Surgical Repositioning Research Articles

Surgical repair of corneal laceration complicated by iris inclusion in a dog

The prolapsed iris through a corneal perforation shallow anterior chamber with hyphema, miosis and is frequently encountered in small animal practice. dyscoria. The pupil was found to be distorted in the The condition may occur following progression of direction of corneal laceration. The physiological complicated corneal ulcers [1] or as a result of full parameters were within the normal range and the thickness corneal lacerations [2]. A prolapsed iris prolapsed iris tissue appeared to be fresh. Hence should be treated as an ocular emergency and requires surgical iris reposition and corneal wound repair under immediate surgical intervention for better prognosis. general anaesthesia was resorted too. The surgical repair usually involves correct reposition Treatment of viable iris tissue or excision of the incarcerated tissue, as well as adequate closure of corneal wound Topical instillation of 1% atropine sulphate [3]. The different corneal bandaging techniques using ophthalmic solution was done prior to surgery to contact lenses, collagen based biomaterials, cyano- achieve mydriasis. Pre-operatively, ceftriaxone acrylate tissue adhesives, corneal graft, third eye lid sodium was administered at the rate of 25 mg/kg body flap, conjunctival flap and temporary tarsorrhaphy for weight intravenously. The dog was premedicated with the repair of full thickness defect in cornea has also atropine sulphate at the rate of 0.045 mg/kg body been described [4]. However, traumatic prolapse of iris weight followed by xylazine hydrochloride at the rate and its surgical repair are less frequently documented. of 1.5 mg/kg body weight, both given intramuscularly. This paper presents a case of corneal laceration General anaesthesia was induced with ketamine complicated by iris inclusion in a dog and its surgical hydrochloride at the rate of 5 mg/kg body weight, repair using collagen sheet prepared from bovine administered intramuscularly. Anaesthesia was mainsmall intestine submucosa adjunct to corneal suturing tained by intravenous infusion of a combination of after iris reposition. xylazine hydrochloride and ketamine hydrochloride, equal quantity by volume and diazepam, given 'to Case History and Clinical Observations effect' along with 5% dextrose saline. The periocular A six month old male non-descript dog was area was carefully clipped and scrubbed with presented to the Veterinary College Hospital, povidone iodine solution diluted with normal saline Mannuthy with the complaint of a dark brown colored (0.2%). The corneal and conjunctival surfaces were mass protruding out from the right eye. History irrigated with isotonic balanced salt solution and the revealed trauma by a sharp object four hours ago. The periocular area was painted with povidone iodine animal was dull and depressed. On clinical solution. The dog was positioned in left lateral examination, the mass was found to be iris, which got recumbency with the eye placed under the objective entangled in the perforated cornea at 10 O'clock lens of the operating microscope (10x). Povidone position (fig. l). The dog showed epiphora, severe iodine (5% w/v) was instilled and the face was draped. blepharospasm and photophobia. Ophthalmic The Castroviejo lid speculum was applied for better

Correction of Hypertelorbitism

Hypertelorbitism has been associated with a variety of congenital deformities. Appropriate timing for surgical correction remains controversial. We present our long-term experience of 33 patients with hypertelorbitism undergoing facial bipartition or orbital box osteotomy. Patients with hypertelorbitism treated with either facial bipartition or orbital box osteotomy and repositioning who had long-term follow-up were studied (n=33). Age at the time of first surgery, preoperative interdacryon distance, and immediate postoperative interdacryon distance were recorded. Relapse was determined on postoperative follow-up, and the need for secondary correction was noted. Physician satisfaction score (range, 0-4) was also assessed. Patients had a mean total follow-up of 14.0 years. With regard to age at the time of initial procedure, patients younger than 6 years were all noted to have relapse, and 83% underwent revision surgery. In patients 6 years or older, only 11% had relapse and required a second operation. Yet, satisfaction scores were similar (3.2 versus 3.5). With regard to the severity of hypertelorbitism, there was no relapse noted among patients with mild hypertelorbitism (interorbital distance [IOD], 30-34 mm). Among those with moderate hypertelorbitism (IOD, 35-40 mm), 29.4% developed relapse. By contrast, all patients with severe hypertelorbitism (IOD, >40 mm) were noted to have relapse requiring repeat correction. Satisfaction scores were similar (3.4 versus 3.3 versus 3.1). Relapse after surgery for hypertelorbitism is related to the age of the patient at correction and the preoperative severity. When possible, surgical repositioning of the orbits should be delayed until later childhood.

