Use of External Approach for Severe Genu Valgo Knee Arthroplasty

The deformities of the lower limbs (genu valgus and genu varus) are alterations frequently developed properly by physiological processes which usually disappear at 2 years (genu varus) and at 7-8 years (genu valgus), being considered in adults normal a 4º-6º genu valgus, however the appearance of the latter is also related to various metabolic pathologies, tumors, traumatic sequelae, infections, skeletal dysplastic and idiopathic genu valgus. In the bibliography, there is a greater consensus on the approach to varus deformity, not so in valgus deformities, where there is no bibliography with a level of evidence that defines established protocols to treat severe valgus deformities>20, currently good treatment results have been demonstrated by means of knee arthroplasty to correct genu valgus deformities, which showed good results in the alignment of the lower extremities through the balance of ligaments in patients with severe genu valgus with pain reduction. , improvements in knee function and with a low rate of complications, the use of these alternatives such as the external approach in total knee replacement in patients with severe genu valgus and medial collateral ligament insufficiency allows correcting large deformities using a technique simple and in most cases without the use of a prosthesis that generates a degree of constraint, progressively improving their living conditions.

Congenital Cyst and Fistula of the Dorsum of the Nose: A Case Report and Literature Review

Congenital cyst and fistula of the dorsum of the nose is a rare congenital entity. We report a new case of dorsum nasal fistula in a 5 years old male patient that communicates the frontal region with the subcutaneous surface. Radiologic imaging showed a median 5mm defect, in the projection of the metopic suture that leads to a communication between the frontal region and the skin figure. Complete resection was performed by an external approach with vertical incision of the cyst. The histological diagnosis was consistent with a dermoid fistulized cyst. The follow-up displayed unremarkable finding, the patient did not present any diplopia nor decreased visual acuity, or any signs of meningitis or cerebrospinal fluid rhinorrhoea, or saddle nose.

Use of Propensity Score Matching to Compare Short Outcomes from Transoral and External Surgical Approaches in Patients with Deep-Lobe Parotid Pleomorphic Adenomas

To compare the outcomes of patients who had deep-lobe parotid gland pleomorphic adenomas (PAs) that extended into the parapharyngeal space after surgical treatment, using a transoral approach or an external approach. One hundred and twelve eligible patients, with deep-lobe parotid gland PAs, were enrolled in this retrospective study. The surgical outcomes were compared for patients who received a transoral approach and an external approach, using 1:1 propensity score matching (PSM). The outcome measures were recurrence rate, facial nerve deficit, Frey’s syndrome, and hospitalization time. The median follow-up time was 4.8 years. After PSM, the transoral approach and external approach groups had no statistically significant difference in recurrence (10.3% vs. 3.4%; p = 0.201). The transoral approach group had no facial nerve deficit, but 5 of 29 patients (17.2%) in the external approach group had transient facial nerve paralysis (p = 0.052). The external approach group had a longer hospitalization time than the transoral approach group (5 vs. 4 days, p = 0.0017). The use of a transoral surgical approach to treat patients with deep-lobe parotid gland PAs led to low recurrence, shorter hospitalization times, and good functional and cosmetic outcomes.

Unusual cause of recalcitrant epistaxis

Nosebleeds are among the most familiar presentations to the emergency department as well as otorhinolaryngologic outpatient services. Bleeding from nasal septal branches of the anterior ethmoid artery (AEA) is common and can be effectively controlled endoscopically. However, the bleeding from a pseudoaneurysm involving the nasal septal branches of AEA is extremely rare and can be troublesome to control using endoscopic methods. We report an adult patient presenting with profuse nasal bleeding postroad traffic accident due to the formation of AEA septal branch pseudoaneurysm. The patient required repeated nasal packing, and the diagnosis was revealed using digital subtraction angiography. Since profuse active bleeding precluded endoscopic visualisation, an external approach had to be adopted to ligate the AEA to control the bleeding. We discuss the management options and nuances for this rare cause of the troublesome nasal bleeding.

External Approach to Bilaterally Septated Maxillary Sinuses: A Case Report

The careful planning of a sinus lift procedure is the key to avoiding surgical complications. In this clinical case, a female patient, 59 years old and totally edentulous in the maxilla, was referred to Egas Moniz’s Dental Clinic Implantology consultation with indication for bilateral external sinus lift of the maxillary sinuses prior to implant placement. Both orthopantomography and cone-beam computed tomography were used to show the anatomy of the maxillary sinuses, which presented multiple sinus septa. A multiple anterolateral window approach was applied in order to avoid perforation of the Schneiderian membrane while accessing it.

Unitary dual of p-adic group SO(7) with support on minimal parabolic subgroup

In this paper, the unitary dual of p-adic group SO(7) with support on minimal parabolic subgroup is determined. In explicit determination of the unitary dual the external approach is used, which represents the basic approach for finding the unitary dual, and consists of two main steps: a complete description of the non-unitary dual and the extraction of the classes of unitarizable representations among the obtained irreducible subquotients. We expect that our results will provide deeper insight into the structure of the unitary dual in the general case.

On analysis of some factors of the sustainability of corporate business in the conditions of the covid-19 pandemic

The presented article aims to identify the key factors that can influence the success of sustainable management of corporate structures in a pandemic and post-pandemic state of the business environment. In the practical sphere, the authors set tasks to develop practical methods that can increase the efficiency of cost management in the strategic horizon and form a system of key performance indicators that allows to adequately assess the results of the corporation's activities. According to the authors, this should be done in advance and consider the lessons learned from cost management in the context of the COVID-19 pandemic. The results were obtained while testing the hypothesis about the relationship between the strategic cost management system and the quality of corporate business. This hypothesis is rejected by the external approach to business quality but confirmed by the internal approach to business quality.

Unusual case of congenital fistula between external auditory canal and nasopharynx

<p class="abstract">Defects in the development in the neck area of the embryo result in branchial cleft anomalies. Various first branchial cleft anomalies are described in literature including preauricular sinuses, cysts and collaural fistula. In our case study, we document a very unusual case of fistula between floor of external auditory canal and nasopharynx. Such patient requires thorough evaluation and step-wise approach to treat. After clinical examination and radiological evaluation, surgically the fistula was excised in toto via external approach using Modified Blair’s incision. In our case, fistulous tract was running from external auditory canal to nasopharynx, running superior and medial to the trunk of facial nerve. No such case is found to be reported in literature after extensive search. Hence, it would be strongly advocated to keep this presentation in the differential diagnosis during evaluation. Also, it is worth mentioning and recommending that a careful radiological examination is a must before approaching for surgery.</p>