INTERSCAPULOTHORACIC AMPUTATION OF THE SHOULDER WITH COMPLETE EXCISION OF THE CLAVICLE

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

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Upbeat vertical nystagmus after brain stem cavernoma resection: a rare case of nucleus intercalatus/nucleus of roller injury

Journal of Neurology ◽

10.1007/s00415-020-09891-4 ◽

2020 ◽

Vol 267 (10) ◽

pp. 2865-2870

Author(s):

Torstein R. Meling ◽

Aria Nouri ◽

Adrien May ◽

Nils Guinand ◽

Maria Isabel Vargas ◽

...

Keyword(s):

Rare Case ◽

Vascular Malformations ◽

Clinical Manifestations ◽

Neurological Injury ◽

Medial Longitudinal Fasciculus ◽

Blurred Vision ◽

Complete Excision ◽

First Case ◽

Vertical Nystagmus ◽

Upbeat Nystagmus

Abstract Introduction CNS cavernomas are a type of raspberry-shaped vascular malformations that are typically asymptomatic, but can result in haemorrhage, neurological injury, and seizures. Here, we present a rare case of a brainstem cavernoma that was surgically resected whereafter an upbeat nystagmus presented postoperatively. Case report A 42-year old man presented with sudden-onset nausea, vomiting, vertigo, blurred vision, marked imbalance and difficulty swallowing. Neurological evaluation showed bilateral ataxia, generalized hyperreflexia with left-sided predominance, predominantly horizontal gaze evoked nystagmus on right and left gaze, slight left labial asymmetry, uvula deviation to the right, and tongue deviation to the left. MRI demonstrated a 13-mm cavernoma with haemorrhage and oedema in the medulla oblongata. Surgery was performed via a minimal-invasive, midline approach. Complete excision was confirmed on postoperative MRI. The patient recovered well and became almost neurologically intact. However, he complained of mainly vertical oscillopsia. The videonystagmography revealed a new-onset spontaneous upbeat nystagmus in all gaze directions, not suppressed by fixation. An injury of the rarely described intercalatus nucleus/nucleus of Roller is thought to be the cause. Conclusion Upbeat nystagmus can be related to several lesions of the brainstem, including the medial longitudinal fasciculus, the pons, and the dorsal medulla. To our knowledge, this is the first case of an iatrogenic lesion of the nucleus intercalatus/nucleus of Roller resulting in an upbeat vertical nystagmus. For neurologists, it is important to be aware of the function of this nucleus for assessment of clinical manifestations due to lesions within this region.

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Collaural fistula (Work Type II first branchial cleft anomaly) with prolonged morbidity: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211014515 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110145

Author(s):

Dorji Penjor ◽

Morimasa Kitamura

Keyword(s):

External Auditory Canal ◽

Fistulous Tract ◽

Type Ii ◽

Complete Excision ◽

Incision And Drainage ◽

Branchial Cleft ◽

Repeated Infections ◽

Branchial Anomalies ◽

Work Type

Collaural fistula is a very rare Work Type II first branchial cleft anomaly in which there is a complete fistulous tract between external auditory canal and the neck. Misdiagnosis and mismanagement can lead to prolonged morbidity and complications due to repeated infections. We present a case of an 18-year-old lady with a recurrent discharging sinus on her neck for 4 years. She has been treated with repeated incision and drainage and multiple antibiotics in the past. Otoscopic examination revealed an opening on the floor of the left external auditory canal. A diagnosis of an infected collaural fistula was made. Complete excision of the fistulous tract was done after treatment of the active infection. On follow-up, there was no further recurrence at 1 year. Sound knowledge of embryology of branchial anomalies with good history and examination is important to make correct and early diagnosis to prevent morbidity.

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Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718767 ◽

2020 ◽

Author(s):

Ravi Sankar Manogaran ◽

Raj Kumar ◽

Arulalan Mathialagan ◽

Anant Mehrotra ◽

Amit Keshri ◽

...

