The Effectiveness of Skeletal Reconstruction in Severe Post Rhinoplasty Nasal Deformity

2020 ◽  
Author(s):  
Amir A Sazgar ◽  
Shabnam Hajialipour ◽  
Ali Razfar ◽  
Sara Rahavi-Ezabadi
Keyword(s):  
Outcome Evaluation ◽  
P Value ◽  
Patient Demographics ◽  
Revision Rhinoplasty ◽  
Symptom Evaluation ◽  
Facial Plastic ◽  
Aesthetic Results ◽  
Side Walls ◽  
One Year ◽  
Skeletal Reconstruction

Abstract Background Revision rhinoplasty in patients with multiple prior surgeries is among the most challenging procedures in facial plastic surgery. Evaluating patient satisfaction in this unique patient population is important in determining which technique is effective. Objective In this study, we attempted to determine the outcomes of total nasal skeletal reconstruction in patients with severe post rhinoplasty deformity due to multiple previous revision surgeries. Methods A retrospective medical record analysis of ambulatory surgery and hospital databases was performed relating to rhinoplasty patients between April 2014 to December 2018. Patient demographics, surgical technique, and functional and aesthetic outcome assessment data were retrieved. Patients’ functional satisfaction was measured with the Nasal Obstruction Symptom Evaluation (NOSE) instrument, and the Rhinoplasty Outcome Evaluation (ROE) instrument was used to evaluate cosmetic results. Results A total of 253 revision rhinoplasties were extracted. Of these, 25 patients were revision cases with total skeletal reconstruction. The patients had undergone a mean of 3.2 previous rhinoplasties. Mean preoperative ROE and NOSE scores were 6.36 ±3.69 and 80.33±12.02, respectively. Septum, tip, dorsum, and side walls were reconstructed in all cases. The mean postoperative ROE and NOSE score after one year were 17.27±4.67 and 53.33 ±19.80 respectively, which were statistically significant (p-value <0.001). Conclusions Having the knowledge and experience to perform total nasal skeletal reconstruction by rebuilding an unsalvageable nose leads to long-standing satisfactory functional and aesthetic results.

scholarly journals Analysis of revision rhinoplasty; what is the problem and the management?

2019 ◽  
Vol 7 (1) ◽  
pp. 36
Author(s):  
Mohamed Alhadad ◽  
Dalia El Sakka ◽  
Medhat Samy ◽  
Ahmed Fergany
Keyword(s):  
Patient Satisfaction ◽  
Prospective Study ◽  
Outcome Evaluation ◽  
P Value ◽  
University Hospitals ◽  
Revision Rhinoplasty ◽  
Significant Difference ◽  
A Prospective Study ◽  
Surgery Department

Background: Revision rhinoplasty is reported to occur in 8% to 15%. Reoperation should be performed to correct deformities that were not diagnosed or addressed in previous surgeries, such as those from poor planning, performance and poor surgical healing. The aim of the study was to evaluate the problem of each case seeking revision rhinoplasty and different modalities for management to reach satisfactory results.Methods: This is a prospective study which was done in plastic surgery department, Menoufia University Hospitals over the period from December 2017 to December 2019. The study included 31 patients underwent previous rhinoplasty.Results: Patients were selected from the outpatient clinic, 31 patients who had varieties of nasal deformities. Mean age of the patients was 31.7 years. Female represent the majority of patients by 80.60% and males were 19.40% with significant difference in satisfaction (p=0.05). Patient satisfaction after surgery and it was excellent for 14 cases (45.20%), good for 9 cases (29 %) and it was fair in 8 cases (25.8%). Rhinoplasty outcome evaluation (ROE) score was correlated with patient satisfaction grades as mean of ROE score in excellent group was 67.5; in good group was 58.3; while in fair group was 38.8 with significant p value (0.001).Conclusions: Excellent patient satisfaction is related good planning, close follow up time, and less complication. Cartilage grafts especially rib cartilage is considered a lifeboat for revision rhinoplasty. We can link grades of patient satisfaction to ROE score.

