A Novel Nonsurgical Technique for Correcting Congenital Auricular Anomalies

Congenital ear anomalies are associated with psychological morbidity. Ear deformities can usually be corrected by nonsurgical techniques such as splinting or molding in the neonatal period, initiated before 6 weeks. Without early corrections, many will require otoplasty during childhood. We introduce a novel silicone-based custom mold technique for congenital ear anomalies. The highly malleable silicone was pushed into every part of the auricle, enabling the auricle to remain in the desired shape, with new molds made weekly. Of 31 newborns (18 males, 13 females), 54 ears were treated. Average age at treatment initiation was 26.8 days. The mean treatment duration was 43.2 days, with a median of 28 days. Normal appearance and parent's satisfaction were achieved in 30 patients with 49 deformed ears and also in four newborns older than 6 weeks. Three concha type microtia in two patients achieved great improvements and parents' satisfaction. No complications were reported. Marked aesthetic improvements and normal appearance were achieved for all deformed auricles treated, and improvements in the concha type microtia will partially alleviate future surgical corrections. The results are not inferior to other techniques. The advantages are as follows: cost-effective, time-saving, simple to master, no need for hair shaving, and easy use for parents. Patients older than 6 weeks of age achieved normal auricle appearance, enabling the correction in older newborns. Custom made silicone auricle molding offers a simple nonsurgical technique for correcting congenital ear anomalies, alleviating the need for future surgical corrections.

Comparison of Tomography Suspect Keratoconus Defined by Sirius and Pentacam in a Chinese Cohort

Purpose: The study is to compare the proportion of tomography suspect keratoconus (TSK) defined by Sirius and Pentacam, and to explore the possible causes of the differences between them in a Chinese cohort.Methods: Single center prospective cohort study. All subjects were selected from the Peking University Third Hospital Ectasia Cornea Disease Cohort Project database, which included myopic patients seeking corneal refractive surgical corrections since the year of 2013. In this study, all cases which were examined by Sirius and Pentacam respectively and have been followed up at least 2 years without abnormalities after laser corneal refractive surgeries (LASEK, FS-LASIK or SMILE). The composition ratio of TSK from Sirius and Pentacam, corneal diameter and thickness, and variables of corneal tomographers between the ‘normal eyes’ and the ‘TSK eyes’ defined by Sirius and Pentacam were compared. Results: To the date of December 31, 2018, total 171 cases (278 eyes) were selected in this study. Total 167 (167/278, 60.1%) eyes were diagnosed of TSK by Sirius, and 203 (203/278, 73.0%) eyes were diagnosed of TSK by Pentacam (P<0.001). The corneal horizontal diameter is 11.40 and 11.60 mm in normal eyes and Sirius-TSK eyes (P<0.001). The corneal horizontal diameter is 11.74 and 11.43 mm in normal eyes and Pentacam-TSK eyes (P<0.001). The central corneal thickness measured by Sirius is 530.1 μm and 518.1 μm (P=0.001) in normal eyes and Sirius-TSK eyes. The central corneal thickness measured by Pentacam is 521.5 μm and 526.6 μm (P=0.102) in normal eyes and Pentacam-TSK eyes. Conclusions: The proportion of TSK eyes diagnosed by Sirius is less than those diagnosed by Pentacam in Chinese. Smaller corneal diameter is liable to be judged as false positive of keratoconus by Pentacam in Chinese compared with Sirius. Thinner corneal thickness is liable to be judged as false positive of keratoconus by Sirius in Chinese compared with Pentacam.

Evaluation of Prognostic Factors for Palatal Fistulas after Cleft Lip and Palate Surgery in a North-Western Romanian Population over a 10-Year Period