Keyword(s):

Skull Base ◽

Surgical Approach ◽

Nerve Palsy ◽

Tertiary Care ◽

Surgical Approaches ◽

Microsurgical Anatomy ◽

Complete Excision ◽

Lateral Skull Base ◽

The Individual ◽

Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

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Endoscopy-assisted removal of periorbital inclusion cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds10332 ◽

2011 ◽

Vol 7 (2) ◽

pp. 161-164 ◽

Cited By ~ 5

Author(s):

George Chater-Cure ◽

Caitlin Hoffman ◽

Jared Knopman ◽

Samuel Rhee ◽

Mark M. Souweidane

Keyword(s):

High Speed ◽

Complete Removal ◽

Skin Incision ◽

Clinical Findings ◽

Complete Excision ◽

Alternative Approach ◽

Cyst Recurrence ◽

Scalp Incision ◽

Access Technique

Object Surgical treatment for periorbital inclusion cysts typically involves a brow, pterional, or partial bicoronal scalp incision for sufficient exposure. The authors have recently employed an endoscopy-assisted technique as an alternative approach intended to minimize the length of the skin incision and avoid scarring in the brow. Methods Children having typical clinical findings of a dermoid cyst located on the hairless forehead were selected to undergo endoscopy-assisted cyst removal. For suspected intradiploic lesions, MR imaging was used to assess osseous involvement. After induction of general anesthesia, a 1–2-cm curvilinear incision was made posterior to the hairline. A 30°-angled endoscope (4 mm) was then used for dissection in the subgaleal compartment. Subgaleal dissection was followed by a circumferential periosteal incision in which the authors used an angled needle-tip unipolar cautery. For lesions within the diploe, a high-speed air drill was used to expose the lesion. Complete removal was accomplished with curettage of either the skull or dural surface. Results Eight patients (5–33 months of age) underwent outpatient endoscopic resection. Seven cysts were extracranial, and 1 cyst extended through the inner table. In all patients complete excision of the cyst was achieved. There was negligible blood loss, no dural violation, and no postoperative infection. There have been no recurrences at a mean follow-up of 15 months. Conclusions Endoscopy-assisted resection of inclusion cysts of the scalp and calvaria is a safe and effective surgical approach. The technique results in negligible incisions with less apparent scarring compared with previously described incisions. This limited-access technique does not appear to be associated with a higher incidence of cyst recurrence.

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Hybrid treatment of fibroadipose vascular anomaly: A case report

Open Medicine ◽

10.1515/med-2020-0228 ◽

2020 ◽

Vol 15 (1) ◽

pp. 890-897

Author(s):

Francesco Stillo ◽

Federica Ruggiero ◽

Antonio De Fiores ◽

Rita Compagna ◽

Bruno Amato

Keyword(s):

Patient Satisfaction ◽

Vascular Anomaly ◽

Rare Type ◽

Complete Excision ◽

Hybrid Treatment ◽

Constant Pain ◽

Additional Surgery ◽

Ethanol Embolization

AbstractBackgroundFirst identified in 2014, fibroadipose vascular anomaly (FAVA) is a very rare type of venous and lymphatic malformation. Marked by tough fibrofatty tissue in the extremities overtaking portions of the muscles, it is associated with constant pain and contracture of the affected extremity. There is a paucity of literature, and no guidelines on treatment procedure are available. This case highlights the role of hybrid treatment with primary ethanol percutaneous ethanol embolization and additional surgery for radicality in excision of FAVA lesions.Case summaryA 9-year-old girl with FAVA underwent the hybrid treatment. The achievements of complete excision, clinical response, and patient satisfaction in long-term follow-up were assessed. Following the hybrid treatment, the patient experienced significant improvement in pain. Concurrent symptoms of physical limitation, leg swelling, and skin hyperesthesia also improved. The clinical benefit, supported by postoperative physiotherapy, was well stabilized at 6-month follow-up, resulting in complete patient satisfaction at 12- and 36-month follow-ups. No major complications were encountered.ConclusionEthanol embolization plus surgery is a safe, effective, and long-term hybrid treatment of symptomatic FAVA lesions.

