Usefulness of Magnetic Mallet in Oral Surgery and Implantology: A Systematic Review

This systematic review aimed to answer the question: “Is the use of magnetic mallet effective in oral and implant surgery procedures in terms of tissue healing, surgery outcome, and complication rate compared to traditional instruments?” A literature search of PubMed, Scopus, and Web of Science databases (articles published until 1 October 2021) was conducted, in accordance with the PRISMA statement, using the keywords “magnetic mallet”, “electric mallet”, “oral surgery”, “implantology”, and “dental implant”. Of 252 articles, 14 were included in the review (3 for teeth extraction, and 11 for implant dentistry). Out of a total of 619 dental extractions (256 patients) performed with the magnetic mallet (MM), no complications were reported. Implants inserted totaled 880 (525 patients): 640 in the MM groups (382), and 240 in control groups (133). The survival rate of implants was 98.9% in the MM groups, and 95.42% in the control groups. Seven patients experienced benign paroxysmal positional vertigo after implant surgery, all in control groups. Results are not sufficient to establish the effectiveness of MM in oral and implant surgery procedures. Randomized controlled trials with a large sample size are needed.

EAR RECONSTRUCTION SURGERY: OUTCOME ANALYSIS OF 108 PATIENTS

Objective: To find out the outcome of the ear Reconstruction and its association with improvement in psychological wellbeing along with physical benefits. Study Design: A cross-sectional study. Place and Duration of Study: Department of Plastic Surgery and ENT, Combined Military Hospital Quetta and Multan in liaison with the department of Psychiatry, from Jan 2017 to Jan 2021. Methodology: A sample size of 108 was estimated while keeping level of significance 5%, confidence level 90%, estimated true proportion 63% based on the observation made in the study by Steffen, and 5% of absolute precision. Specific performas were filled by the patient pre and post operatively and data analysis was performed using SPSS-20. Results: The mean age was 20 ± 8.75 years with a range of 12-29 years. Thirteen (11.11%) were male and ninety-five (87.8%) were females, 14 (12.9%) were married, 94 (86%) were un-married and all (100%) had social support. Fifty-two (48.1%) had primary education. Ninety-four (94%) were un-employed. Fifty-five (50.9%) of participants had congenital ear defect. Ninetyeight (90.7%) of the participants showed confidence in surgical procedure and would go for the same procedure if required, 5 (4.6%) said no to the same procedure while 8 (7.4%) did not know whether to opt for same procedure. Conclusion: Ear Reconstruction is a very rewarding procedure for surgeon and patients. Apart from aesthetic and functional improvement it also enhances the self-esteem of the patients.

Genetic Pattern, Orthodontic and Surgical Management of Multiple Supplementary Impacted Teeth in a Rare, Cleidocranial Dysplasia Patient: A Case Report

Background: Cleidocranial dysplasia (CCD) is a rare, autosomal dominant skeletal dysplasia with a prevalence of one per million births. The main causes of CCD are mutations in the core-binding factor alpha-1 (CBFA1) or runt-related transcription factor-2 (RUNX2), located at the 6p21 chromosomal region. RUNX2 plays important roles in osteoblast differentiation, chondrocyte proliferation and differentiation, and tooth formation. The disease is characterized by clavicular aplasia or hypoplasia, Wormian bones, delayed closure of cranial suture, brachycephalic head, maxillary deficiency, retention of primary teeth, inclusion of permanent teeth, and multiple supernumerary teeth. Materials and Methods: A 22-year-old girl suffering from cleidocranial dysplasia with short stature, narrow shoulders, craniofacial manifestations (short face, broad forehead, etc.) and dental anomalies (different lower dental elements under eruption, supernumerary and impacted multiple teeth, etc.) was examined at our service (Complex Operative Unit of Odontostomatology of Policlinico of Bari). RX Orthopantomography (OPG) and cone beam computed tomography (CBCT) were requested to better assess the position of the supernumerary teeth and their relationships with others and to evaluate the bone tissue. Results: Under eruption was probably caused by dental interferences with supernumerary teeth; hence, extractions of supernumerary upper canines and lower premolars were performed under general anaesthesia. Surgery outcome was excellent with good tissue healing and improvements in the therapeutic possibilities with future orthodontics. Conclusions: The objective of this article is to give an update about radiological, clinical, and molecular features of CCD and to alert the health team about the importance of establishing an early diagnosis and an appropriate treatment in these patients to prevent impacted teeth complications and to offer them a better quality of life.

