scholarly journals Teardrop Fracture of the Axis: An Evaluation of Vertebral Instability and Individualized Treatment

2021 ◽  
Author(s):  
Xin Xin ◽  
Chen Yue ◽  
Guoqing Li ◽  
Xinxin Liu
Keyword(s):  
Vertebral Body ◽  
Treatment Process ◽  
Treatment Plan ◽  
Individualized Treatment ◽  
Avulsion Fractures ◽  
Disease Characteristics ◽  
Prevertebral Soft Tissue ◽  
Teardrop Fracture ◽  
The Stability ◽  
Classification And Treatment

Abstract Background: Teardrop fractures of the axis (TDFAs) are avulsion fractures of the anterior-inferior part of the axis. Whether conservative or surgical treatment is better for TDFAs is controversial. Previously, image-based evaluations of the fractures have mainly focused on the teardrop fragment, the intervertebral disc and the prevertebral soft tissue. The treatment plan depends on the doctor's evaluation of fracture stability based on personal experience. Methods: From January 2012 to December 2018, a total of 12 patients with TDFA were included in this prospective study. The stability of the TDFA vertebral body was evaluated by lateral X-ray measurements. Based on the evaluation of vertebral body stability, as well as the disease characteristics of the patients, individualized treatment schemes were adopted. Results: Through the classification and treatment process, 6 patients with absolute instability and 6 patients with relative instability were identified. A total of 8 patients underwent surgery, and 4 patients were treated conservatively. A total of 12 patients finally achieved osseous fusion. Conclusion: The treatment for TDFA should be determined by considering both the instability of the axial vertebra and the disease characteristics of the patient. With an appropriate classification and treatment process, both surgery and conservative treatment can yield good clinical outcomes.

Facial Esthetics Classification and Gingival Pigmentation Index of Treatment Needs

2019 ◽  
Vol 11 (1) ◽  
pp. 77-88
Author(s):  
Puzhankara Lakshmi ◽  
Menon Sai Megha ◽  
Suresh Reshma
Keyword(s):  
Indian Population ◽  
Treatment Plan ◽  
Specific Treatment ◽  
Treatment Modalities ◽  
Treatment Needs ◽  
Complete Coverage ◽  
Facial Esthetics ◽  
Comprehensive Classification ◽  
Precise Assessment ◽  
Classification And Treatment

Background : The Indian population shows an extensive range of gingival pigmentation. A detailed description of the gingival pigmentation pattern would provide data for the formulation of an efficient plan for depigmentation. This article gives a novel comprehensive classification to aid in the precise assessment of the pattern and distribution of gingival pigmentation and decision regarding the methods for depigmentation. Methods : Previously existing, established indices and classifications for degree of pigmentation, facial complexion, smile line, lip colour and their modifications were used to differentiate various categories of Esthetics: Esthetic, Unaesthetic-mild, Unaesthetic-severe. Treatment needs were formulated based on the category of Esthetics. Results : The various categories of esthetics include E (Esthetic), M (Unaesthetic-Mild), N (UnaestheticSevere) and specific treatment modalities have been assigned based on the treatment needs. Discussion : The treatment for gingival pigmentation should be based on overall facial esthetics. The classification given in this article takes into consideration the components of facial esthetics: Facial Pigmentation, Degree and distribution of gingival pigmentation, smile line and lip colour. The treatment plan proposed considers the need for the treatment and the possible treatment for each category of esthetics. Conclusion : The classification proposed in this article attempts a complete coverage of combinations of facial esthetic components and the Treatment Index encompasses all the possible treatment modalities for each combination. Although a learning curve might exist, once mastered, the classification and treatment index would serve as a baseline for determining treatment needs in patients with gingival pigmentation.