Re-establishment of occlusion after unilateral condylar fracture

Complications resulting from condylar fracture include occlusal disturbance due to loss of leverage from temporomandibular joint (TMJ). In general, closed reduction with active physical training has been performed, and under favorable circumstances, adaptation occurs in attempt to restore the articulation. The patient in this case report had unilateral condylar fracture accompanied with multiple teeth injuries, but he was left without any dental treatment for 1 mon which led to unrestorable occlusal collapse. Fortunately, delayed surgical repositioning of dislocated maxillary anterior teeth followed by consistent long-term physical training has been proved successful. Normal occlusion and satisfactory remodeling of condyle were obtained on 10 mon follow-up.

Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome

Intrusive luxation in the permanent dentition is an uncommon injury but it is considered one of the most severe types of dental trauma because of the risk for damage to the periodontal ligament, pulp and alveolar bone. Management of intrusive luxation in the permanent dentition is controversial. The purpose of this study was to evaluate pulp survival and periodontal healing in intrusive luxated permanent teeth in relation to treatment alternatives, degree of intrusion and root development. The material consisted of 60 intruded permanent teeth in 48 patients (32 boys and 16 girls) aged 6-16 years (mean 9.4, median 9.0). The observation time was 6-130 months (mean 47.8, median 40.0). The analysed treatments were spontaneous re-eruption (17 teeth), orthodontic extrusion (12 teeth) and surgical reposition (31 teeth). The degree of intrusion was registered as mild (0-3 mm), moderate (4-6 mm) and severe (≥7 mm). Root development was categorized with respect to root formation and development of the apex into four stages; one-quarter to three-quarters root formation, full root formation with open apex, full root formation with half-closed apex and full root formation with apex closed. Ankylosis-related resorption with pulp necrosis was diagnosed in 20 teeth, ingrowth of bone apically in two teeth, pulp necrosis without ankylosis-related resorption in 23 teeth and pulp revitalization occurred in 15 teeth. Significant correlations to the treatment outcome were root development (P = 0.03) and degree of intrusion (P = 0.03). No firm conclusion could be drawn for the difference in outcome between orthodontic extrusion and surgical reposition. To conclude, evaluation of the prognosis for intruded teeth should be based on the stage of root development and degree of intrusion. In teeth with immature root development, no active treatment appears to result in fewer healing complications.

Correction of the Lower Eyelid Malpositioning in the Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is an autosomal dominant complex eyelid malformation. The authors aim to offer an explanation for the lower eyelid malformation and propose a novel surgical approach to correct it. An observational and interventional case series of 10 consecutive, molecularly proven BPES patients who underwent surgical repair of the lower eyelid malformation. During surgery detailed anatomical examination and surgical repositioning of the medial canthal tendon was performed. All the patients were followed up regularly after the surgery and assessed for epiphora. All patients exhibited a marked asymmetry in the attachment of the lower and upper eyelid to the medial canthal tendon, with the lower eyelid being much less attached. This resulted in an abnormal downward concavity with a temporal ectropion and a temporally displaced lower eyelid. Consequently, the inferior punctum was displaced temporally. All patients underwent a novel surgical technique to remediate this, namely, inserting a 4.0 nylon suture between the tarsal plate of the lower eyelid and the medial canthal tendon during telecanthus surgery. This simple additional surgical step corrected not only the position of the lower eyelid but also its abnormal downward concavity, the temporal ectropion and the lateral displacement of the inferior punctum. None of the authors' patients had lasting epiphora. Lateral displacement of the inferior punctum is an important hallmark in the diagnosis of BPES. The authors demonstrate an anatomical explanation for the complex lower eyelid malformation and also propose a novel surgical technique to correct this. During surgical repair of the telecanthus and blepharophimosis, specific attention should be paid to reattachment of the lower eyelid to the medial canthal tendon. This understanding improves clinical diagnosis and surgical treatment of BPES patients.

Surgical Technique for Thumb-in-palm Deformity in Cerebral Palsy

The most common surgical procedure performed by hand surgeons in cerebral palsy for thumb-in-palm deformity is release of the adductor pollicis muscle from the middle metacarpal origin, with additional release of the thenar muscles or flexor pollicis longus, as indicated, to decrease the flexion adduction forces across the first ray. Tendon transfer to augment extension and abduction of the thumb metacarpal will help avoid recurrence, and it commonly includes rerouting of the extensor pollicis longus. Stabilization of the metacarpophalangeal joint might be necessary if hyperextension deformity exists. The assessment of the patient should occur over several visits to determine the correct combination of procedures that will best help the patient achieve a more functional upper extremity or improve hygiene. With appropriate planned procedure, meticulous surgical technique, and adherence to a postoperative rehabilitation regimen, patients can obtain substantial improvement with thumb-in-palm surgical re-positioning.