Evaluation of Mandibular Arch Width Changes following Fixed Retention in Post Orthodontic Patients - a Randomized Clinical Trial

2020 ◽  
Author(s):  
Nasreen Iqbal Nagani
Keyword(s):  
Stainless Steel ◽  
Steel Wire ◽  
P Value ◽  
Chi Square ◽  
Mandibular Arch ◽  
Arch Width ◽  
Orthodontic Patients ◽  
Mean Differences ◽  
One Year ◽  
The Stability

Background: Retention is an integral phase in which teeth are maintained in their newly adapted position for which retainers are inserted. Retainers are generally of two types: removable and fixed. Fixed retainers are indicated in the mandibular arch for an indefinite period specifically in the non-extraction cases. Changes in intercanine and intermolar widths are valuable parameters to evaluate the stability. The objectives of this study were to assess and compare the mandibular intercanine and intermolar width changes following orthodontic treatment after insertion of two types of fixed lingual retainers for one year. Methods: Total 54 subjects were recruited in which two types of fixed lingual retainers were inserted in the mandibular arch randomly. Intercanine and intermolar arch widths were measured by digital caliper of 0.01 mm accuracy. Data was analyzed by using Statistical Package of Social Sciences (SPSS V-21). Chi-square and independent t tests were used to compare baseline characteristics. Intercanine and intermolar widths were assessed and compared using independent t test, p-value ≤ 0.05 is considered as statistically significant. Results: Intercanine width increased from baseline to T4 in both retainers. When mean differences of intercanine width were compared between two retainers significant differences were observed at T1, T2, T3 and T4 with significant p-values (< 0.05) and increased intercanine width with multistranded stainless steel wire (MSW) retainers. Conclusion: Mandibular intercanine width increases significantly in post retention phase with multistranded stainless steel retainers. Thus, fiber reinforced composite retainers are more effective in preserving the arch width changes.

scholarly journals 1-Year Evaluation of OT Bridge Abutments for Immediately Loaded Maxillary Fixed Restorations: A Multicenter Study

2021 ◽  
Author(s):  
Rosario Acampora ◽  
Marco Montanari ◽  
Roberto Scrascia ◽  
Emiliano Ferrari ◽  
Massimo Pasi ◽  
...  
Keyword(s):  
Survival Rates ◽  
Health Impact ◽  
P Value ◽  
Success Rates ◽  
Marginal Bone Loss ◽  
Bridge Abutments ◽  
Bleeding On Probing ◽  
Fixed Dental Prosthesis ◽  
Low Profile ◽  
One Year

Abstract Objective  Preliminary data on survival and success rates of immediately loaded, maxillary, screw-retained, implant-supported, fixed restorations delivered on narrow and low-profile OT Equator abutments (OT Bridge, Rhein’83) were evaluated. Materials and Methods This retrospective study evaluated data collected from patients rehabilitated with OT Bridge prosthetic concept between November 2017 and February 2019 in six different centers. Outcome measures were implant and prosthetic survival rates, biological and technical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index. Results A total of 76 implants were inserted in 14 patients. Patients were followed for a mean period of 15.8 months (range = 12–24). All the patients receive OT Equator (Rhein'83) as intermediate abutments. One year after loading, one implant failed (1.3%). None of the prosthesis failed. One prosthetic complication was experienced in one patient. Three out of 76 implants were connected to the prosthetic framework using only the Seeger system, without screw. Difference in OHIP values was statistically significant (71.9 ± 8.5; p = 0.000). One year after loading, MBL was 0.21 ± 0.11 mm and p-value was 0.000. One year after loading, 8.7% of the examined implant sites present positive bleeding on probing, while 6.4% of the implant sites presented plaque. Conclusion The OT Equator abutments (Rhein'83) showed successful results when used to support maxillary fixed dental prosthesis delivered on four to six implants. High implant and prosthetic survival rates, very low complications, high patient satisfaction, and good biological parameters, including only 0.2 mm of bone remodeling were experienced one year after function. Further studies are needed to confirm these preliminary results.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = &lt;.001), and more often missed grade 1 (&lt; 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

Does perianal disease influence the efficacy of combination therapy in Crohn’s disease?

