Fusion of Technology in Cochlear Implantation Surgery: Investigation of Fluoroscopically Assisted Robotic Electrode Insertion

The HEARO cochlear implantation surgery aims to replace the conventional wide mastoidectomy approach with a minimally invasive direct cochlear access. The main advantage of the HEARO access would be that the trajectory accommodates the optimal and individualized insertion parameters such as type of cochlear access and trajectory angles into the cochlea. To investigate the quality of electrode insertion with the HEARO procedure, the insertion process was inspected under fluoroscopy in 16 human cadaver temporal bones. Prior to the insertion, the robotic middle and inner ear access were performed through the HEARO procedures. The status of the insertion was analyzed on the post-operative image with Siemens Artis Pheno (Siemens AG, Munich, Germany). The completion of the full HEARO procedure, including the robotic inner ear access and fluoroscopy electrode insertion, was possible in all 16 cases. It was possible to insert the electrode in all 16 cases through the drilled tunnel. However, one case in which the full cochlea was not visible on the post-operative image for analysis was excluded. The post-operative analysis of the electrode insertion showed an average insertion angle of 507°, which is equivalent to 1.4 turns of the cochlea, and minimal and maximal insertion angles were recorded as 373° (1 cochlear turn) and 645° (1.8 cochlear turn), respectively. The fluoroscopy inspection indicated no sign of complications during the insertion.

Hydrophobicity in clearwing butterflies and moths: impact of scale 2 micro and nanostructure, and trade-off with optical transparency

In opaque butterflies and moths, scales ensure vital functions like camouflage, thermoregulation, and hydrophobicity. Wing transparency in some species - achieved via modified or absent scales - raises the question of whether hydrophobicity can be maintained and of it dependence on scale microstructural (scale presence, morphology, insertion angle, and coloration) and nanostructural (ridge spacing and width) features. To address these questions, we assessed hydrophobicity in 23 clearwing species differing in scale micro and nanofeatures by measuring static contact angle (CA) of water droplets in the opaque and transparent patches of the same individuals at different stages of evaporation. We related these measures to wing structures (macro, micro, and nano) and compared them to predictions from Cassie-Baxter and Wenzel models. We found that overall, transparency is costly for hydrophobicity and this cost depends on scale microstructural features: transparent patches are less hydrophobic and lose more hydrophobicity with water evaporation than opaque patches. This loss is attenuated for higher scale densities, coloured scales (for erect scales), and when combining two types of scales (piliform and lamellar). Nude membranes show lowest hydrophobicity. Best models are Cassie-Baxter models that include scale microstructures for erect scales, and scale micro and nanostructures for flat scales. All findings are consistent with the physics of hydrophobicity, especially on multiscale roughness. Finally, wing hydrophobicity negatively relates to optical transparency. Moreover, tropical species have more hydrophobic transparent patches but similarly hydrophobic opaque patches compared to temperate species. Overall, diverse microstructures are likely functional compromises between multiple requirements.

Root canals shaped by nickel-titanium instrumentation with automated computerized numerical control systems

Background To investigate the efficacy of a nickel-titanium (NiTi) file with an automated computerized numerical control (CNC) system for root canal shaping. Methods The movement of the automated device and the insertion angle were investigated. In Experiment 1, simulated resin root canals were randomly divided into four groups (n = 20): manual downward movement using a handpiece (Group 1), vertical downward movement by CNC (Group 2), reciprocating up and down movement by CNC (Group 3), and spiral up and down movement by CNC (Group 4). In Experiment 2, five different insertion angles of the NiTi file were evaluated (n = 20). Four parameters were used to evaluate the shaping ability: change in the working length, central axis offset, curvature variation, and preparation time. Groups were compared using one-way analysis of variance (ANOVA) with significance was set at P < 0.05. Results The change in central axis position in the curved part of the root canal was found to be smaller in Group 4 than in other groups (P < 0.05). The curvature changes and preparation time of Groups 1 and 4 were significantly reduced compared with Groups 2 and 3 (P < 0.05). The variation in working length and curvature in the 5° insertion angle group was significantly smaller than in the other groups (P < 0.05). Conclusions A spiral up and down movement, controlled by the CNC machine, and 5° insertion angle, maintained original root canal shape more precisely than other methods.

Effect of miniscrew insertion angle in the maxillary buccal plate on its clinical survival: a randomized clinical trial

Introduction This study sought to assess the effect of miniscrew insertion angle (vertical and oblique) on its clinical survival under shearing forces in orthodontic patients undergoing canine retraction. Materials and methods In this split-mouth randomized controlled clinical trial, 50 miniscrews were placed bilaterally in 25 patients with 45° and 90° insertion angles relative to a line perpendicular to the occlusal plane distal to the maxillary first premolar extraction site. Allocation of insertion angles to the right/left side was random using the Random Allocation Software. The patients, clinician, and statistician were blinded to the allocation of miniscrews to the side of jaw. The patients were followed-up monthly for 6 months. The primary outcome was the clinical survival of miniscrews, which was evaluated at each follow-up session. The secondary outcomes were the miniscrew stability based on the Periotest value (PTV) and the level of pain experienced by patients at 1, 12, and 24 h, and 7 days after miniscrew placement using a visual analog scale (VAS). Data were analyzed using paired t-test, repeated measures ANOVA, and McNemar’s test. Results The clinical survival rate of miniscrews placed at 90° and 45° angles was 76% and 88%, respectively. This difference was not statistically significant (P = 0.375). No significant difference was noted between the two groups regarding the PTV or the pain score either (P > 0.05). Conclusion Clinically, the insertion angle of miniscrews (90° versus 45° relative to a line perpendicular to the occlusal plane) has no significant effect on the miniscrew survival rate or stability during orthodontic treatment. Trial registration This trial was registered at www.irct.ir (IRCT20190901044659N1). Protocol The protocol was published after trial commencement.

