scholarly journals Anatomical Comparative Study of the External Nasal Nerve in Caucasian and Asian: Application for Minimizing Nerve Damage in Rhinoplasty

2021 ◽  
Author(s):  
Yue Chen ◽  
Catherine B. Carr
Keyword(s):  
Nerve Injury ◽  
Average Distance ◽  
Asian Population ◽  
Anatomical Structure ◽  
Full Description ◽  
Exit Point ◽  
Level Of Evidence ◽  
Patient’S Satisfaction ◽  
Type Iv ◽  
Significant Difference

Abstract Background The numbness of the nasal tip is the main symptom of the external nasal nerve injury, especially after rhinoplasty. This postoperative syndrome can reduce the patient’s satisfaction with the operation. Having a better understanding of the anatomical structure and intraoperative protection can effectively avoid nerve injury. At present, the anatomical research on this nerve is all from Asia. This study aims to fill the gap in the anatomical study of this nerve in Caucasians and provides comparative results with Asians. Material and Methods A total of 20 Caucasian cadavers were embalmed using the Thiel method. On dissection, after complete exposure of the external nasal nerves, the distance between the exit point of the external nasal nerve and the nasal midline was measured, and the morphology of the nerves was compared with the Asian data. The nerves were classified into types based on their branching pattern. Results The nerve plane was the same as the Asian record. The distance ranged from 5.08 to 11.94 mm (mean, 8.31 ± 1.85 mm). This distance has statistical significant difference compared with the Asian population (P < 0.01). The average distance is larger, and the distribution range of the exit point is wider. On classification, 35 of 40 cases had the same type results as those previously reported, with the primary types I, II and III. Five new varieties were found which are classified as subtypes of the primary types and a new type IV. Furthermore, the bifurcation position in two-thirds of the type II cases and variations is proximal to that seen in the Asian population. Conclusions The anatomical structure of the external nasal nerve in Caucasians and Asians has obvious differences. This nerve in Caucasians is more likely to be damaged during rhinoplasty than Asians. Except the primary types, the classification of the external nasal nerve also includes subtypes and type IV. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques

2019 ◽  
Vol 39 (9) ◽  
pp. 927-942 ◽  
Author(s):  
Andrew A Jacono ◽  
A Sean Alemi ◽  
Joseph L Russell
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Meta Analysis ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Facial Nerve Injury ◽  
Significant Difference ◽  
Meta Analyses ◽  
Smas Flap

AbstractBackgroundSub-superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, compared with less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection.ObjectivesThe authors sought to aggregate and summarize data on complications among different SMAS facelift techniques.MethodsA broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total 183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rates of temporary nerve injury and were the only techniques to show a statistically significant difference compared with SMAS plication (odds ratio [OR] = 2.71 and 2.22, respectively, P < 0.05). Risk of permanent injury did not differ among techniques. An increase in major hematoma was found for the deep plane (1.22%, OR = 1.67, P < 0.05) and SMAS imbrication (1.92%, OR = 2.65, P < 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR = 2.29, P < 0.01).ConclusionsThere are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Technique should be selected based on quality of results and not the complication profile.Level of Evidence: 2

scholarly journals Incidence of and Functional Significance of Floating Toe After Weil Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141989195
Author(s):  
Emilio Wagner ◽  
Luis A. O’Connell ◽  
Ruben Radkievich ◽  
Nathaly Caicedo ◽  
Pablo Mococain ◽  
...  
Keyword(s):  
Clear Correlation ◽  
Functional Scale ◽  
Level Of Evidence ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
The Mean ◽  
American Orthopaedic ◽  
Toe Deformity