Reply to Huang et al.

Referring the Letter to the Editor ‘contraindications to percutaneous tracheostomy due to anomaly of aortic arch branches origin and running’ by Huang et al. [1] we think that nothing is impossible! We agree that percutaneous dilatational tracheostomy (PDT) is the procedure of choice and that the surgical option is still valid in particular selected cases, but in general, minimally invasive procedures should never endanger the safety of the patient. There is not a good ideal timing for the execution of a specified tracheostomy yet (ET: early tracheostomy; IT: intermediate tracheostomy, LT: late tracheostomy) [2,3]. There is also the Fantoni trans-laryngeal tracheostomy (TLT) that allows, through maneuver ‘in-out’, to remedy the problem of skin infection [4,5]. In the specific case we described in our article [6], to perform a tracheostomy, it would be needed to perform a surgical repositioning of supra-aortic vessels, but we preferred a conservative approach and at the end an appropriate weaning followed 27 intubation days. Since 1998, in our department, we have been carried out about 617 tracheostomy (403 TLT and 214 PDT) with use of surgical tracheostomy in approximately 10% of cases. Among the major complications we mention a case of death because of decubitus in innominate artery and two tracheal-esophageal fistula (when we routinely used the Fantoni TLT). We conclude by stressing once again that all tracheostomy options, even in very complex cases, are possible but our choice is always minimally invasive procedure (PDT and TLT). We use the surgical approach only in very special selected cases. We believe that the ideal timing is ‘early tracheostomy’ and that the patient safety is one of the important factors in the choice of the method. In our case the wait-behavior allowed the good solution of the problem without major surgery.

Management of intrusive luxation in the primary dentition by surgical repositioning: an alternative approach

Intrusive luxation is the most common trauma during early infancy which results in the displacement of the tooth into its alveolus. Depending on the severity of the intrusion, the American Academy of Pediatric Dentistry recommends either extraction or spontaneous re-eruption for the primary tooth. This case report provides a brief insight into surgical repositioning as an alternative treatment option for the management of intruded primary tooth in a 4-year-old girl.

Complications Encountered in Temporary Orthodontic Anchorage Device Therapy

Although absolute anchorage with the use of fixed skeletal implants is not a recent concept in orthodontic mechanotherapy, its popularity in recent years has increased exponentially as a result of the advent and widespread manufacture of temporary anchorage devices (TADs). TADs are an invaluable asset to contemporary orthodontics, facilitating tooth movement that might otherwise require (1) surgical repositioning of the jaws, (2) extraction of permanent teeth, and/or (3) extended use of extraoral anchorage. As more orthodontists incorporate TADs into their therapeutic regimens, the clinician should be cognizant of the variety of iatrogenic sequelae that may occur with the employment of such adjuncts. Complications include, but are not limited to, encroachment upon adjacent anatomical structures, mucosal perforations or tears, peri-implantitis, and unintended tooth movement. A review of some common problems with clinical examples, as well as protocols for prevention is presented.

Clinical investigation of surgical iris reposition through segmental small incision for iridodiastasis

Objective To discuss the effect of surgical iris reposition through segmental small incision on iridodiastasis. Methods We made iris plasty surgery by repositing the root of iris through segmental small incision on 63 patients (63 eyes) of traumatic iridodiastasis. Results The iris was reposited successfully in all the patients. No complication was observed. The pupil showed a round or oval shape ater operation. The symptom of diplopia disappeared. Conclusion Segmental small incision method is an microtraumatic, safe, simple and effective surgery. Key words: iridodiastasis,traumatic; iris plasty; reposition

Impact of Floating Mass Transducer Coupling and Positioning in Round Window Vibroplasty