2020 ◽  
Author(s):  
Rui de Sousa Magalhães ◽  
Sofia Xavier ◽  
Tiago Cúrdia Gonçalves ◽  
Francisca Dias de Castro ◽  
Bruno Rosa ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Clinical Remission ◽  
Odds Ratio ◽  
Perianal Disease ◽  
Outcome Variable ◽  
P Value ◽  
Disease Relapse ◽  
Endoscopic Remission ◽  
Remission Rates ◽  
One Year

Background: Perianal disease is associated with a disabling course of CD. We aim to study the impact of perianal disease on CD remission rates, after a one-year course of infliximab in combination therapy with azathioprine. Methods: Cohort, retrospective, single centre study, including consecutive CD patients on combination therapy, followed for one year since induction. The outcome variable was split into clinical and endoscopic remission. The correlation towards the outcome variable was assessed with univariate and multivariate analysis, and a survival assessment, using SPSS software. Results: We assessed 74 CD patients, of whom 41 (55.4%) were female, with a mean age of 36 years-old. Thirty-nine percent of the patients presented perianal disease at diagnosis (n=29). We documented 70.3% clinical and 47.2% endoscopic remissions. Several variables had statistical significance towards the outcomes (endoscopic and clinical remission) in the univariate analysis. After adjusting for confoundment, patients with perianal disease presented an odds ratio of 0.20 for achieving endoscopic remission (odds ratio 0.201 CI [0.054-0.75] p-value 0.017) and an odds ratio of 0.203 for achieving clinical remission (OR 0.203 CI [0.048-0.862] p-value 0.031). Sixty-six patients (89.2%) presented an initial response to treatment, from whom, 20 (30.3%) exhibited at least one disease relapse (clinical and/or endoscopic). Patients with perianal disease presented higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meyer curves (Breslow p-value 0.043). Conclusion: In the first year of combination therapy, perianal disease is associated with an 80% decrease in endoscopic and clinical remission rates and higher ratio of disease relapse.

Evaluation of ‘the R-Model’ crisis intervention de-escalation training for law enforcement

2019 ◽  
Vol 93 (4) ◽  
pp. 271-289 ◽  
Author(s):  
Jillian Peterson ◽  
James Densley ◽  
Gina Erickson
Keyword(s):  
Law Enforcement ◽  
Crisis Intervention ◽  
Health Resources ◽  
Police Department ◽  
Preliminary Evidence ◽  
Outcome Evaluation ◽  
Calls For Service ◽  
Model Research ◽  
One Year

This study presents findings from a process and outcome evaluation of a custom crisis intervention and de-escalation training for law enforcement, delivered in-house to a suburban Minnesota police department (the R-Model: Research, Respond, Refer). Individual officer survey data showed the R-Model significantly decreased stigma and increased self-reported knowledge of mental health resources over baseline. Knowledge of resources held at the 4-month follow-up. One-year follow-up data at the agency level, showed decreases in the number of crisis calls for service and the number of repeat calls to the same addresses, even when compared to crisis call rates at similar police departments. Findings provide preliminary evidence that the R-Model may be an effective model that warrants additional study.

Evaluation of Transient Elastography in Prediction Of De novo Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nadia abdelaty Abdelkader ◽  
Moustafa Hamed Abdelaleem ◽  
Mohammed El-Gharib Abo El- maaty ◽  
Heba Ismail Aly ◽  
Sayed Ahmed Sayed
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transient Elastography ◽  
P Value ◽  
Hepatic Decompensation ◽  
Non Invasive ◽  
Prediction Of Mortality ◽  
The Mean ◽  
One Year