Background: The most frequent complication after Weil osteotomies is a floating toe deformity, but there are no reports about its effect on the patient. In this study, we analyzed the consequences of floating toe deformities after the performance of a modified Weil osteotomy (MWO) or a modified Weil osteotomy with interphalangeal fixation (MWOIF). Methods: We performed a retrospective review with a prospective follow-up of 50 patients (98% women, 120 rays) who underwent MWO (65 rays) or MWOIF (55 rays), with a mean age of 54 ± 12 years and a minimum follow-up of 4 years (mean of 6 years). We analyzed the presence of floating toe deformity in MWO and MWOIF and the outcomes measured by the subjective satisfaction, Lower Extremity Functional Scale (LEFS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and quality of prehension force between patients with or without floating toe deformity. Results: The mean floating toe incidence was of 57%, with no significant difference between operative techniques (48% MWO, 67% MWOIF; P = .053). Our analysis did not show differences in satisfaction, LEFS and AOFAS scores, or grip strength between the group of patients with or without floating toes. Conclusion: The presence of a floating toe deformity was more frequent than generally believed but did not have a meaningful impact on the patient’s satisfaction or functional outcomes measured by the AOFAS and LEFS scales. There was no clear correlation between operative technique, floating toe, and quality of prehension force. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice

2016 ◽  
Vol 9 ◽  
pp. CMAMD.S40401 ◽  
Author(s):  
Marie Bossert ◽  
Daniel Boublil ◽  
Jean-Marc Parisaux ◽  
Ana-Maria Bozgan ◽  
Emmanuel Richelme ◽  
...  
Keyword(s):  
Success Rate ◽  
Safety Concern ◽  
Demographic Data ◽  
Daily Practice ◽  
Ankle Osteoarthritis ◽  
Level Of Evidence ◽  
Imaging Guidance ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Highly Correlated

Background The objective of this survey was to assess retrospectively the interest of performing viscosupplementation using imaging guidance in patients suffering from ankle osteoarthritis (OA). Patients and Methods This is a multicenter retrospective survey using a standardized questionnaire. Fifty patients suffering from ankle OA and treated, in daily clinical practice, with a single intra-articular injection of a novel viscosupplement made of a combination of a non-animal cross-linked hyaluronan and mannitol, HANOX M-XL, were included in the survey. The injection procedure (imaging or landmark guidance), demographic data, patient's self-evaluation of pain, satisfaction, treatment efficacy, and tolerability were collected. Predictive factors of both efficacy and patient's satisfaction were investigated. Results The percentages of patients very satisfied/satisfied and not really satisfied/dissatisfied with the treatment were 68% and 32%, respectively. Efficacy was rated as very good, good, moderate, and poor by 38%, 30%, 12%, and 20% of the cases, respectively. Efficacy was unrelated to gender and age and was highly correlated with pain score ( P < 0.0001). In satisfied patients, the decrease in consumption of analgesics/non-steroidal anti-inflammatory drugs was >75% in 64% of the cases. Efficacy was significantly different with regard to imaging guidance. There was a statistically significant difference in efficacy and satisfaction between landmark-guided and imaging-guided injections ( P = 0.02). The success rate was 2.3 times higher in the imaging-guided group than in the landmark-guided group. No significant difference was found between patients injected under fluoroscopy or ultrasound guidance, despite a trend favoring ultrasound ( P = 0.09). Tolerability was rated as very good/good in 47 patients, moderate in two, and poor in one and was unrelated to the type of guidance. Conclusion This preliminary study suggests that the use of imaging guidance significantly optimizes the success rate of ankle viscosupplementation. No safety concern was observed. LEVEL OF EVIDENCE III.

scholarly journals Concomitant Use of Hyaluronic Acid and Laser in Facial Rejuvenation

2019 ◽  
Vol 43 (4) ◽  
pp. 1061-1070 ◽  
Author(s):  
Fernando Urdiales-Gálvez ◽  
Sandra Martín-Sánchez ◽  
Mónica Maíz-Jiménez ◽  
Antonio Castellano-Miralla ◽  
Leonardo Lionetti-Leone
Keyword(s):  
Hyaluronic Acid ◽  
Botulinum Toxin A ◽  
Scientific Evidence ◽  
Combined Treatment ◽  
Facial Rejuvenation ◽  
Full Description ◽  
Dermal Fillers ◽  
Level Of Evidence ◽  
Laser Technology ◽  
Patient’S Satisfaction