The round window application of the Vibrant Sound bridge, the so-called round window vibroplasty, is gaining increasing popularity for hearing rehabilitation of patients with mixed hearing loss or conductive hearing loss. In these patients, conventional hearing amplification and/or surgical restoration is either not possible or has failed because of chronic ear disease, extensive otosclerosis, or malformations. The exact mechanisms of direct cochlear stimulation via the round window membrane are not yet completely understood. It is unclear what kind and what degree of contact is required between the floating mass transducer (FMT) and the round window membrane (RWM) to elicit a functional hearing perception with the implant. We investigated the coupling efficiency between the FMT and the RWM and how the efficiency is altered by the FMT position, the degree of FMT-RWM contact, and the use of a soft tissue coupler. Prospective cohort study. Tertiary referral center in Western Australia. Patients undergoing round window vibroplasty for a mixed or conductive hearing loss otherwise not aidable. Patients underwent round window vibroplasty and received audiological and coupling analysis in the follow-up. These data were then correlated with FMT positioning and the extent of FMT-RWM interface as determined by postoperative high-resolution temporal bone computed tomography. Coupling and hearing levels in relation to FMT positioning and degree of FMT-RWM contact. Of 10 patients, 8 were available for vibroplasty behavioral threshold testing. In 2 patients, testing could not be done because of wound breakdown requiring device explantation in 1 case, and in the other case, the bone conduction thresholds dropped 2 months after implantation, thus falling out of the performance range of the device. Postoperative FMT migration occurred in 50% of the patients (3/6) with recurrent chronic ear disease and status after multiple previous ear operations. All patients, including the 3 patients requiring surgical repositioning of the FMT, attained significantly improved speech in quiet and speech in noise when compared with the preoperatively best aided performance. All patients showed significantly improved average Abbreviated Profile of Hearing Benefit scores with the use of the FMT. Direct (partial or complete) contact with the RWM resulted in good coupling efficiency; soft tissue coupling resulted in a reduced coupling efficiency.

Multidisciplinary management of impacted central incisors due to supernumerary teeth and an associated dentigerous cyst

Supernumerary teeth are the most common developmental dental anomaly resulting from hyperactivity of dental lamina, dichotomy, environmental factor, or polygenetic process of atavism. Supernumerary teeth present classical oral complication such as impaction of adjacent teeth, crowding, diastema formation, rotation, displacement of teeth, and occlusal interference. A dentigerous cyst associated with anterior supernumerary teeth (mesiodens) is rare and accounts for 5% of all dentigerous cysts. The present case reports describe the successful management of the impacted permanent maxillary central incisor positioned high in the vestibule. A combination of surgical and orthodontic techniques was employed to improve treatment outcome with greater hard and soft tissue preservation and to prevent psychological problems. In the surgical phase, supernumerary teeth and dentigerous cyst were removed. Subsequently traction was employed by bonding bracket on the labial surface using closed and open eruption techniques. Successively, fixed orthodontic treatment was started to align permanent maxillary central incisors in an occlusal plane. Thus, combination of surgical and orthodontic method can be the treatment of choice over surgical extraction, implant placement, and surgical repositioning.

Pulmonary alveolar proteinosis and successful therapy with combined lavage procedures: Case reports

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of lipoproteinaceous material within alveolar spaces. Whole-lung lavage (WLL) has been the most common therapeutic intervention for this disorder. However, patients presenting with PAP are usually hypoxemic or in poor clinical condition, and WLL may be impossible to perform. In such cases, multiple segmental lavage (MSL) may be advocated as a first-choice therapy prior to WLL. Herein, we present two cases with idiopathic PAP treated successfully with both lavage techniques consecutively. After the MSL procedure, WLL was performed, and both patients showed a marked clinical and physiologic improvement. Therefore, for patients who are not good candidates for general anesthesia, we recommend MSL (or 'prewash') before WLL to produce an increase in the blood oxygen level for long-duration general anesthesia. In the surgical room, close monitoring and repositioning of the patient as well as maintenance and inspection of the correct tube position, and manual chest wall percussion are extremely important for the safety and success of the procedure.

Surgical Reposition of a Dislocated Ex-PRESS Miniature Device

To present a technique of surgical reposition of the Ex-PRESS miniature glaucoma device when dislocated in corneal limbus. A 54-year-old woman diagnosed with glaucoma, with a 3-month history of Ex-PRESS miniature implant, was referred to our department because of progressive intraocular pressure (IOP) rise. Slit-lamp biomicroscopy showed the posterior flange of the implant located in the corneal limbus; IOP was 34 mmHg. Surgical technique consisted of reopening of the conjunctiva and the scleral flap, excision of the corneal tissue covering the flange, and stitching the implant to the sclera with polyprolene suture. Postoperatively, IOP rapidly reduced to 5 mmHg and was balanced to 10 mmHg in the follow-up. Corneal dislocation of the Ex-PRESS implant, when associated with ocular hypertension, needs surgical treatment. Before considering a trabeculectomy, it could be valuable to attempt an implant reposition.

Intraoral vertical ramus osteotomy improved the stomatognathic function in an elderly patient with mandibular protrusion: a case report.

