Surrounding Structures Research Articles

Abstract 4145890: P-Wave Parameters on 12-Lead Electrocardiogram after Catheter Ablation: A Comparison between Pulsed Field Ablation and Cryoablation

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). The most popular current methods of CA include radiofrequency ablation (RFA) and cryoablation (CRYO) which are thermal methods of ablation known to affect the autonomic nervous system through ablation of cardiac ganglionated plexi (GP). Pulsed[SC1] -field ablation (PFA) is a newer method of CA with demonstrated efficacy that preferentially affects cardiac cells and spares surrounding structures such as GP through irreversible electroporation which does not lead to chronic fibrosis like RFA or CRYO. Elevations in the marker the marker P terminal force (PTF) have been associated with AF/stroke and have been known to correlate with atrial fibrosis, and higher PTF after cryoablation for patients with paroxysmal AF has been associated with an increased risk of recurrence. The differences in P-wave parameters pre and post PFA have not been studied. Objective: To investigate the differences in P-wave parameters after PFA and compare them to CRYO. Methods: We identified 40 patients who underwent PFA (20 patients) or CRYO (20 patients) for paroxysmal AF and compared P-wave parameters including duration and amplitude in leads aVF, V1 and the PTF calculated as the duration x amplitude of the terminal negative component of the P-wave in V1. Data were obtained from 12-lead electrocardiograms obtained pre and post ablation. Results: The mean age of patients in our study was 61 with 75% male and 33% on antiarrythmics. We noticed a significant reduction in PTF for patients who underwent CRYO (54 mVmS at baseline compared to 36.8 mVmS after CRYO, p = 0.04) and no significant reduction in PTF for patients who underwent PFA (46 mVmS at baseline compared to 38 mVmS after PFA, p = 0.27). There was also a significant increase in HR after CRYO (65 bpm at baseline compared to 78 bpm after CRYO, p=0.01) and no significant change in HR after PFA (61 bpm at baseline compared with 60 bpm after PFA, p=0.8). There was no statistical difference in both groups looking at aVF or total V1 duration or amplitude pre and post ablation. Conclusions: CRYO leads to a significant change in PTF after ablation while PFA does not, consistent with the notion that PFA does not lead to fibrosis and PTF is not a useful marker for measuring risk of recurrence of AF post PFA.

Prediction of splash noise in a rectangular tank under longitudinal periodic excitation

Sloshing phenomena within fuel tanks have emerged as a significant contributor to noise in hybrid and high-end vehicles, particularly as other sources of noise, such as those from the engine and transmission system, minimized. The manifestation of noise during sloshing results from the dynamic interplay between the fluid within the tank and both its surrounding structures and the fluid itself. “Splash noise” is an acoustic phenomenon which arises due to pressure fluctuations induced by fluid-fluid interactions during sloshing. Thus, the generation of splash noise encompasses a multi-physics process involving fluid flow and acoustic radiation. Accurate prediction of splash noise is crucial for implementing measures to mitigate it during the design phase. The current paper proposes a hybrid approach for predicting splash noise within a rectangular tank. The first step in the methodology is to predict the flow field within the tank, from which acoustic sources are computed. These sources are then utilized to calculate the sound propagation based on the acoustic analogy. To emulate a regime dominated by fluid-fluid interactions, periodic longitudinal excitations are imposed on the rectangular tank, both with and without baffles. Parameters such as fluid free-surface profile, tank wall pressures, and radiated sound pressure levels are systematically calculated and subsequently validated against experimental results available in the existing literature.