Cleft lip and palate is the most frequent birth anomaly, with increasing reported rates of complications, such as palate fistulae. Current studies concerning the occurrence rate of cleft lip and palate (CLP) report 2 to 10 cases in 10,000 births. The purpose of this study was to investigate the existence of factors that could predict the occurrence of fistulae after cleft lip and palate surgery. A retrospective study was performed by collecting and analyzing data from all patients who were operated for cleft lip and/or palate in the Maxillo-Facial Department of the Emergency Clinical County Hospital of Cluj-Napoca, Romania, between 2010 and 2020. We investigated the existing evidence for possible links between the number of fistulae observed after the primary palatoplasty and the age at which the primary palatoplasty was performed, the sex of the patient, the type of cleft, the timing of the surgical corrections, and the presence of comorbidities. A total of 137 cases were included for analysis. A significant link between the number of fistulae and the type of cleft was found (with fistulae occurring more frequently after the surgical correction of CLP—p < 0.001). No evidence was found for the existence of significant links between the number of fistulae and the patient’s sex, the timing of surgery, or the presence of comorbidities. This study concluded that the incidence of palatal fistulae appears to be influenced by the type of cleft (CLP), but not by the sex of the patient, the timing of surgery, or the presence of comorbidities.

How to Quantitatively Balance a Total Knee? A Surgical Algorithm to Assure Balance and Control Alignment

To achieve a balanced total knee, various surgical corrections can be performed, while intra-operative sensors and surgical navigation provide quantitative, patient-specific feedback. To understand the impact of these corrections, this paper evaluates the quantitative impact of both soft tissue releases and bone recuts on knee balance and overall limb alignment. This was achieved by statistically analyzing the alignment and load readings before and after each surgical correction performed on 479 consecutive primary total knees. An average of three surgical corrections were required following the initial bone cuts to achieve a well aligned, balanced total knee. Various surgical corrections, such as an arcuate release or increasing the tibial polyethylene insert thickness, significantly affected the maximum terminal extension. The coronal alignment was significantly impacted by pie-crusting the MCL, adding varus to the tibia, or releasing the arcuate ligament or popliteus tendon. Each surgical correction also had a specific impact on the intra-articular loads in flexion and/or extension. A surgical algorithm is presented that helps achieve a well-balanced knee while maintaining the sagittal and coronal alignment within the desired boundaries. This analysis additionally indicated the significant effect that soft tissue adjustments can have on the limb alignment in both anatomical planes.

The possible causes for tomography suspect Keratoconus in a Chinese cohort

Background To explore the possible causes of tomography suspect keratoconus (TSK) marked by Tomography in screening keratoconus in a Chinese cohort, and the reasonable range of corneal horizontal diameter and thickness for decreasing the proportion of TSK. Methods Nested case-control study from a single center prospective cohort. All subjects were selected from the Peking University Third Hospital Ectasia Cornea Disease Cohort Project database, which included myopic patients seeking corneal refractive surgical corrections since 2013. Demographic information, basic eye examination, and auxiliary equipment examination including refraction, IOL-master, Pentacam, Sirius, and Topolyzer were recorded. In this study, all cases were classified into two groups: TSK group and normal control (NC) group, and all of them were followed up at least 2 years. The former is consisted of those whose screening examinations of tomography are abnormal, the latter is those whose screening examinations are normal. All of them have already been followed up at least 2 years without abnormalities after excimer laser corneal refractive surgeries. Unpaired t tests and Chi-square tests were used to compare the differences of indices from the tomography between the two groups. Results Of 183 TSK eyes (109 patients) and 160 NC eyes (83 patients), the mean age is 28.0 and 26.3 years old respectively. The corneal horizontal diameter is 11.5–11.8 mm in TSK group and 11.8–12.0 mm in NC group. The central corneal thickness is nearly 520 μm in the former and 550 μm in the latter. For Sirius, the TSK ratio of indices of SIf and SIb is 41.5 and 39.9% respectively in TSK group. For Pentacam, the TSK ratio of index IHD is 59.0% and “final D” is 72.7%. Conclusions Corneal horizontal diameter and central corneal thickness have great influences on the results of corneal tomography in detecting the suspect keratoconus.

