observational studies comparing the outcomes of orthodontic or surgical re-position of intrusive luxation of permanent teeth compared with spontaneous re-eruption were considered.Data extraction and synthesisTwo reviewers abstracted data and assessed study quality using the Cochrane Risk of Bias tool. Periodontal and pulpal outcomes after treatment were compared using risk ratios (RR) with 95% confidence intervals (CI) and meta-analysis conducted.ResultsEight studies involving a total of 440 patients were included. All of the studies were considered to be at high risk of bias. A meta-analysis of four studies comparing surgical re-positioning vs spontaneous re-eruption suggested no significant difference RR = 1.30 (95% CI; 0.90-1.88) P = 0.16. Meta-analyses were also performed for secondary outcomes and other sub-groups.ConclusionsWhile the review suggests that spontaneous re-eruption should be the treatment of choice the quality of the available evidence is poor.

Achievability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery

The present study was aimed to investigate the effects of sequencing a two-component surgical procedure for correcting malpositioned jaws (bimaxillary osteotomies); specifically, surgical repositioning of the upper jaw—maxilla, and the lower jaw—mandible. Within a population of 116 patients requiring bimaxillary osteotomies, the investigators analyzed whether there were statistically significant differences in postoperative outcome as measured by concordance with a preoperative digital 3D virtual treatment plan. In one group of subjects (n = 58), the maxillary surgical procedure preceded the mandibular surgery. In the second group (n = 58), the mandibular procedure preceded the maxillary surgical procedure. A semi-automated analysis tool (OrthoGnathicAnalyser) was applied to assess the concordance of the postoperative maxillary and mandibular position with the cone beam CT-based 3D virtual treatment planning in an effort to minimize observer variability. The results demonstrated that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. In selected circumstances, such as a planned counterclockwise rotation of both jaws, the mandible-first sequence resulted in more predictable displacements of the jaws.

Chronic Uterine Inversion Following Mid-Trimester Abortion.

Uterine inversion during the postpartum period is a relatively rare but serious complication. It occurs as acute, chronic and subacute forms depending on time interval from delivery. In terms of onset of the inversion, acute describes the event occurring before cervical ring contraction. If the cervical ring has contracted, a subacute inversion has occurred. The inversion is classified as chronic if 4 weeks have elapsed after the event. Severe postpartum hemorrhage and shock result from the uterine inversion. If unrecognized, this obstetric emergency could cause serious morbidity or death. The reported incidence of uterine inversion varies considerably in the literature. Treatment options for this obstetric complication also vary from patient to patient and depend upon surgeon’s familiarity with the procedure. Available options for correcting an inversion are hydrostatic as well as manual and surgical reposition with or without pharmacological agents (uterine relaxants). Here is a case report of complete chronic uterine inversion following spontaneous mid-trimester abortion.

Recurrent Vitreous Hemorrhage Secondary to Sulcus Positioning of a One-Piece Acrylic Intraocular Lens Haptic: Report of 3 Cases and Management With Retrocapsular Haptic Repositioning

Three pseudophakic patients presented with recurrent, unilateral vitreous hemorrhage, one of which also had uveitis, glaucoma, and hyphema, consistent with “uveitis–glaucoma–hyphema (UGH)-Plus” syndrome. Arcuate transillumination defects secondary to inadvertent placement of 1 intraocular lens (IOL) haptic in the sulcus were identified in each case. The second haptic and optic were located in the capsular bag. The IOLs were all single-piece foldable acrylic lenses with square-edge haptic design. Surgical repositioning of the malpositioned haptic from the sulcus to the retrocapsular space resulted in the resolution of the recurrent vitreous hemorrhage. This series highlights the fact that recurrent vitreous hemorrhage secondary to iris chafing, with or without UGH, may occur in cases where a square-edge IOL haptic is placed in the sulcus. Vitrectomy with repositioning of the malpositioned IOL is a simple alternative to IOL exchange in these cases.

Clinical and MRI Evaluation of Orthodontic Mini-Screws for Disc Repositioning in Internal Derangement of TMJ: A Prospective Study.

The purpose of this study was to assess the efficacy of orthodontic mini-screws as a modified suture anchor for disc repositioning in cases of internal derangement of the temporomandibular joint. A prospective evaluation of ten patients was undertaken for a period of 6months using this modified approach from Jan 2014 to Jun 2016. Symptomatic patients with clinical and MRI features suggestive of internal derangement of TMJ and willing to undergo surgical repositioning of articular disc to alleviate symptoms of temporomandibular dysfunction were taken up for the study. Post-operatively, functional outcomes were assessed in terms of reduction in pain, joint movement and absence of joint noise and clicking sounds. Post-operative MRI was used to assess the disc position and morphological changes in the disc and arthritic changes in the condyle. All patients underwent a surgical repositioning of the anteriorly displaced disc by the modified orthodontic suture anchor. Patients were post-surgically followed up at intervals of 1, 3 and 6months. Immediate complications in terms of pain, restriction of functional motion and transient facial nerve palsy were noted. Late complications include temporal nerve palsy in one case. All patients experienced significant improvement with good functional outcomes and stable repositioning of disc was noticed at the end of 6months. The modified disc repositioning using an orthodontic screw via a mini preauricular approach provided a good functional outcome in all patients as assessed over a period of 6months. However, the long-term functional sequel of the procedure and changes in the articular disc needs to be assessed.