AbstractBackgroundFacial aging is a process that involves many different changes. Therefore, in many patients, it may be necessary to perform a combined treatment. Botulinum toxin A and dermal fillers are the two most popular nonsurgical cosmetic procedures performed globally to treat age-associated changes. However, there are not many studies reporting the concomitant use of dermal fillers and laser technology for facial rejuvenation. This review aims to assess the concomitant use of dermal hyaluronic acid (HA) fillers and laser technology for facial rejuvenation.MethodsThe present updated consensus recommendations are based on the experience and opinions of the authors and on a literature search.ResultsIf a combined procedure (HA and light treatments) is to be performed, on the same day, the panel recommends starting always with the light treatments, avoiding skin manipulations after having injected HA. To customize the therapeutic management, it is crucial to establish a precise diagnosis of the photodamage and loss of volumes suffered by the patients.ConclusionsThe currently available scientific evidence about the combined use of HA fillers and laser–radiofrequency–intense pulsed light (laser/RF/IPL) is limited and encompasses mainly small and nonrandomized studies. Nevertheless, most of these studies found that, on average, the concomitant use (same day) of laser and HA fillers for facial rejuvenation represents an effective and safe strategy which improves clinical results and patient’s satisfaction. Future well-designed clinical studies are needed regarding the effectiveness and safety of combination filler/laser treatments.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authorswww.springer.com/00266.

scholarly journals Distal Biceps Repair With Flexible Instrumentation and Risk of Posterior Interosseous Nerve Injury: A Cadaveric Analysis

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711881052
Author(s):  
Jimmy Tat ◽  
Adam Hart ◽  
Adam Cota ◽  
Khalid Alsheikh ◽  
Dominique Behrends ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Anterior Approach ◽  
Single Incision ◽  
Guide Wire ◽  
Anatomic Reconstruction ◽  
Exit Point ◽  
Posterior Interosseous Nerve ◽  
Distal Biceps ◽  
Cortical Button ◽  
Significant Difference

Background: Current repair techniques using cortical button fixation cannot achieve anatomic reconstruction of the distal biceps when performed through a single-incision anterior approach. We recently introduced a single-incision technique that uses flexible guide pins and flexible reamers to allow for an insertion point on the tuberosity that more closely approximates the anatomic footprint of the distal biceps. Purpose: To investigate the safety of this technique with regard to nerve injury by comparing the guide pin position relative to the posterior interosseous nerve in 16 cadaveric elbows through use of a flexible versus rigid reamer. Study Design: Descriptive laboratory study. Methods: A standard single-incision anterior approach was performed in all cadaveric specimens, and the biceps tendon was dissected off the tuberosity. In 8 specimens, a traditional straight guide pin was used with a cortical button repair inserted through the bicipital tuberosity as close to the anatomic tendon footprint as possible. In the remaining 8 specimens, a curved guide was used to insert a flexible guide wire through the tuberosity within the native footprint. Dissection was carried out to measure the distance from the exit point of the guide pin to the posterior interosseous nerve. The 2 groups were compared by use of nonparametric Wilcoxon rank-sum test (significance threshold, P < .05). Results: The mean distance of the guide wire to the posterior interosseous nerve was 11.6 mm (SD, 3.4 mm; range, 6.5-16.9 mm) in the standard rigid instrument group compared with 8.6 mm (SD, 4.2 mm; range, 1.0-13.9 mm) in the flexible instrumentation group; the difference between groups was not statistically different ( P = .19; 95% CI, –1.1 to 7.1). Conclusion: Based on our cadaveric testing, the use of flexible instrumentation in a single-incision repair of the distal biceps presents with no significant difference in risk of damage to the posterior interosseous nerve compared with standard rigid instruments. In view of the relatively small number of specimens, however, some caution should be observed when applying these results clinically. Clinical Relevance: As contemporary techniques in sports medicine strive to re-create each patient’s native anatomic characteristics, the use of flexible instruments allows for a more anatomic repair of the distal biceps, and our study demonstrates that it is a safe option. The next step is to evaluate its safety in vivo.