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A Challenging Case of a Physeal Bar Endoscopic-Assisted Resection in a Short Stature Child: Case Report and Literature Review

Case Reports in Orthopedic Research ◽

10.1159/000516769 ◽

2021 ◽

pp. 115-120

Author(s):

Melanie Ribau ◽

Mário Baptista ◽

Nuno Oliveira ◽

Bruno Direito Santos ◽

Pedro Varanda ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Short Stature ◽

Clinical Presentation ◽

Normal Growth ◽

Limb Length Discrepancy ◽

Complete Excision ◽

Physeal Bar ◽

Surgical Options ◽

The Ideal

Partial physeal bars may develop after injury to the growth plate in children, eventually leading to disturbance of normal growth. Clinical presentation, age of the patient, and the anticipated growth will dictate the best treatment strategy. The ideal treatment for a partial physeal bar is complete excision to allow growth resumption by the remaining healthy physis. There are countless surgical options, some technically challenging, that must be weighted according to each case’s particularities. We reviewed the current literature on physeal bars while reporting the challenging case of a short stature child submitted to a femoral physeal bar endoscopic-assisted resection with successful growth resumption. This case dares surgeons to consider all options when treating limb length discrepancy, such as the endoscopic-assisted resection which might offer successful results.

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Thyroglossal Duct Cyst Papillary Carcinoma With Airway Compromise

Ear Nose & Throat Journal ◽

10.1177/01455613211022077 ◽

2021 ◽

pp. 014556132110220

Author(s):

Po-Kai Huang ◽

Li-Chun Hsieh ◽

Yi-Shing Leu

Keyword(s):

Symptom Relief ◽

Thyroid Tissue ◽

Neck Mass ◽

Thyroglossal Duct Cyst ◽

Ectopic Thyroid ◽

Airway Compromise ◽

Duct Cyst ◽

Complete Excision ◽

Thyroglossal Duct ◽

Ectopic Thyroid Tissue

Thyroglossal duct cysts are typically benign and usually asymptomatic. Malignant transformation is uncommon. Intralaryngeal extension is rare and results in dysphonia or dyspnea. There is no literature nowadays reporting the thyroglossal duct cyst carcinoma combining the clinical features of intralaryngeal extension. The authors present a case of progressive hoarseness and midline neck mass for 2 years. The laryngoscope and computed tomography revealed a 6-cm thyroglossal duct cyst containing ectopic thyroid tissue with intralaryngeal extension and causing airway obstruction. Complete excision with Sistrunk operation revealed papillary thyroid carcinoma. The patient resumed normal phonation after the surgery. There was no evidence of tumor recurrence and no hoarseness or dyspnea at 6 months follow up. This is the first reported case of a huge thyroglossal duct cyst carcinoma with intralaryngeal extension causing airway compromise. Complete excision of tumor is essential and vital to the symptom relief. A thyroglossal duct cyst carcinoma with endolaryngeal involvement should be considered in the differential diagnosis when the case has a massive midline neck mass with ectopic thyroid tissue and develops dyspnea or hoarseness concurrently.

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A Case Report on Frontal Osteoma

Pulse ◽

10.3329/pulse.v9i1.31881 ◽

2017 ◽

Vol 9 (1) ◽

pp. 45-48

Author(s):

MR Molla ◽

F Ferdousi ◽

DR Shankar ◽

AKMB Karim

Keyword(s):

Case Report ◽

Frontal Lobe ◽

Frontal Sinus ◽

Clinical Findings ◽

Complete Excision ◽

Tumor Mass ◽

The Right ◽

Orbital Region

A 13 years old boy admitted with the complaint of progressive exophthalmos and gradually decreasing vision on right eye, also occasional headache and deformity on the right fronto-orbital region. Radiological & clinical findings revealed a case of frontal osteoma in the right frontal sinus extending up to right frontal lobe, eroding right roof of the orbit. Complete excision of the tumor mass was possible surgically. Biopsy confirmed a case of osteoma. Below is a discussion on diagnosis & management of frontal osteomaPulse Vol.9 January-December 2016 p.45-48

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Endometriosis of the Inguinal Canal Mimicking a Hydrocele of the Canal of Nuck

Case Reports in Surgery ◽

10.1155/2020/8849317 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Oshan Basnayake ◽

Umesh Jayarajah ◽

Sanjeewa Anuruddha Seneviratne

Keyword(s):

Inguinal Canal ◽

Imaging Findings ◽

Complete Excision ◽

Canal Of Nuck ◽

Healthy Female

Isolated presentation of endometriosis of the inguinal canal is infrequent, and the clinical and imaging findings may be misleading in such patients. We describe an otherwise healthy female with isolated inguinal endometriosis presenting as a hydrocele of the canal of Nuck. Surgeons should consider such unusual presentations and obtain imaging and histological evaluations in doubtful instances. Complete excision was curative in our patient with no evidence of recurrence.

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