scholarly journals Surgical Approach to Orbital Floor Fractures: Comparing Complication Rates Between Subciliary and Subconjunctival Approaches

2020 ◽  
Vol 13 (1) ◽  
pp. 45-48
Author(s):  
Joel A. Bronstein ◽  
William J. Bruce ◽  
Fadi Bakhos ◽  
Dalia Ishaq ◽  
Cara J. Joyce ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Complication Rate ◽  
Patient Characteristics ◽  
Orbital Floor ◽  
Study Patient ◽  
Complication Rates ◽  
Postoperative Complication Rate ◽  
Corneal Injury ◽  
Orbital Floor Fractures ◽  
Orbital Floor Reconstruction

Background: There are multiple approaches to repairing orbital floor fractures. This study compares the postoperative complications of the subciliary and transconjunctival approaches. Methods: The electronic medical records from 2 hospitals were screened for CPT codes associated with orbital floor reconstruction. A total of 184 patients were identified and included in the study. Patient characteristics and complications were compared by surgical approach. Results: Of the 184 patients, 82 (44.6%) were in the subciliary group and 102 (55.4%) were in the transconjunctival group. The overall postoperative complication rate was 25.5%. The most common of these were diplopia (11.4%), corneal injury (7.1%), proptosis (5.4%), and enopthalmos (4.9%). The complication rate was not statistically significant between the 2 groups. Conclusion: Subciliary and transconjunctival approaches to orbital floor repair are equally safe. This study is limited by a smaller sample size, and a larger study will likely be necessary to fully address this question.

scholarly journals ORBITAL FLOOR RECONSTRUCTION WITH TITANIUM MESH;

2014 ◽  
Vol 21 (03) ◽  
pp. 575-579
Author(s):  
Muhammad Usman Khalid ◽  
Arshad Mahmood Malik ◽  
Omer Sefvan Janjua
Keyword(s):  
Study Design ◽  
Complication Rate ◽  
Maxillofacial Surgery ◽  
Male Gender ◽  
Orbital Floor ◽  
Titanium Mesh ◽  
No Donor ◽  
Orbital Floor Fractures ◽  
Orbital Floor Reconstruction ◽  
Infraorbital Rim

Objective: To determine the outcome of orbital floor reconstruction with titaniummesh in terms of diplopia, enophthalmos, dystopia and infection etc. Study design: Descriptivecase series. Place & duration of study: Department of Oral & Maxillofacial Surgery, PunjabMedical College / Allied Hospital Faisalabad. One and Half year from 01-10-12 to 31-03-14.Material and Method: Twenty two patients clinically and radiographically having defect in theorbital floor due to trauma were included in the study. Titanium mesh was used to reconstruct theorbital floor through infraorbital rim incision and secured in place with 5mm micro screws. Thevariables to be analyzed were diplopia, enophthalmos, orbital dystopia and infection. Results: Inour study male gender predominates over female 20/22. Mean age of patients is 29.36 years ±5.21. Diplopia persisted in 2/10 (20%) patients. Enophthalmos persisted in 7/18 (38.8%) patients.dystopia persisted in ¼ (25%) patients. Infection didn’t develop in any of our patient (0%). Visualacuity was not affected in any of the patient (0%). Conclusions: Titanium mesh is a suitablematerial for reconstruction of orbital floor fractures with little complication rate and no donor sitemorbidity.

scholarly journals Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
M. D. Filipe ◽  
E. de Bock ◽  
E. L. Postma ◽  
O. W. Bastian ◽  
P. P. A. Schellekens ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Complication Rate ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Complication Rates ◽  
Flap Necrosis ◽  
Postoperative Complication Rate ◽  
Common Cancer ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

AbstractBreast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

scholarly journals The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review

Medicines ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 6
Author(s):  
Akash Sivam ◽  
Natalie Enninghorst
Keyword(s):  
Disease Transmission ◽  
Narrative Review ◽  
Orbital Floor ◽  
Alloplastic Materials ◽  
Complex Anatomy ◽  
Orbital Floor Fractures ◽  
Orbital Floor Reconstruction ◽  
Material Choice ◽  
Properties Of Materials ◽  
Catastrophic Disease

The aim of this study is to present a narrative review of the properties of materials currently used for orbital floor reconstruction. Orbital floor fractures, due to their complex anatomy, physiology, and aesthetic concerns, pose complexities regarding management. Since the 1950s, a myriad of materials has been used to reconstruct orbital floor fractures. This narrative review synthesises the findings of literature retrieved from search of PubMed, Web of Science, and Google Scholar databases. This narrative review was conducted of 66 studies on reconstructive materials. Ideal material properties are that they are resorbable, osteoconductive, resistant to infection, minimally reactive, do not induce capsule formation, allow for bony ingrowth, are cheap, and readily available. Autologous implants provide reliable, lifelong, and biocompatible material choices. Allogenic materials pose a threat of catastrophic disease transmission. Newer alloplastic materials have gained popularity. Consideration must be made when deliberating the use of permanent alloplastic materials that are a foreign body with potential body interactions, or the use of resorbable alloplastic materials failing to provide adequate support for orbital contents. It is vital that surgeons have an appropriate knowledge of materials so that they are used appropriately and reduce the risks of complications.

