Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review

Intraorbital tumor could be approached by numerous surgical methods. The neuroendoscopic endonasal approach could provide a feasible corridor for indicated tumors. Herein we present a series of 6 consecutive intraorbital tumors from April 2018 to October 2020, which received endonasal endoscopic resection. Cadaveric dissection was performed for the intraconal approach, and the literature was also reviewed. Five tumors were located intraconally, while one extraconally. The pathology revealed 1 angioleiomyoma, 1 cavernous hemangioma, 1 pilocytic astrocytoma, 1 meningioma, and 2 schwannomas. Five of the six achieved gross total resection, including 3 tumors with lateral extension beyond the optic nerve. Preoperative visual deterioration was observed in 4 of the 6 patients, and all got improvement postoperatively. Transient oculomotor nerve palsy was presented in one patient postoperatively. No cerebrospinal fluid leakage, enophthalmos, or strabismus was observed. The median follow-up time is 27 months (11~41 months). At the 6-month follow-up, the visual acuity remained unchanged compared with that at discharge. Proptosis was resolved in 2 of the 3 patients; diplopia was improved in one patient. In conclusion, endoscopic endonasal intraconal approach could be suitable for selected pathological conditions, and for both medial or beyond medial extraconal and intraconal orbital tumors.

Incidence of Patterns of Bony modification of Neck of the Talus in Indian Population

Objective: The present study is an attempt to determine the various types of bony modifications on the dorsum of the neck of the human tali of both feet due to the continuous habit of squatting in humans and correlating these findings to the existing literature. Materials and Methods: 70 tali of unknown sex, obtained from the Department of Anatomy of MVJ Medical College and Research Hospital, Bangalore were used for the study. The dorsal surface of talar neck was carefully examined for the presence of medial and lateral squatting facets, combined facets, continuous gutter shaped facets and extension of trochlear surface. The collected data were tabulated and percentage of each facets and trochlear extensions were calculated. Statistical analysis of data was performed. Results: Out of 70 dry human tali, lateral squatting facets were present in 29 (41.4%) bones and medial squatting facets were seen in 11 (15.7%) bones, gutter shaped facets in 12 (17.1%) tali and combined facet present in 10 (14.2%) tali. Complete absence of facet was observed in 8 tali. Lateral extension of trochlear surface on the dorsum of neck was seen in 60 (85.7%) bones and medial trochlear extension was seen in 8(11.5%) bones. Lateral squatting facets were more common on right side but medial, gutter and combined facets though less frequent were seen more on left side. Lateral extensions were more commonly seen than medial extensions. Conclusion: The knowledge of incidence of these modifications on the dorsal surfaces of neck of the talus acts as a key anthropological factor to identify the racial and regional origin of unclaimed skeleton. Hence the results of this study will be of great help for forensic experts, anthropologist who are handling the unidentified skeletons. KEY WORDS: Squatting Facets, Talus, Trochlear extensions, Sub Talar Joint Stability.

Displacement and stress distribution of the craniomaxillofacial complex under different surgical conditions: a three-dimensional finite element analysis of fracture mechanics

Objective To provide a simplified treatment strategy for patients with maxillary transverse deficiency. We investigated and compared the fracture mechanics and stress distribution of a midline palatal suture under dynamic loads during surgically-assisted rapid palatal expansion. Methods Based on the cone-beam computed tomography (CBCT) data of a 21-year-old female volunteer, a three-dimensional model of the cranio-maxillofacial complex (including the palatal suture) was constructed. A finite element analysis model was constructed based on meshwork. After the yield strength of the palatal suture was set, an increasing expansion force (0–500 N) was applied within 140 ms to calculate the time–load curve, which mimicked nonsurgical bone expansion (model A). The same method was used to evaluate the fracture process, time and stress distribution of the palatal suture in maxillary lateral osteotomy-assisted (model B) and LeFort osteomy I (LFIO)-assisted expansion of the maxillary arch (model C). Results Compared with model A, the palatal suture of model B and model C showed a faster stress accumulation rate and shorter fracture time, and the fracture time of model B and model C was almost identical. Compared with model A, we discovered that model B and model C showed greater lateral extension of the maxilla, and the difference was reflected mainly in the lower part of the maxilla, and there was no difference between model B and model C in lateral extension of the maxilla. Conclusions Compared with arch expansion using nonsurgical assistance (model A), arch expansion using maxillary lateral wall-osteotomy (model B) or LFIO had a faster rate of stress accumulation, shorter time of fracture of the palatal suture and increased lateral displacement of the maxilla. Compared with arch expansion using LFIO (model C), arch expansion using lateral osteotomy (model B) had a similar duration of palatal suture rupture and lateral maxillary extension. In view of the trauma and serious complications associated with LFIO, maxillary lateral wall-osteotomy could be considered a substitute for LFIO.