Emerging Ocular Side Effects of Immune Checkpoint Inhibitors: A Comprehensive Review

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, offering significant improvements in patient survival across various malignancies. However, their use is associated with a broad spectrum of immune-related adverse events (irAEs), including those affecting the eye and its surrounding structures, collectively termed ocular irAEs (OirAEs). Although rare, OirAEs (e.g., keratitis, uveitis, retinal vasculitis, etc.) can significantly impact a patient’s quality of life, leading to ocular complications if left untreated. This review provides a comprehensive overview of OirAEs associated with ICIs, including their clinical manifestations, underlying mechanisms, and current management strategies. We delve into the anterior and posterior segment adverse events, highlighting conditions such as dry eye, uveitis, and retinal disorders, as well as neuro-ophthalmic and orbital complications. Furthermore, we discuss the challenges in diagnosing and treating these conditions, particularly given the overlap with other autoimmune and paraneoplastic syndromes. Finally, we identify key knowledge gaps and suggest future research directions aimed at optimizing the management of OirAEs while maintaining the efficacy of cancer therapy. This review underscores the need for increased awareness among clinicians to prevent irreversible ocular damage and enhance patient outcomes.

Absolute Train Localization Based on the Identification of Surrounding Structures Using 1D LiDAR Sensor

ABSTRACTTrain localization is an essential technology for effective train control. Currently, train localization primarily relies on using track circuits and balises, which are placed along the track to provide precise location information. However, balises have to be placed at intervals of a few kilometers. This increases maintenance costs and makes them vulnerable to being damaged by ice blocks falling from moving trains. Therefore, in this study, we propose a method for absolute train localization based on structure detection and identification using a 1D light detection and ranging (LiDAR) sensor to reduce the number of balises. Structure identification is achieved using scan matching. In the experiments using a car, the proposed method achieved an identification success rate of over 90%. We also considered the effect of raindrops by filtering the measurement data. By testing and analyzing the identification results, we successfully reduced all cases of misidentification.

008. Massive Teratoma Attached to The Inferior Vena Cava and Abdominal Aorta in Pediatric Patient: A Case Report

Background: Massive teratomas are rare and complex tumors that can grow large and involve crucial structures, such as the inferior vena cava (IVC) and abdominal aorta. These tumors can be challenging to resect, especially in pediatric cases, due to their size and proximity to vital organs. Case: A 9-year-old boy was admitted with a history of an abdominal mass first detected at age 3. Over the years, the mass had progressively enlarged, initially the size of a grape and later the size of a tennis ball by age 6. Recent imaging, including CT scans, showed a retroperitoneal mass measuring approximately 20 x 10 cm with characteristics of a mature cystic teratoma. The mass was compressing surrounding structures, including the duodenum, pancreas, and left kidney, and was adherent to both the IVC and abdominal aorta. The surgical team performed a laparotomy with adhesiolysis, extensive tumor excision, and vascular repair. Vascular control was established, and the tumor was successfully removed, including sheared portions of the abdominal aorta, which required ligation and repair of the affected vessels. Conclusion: This case illustrates the complexity and challenges of managing massive retroperitoneal teratomas. Through a multidisciplinary approach, it was possible to achieve complete excision and ensure the patient’s recovery with no immediate complications.

Sizing of the aortic valve using virtual reality - next step towards personalized medicine?