scholarly journals Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Sarah Neu ◽  
Jennifer Locke ◽  
Mitchell Goldenberg ◽  
Sender Herschorn
Keyword(s):  
Patient Characteristics ◽  
Urethral Diverticulum ◽  
Pelvic Surgery ◽  
Study Patient ◽  
Complication Rates ◽  
Urethrovaginal Fistula ◽  
Fascial Sling ◽  
Significant Difference ◽  
Sling Placement

Introduction: We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. Methods: All patients diagnosed with UVF at our center from 1988–2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. Results: A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35–62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4–72). Conclusions: UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.

To biopsy or to not biopsy, that is the question: A single-center retrospective analysis of outcomes of liver biopsy with hepatocellular carcinoma and other liver diseases.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16606-e16606
Author(s):  
Sophia Seo-hyeon Lee ◽  
Wei Yang ◽  
Julie Haewon Rowe
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Biopsy ◽  
Complication Rate ◽  
Liver Diseases ◽  
Patient Characteristics ◽  
Bleeding Complications ◽  
Complication Rates ◽  
Tumor Seeding ◽  
Biopsy Complications

e16606 Background: Unlike other malignancies, hepatocellular carcinoma (HCC) is most often diagnosed radiologically, based on previous studies suggesting complication rates of 1.4%-3.4% (e.g., bleeding) and concerns regarding “tumor seeding.” Lack of tissue for analysis has led to a lag in understanding the molecular biology of HCC. Molecular characterization of biopsies may allow HCC subtyping in order to personalize medicine, thus the potential of liver biopsy’s safety and utility needs to be reassessed. Methods: We performed a retrospective review of patients who underwent biopsy for suspected HCC or other liver diseases between Jan 1, 2010 and Jan 1, 2020. Demographics and clinical data including comorbidities, renal function, ascites, hepatic encephalopathy, varices, and labs including hemoglobin, WBC, platelets, sodium, creatinine, liver function test and coagulation studies were collected. Child Pugh (CP) and MELD-Na scores were calculated. Adherent medications at the time of biopsy and type of biopsy with any complications were included. Results: A total of 427 patients underwent liver biopsy. Patient characteristics are given in the table. Most patients (97%) underwent core needle biopsy. Biopsy complication rate was 1.23% (n = 5); these included bleeding (80%, n = 4), hospitalization (60%, n = 3), infection (20%, n = 1), and death (20%, n = 1). In the 5 patients, increased creatinine was associated with bleeding complications; however, one patient was on dialysis (Cr = 11.20), and this should be interpreted with caution. Existing comorbidities, concurrent medication use (including anticoagulants), CP and MELD-NA score, and lab findings were not associated with biopsy complications. Conclusions: To our knowledge, this review is first to demonstrate a low complication rate of 1.23% in suspected HCC patients who underwent liver biopsy in the current era of improved radiological techniques. This is consistent with historical data in liver disease patients. Comorbidities, being on anticoagulants, CP and MELD scores do not predict for biopsy complications. Higher creatinine was associated with more complications, but this needs to be examined in a larger study. Biopsy should be considered a valuable tool in understanding the molecular profiles of HCC, which could lead to more novel treatment. [Table: see text]

scholarly journals Blowout Fracture in a 3-Year-Old

2013 ◽  
Vol 6 (2) ◽  
pp. 133-136 ◽  
Author(s):  
Britt I. Pluijmers ◽  
Maarten J. Koudstaal ◽  
Dion Paridaens ◽  
Karel G.H. van der Wal
Keyword(s):  
Young Children ◽  
Surgical Planning ◽  
Clinical Symptoms ◽  
Orbital Floor ◽  
Conservative Approach ◽  
Transconjunctival Approach ◽  
Blowout Fracture ◽  
Fractures In Children ◽  
Orbital Floor Fractures ◽  
Orbital Floor Reconstruction

A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed through a transconjunctival approach. This case highlights the rarity of pure blowout fractures in young children. The specific presentation and diagnostics of orbital floor fractures in children and the related surgical planning and intervention are discussed.

scholarly journals Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization

2019 ◽  
Vol 30 (3) ◽  
pp. 308-313 ◽  
Author(s):  
Julia Onken ◽  
Kathrin Obermüller ◽  
Franziska Staub-Bartelt ◽  
Bernhard Meyer ◽  
Peter Vajkoczy ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Complication Rate ◽  
Posterior Approach ◽  
Surgical Complication ◽  
Extent Of Resection ◽  
Surgical Approaches ◽  
Special Focus ◽  
Complication Rates ◽  
Duration Of Surgery ◽  
Spinal Meningiomas

OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.

scholarly journals Indwelling pleural catheters for malignancy-associated pleural effusion: report on a single centre’s ten years of experience

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nikolaj Frost ◽  
Martin Brünger ◽  
Christoph Ruwwe-Glösenkamp ◽  
Matthias Raspe ◽  
Antje Tessmer ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Symptom Relief ◽  
Large Population ◽  
Patient Characteristics ◽  
Definitive Treatment ◽  
Study Patient ◽  
Complication Rates ◽  
Sclerosing Agents ◽  
Gynaecologic Cancer ◽  
Favourable Safety Profile

Abstract Introduction Recurrent pleural effusion is a common cause of dyspnoea, cough and chest pain during the course of malignant diseases. Chemical pleurodesis had been the only definitive treatment option until two decades ago. Indwelling pleural catheters (IPC) emerged as an alternative, not only assuring immediate symptom relief but also potentially leading to pleurodesis in the absence of sclerosing agents. Methods In this single-centre retrospective observational study patient characteristics, procedural variables and outcome in a large population of patients with IPC in malignancy were evaluated and prognostic factors for pleurodesis were identified. Results From 2006 to 2016, 395 patients received 448 IPC, of whom 121 (30.6%) had ovarian, 91 (23.0%) lung and 45 (11.4%) breast cancer. The median length of IPC remaining in place was 1.2 months (IQR, 0.5–2.6), the median survival time after insertion 2.0 months (IQR, 0.6–6.4). An adequate symptom relief was achieved in 94.9% of all patients, with no need for subsequent interventions until last visit or death. In patients surviving ≥30 days after IPC insertion, pleurodesis was observed in 44.5% and was more common in patients < 60 years (HR, 1.72; 95% CI, 1.05–2.78; p = 0.03). The use of an additional talc slurry via the IPC was highly predictive for pleurodesis (HR 6.68; 95% CI, 1.44–31.08; p = 0.02). Complications occurred in 13.4% of all procedures (n = 60), 41.8% concerning infections (local infections at the tunnel/exit site (n = 14) and empyema (n = 11)), and 98.3% being low or mild grade (n = 59). Complication rates were higher in men than women (18.6 vs. 12.4%, p = 0.023). Conclusion High efficacy in symptom relief and a favourable safety profile confirm IPC as suitable first line option in most malignant pleural effusions. The study presents the largest dataset on IPC in gynaecologic cancer to date. Gender-specific differences in complication rates warrant further study.

scholarly journals C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures—a comparative retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Eva Steinhausen ◽  
Wolfgang Martin ◽  
Rolf Lefering ◽  
Sven Lundin ◽  
Martin Glombitza ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Complication Rate ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Matched Pairs ◽  
Calcaneal Fractures ◽  
Postoperative Complication Rate ◽  
Wound Edge

Abstract Background Locking plate osteosynthesis via an L-shaped lateral approach is the gold standard in treating displaced intra-articular calcaneal fractures. High complication rates are known for this approach. The most frequent complications are wound edge necrosis and superficial wound infections. To reduce complication rates, a locking intramedullary nail (C-Nail) was developed that can be implanted minimally invasively via a sinus tarsi approach. We compared the postoperative complication rate and the outcome of plate osteosynthesis versus C-Nail in displaced intra-articular calcaneal fractures. Methods All patients with calcaneal fractures who received osteosynthesis with either plate or C-Nail between January 2016 and October 2019 in our institution were retrospectively analyzed. A subgroup analysis was performed with matched pairs (matching Sanders type, age, Böhler’s angle postoperative in normal range, 33 pairs). Endpoints were postoperative complication rate, bone healing, full weight-bearing and functional outcome. Treatment groups were compared using Fisher’s exact test for binary data, and Mann-Whitney U-test for continuous data. A p-value < 0.05 was considered statistically significant. Results One hundred and one calcaneal fractures were included (C-Nail n = 52, plate n = 49). Patients with C-Nail developed significantly less postoperative complications (p = 0.008), especially wound edge necrosis (p < 0.001). Screw malposition was found more often in the C-Nail group. The rates of achieving full weight-bearing as well as bone healing were comparable in both groups, but in each case significant faster in the C-nail subgroup. The results of the matched-pairs analysis were comparable. Conclusions The postoperative complication rate was significantly lower in the C-Nail group. The C-Nail appears to be a successful alternative in the treatment of calcaneal fractures, even in Sanders IV fractures because of the minimal-invasive implantation as well as the high primary stability. Long-term analysis of this new implant including elaboration on functional outcome is planned. Trial registration Deutsches Register Klinischer Studien (DRKS) DRKS00020395. Date of registration 3 January 2020.

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