This article reports the successful surgical-orthodontic treatment of an elderly patient with dentofacial deformity and signs and symptoms of temporomandibular disorder (TMD). The patient was a 63-year-old woman with a concave profile due to mandibular protrusion. To correct skeletal deformities, the mandible was posteriorly repositioned by employing intraoral vertical ramus osteotomy (IVRO) following presurgical orthodontic treatment. After active treatment for 31 months, the facial profile was significantly improved and satisfactory occlusion was achieved. In addition, TMD symptoms of clicking sounds on the left side and difficulty in mouth opening were resolved. Regarding the findings of magnetic resonance imaging, anterior disc displacement in the opening phase was improved in the temporomandibular joint on the left side. Furthermore, stomatognathic functions were also improved without any aggravation of age-related problems. In conclusion, surgical repositioning of the mandible using IVRO leads to both morphological and functional improvements even in elderly patients.

Management of intrusive luxation of maxillary incisors with dens in dente: a case report

Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17-year-old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens-in-dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1-year follow up revealed a satisfactory clinical and radiographic outcome.

Combination joint-preserving surgery for forefoot deformity in patients with rheumatoid arthritis

Proximal osteotomies for forefoot deformity in patients with rheumatoid arthritis have hitherto not been described. We evaluated combination joint-preserving surgery involving three different proximal osteotomies for such deformities. A total of 30 patients (39 feet) with a mean age of 55.6 years (45 to 67) underwent combined first tarsometatarsal fusion and distal realignment, shortening oblique osteotomies of the bases of the second to fourth metatarsals and a fifth-ray osteotomy. The mean follow-up was 36 months (24 to 68). The mean foot function index scores for pain, disability and activity subscales were 18, 23, and 16 respectively. The mean Japanese Society for Surgery of the Foot score improved significantly from 52.2 (41 to 68) to 89.6 (78 to 97). Post-operatively, 14 patients had forefoot stiffness, but had no disability. Most patients reported highly satisfactory walking ability. Residual deformity and callosities were absent. The mean hallux valgus and intermetatarsal angles decreased from 47.0 degrees (20 degrees to 67 degrees) to 9.0 degrees (2 degrees to 23 degrees) and from 14.1 degrees (9 degrees to 20 degrees) to 4.6 degrees (1 degree to 10 degrees), respectively. Four patients had further surgery including removal of hardware in three and a fifth-ray osteotomy in one. With good peri-operative medical management of rheumatoid arthritis, surgical repositioning of the metatarsophalangeal joint by metatarsal shortening and consequent relaxing of surrounding soft tissues can be successful. In early to intermediate stages of the disease, it can be performed in preference to joint-sacrificing procedures.

Mandibular “tripod” advancement of a Class II Division 2 deepbite malocclusion

This case report describes the treatment of a 25-year-old woman with a Class II malocclusion, secondary to mandibular skeletal deficiency, and mild overclosure. Inferior surgical repositioning of the maxilla is often the treatment of choice for patients with maxillary vertical deficiency; however, this patient had borderline vertical deficiency that was treated with a mandibular "tripod" advancement (leveling of the mandibular arch after surgery) coupled with a setback and down-grafting genioplasty. The surgical-orthodontic treatment plan, combined with cosmetic dentistry, resulted in dramatically improved facial esthetics and occlusal relationships.

Laparoscopic placement of peritoneal dialysis catheter: description and results of a two-port technique

To test the feasibility, efficacy and safety of a new two port laparoscopic technique for dialysis catheter placement. From January 2006 to July 2009 51 patients underwent dialysis catheter placing using an original technique. All procedures were finished laparoscopically using two 12 mm-sized ports. Our technique bases on placing Oreopoulos-Zellerman catheter along a straight Guyon s guide with atraumatic tip, visually guaranting optimal placement. Catheter can be repositioned if desired by reentering the guide. Median follow-up was 25 months. Mean operating time was 32 minutes (range 15-55 minutes). One patient suffered an immediate postoperative catheter obstruction that required surgical repositioning. No other technical intra or early postoperative complications related to technique were reported. Mean time to discharge 1.02 +/- 2.2 days. Catheter outflow failure rate was 7.6%. Conversion to haemodialysis due to peritonitis 13%. Peritonitis per patient/year was 0.27. Catheter 6 mo, 1 year and 2 year survival rate was 94%, 87% and 72%. Catheter migration rate was 4%. There was no peritoneal dialysis liquid leakage. The two ports technique described is an easy and rapid procedure, with few complications and early discharge. Due to its reliability, offers good catheter function outcome.

硬性内視鏡を補助的に用いた口内法による関節突起骨折観血的整復術

硬性内視鏡を補助的に用いた口内法による関節突起骨折観血的整復術