Abstract Background High-quality imaging is integral throughout the transcatheter aortic valve implantation (TAVI) process, from patient selection and preprocedural planning to real-time guidance during the procedure and postprocedural follow-up. Multislice computed tomography (MSCT) is currently the gold standard. The next step in this area is the three-dimensional (3D) visualization of cardiac and extra-cardiac structures using virtual reality (VR). Purpose This study aimed to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in the planning of TAVI procedures. Methods Based on the preprocedural MSCT data of 60 patients who underwent TAVI at our heart center, measurements using 3mensio software were compared with 3D visualizations and measurements using VR software. Additionally, eight physicians evaluated the application of VR using a structured questionnaire to define its benefits and limitations. Results VR measurements correlated well with the 3mensio software measurements, and there were no significant differences between the two methods. The VR measurements were mentioned first: Annulus perimeter 77.4 ± 7.8 vs. 77.0 ± 8.1 (p=0.182), r = 0.929; Annulus diameter 24.6 ± 3.2 vs. 24.4 ± 2.6 (p=0.483), r = 0.868; LVOT diameter 23.5 ± 3.1 vs. 23.7 ± 2.8 (p=0.442), r = 0.785; SoV left 32.9 ± 4.1 vs. 32.7 ± 3.7 (p=0.331), r = 0.920; SoV right 30.8 ± 4.3 vs. 30.7 ± 3.7 (p=0.653), r = 0.909; noncoronary SoV 32.9 ± 3.6 vs. 32.6 ± 3.7 (p=0.209), r = 0.913; STJ 30.0 ± 3.6 vs. 29.7 ± 3.2 (p=0.175), rs = 0.882; Ascending aorta 34.5 ± 3.4 vs. 34.5 ± 3.1 (p=0.469), r = 0.921, RCA height 15.1 ± 3.2 vs. 15.4 ± 3.2 (p=0.179), rs = 0.910, LCA height 12.4 ± 2.7 vs. 12.3 ± 3.0 (p=0.252), rs = 0.924. Furthermore, users reported that VR simplified anatomical understanding (1.3 ± 0.5 vs. 1.9 ± 0.4, p = 0.046), and improved 3D comprehension (1.1 ± 0.4 vs. 2.3 ± 0.5, p = 0.023). Conclusion The use of VR in the planning of TAVI procedures enables precise and reproducible measurements. In addition, VR can help assess the often complex anatomy, which can increase the safety and efficiency of procedures. Further clinical studies are needed to evaluate the potential benefits of VR application in planning and performing other structural interventions.

Are variations in ventricular catheter placement related to design of the catheter? A single-center cohort study.

The use of intracranial catheters is a common procedure used for neurosurgical patients with a variety of pathologies. Despite its frequency of use, shunt failure and revision have been reported to be a common problem. Given that depth of insertion can significantly affect the catheter tip position, a single institution retrospective chart review was performed to examine the accuracy of shunt and external ventricular drain (EVD) placement. Computed tomography (CT) images of the head following shunt or ventriculostomy insertion were analyzed to determine the delta between the final length of the intracranial catheter and the intended depth described in the operative notes. We found that there was a statistically significant difference in the accuracy of placement when comparing EVDs to shunts. The most used EVDs at our institution are marked with a solid black line in increments spaced 2 cm apart. The most used ventricular shunt catheter has a marking at 5 cm and 10 cm from the tip of the catheter. We believe that the visual confirmation that is afforded by metric unit markings on the EVD allows for better final placement of the catheter at the outer table of the calvarium. The addition of regular millimeter metric unit markings by the manufacturer is imperative in decreasing the chances of error in the insertion of ventricular catheters and preventing potential neurovascular injury to the surrounding structures.

Case report: A Unique Case of Brainstem Anesthesia and Contralateral Amaurosis Following a Sub-Tenon Block.

To report and discuss a case of brainstem anesthesia and contralateral amaurosis following a sub-Tenon block. Single surgical case report of a patient who underwent an uncomplicated pars plana vitrectomy for an epiretinal membrane peel in the left eye following a sub-Tenon anesthesia technique. Post-operatively, the patient experienced symptoms of brainstem anesthesia as well as akinesia, a non-reactive pupil, and reduced visual acuity in the contralateral eye which gradually resolved within 24 hours. Imaging was within normal limits and did not reveal any anatomic abnormalities. Despite the use of a blunt-ended cannula in a sub-Tenon block, there is a non-negligible risk of it penetrating surrounding structures such as the optic nerve sheath. This case emphasizes the importance of monitoring for brainstem anesthesia and contralateral eye affections in patients both intra- and post-operatively.