Evaluation of Optimal Sites for the Insertion of Orthodontic Mini-implants at Mandibular Symphysis Region Through Cone-beam Computed Tomography

Background: This study evaluates the overall bone thickness (OBT) and cortical bone thickness (CBT) of mandibular symphysis and to determine the optimal sites for the insertion of orthodontic mini-implants.Methods: Cone-beam computed tomography (CBCT) images of 32 patients (18 males, 14 females), including 16 adults and 16 adolescents were included in this study. The sample was further categorized into three facial types: low angle, average angle, and high angle. OBT and CBT were measured at the mandibular symphysis region. All measurements were performed at six different heights (2 mm, 4 mm, 6 mm, 8 mm, 10 mm, and 12 mm from cementoenamel junction [CEJ]) and at seven different angles (0, 10, 20, 30, 40, 50, 60 degrees to the occlusal plane). Results: Neither OBT nor CBT was influenced by age or sex, except for that CBT was significantly thicker in adults than in adolescents. OBT and CBT were significantly thicker in low-angle cases than in average- and high-angle cases. Both OBT and CBT were significantly influenced by insertion locations, insertion heights, insertion angles, and their interactions. CBT and OBT gained the greatest value at the location between two lower central incisors, and became greater with the increase of insertion height and insertion angle. Both recommended and optimal insertion sites were mapped. Conclusions: Mandibular symphysis region was suitable for the placement of orthodontic mini-implants. The optimal insertion site was 6-10 mm apical to CEJ between two lower central incisors with an insertion angle being 0-60 degrees to the occlusal plane.

Optimal ilio-sacral screw trajectory in paediatric patients : a computed tomography study

Pelvic fixation during procedures performed to treat spinal deformities in paediatric patients remains challenging. No computed tomography studies in paediatric have assessed the optimal trajectory of ilio- sacral screws to prevent screw malposition. We used pelvic computed tomography from 80 children divided into four groups : females <10 and ≥10 years and males <10 and ≥10 years. A secure triangular corridor parallel to the upper S1 endplate was delineated based on three fixed landmarks. The optimal screw insertion angle was subtended by the horizontal and the line bisecting the secure corridor. Student’s t test was applied to determine whether the optimal screw insertion angle and/or anatomical parameters were associated with age and/or sex. Mean optimal angle was 32.3°±3.6°, 33.8°±4.7°, 30.2°±5.0°, and 30.4°±4.7° in the younger females, younger males, older females, and older males, respectively. The mean optimal angle differed between the two age groups (p=0.004) but not between females and males (p=0.55). Optimal mean screw length was 73.4±9.9 mm. Anatomical spinal canal parameters in the transverse plane varied with age (p=0.02) and with sex in the older children (p=0.008), and those in the sagittal plane varied with sex (p=0.04). Age affected ilio-sacral screw positioning, whereas sex did not. Several anatomical spinal canal parameters varied with age and sex. These results should help to ensure safe and easy ilio-sacral screw placement within a secure corridor.

Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle

Objective: Vertigo is a common side effect of cochlear implant (CI) treatment. This prospective study examines the incidence of postoperative vertigo over time and aims to analyze influencing factors such as electrode design and insertion angle (IA).Study Design and Setting: This is a prospective study which has been conducted at a tertiary referral center (academic hospital).Patients: A total of 29 adults were enrolled and received a unilateral CI using one of six different electrode carriers, which were categorized into “structure-preserving” (I), “potentially structure-preserving” (II), and “not structure-preserving” (III).Intervention: Subjective vertigo was assessed by questionnaires at five different time-points before up to 6 months after surgery. The participants were divided into four groups depending on the time of the presence of vertigo before and after surgery. Preoperatively and at 6 months postoperatively, a comprehensive vertigo diagnosis consisting of Romberg test, Unterberger test, subjective visual vertical, optokinetic test, video head impulse test, and caloric irrigation test was performed. In addition, the IA was determined, and the patients were divided in two groups (&lt;430°; ≥430°).Main Outcome Measures: The incidence of vertigo after CI surgery (group 1) was reported, as well as the correlation of subjective vertigo with electrode array categories (I–III) and IA.Results: Among the participants, 45.8% experienced new vertigo after implantation. Based on the questionnaire data, a vestibular origin was suspected in 72.7%. The results did not show a significant correlation with subjective vertigo for any of the performed tests. In group 1 with postoperative vertigo, 18% of patients showed conspicuous results in a quantitative analysis of caloric irrigation test despite the fact that the category I or II electrodes were implanted, which are suitable for structure preservation. Average IA was 404° for the overall group and 409° for group 1. There was no statistically significant correlation between IA and perceived vertigo.Conclusions: Though vertigo after CI surgery seems to be a common complication, the test battery used here could not objectify the symptoms. Further studies should clarify whether this is due to the multifactorial cause of vertigo or to the lack of sensitivity of the tests currently in use. The proof of reduced probability for vertigo when using atraumatic electrode carrier was not successful, nor was the proof of a negative influence of the insertion depth.