CU-SIL DENTURE AS A TRANSITIONAL PROSTHESIS TO PRESERVE THE REMAINING NATURAL TEETH USING PERMANENT SILICONE LINER

2021 ◽  
Vol 17 (2) ◽  
pp. 69-73
Author(s):  
Manu Rathee ◽  
◽  
Divakar S ◽  
Sujata Chahal ◽  
Sandeep Singh
Keyword(s):  
Alternative Treatment ◽  
Case Reports ◽  
Treatment Plan ◽  
Alveolar Ridge ◽  
Psychological Benefits ◽  
Missing Teeth ◽  
Denture Base ◽  
Natural Teeth ◽  
Set Up ◽  
The Stability

The goal of modern dentistry is to be conservative, preserving teeth but also maintaining the stability of the remaining alveolar ridge and the periodontium's proprioceptive capabilities. Cu-sil denture is the simplest approach in the preservation of teeth and maintaining proprioception. It is a type of transitional denture that provides an alternative treatment plan for the patients willing to replace their missing teeth while retaining their remaining natural teeth. It gives potential psychological benefits to the patients by avoiding extractions. It's a tissue-bearing acrylic appliance with a soft viscoelastic wrap that clasps the neck of each dentition, sealing out food and water simultaneously protecting and splinting each remaining tooth from the rigid acrylic denture base. This case reports series describes chairside techniques to fabricate Cu-sil dentures in the usual dental set-up

Clinical features of the extension teardrop fracture of the axis: review of 13 cases

2011 ◽  
Vol 14 (6) ◽  
pp. 710-714 ◽  
Author(s):  
Masahiko Watanabe ◽  
Daisuke Sakai ◽  
Yukihiro Yamamoto ◽  
Masato Sato ◽  
Joji Mochida
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Clinical Features ◽  
Neurological Deficit ◽  
Spinal Injury ◽  
High Energy ◽  
Presenting Symptoms ◽  
Upper Cervical ◽  
Prevertebral Soft Tissue ◽  
Teardrop Fracture

Object Extension teardrop fracture of the axis is an extremely rare cervical spinal injury. The classic clinical features, which have mainly been described by radiologists rather than spine surgeons, include its occurrence in elderly patients with osteoporosis, an association with minimal or no prevertebral soft-tissue swelling, and an absence of associated neurological deficit. However, recent case studies indicate notable exceptions to these clinical features, although few studies have investigated osteoporosis in these patients. The purpose of the present study was to clarify the clinical features of extension teardrop fracture of the axis. Methods The authors retrospectively reviewed data obtained in 13 patients with regard to their injury etiology, neurological deficit, treatment and outcome (residual neck pain), and imaging findings (size and displacement of the fragment, C2–3 subluxation, disc injury, and osteoporosis of the axis). Results Extension teardrop fracture of the axis constituted 11.6% of upper cervical spinal injuries at the authors' institute. The mean age of the patients was 49.5 years and distinct osteoporosis was identified in only 1 patient. A C2–3 subluxation was observed in 2 patients, in whom the displacement of the fragment was significant, although its size did not appear to have an effect. Magnetic resonance imaging, undertaken in 7 patients within 48 hours of injury, showed no disc injuries. Instability of the cervical spine was absent in all patient at follow-up. Only one patient underwent surgery for the presenting symptoms of dysphagia. The other patients were treated conservatively. The authors examined 9 patients directly; these patients had bony fusion and did not complain of neck pain, except for a patient with traumatic spondylolisthesis. Conclusions Extension teardrop fracture of the axis is generally caused by hyperextension of the cervical spine caused by a direct high-energy blow to the forehead or mandible. Based on the present case study, the authors believe that osteopenia and older age should not be considered risk factors. Most patients with an extension teardrop fracture of the axis can be treated conservatively, and surgical intervention may only be indicated for specific cases, such as those in which a patient presents with dysphagia or with other complicated fractures.

scholarly journals Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Lauren Surdyke ◽  
Jennifer Fernandez ◽  
Hannah Foster ◽  
Pamela Spigel
Keyword(s):  
Traumatic Brain Injury ◽  
Differential Diagnosis ◽  
Brain Injury ◽  
Treatment Plan ◽  
Inpatient Rehabilitation ◽  
Individualized Treatment ◽  
Rehabilitation Team ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Comprehensive Therapy

Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

scholarly journals Mechanical Properties and Clinical Significance of Orthodontic Wires

2022 ◽  
Author(s):  
Mohamed Ali Sawas ◽  
Mohammed Ahmed Al Nassir ◽  
Lojain Mohammed Nayas ◽  
Meshari Nasser Alabdulkarim ◽  
Farah Youssef Faden ◽  
...  
Keyword(s):  
Orthodontic Treatment ◽  
Treatment Process ◽  
Tooth Movement ◽  
Treatment Plan ◽  
Chemical Properties ◽  
Clinical Applications ◽  
Orthodontic Wires ◽  
Adequate Knowledge ◽  
Orthodontic Wire ◽  
Fixed Appliances