Sonographic Verification and Clinical Significance of the Features of Surrounding Structures in Knee Osteoarthritis

Background: Osteoarthritis (OA) of the knee joint is one of the most dangerous diseases, the most significant manifestation of which is chronic pain syndrome. There is a low correlation between the radiographic stage of OA and pain progression. First of all, this is a variety of pain syndromes, among which is the pathology of periarticular structures (AS). To date, the contribution of this type to the clinical picture of OA has been sufficiently studied, primarily due to the fact that the list and frequency of these lesions have not yet been described.Aim: to describe the basis of the main periarticular structures in patients with different radiographic stages of knee OA according to ultrasound data.Materials and methods: The observational study has currently included 88 patients who had an outpatient appointment with a rheumatologist for knee osteoarthritis between 2021 and 2023. The study assessed 110 knee joints using clinical and ultrasound techniques.Results: The most common periarticular ultrasound changes, regardless of radiographic stage, were pes anserine tendinopathy (57.3 %), Baker’s cyst (45.5 %), fibrosis of the severe Hoffa body (40 %) and ligamentopathy of the medial collateral ligament (36). ,4). %). A significant correlation was found between the number of changes according to ultrasound and the radiological stage (ρ=0.45 [95 % CI: 0.28, 0.59], p <0.001) as well as between the VAS and the definition of identified ultrasound changes (ρ= 0.29 [95 % CI: 0.11, p=0.002); In addition, it was shown that late stages of OA are associated with a greater content of changes (p <0.001).Conclusion: Changes in periarticular structures are present in most patients with knee osteoarthritis; their number correlates with the VAS value and radiographic stage of OA. Details of these changes, their clinical significance and pathogenetic contribution to the progression of knee OA require further study.

Is endoscopic decompression for Morton's neuroma a safe technique?

IntroductionMorton's neuroma is predominantly attributed to chronic nerve entrapment within third space adjacent metatarsals, the deep transverse metatarsal ligament (DTML), and the plantar skin. While conservative treatments are of election, failures require alternative interventions such as ultrasound-guided injections and various surgical procedures, including minimally invasive neurectomy and DTML release. This study aimed to anatomically assess the risks associated with the endoscopic dorsal surgical decompression of Morton's neuroma. Materials and methodsTwenty feet from ten fresh-frozen cadaveric specimens underwent a dorsal percutaneous approach for endoscopic access. Surgical procedures were monitored by three foot and ankle surgeons. Post-surgical anatomical dissections were conducted to evaluate potential risks to surrounding structures. ResultsThe endoscopic technique successfully sectioned the DMTL in all specimens (100%) without iatrogenic injury of tendons, nerves, or arteries, while lumbricals may be at risk. ConclusionEndoscopic dorsal decompression of Morton's neuroma presents as an accessible minimally invasive surgical option with low risk of collateral associated injuries.

Dysphagia and Dysphonia After Head and Neck Cancer.

The purpose of this work is to synthesize the latest developments in diagnosis and management of acute and late dysphagia and dysphonia in oral cavity cancer. A literature search was conducted using PubMed, Web of Science, Embase and Google Scholar in May 2024 of articles published between 2021 and 2024. Keywords in the search terms included oral cavity cancer, dysphagia, dysphonia, deglutition, swallowing, voice, oral cavity cancer treatment, oral cavity radiation, chemotherapy, dysgeusia, xerostomia, swallow preservation. Twenty-seven pertinent studies fit the inclusion criteria. The most common dysphagic complaints following head and neck cancer are trismus, xerostomia, mucositis and dysphagia. Dysphonia, change in voice is reported by half of head and neck cancer survivors. Fibrosis and neuropathy following radiation therapy to the oral cavity, tongue, oropharynx and its surrounding structures is the most common etiology of post-treatment dysphonia. Oral cavity cancers cause speech and swallowing dysfunction due to both anatomic and post-treatment changes. These sequalae can be detrimental to the quality of life of the head and neck cancer survivor. For both dysphagia and dysphonia after head and neck cancer early speech and swallow therapy with a Speech Language Pathologist are essential to restoring and maintaining function.