Achieving a Balanced Knee in Robotic TKA

Total knee arthroplasty (TKA) surgery with manual instruments provides a quantitatively balanced knee in approximately 50% of cases. This study examined the effect of combining robotics technology with real-time intra-operative sensor feedback on the number of quantitatively balanced cases in a consecutive series of 200 robotic-assisted primary TKAs. The robotics platform was used to plan the implant component position using correctable poses in extension and a manual, centrally pivoting the balancer in flexion, prior to committing to the femoral cuts. During the initial trialing, the quantitative state of balance was assessed using an instrumented tibial tray that measured the intra-articular loads in the medial and lateral compartments. These sensor readings informed a number of surgical corrections, including bone recuts, soft-tissue corrections, and cement adjustments. During initial trialing, a quantitatively balanced knee was achieved in only 65% of cases. After performing the relevant soft-tissue corrections, bone recuts, and cement adjustments, 87% of cases ended balanced through the range of motion. Meanwhile, this resulted in a wide range of coronal alignment conditions, ranging from 6° valgus to 9° varus. It is therefore concluded that gaps derived from robotics navigation are not indicative for a quantitatively balanced knee, which was only consistently achieved when combining the robotics platform with real-time feedback from intra-operative load sensors.

Neonatal Outcome of Choanal Atresia Surgical Corrections- Experience from a Tertiary Care Centre from Eastern India

Choanal atresia is a congenital condition that occurs due to developmental failure of nasal cavity to communicate with the nasopharynx. There can be both unilateral and bilateral occlusion, bony, soft tissue and both. It can present at birth or early in the neonatal period or even later in life. This case series included three patients, who were admitted in the Neonatal Intensive Care Unit (NICU) and they underwent surgical correction in the hospital. All these cases had different presentations and clinical course. First case was admitted for respiratory failure and sepsis and, later was diagnosed as bilateral choanal atresia. Second case was admitted at 17 days of life with diagnosis of Hypoxic Ischaemic Encephalopathy (HIE) and multiple extubation failure and later was diagnosed as unilateral choanal atresia. Third case had respiratory distress soon after birth and was referred with a diagnosis of suspected choanal atresia. It was confirmed as bilateral choanal atresia and the child improved after surgical correction. All three cases were out born and referred in the hospital at different postnatal ages with varied symptoms. The lessons learnt in management of first case helped in subsequent cases resulting in better outcome.

Tumor-induced rickets-osteomalacia: an enigma

ObjectivesWe report a case of pediatric thoracic tumor-induced osteomalacia (TIO) causing severe hypophosphatemic rickets with delayed diagnosis and emphasize on timely management of this rare entity.Case presentationA young boy presented with rickets since five years of age. Biochemical evaluation revealed hypophosphatemia, hyperphosphaturia, elevated alkaline phosphatase and normal calcium levels. Initially managed as hereditary hypophosphatemic rickets, he was given phosphorus supplements and calcitriol. Despite the therapy, skeletal deformities worsened requiring surgical corrections. Subsequently, he developed iatrogenic tertiary hyperparathyroidism for which he underwent total parathyroidectomy. Later on, he was found to have fibroblast growth factor-23 secreting thoracic mass (10.5 cm in largest dimension) which was excised with significant post operative improvement. Histopathology showed phosphaturic mesenchymal tumor-mixed connective tissue variant, confirming the diagnosis of TIO.ConclusionTIO, a correctable cause of hypophosphatemic rickets, should be considered in children presenting with hypophosphatemic rickets with evident mass on examination/imaging and in refractory cases.

Observational outcome in surgery for Chiari malformation patients

Chiari malformation is the commonest anomaly of the craniovertebral junction involving both the skeletal as well as the neural structures. It is congenital anomaly of the hindbrain characterised by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Most common presenting symptoms was pain in the nape of neck with sub-occipital headache and weakness. If not intervened early in these cases they may progress to quadriparesis and respiratory failure. This study includes authors experience of 30 surgical corrections of Chiari malformation performed at civil hospital Ahmedabad from 2017 to 2019. The age and sex of the patient, the presence of syrinx, the type of surgical procedure and the clinical outcome were determined post-operatively and on follow up. Cerebro spinal fluid leak and collection were observed in patient who undergone duroplasty only with no leakage in patient undergone syringo-subarachnoid shunt. Overall, tingling/numbness had best improvement showed improvement in 13 out of 16 patients. Power showed improvement in 20 out of 27 patients and pain showed improvement in 18 patients. Wasting, clawing and cerebellar signs and bony deformity showed no improvement in any of the above procedures. Authors can conclude for Chiari malformation decompression with or without duroplasty with additional procedure with post-operative physiotherapy and analgesia is the suitable treatment.