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and it is also a common cause of death in patients with chronic liver disease. The curative treatment options for HCC that are currently available are surgical resection, liver transplantation and radiofrequency ablation .Despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA. Aim of the work To evaluate the role of transient elastography (as an indirect indicator to degree of liver fibrosis) in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation in hepatitis C related hepatocellular carcinoma .And to compare between transient elastography and other non invasive fibrosis indices in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation hepatitis C related hepatocellular carcinoma Patients and methods This prospective cohrt study was conducted on hepatocellular carcinoma patient, who underwent radiofrequency ablation in Tropical Medicine Department in Eldemerdash and Ain Shams Specialized Hospital, HCC clinic Ain Shams University Hospitals, Cairo, Egypt between march, 2017 and May, 2019. Data of the patient, who underwent radiofrequency ablation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and underwent radiofrequency ablation were followed up for 12 months. Results TE revealed 28 patients with F4 and only 2 patients with F3, the mean measurement of liver stiffness was (22.45 ± 10.36) KPa. There was a significant negative correlation between LS and denovo recurrence of HCC (mean of LS in patients with complete response was 17.19 ± 3.32 and the mean of LS in patient with denovo recurrence was 36,94 ± 5.93,with the The best cut off value ≥24.65 (p value &lt; 0.001)). There was no significant correlation between CDC, FIB4, API scores and denovo recurrence of HCC. Also it was found that the LS was significantly associated with prediction of manifestation of hepatic decompensation after RFA (means of LS in patient without manifestation decompensation after RFA (p value &lt;0.001) .Regarding prediction of mortality, LS at cut off value &gt; 42 .75 (p value = 0,031) was significantly associated with prediction of mortality after one year of RFA. As regard serum non invasive fibrosis indices our results showed correlation between FIB4 score and hepatic decompensation after one year of intervention (the mean of FIB4 score in patients ascites and jaundice was 6.05 ± 4.71 (p value = 0.05) ).Therewas no statistically significant correlation between CDS and API with hepatic decompensation after RFA .As regard role of serum non invasive fibrosis indices in prediction of mortality after RFA, FIB4 score, CDS and API were statistically non significant. Conclusion Our data suggest that LS measurement is a useful predictor of HCC de novorecurrence overall survival and possibility of hepatic decompensation after RFA

STUDY OF INCIDENCE OF THE CORONAL APPROACH IN CRANIOFACIAL TRAUMA AND ADVANTAGEOUS OF TITANIUM MESH IN RECONSTRUCTION OF CRANIOFACIAL DEFECTS.

2021 ◽  
pp. 53-54
Author(s):  
Mastan Shaik
Keyword(s):  
Maxillofacial Surgery ◽  
Frontal Bone ◽  
Male Participant ◽  
Female Participant ◽  
Oral And Maxillofacial Surgery ◽  
Industrial Accidents ◽  
Nasal Bones ◽  
Aesthetic Results ◽  
One Year ◽  
Craniofacial Defects

INTRODUCTION: The coronal approach gives a broad exposure to the frontal bone, the calvaria, the nasal bones, the orbits, the subcondylar region, the zygoma and the zygomatic arch and gives ideal aesthetic results with less complication. The common craniofacial fractures are Nasal bones (45%), cranial bones (24%), Mandible (13%), Zygoma (13%), Orbital blowout (3%), Maxilla (2%). Common causes of fractures are Road trafc accident, Assault, Industrial accidents, Recreational accidents, Frontal bone fracture. METHOD: The study was carried out for a period of one year from March 2020 to March 2021. The study conducted in St Joseph dental college ELURU in the department of Oral and Maxillofacial Surgery. The age limit for this study was below 30 years. The number of subjects involved in this study was 5. Number of females was 3 and males were 2 in this study. RESULT: Number of female participants in this study was 3 and number of male participants was 2.Number of male participants with coronal incision were 1 and number of participants with pretrichial incision were 2.Out of 2 one for male participant and one for female participant. CONCLUSION: The coronal ap has recently become a preferred approach for access to the craniofacial skeleton and orbit. This method of exposure has become particularly useful with increased indications for rigid internal xation and primary bone grafting in the management of complex facial fractures.

scholarly journals Can reducing the number of stitches compromise the outcome of laparoscopic Burch surgery in the treatment of stress urinary incontinence? Systematic review and meta-analysis