Comparative Study of Pancreatic Head and Body Size in Diabetic and Nondiabetic Individuals Age Group >65 Years by USG

Abstract Background and Objectives: Diabetes mellitus is the collective term for disorders affecting glucose homeostasis. The pancreas is situated in the retroperitoneum within the anterior pararenal fascial space and positioned anteriorly to the aorta and inferior vena cava. Specifically, the pancreas is commonly located just below the origin of the superior mesenteric artery. Ultrasound imaging serves as a valuable tool for acquiring detailed information about the pancreas, encompassing factors such as pancreatic size, echotexture, ductal anatomy, and the surrounding structures. This imaging modality not only facilitates diagnostic evaluations but also allows for interventional procedures, all accomplished efficiently within a brief time frame and at a minimal cost. Subjects and Methods: One hundred and fifty healthy adults as controls and 150 diabetic patients of the same age group >65 years of age group were evaluated by ultrasound sonography. Results: The mean pancreatic head and body is 2.01 ± 0.38 cm and 1.26 ± 0.18 cm, respectively, in diabetic participants, whereas in controls, it is 2.40 ± 0.13 cm and 1.59 ± 0.17 cm. This showed a significant decrease in pancreatic head and body size in diabetic individuals. Interpretation and Conclusions: Diabetic individuals exhibit smaller pancreatic head and body compared to normal controls.

Safety and efficacy of conventional compared to segmented esophageal fully covered self-expanding metal stents: a retrospective multicenter case-control study.

Segmented self-expanding metal stents (SEMS) are an alternative to conventional unsegmented SEMS in the treatment of esophageal strictures. Due to their segmented design, they may adapt better to the surrounding structures making them less likely to migrate or cause trauma. We examined if there are clinically relevant differences between segmented and conventional esophageal SEMS in benign and malignant stenosis in terms of their functionality and safety. We performed a multicenter, retrospective case-control study of segmented and conventional SEMS implantations in esophageal stenosis. Outcome parameters were adverse events such as migration, occlusion, and severe complications (i.e., bleeding and perforation). 79 segmented SEMS were identified and compared to 79 conventional SEMS implantations. Groups were similar in terms of age, gender, and etiology. We observed 13.9% severe complications (SEMS-associated clinically significant bleeding or perforation) in the conventional SEMS group compared to 3.8% in the segmented SEMS group. This difference was statistically significant (p = 0.025). Rates of migration and occlusion were similar between both groups. Likewise, there was no significant difference in terms of short-term (30days) clinical success. In this first controlled analysis, segmented SEMS were associated with fewer severe clinical complications compared to conventional SEMS.

Visualization of the infratemporal fossa: enhancing anatomical learning through three-dimensional modeling.

The infratemporal fossa and pterygopalatine fossa are critical pathways for blood vessels and nerves leading to the orbit, nasal cavity, and oral cavity. Anatomical observation of these areas is challenging for learners due to their complex connections with surrounding structures and their deep location within the body. Since it is not easy to understand this area in three dimensions with only textbook images, there is a need to produce three-dimensional (3D) content. Most existing 3D data have reconstructed the digital imaging and communication in medicine files from computed tomography images with high accuracy; however, the surrounding structures often obstruct the view. For this reason, this project utilized Cinema4D (R18; Maxon) software to refine the modeled bones and to create 3D models of muscles, blood vessels, and nerves that accurately represent their anatomical shapes and pathways. To facilitate easier access for learners via PC, the content was converted into PDF format. This enables the educational materials to be more easily viewed and the main structures more clearly observed using a computer-based viewer.