Treatment of a Horizontally Impacted Permanent Incisor in a 9-Year-Old Girl: A Case Report

Impaction of maxillary central incisors is not common. Treatment of an impacted central incisor is challenging as it relates to facial esthetics and dental function.Although impaction of permanent teeth is rarely diagnosed in mixed dentition period, an impacted central incisor is usually diagnosed when there is a delay in the eruption of tooth.Tooth impaction may result from a number of local etiological factors such as lack of space for eruption, presence of supernumerary teeth, disturbances in the path of eruption and presence of pathological cysts. Management options for such teeth include (1) surgical extraction and moving the lateral incisor to replace the central incisor and changing the anatomy of other teeth, (2) extraction of the impacted tooth followed by bridge or implant placement, (3) surgical repositioning of the impacted tooth, and (4) orthodontic correction of the impacted tooth.The purpose of this article was to describe surgical exposure and orthodontic treatment of a horizontally impacted permanent maxillary central incisor, parallel to the occlusal plane in a 9-year-old girl. The impacted tooth was surgically exposed and traction was done with orthodontic intervention.

Alternative Distraction Osteogenesis Technique After Implant Placement for Alveolar Ridge Augmentation of the Maxilla

An alternative technique to reconstruct atrophic alveolar vertical bone after implant placement is presented. The technique consists of distraction osteogenesis or direct surgical repositioning of an implant-and-bone block segment after segmental osteotomies that can be used in esthetic or unesthetic cases. Initially, casts indicating the implant position are obtained and the future ideal prosthetic position is determined to guide the model surgery. After the model surgery, a new provisional prosthesis is fabricated, and an occlusal splint, which is used as a surgical guide and a device for distraction osteogenesis, is custom fabricated. Then, the surgery is performed. For mobilization of the implant-and-bone block segment, 2 vertical osteotomies are performed and then joined by a horizontal osteotomy. The implant-and-bone block segment is moved to the planned position. If a small movement is planned, then the implant-and-bone segment is stabilized; for larger movements, the implant-and-bone segment can be gradually moved to the final position by distraction osteogenesis. This technique has good predictability of the final position of the implant-and-bone segment and relatively fast esthetic rehabilitation. It can be considered for dental implants in regions of vertical bone atrophy.

Safe and Simplified Salvage Technique for Exposed Implantable Cardiac Electronic Devices under Local Anesthesia.

BackgroundSkin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition.MethodsThe records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0–1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study.ResultsSeven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage.ConclusionsBased on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.

A case of successful treatment of a patient with diaphragm disinsertion

A case of 59-year old patient has been described in the article. The patients has got multiple home trauma (multiple fragmental fractures of left ribs, left-sided pneumothorax and pneumomediastinum) in January, 2015. At admission, the left pleural cavity was drained and pharmacological treatment was initiated. After the pneumothorax was resolved, the patient refused further treatment and was discharged from the hospital. The further course of the disease was complicated by rib fractures non-union, development of rib valve and diaphragmic hernia. The patient’s condition gradually deteriorated including exacerbations of chronic obstructive pulmonary disease. In May, 2016, he was admitted in a hospital with severe life-threatening acute respiratory failure. Left-sided thoracotomy with reconstruction of a giant defect of the left diaphragmic dome using surgical mesh was performed. To restore the ribcage and to remove the hernia, open surgical reposition and osteosynthesis of the 10#th let rib with its reconstruction were performed. To resolve the spontaneous pneumothorax which had not resolved by the pleural cavity drainage, the bronchus was locked using an endobronchial valve. This technique was developed in this clinic.

A Case with Bilateral Cleft Lip and Palate in Which Tooth Transplantation Was Performed for the Root Malformed Incisor after Surgical Repositioning of Premaxilla

A Case with Bilateral Cleft Lip and Palate in Which Tooth Transplantation Was Performed for the Root Malformed Incisor after Surgical Repositioning of Premaxilla

Resolution of Intractable Ventricular Tachycardia after Surgical Repositioning of a Heartmate II Inflow Cannula

Resolution of Intractable Ventricular Tachycardia after Surgical Repositioning of a Heartmate II Inflow Cannula