Displacement and Stress Distribution of the Craniomaxillofacial Complex Under Different Surgical Conditions: A Three-Dimensional Finite Element Analysis of Fracture Mechanics

Objective: To provide a simplified treatment strategy for patients with maxillary transverse deficiency. We investigated and compared the fracture mechanics and stress distribution of a midline palatal suture under dynamic loads during surgically-assisted rapid palatal expansion. Methods: Based on the cone-beam computed tomography (CBCT) data of a 21-year-old female volunteer, a three-dimensional model of the cranio-maxillofacial complex (including the palatal suture) was constructed. A finite element analysis model was constructed based on meshwork. After the yield strength of the palatal suture was set, an increasing expansion force (0–500 N) was applied within 140 ms to calculate the time–load curve, which mimicked nonsurgical bone expansion (model A). The same method was used to evaluate the fracture process, time and stress distribution of the palatal suture in maxillary lateral osteotomy-assisted (model B) and LeFort osteomy I (LFIO)-assisted expansion of the maxillary arch (model C). Results: Compared with model A, the palatal suture of model B and model C showed a faster stress accumulation rate and shorter fracture time, and the fracture time of model B and model C was almost identical. Compared with model A, we discovered that model B and model C showed greater lateral extension of the maxilla, and the difference was reflected mainly in the lower part of the maxilla, and there was no difference between model B and model C in lateral extension of the maxilla. Conclusions: Compared with arch expansion using nonsurgical assistance (model A), arch expansion using maxillary lateral wall-osteotomy (model B) or LFIO had a faster rate of stress accumulation, shorter time of fracture of the palatal suture and increased lateral displacement of the maxilla. Compared with arch expansion using LFIO (model C), arch expansion using lateral osteotomy (model B) had a similar duration of palatal suture rupture and lateral maxillary extension. In view of the trauma and serious complications associated with LFIO, maxillary lateral wall-osteotomy could be considered a substitute for LFIO.

Comparing the locking screw direction of three locking plates for lateral clavicle fractures: a simulation study

Background The locking plate is a useful treatment for lateral clavicle fractures, however, there are limits to the fragment size that can be fixed. The current study aimed to measure the screw angles of three locking plates for lateral clavicle fractures. In addition, to assess the number of screws that can be inserted in different fragment sizes, to elucidate the size limits for locking plate fixation. Methods The following three locking plates were analyzed: the distal clavicle plate [Acumed, LLC, Oregon, the USA], the LCP clavicle plate lateral extension [Depuy Synthes, LLC, PA, the USA], and the HAI clavicle plate [HOMS Engineering, Inc., Nagano, Japan]. We measured the angles between the most medial and lateral locking screws in the coronal plane and between the most anterior and posterior locking screws in the sagittal plane. A computer simulation was used to position the plates as laterally as possible in ten normal three-dimensional clavicle models. Lateral fragment sizes of 10, 15, 20, 25, and 30 mm were simulated in the acromioclavicular joint, and the number of screws that could be inserted in the lateral fragment was assessed. Subsequently, the area covered by the locking screws on the inferior surface of the clavicle was measured. Results The distal clavicle plate had relatively large screw angles (20° in the coronal plane and 32° in the sagittal plane). The LCP clavicle lateral extension had a large angle (38°) in the sagittal plane. However, the maximum angle of the HAI clavicle plate was 13° in either plane. The distal clavicle plate allowed most screws to be inserted in each size of bone fragment. For all locking plates, all screws could be inserted in 25 mm fragments. The screws of distal clavicle plate covered the largest area on the inferior surface of the clavicle. Conclusions Screw angles and the numbers of screws that could be inserted in the lateral fragment differed among products. Other augmented fixation procedures should be considered for fractures with fragment sizes < 25 mm that cannot be fixed with a sufficient number of screws.

Sphenoid sinus pneumatization in a sample of Nepalese population: A multidetector computed tomography study.