Endoscopic approaches to the posterior wall of the third ventricle: An anatomical comparison

IntroductionSurgery of lesions in the posterior wall of the third ventricle requires great expertise due to its deep location and important surrounding structures. This region has been traditionally reached through a supracerebellar infratentorial approach, but new options have emerged, especially with the development of neuroendoscopy. MethodsOne formalin-fixed cadaver human head was dissected. Five different endoscopic approaches were performed: interhemispheric transcallosal transchoroidal, frontal transforaminal transchoroidal, supraorbital subfrontal translamina terminalis, expanded endonasal, and supracerebellar infratentorial. An anatomical description of the different approaches was conducted and quantitative measurements (craniocaudal and latero-lateral distances) were taken using the StealthStation ® workstation after performing a CT scan of the specimen. ResultsThe interhemispheric transcallosal transchoroidal, frontal transforaminal transchoroidal, and supraorbital subfrontal translamina terminalis approaches provided great view of all the structures of the posterior wall of the third ventricle. Maximum craniocaudal distance was obtained through the supraorbital subfrontal translamina terminalis approach (10.6 mm), with great difference from the expanded endonasal approach (5.2 mm). The widest latero-lateral distance from inside the third ventricle was achieved through the interhemispheric transcallosal transchoroidal approach (4.6 mm), similar to the expanded endonasal (4.1 mm), and differing from the supraorbital subfrontal translamina terminalis (2.4 mm). ConclusionsThe endoscopic approaches provided an adequate alternative to more traditional microsurgical approaches to the posterior wall of the third ventricle, with a great view of all its structures. The selection of the approach must be taken under consideration in each case.

Modified Combined Impression Technique for Cawood & Howell Class V/VI Mandibular Ridges: A Case Report

Geriatric prosthodontic rehabilitation with compromised residual ridge has become challenging, the principal concern being rejuvenating and maintaining complex stomatognathic functional harmony with severe residual ridge resorption (RRR). Modification of contemporary treatment techniques should be considered to achieve a patient’s functional and esthetic requirements. Contemporary prosthodontics utilizing combination of Neutral zone technique (NZ) and all green impression (AGI) for the management of Cawood & Howell Class V/VI (severely resorbed) ridges are innovative techniques for the construction of removable prosthesis with a profound effect in denture stability and retention, particularly in mandible. NZ implies the principle of synergistic activity of Oro-muscular function in denture stability by arranging the prosthetic teeth within the neutral zone area, hence preventing their interfere with the oro-muscular function, while AGI aimed at achieving prosthesis retention through functional moulding and the viscosity of impression material helps disseminate the forces transmitted to the denture-bearing area reducing the potential for discomfort arise from the soft tissue folds over atrophic ridge. This case report attempts to present a combination of modified impression techniques utilizing all green impression techniques and neutral zone techniques in a 66-year-old patient for C&H Class V mandibular ridge. The goal of this technique is to provide optimal stability covering the maximum denture bearing area and selectively distributing the pressure and to produce a denture molded by oro-muscular function in harmony with its surrounding structures thereby enhancing stability and retention.

A computerized tomography-based study of anatomical variations of the ethmoidal uncinate process

Background: The uncinate process is very relevant with respect to the ventilation and drainage of the frontal, maxillary and anterior ethmoid sinuses in the osteomeatal complex. Aims and Objectives: The study was conducted with the aim to examine and assess various patterns of upper attachment of the ethmoidal uncinate process. The secondary objective of the study was to study the incidence of pneumatization of the uncinate process. Materials and Methods: With the objective to study the various patterns of upper attachment of the uncinate process, the study was conducted at the Department of Ear, Nose, and Throat (ENT) Head and Neck Surgery, at Government Medical College, Doda, J and K, India. The period of study was from November 2020 up to November 2021. The study involved 100 patients who had presented to the ENT outpatient with nasal and or sinus-related complaints. Results: The study included 58 males and 42 females. Among the various patterns, it was the type-2 pattern of the uncinate attachment that was the most prevalent (42%). This was followed by a type-1 pattern (attached to the lamina papyracea) (16%) and then a type-6 pattern (14%). Type-3 in 4%, type-4 in 3%, and type-5 in 7%. In 14% of the cases, there was no upper attachment of the uncinate process. The pneumatization of the uncinate process was noted among 42 of the uncinate processes that we studied. The pneumatization was unilateral in 41% and bilateral in 59% of the uncinate process. The patients with a pneumatized uncinate process had more severe clinical presentation. Conclusions: A thorough computerized tomography scan assessment of the attachments of the uncinate process and its variations aids in minimizing damage to the related landmarks during the surgery and helps minimizing the chances of iatrogenic trauma to the nasolacrimal duct, medial orbital wall, and other surrounding structures. It can also assist in figuring out the likely cause of refractory sinusitis.