General Cluster Sorption Isotherm

2020 ◽  
Author(s):  
Christoph Buttersack
Keyword(s):  
Density Functional ◽  
Capillary Condensation ◽  
Cluster Formation ◽  
Full Range ◽  
Full Description ◽  
Cross Sectional ◽  
Macroporous Silica ◽  
Isotherm Equation ◽  
Type Iv ◽  
Classical Thermodynamics

<p>Adsorption isotherms are an essential tool in chemical physics of surfaces. However, several approaches based on a different theoretical basis exist and for isotherms including capillary condensation existing approaches can fail. Here, a general isotherm equation is derived and applied to literature data both concerning type IV isotherms of argon and nitrogen in ordered mesoporous silica, and type II isotherms of disordered macroporous silica. The new isotherm covers the full range of partial pressure (10<sup>-6</sup> - 0.7). It relies firstly on the classical thermodynamics of cluster formation, secondly on a relationship defining the free energy during the increase of the cluster size. That equation replaces the Lennard-Jones potentials used in the classical density functional theory. The determination of surface areas is not possible by this isotherm because the cross-sectional area of a cluster is unknown. Based on the full description of type IV isotherms, most known isotherms are accessible by respective simplifications. </p>

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

2021 ◽  
pp. 036354652199967
Author(s):  
Baris Kocaoglu ◽  
Ahmet Emre Paksoy ◽  
Simone Cerciello ◽  
Matthieu Ollivier ◽  
Romain Seil ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Repair ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Significant Difference ◽  
Hip Abductor ◽  
Tendon Tears

Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

scholarly journals Morphological Changes of the Hip Commonly Associated With Femoroacetabular Impingement Are Not Correlated With Rotational Range of Hip Motion in Elite Soccer Athletes

2021 ◽  
pp. 194173812097366
Author(s):  
André Orlandi Bento ◽  
Guilherme Falótico ◽  
Keelan Enseki ◽  
Ronaldo Alves Cunha ◽  
Benno Ejnisman ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Lower Limb ◽  
Clinical Relevance ◽  
Morphological Changes ◽  
Alpha Angle ◽  
Soccer Players ◽  
Level Of Evidence ◽  
Rotational Movement ◽  
Professional Soccer ◽  
Significant Difference

Background: Morphological changes characteristic of femoroacetabular impingement (FAI) are common in soccer players. However, the clinical relevance of such anatomical variations is still not well-defined. Hypothesis: We hypothesized that high alpha angle values and/or acetabular retroversion index (ARI) are correlated with rotational range of motion (ROM) of the hip and that there are clinical-radiological diferences between the dominant lower limb (DLL) and nondominant lower limb (NDLL) in professional soccer players. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: A total of 59 male professional soccer players (average age 25.5 years, range 18-38 years) were evaluated in the preseason. As main outcome measures, we evaluated the alpha angle and the ARI and hip IR and ER ROM with radiographic analysis. Results: The measurements taken on DLL and NDLL were compared and a significant difference was found between the sides in the ER ( P = 0.027), where the DLL measures were 1.54° (95% CI, 0.18-2.89) greater than the NDLL. There were no significant differences between the sides in the measures of IR ( P > 0.99), total ROM ( P = 0.07), alpha angle ( P = 0.250), and ARI ( P = 0.079). The correlations between the rotation measurements and the alpha angle in each limb were evaluated and the coefficient values showed no correlation; so also between the ARI and rotation measures. Conclusion: Morphological changes of the femur or acetabulum are not correlated with hip IR and ER ROM in male professional soccer players. ER on the dominant side was greater than on the nondominant side. There was no significant difference in the other measurements between sides. Clinical Relevance: In clinical practice, it is common to attribute loss of hip rotational movement to the presence of FAI. This study shows that anatomical FAI may not have a very strong influence on available hip rotational movement in professional soccer athletes.

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

2017 ◽  
Vol 38 (5) ◽  
pp. 485-495 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Chiara Ursino ◽  
Nicola Serra ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Graft ◽  
Repeated Measures ◽  
Osteochondral Lesion ◽  
Young Patients ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Lesion Size ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

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