Introduction: The purpose of study was to assess the prevalence of different types of pneumatization of sphenoid sinus in the Nepalese population as detected in CT scan of paranasal sinus. Materials and Methods: This study included patients attending radiology department for CT scan of paranasal sinus. The CT images of paranasal sinus were assessed for the type of pneumatization of the sphenoid sinus and type of clival, lateral recess and lesser wing extensions. Results: Most common type of pneumatization found in our study was complete sellar type (61.7%) and partial sellar type was second common type (27.4%). Pre-sellar type of pneumatization was seen in 10.9%. There were no patients with conchal type of pneumatization in our study. The clival extension of pneumatization was seen in 64%, lateral extension was found in 35.4%. and lesser wing type of pneumatization was found in 9.7%. Conclusion: Pre-surgical assessment of types and extension of sphenoid sinus pneumatization helps surgeons in surgical planning and to reduce complications during surgery. The variation in prevalence of sphenoid sinus pneumatization was found between our study population and other different population. This confirms that ethnicity influences types and extension of sphenoid sinus pneumatization.

Submitral Aneurysm Presenting as Pulsating Epigastric Mass—Diagnostic and Surgical Considerations

Submitral aneurysm (SMA) is a rare anomaly that typically occurs adjacent to the posterior leaflet of the mitral valve. We report the case of a ten-year-old female child presenting with SMA with anteroinferior extension, differing from the more typical posterior and lateral extension. Successful surgical management is described.

The Late-Quaternary morphostratigraphic record of glaciation, paleoseismicity and postglacial environmental changes in fjord-lakes of Québec-Labrador

&lt;p&gt;Hydroacoustic surveys were conducted in eight fjord-lakes of Qu&amp;#233;bec-Labrador in order to analyse their Late-Quaternary geomorphological and stratigraphic record of glaciation, paleoseismicity and postglacial environmental changes. This large morphostratigraphic dataset provided a unique opportunity to establish a conceptual model of the evolution for fjord-lakes in relation to deglaciation, glacio-isostatic rebound, sediment fluxes and paleoseismicity. The analysis of the morphology and distribution of many morainic deposits into the fjord-lakes (hummocky moraines, morainic sills and morainic complexes) allows relating their formation to the glacial erosion potential, as well as to climatic and topographic controls. During past glaciations, a topographic sill was left uneroded at the opening of valleys due to the decrease in the glacial erosion potential associated with the lateral extension of the glacier down-ice; this bedrock sill created in turn an anchoring point to the ice during deglaciation. Hummocky moraines were documented at the outlet of five fjord-lakes that are located within the deepest and narrowest valleys of the studied systems. Based on our analysis of these sublacustrine landform-sediment assemblages, fjord-lakes constitute distinct sedimentary systems that should be differentiated from typical fjord system (i.e., in marine waters). The large-scale landforms contained in the fjord-lakes of Qu&amp;#233;bec-Labrador (i.e., esker, moraines, gullies, lateral banks, turbidity channels and circular cavities) are inherited from their past subglacial, glaciomarine and paraglacial conditions, while only small deltaic bedforms (i.e., sediment waves and crescent-shaped bedforms) were formed in postglacial times. The present-day hydrological regime of fjord-lakes of Qu&amp;#233;bec-Labrador is considered river-driven, except for the lakes located near active seismic zones where widespread postglacial mass-movements are documented.&lt;/p&gt;

Nanostructure Determines the Wettability of Gold Surfaces by Ionic Liquid Ultrathin Films

Ionic liquids are employed in energy storage/harvesting devices, in catalysis and biomedical technologies, due to their tunable bulk and interfacial properties. In particular, the wettability and the structuring of the ionic liquids at the interface are of paramount importance for all those applications exploiting ionic liquids tribological properties, their double layer organization at electrified interfaces, and interfacial chemical reactions. Here we report an experimental investigation of the wettability and organization at the interface of an imidazolium-based ionic liquid ([Bmim][NTf2]) and gold surfaces, that are widely used as electrodes in energy devices, electronics, fluidics. In particular, we investigated the role of the nanostructure on the resulting interfacial interactions between [Bmim][NTf2] and atom-assembled or cluster-assembled gold thin films. Our results highlight the presence of the solid-like structured ionic liquid domains extending several tens of nanometres far from the gold interfaces, and characterized by different lateral extension, according to the wettability of the gold nanostructures by the IL liquid-phase.