Anatomical Course of the Recurrent Laryngeal Nerve and Its Relationship with the Surrounding Structures: A Prospective Surgical Study

Anatomical Course of the Recurrent Laryngeal Nerve and Its Relationship with the Surrounding Structures: A Prospective Surgical Study

Triad of temporomandibular joint ankylosis, micrognathia, and obstructive sleep apnoea: a systematic review of surgical management

Complex functional issues arising from temporomandibular joint (TMJ) ankylosis are associated with abnormal mandibular growth secondary to the condylar-glenoid fossa and its surrounding structures. These include severe limited mouth opening, micrognathia, mandibular asymmetry, and obstructive sleep apnoea (OSA), which necessitate effective treatment to allow optimum functional rehabilitation. This article aims to present a comprehensive systematic review of the surgical strategy for patients who present with a triad of TMJ ankylosis, micrognathia and OSA via a literature search of PubMed, Google Scholar, and Scopus following PRISMA guidelines. The outcomes of interest were difference in maximum mouth opening, incidence of reankylosis, amount of mandibular advancement, posterior airway space, preoperative and postoperative apnoea/hypopnoea index, and arterial oxygen saturation, as well as changes in other cephalometric or polysomnographic variables. Thirty four studies involving 360 patients were included. Surgical interventions included distraction osteogenesis (DO), release of TMJ ankylosis and mandibular advancement, simultaneous arthroplasty and DO, pre-athroplasty DO, and post-arthroplasty DO. Most studies reported functional post-intervention mouth opening, with reankylosis reported in four. Mandibular advancement was between 6 mm and 34 mm. All studies reported improvement in the various polysomnographic variables measured. In conclusion, the systematic review was conducted based on a low level of literature evidence. Even though various surgical strategies were reported, effective case-specific management of TMJ ankylosis with micrognathia and OSA requires comprehensive assessment and careful consideration of surgical options that promote mandibular advancement and airway improvement.

Feasibility, Accuracy, and Reproducibility of Aortic Valve Sizing for Transcatheter Aortic Valve Implantation Using Virtual Reality.

Detailed visualization and precise measurements of aortic valve dimensions are critical for the success of transcatheter aortic valve implantation and for the prevention of complications. Currently, multislice computed tomography is the gold standard for assessment of the aortic annulus and surrounding structures to determine the prosthesis size. New technologies such as virtual reality (VR) not only enable 3-dimensional (3D) visualization with the potential to improve understanding of anatomy and pathology but also allow measurements in 3D. This study aims to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in preprocedural sizing for transcatheter aortic valve implantation. Based on the preprocedural multislice computed tomography data, 3mensio measurements and 3D visualizations and measurements using VR software were performed retrospectively on 60 consecutive patients who underwent transcatheter aortic valve implantation at our heart center. There were no significant differences but strong correlations between the VR measurements compared with those performed with the 3mensio software. Furthermore, excellent or good intra- and interobserver reliability could be demonstrated for all values. In a structured questionnaire, users reported that VR simplified anatomical understanding, improved 3D comprehension of adjacent structures, and was associated with very good self-perceived depth perception. The use of VR for preprocedural transcatheter aortic valve implantation sizing is feasible and has precise and reproducible measurements. In addition, 3D visualization improves anatomical understanding and orientation. To evaluate the potential benefits of 3D visualization for planning further cardiovascular interventions, research in this field is needed.