Orthodontic treatment is usually conducted by applying forces to certain teeth to move them into a targeted position. Orthodontic wires have been reported to be the primary modalities used in fixed-appliances-based orthodontic treatment to induce favorable tooth movement events. Accordingly, acquiring adequate knowledge about these approaches' clinical applications and biochemical behavior is essential when planning for a successful orthodontic treatment. Orthodontic wires are widely used and are mainly composed of composites, polymers, alloys and metals. Accordingly, the physical properties and clinical application of orthodontic wires vary based on their composition. In this context, it was recommended that achieving favorable outcomes of orthodontic treatment obliges clinicians to decide the best orthodontic wire and treatment plan based on the chemical properties and related clinical applications of each wire. Therefore, wires that tend to produce increasing stiffness gradually are generally used. However, it should be noted that no ideal wire exists. Therefore, favoring the application of a wire over the other should be based on the intended outcomes and stage of the treatment process. 

scholarly journals CLRM-06. COMPARISON OF INDIVIDUALIZED ANTI-CANCER THERAPY REGIMENS RECOMMENDED BY A MULTIDISCIPLINARY MOLECULARLY-DRIVEN TUMOR BOARD IN A PEDIATRIC DIPG CLINICAL TRIAL (PNOC003) VERSUS THOSE SELECTED BY THE CNS-TAP TOOL

2021 ◽  
Vol 3 (Supplement_4) ◽  
pp. iv2-iv2
Author(s):  
Holly Roberts ◽  
Karthik Ravi ◽  
Allison Schepers ◽  
Bernard Marini ◽  
Cassie Kline ◽  
...  
Keyword(s):  
Anticancer Agents ◽  
Treatment Plan ◽  
Pilot Trial ◽  
Study Participant ◽  
Molecular Profiling ◽  
Individualized Treatment ◽  
Tumor Board ◽  
Treatment Recommendation ◽  
Patient Specific ◽  
Genomic Profiling

Abstract Genetic sequencing of diffuse intrinsic pontine gliomas (DIPG) has revealed genomic heterogeneity, fueling an interest in individualized targeted therapies. A feasibility study, PNOC003: Molecular Profiling for Individualized Treatment Plan for DIPG (NCT02274987), was completed within the Pacific Pediatric Neuro-Oncology Consortium in which a multidisciplinary tumor board reviewed molecular and genomic profiling of each participant’s tumor to make targeted therapy recommendations. Separately, our team developed the Central Nervous System Targeted Agent Prediction (CNS-TAP) tool, which combines pre-clinical, clinical, and CNS penetration data with patient-specific genomic information to derive numeric scores for anticancer agents to objectively evaluate these therapies for use in patients with CNS tumors. We hypothesized that agents highly-scored by CNS-TAP would overlap with agents recommended by the PNOC003 tumor board. For each study participant, we retrospectively utilized the genomic profiling report to identify actionable alterations and incorporated these data into CNS-TAP to find the highest-scoring agents. We compared these CNS-TAP-recommended agents with recommendations from the tumor board for each of the 28 PNOC003 participants. Overall, 93% of patients (26/28) had at least one agent recommended by both the tumor board and CNS-TAP. Additionally, 38% of all agents (36/95) chosen by the tumor board were also selected by CNS-TAP. When only molecularly targeted anticancer agents were included in a sub-analysis, 60% of agents (34/57) were recommended by both methods. At present, we are prospectively evaluating the CNS-TAP tool within PNOC008: A Pilot Trial Testing the Clinical Benefit of Using Molecular Profiling to Determine an Individualized Treatment Plan in Children and Young Adults with High-Grade Glioma (NCT03739372). The CNS-TAP tool recommendations are shared during the PNOC008 molecular tumor board meetings once a consensus treatment recommendation has been reached. Subsequent analyses will focus on any adjustments in therapy decisions within the tumor board that result from the CNS-TAP tool output.

OPRM1 influence on and effectiveness of an individualized treatment plan for prescription opioid use disorder patients

2018 ◽  
Vol 1425 (1) ◽  
pp. 82-93 ◽  
Author(s):  
Javier Muriel ◽  
César Margarit ◽  
Beatriz Planelles ◽  
María J. Serralta ◽  
Carmen Puga ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Opioid Use Disorder ◽  
Individualized Treatment ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use
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