2017 ◽  
Vol 44 (6) ◽  
pp. 649-654 ◽  
Author(s):  
RICARDO JOSÉ SOUZA ◽  
JOSÉ ANACLETO DUTRA RESENDE JÚNIOR ◽  
CLARICE GUIMARÃES MIGLIO ◽  
LEILA CRISTINA SOARES BROLLO ◽  
MARCO AURÉLIO PINHO OLIVEIRA ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
P Value ◽  
Open Technique ◽  
Control Series ◽  
One Year ◽  
Cure Rates

ABSTRACT The retropubic colposuspension in the treatment of stress urinary incontinence has been rescued with the laparoscopic route. Some authors have reduced the number of stitches, from two to one, due to the difficulty of suturing by this route. To what extent can this modification compromise outcome? To answer this question, we performed a systematic review and meta-analysis on the MEDLINE/PubMed and LILACS/SciELO databases between 1990 and 2015. We included randomized clinical trials, cohort studies and case-control series comparing laparoscopic versus open Burch, and two versus one stitch in laparoscopic Burch, with a minimum follow-up of one year. Fourteen studies compared laparoscopic versus open Burch, in which we found no differences between the two techniques using one stitch (Relative Risk - RR - of 0.94, 95% CI 0.79-1.11) and two stitches (RR of 1.03, 95% CI 0.97-1.10). Only one study compared one stitch versus two stitches in laparoscopic Burch, with cure rates of 68% versus 87%, respectively (p-value= 0.02). We did not identify differences when compared open technique with two stitches versus laparoscopic with one stitch and open technique with two stitches versus laparoscopic with two. The study comparing one versus two laparoscopic stitches demonstrated superior results with the latter. Although there is no robust evidence, when Burch surgery is performed laparoscopically, the use of two stitches seems to be the best option.

scholarly journals Topical Diltiazem Versus Topical Glyceryl Trinitrate In The Management Of Chronic Anal Fissure

JMS SKIMS ◽  
2014 ◽  
Vol 17 (2) ◽  
pp. 55-58
Author(s):  
Shams Ul Bari ◽  
Ajaz Ahmad Malik ◽  
Khurshid Alam Wani ◽  
Ajaz A Rather
Keyword(s):  
Side Effects ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
P Value ◽  
Double Blind ◽  
Surgical Methods ◽  
Significant Difference ◽  
Topical Glyceryl Trinitrate ◽  
One Year

Background: Chemical sphincterotomy is a novel way for treating patients of chronic anal fissure which avoids the risk of fecal incontinence associated with traditional surgical methods. Aims and objectives: The aim of this study was to compare the results of topical Diltiazem with topical Glyceril trinitrate in the management of chronic anal fissure. Methods: 71 patients in the age group of 15 - 61 years with chronic anal fissure were included in this prospective, randomized, double-blind trial over a period of two years with further follow up for one year. The patients were randomly allocated to either Diltiazem gel 2% (37 patients) or Glyceril trinitrate ointment 0.2% (34 patients) and were asked to use the treatment twice daily for 8 weeks. Each patient was reviewed every two weeks. Symptoms, healing, side effects and recurrence were compared using SPSS version 10 employing X2 test. A p-value below 0.05 was considered statistically significant. Results: Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glyceril trinitrate in terms of symptoms, wound healing, side effects ( headaches) and recurrence (p=0.03 and 0.003 respectively). Healing occurred in 34 of 37 (92%) patients treated with Diltiazem after 6 weeks and 27 of 34 (80%) patients treated with Glyceril trinitrate after 8 weeks, which shows a significant difference in favour of Diltiazem (P < 0.001). The rest of the patients did not heal and underwent sphincterotomy (SILS). Headache occurred in all of the patients treated with Glyceril trinitrate but none of the patients treated with Diltiazem. Conclusion: Diltiazem gel was found to be better than Glyceril trinitrate ointment due to significantly higher healing rate and fewer side-effects. JMS 2014;17(2):55-58

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