A game theory based analysis of network connectivity reveals that state transition is crucial for epilepsy surgery outcome prediction

Seizures recur in half of patients who undergo epilepsy surgery. Presurgical workup mainly focuses on seizures, but only partially helps predicting outcomes, even after invasive electroencephalography. We conceived a generalizable model to detect epileptogenic networks through connectivity changes and identified the crucial role of the transition from pre-seizure to seizure, achieving the highest outcome prediction (93%) to date in a chronological cohort of 21 patients with 3-year follow-up or more.

The Wagner Modular (S2) Prosthesis for Proximal Femur Bone Loss ; Prospective Study of 19 Cases

Background: Wagner proximal femur prosthesis is the versatile modular implant. Study Design: Prospective study Setting: Department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from January 2013 to December 2019. Methodology: Total 19 patients of both genders with proximal femur bone loss due to tumor, implant failure for proximal femur fixation, comminuted intertrochanteric fracture, and failed arthroplasty included in the study. After taking written informed consent, detailed demographics including age, gender, indication of wagner prosthesis, and wagner stem type were recorded. Among all the patients 11 patients received total hip replacement and 8 patients received bipolar. Complications associated with procedure were recorded. Outcomes were assessed by Merle D Aubgine scale. Results: Total 19 patients were included in the study who were operated with wagner prosthesis for proximal femur bone deficit problems. 7 (37%) patients were male and 12 (67%) were female , between age of 16 to 70. 13 (68%) patient have proximal femur problem on right side and 6(32%) patient on left side .10 Patient have proximal femur fixation problems and 9 with proximal femur tumor. Modular wagner prosthesis used in all patients . Per-operative one (5%) patient have perforation of cortex and One (5%)patient posterior hip dislocation on next day . Two (11%) patient had per-operative fracture . Maximum follow-up is from 6.3 years to minimum 6 months. One patient with metastasis died within four weeks of surgery. Outcome measured with modified Merle D Aubgine scale showed no excellent , good in 15(79%) , fair 3 (16%), poor 1(5%). Conclusion: Wagner proximal femur modular implant is a versatile implant for proximal femur fixation failure and after proximal femur resection in tumor patients. It is modular with variable options to make stable hip joint. It is cheap as comparative to proximal femur replacement implant for tumor. Keywords: Implant failure, Proximal femur, Tumor, Wagner implant.

Selection of children with drug resistant epilepsy who are candidates for epilepsy surgery: pre and post-operative evaluation

Objective To select patients with drug resistant epilepsy following up in Pediatrics Neurology Outpatient Clinic of Children's Hospital, Ain Shams University who are candidates for epilepsy surgery and to detect outcome of epilepsy surgery in such children as regards seizures control. Methods This prospective study was conducted over a period of 36 months and comprises of 3 stages. Stage 1 includes selection of candidates for epilepsy surgery and preoperative evaluation. Evaluation included clinical assessment, video EEG, MRI epilepsy protocol. Stage 2 include surgery phase where decision of surgery was made by a multidisciplinary team. Stage 3 includes post-operative evaluation as regards Seizures frequency, Seizures Severity using Chalfont score, Engel Epilepsy Surgery Outcome Scale and the International League Against Epilepsy (ILAE) outcome classification. Data was tabulated and analyzed with SSPS package for windows. Results 17 patients underwent epilepsy surgery. Results revealed significant decrease in seizures frequency and severity at 6 and 12 months after surgery. As regards Engel Epilepsy Surgery Outcome Scale 11 (64.7%) patients were class I at 12 months. As regards the ILAE outcome classification 10 (58.8%) patients are class 1 at 12 months. Conclusions epilepsy surgery can be a hope for patients with drug resistant epilepsy who are well selected and evaluated preoperatively. New studies on larger number and for longer duration are recommended.

EP.TH.305Savi Scout Radar versus Wire-Guided Localisation in Breast Cancer Surgery: A Systematic Review and Meta-Anaylsis of Surgical Outcomes

Aims Wire-guided localisation (WGL) has been the standard technique for localisation of non-palpable breast cancers (NPBC) for almost 40 years. However, WGL has disadvantages including peri-operative scheduling challenges and patient discomfort. Savi Scout localisation (SSL) is a novel alternative that utilises an implantable wireless non-radioactive reflector. A systematic review and meta-analysis was performed to compare outcomes of SSL versus WGL in NPBC surgery. Methods Embase, MEDLINE, PubMed and the Cochrane Library (1946 to December 2020) were searched using PRISMA guidelines for studies comparing SSL and WGL in NPBC surgery. Outcome measures analysed were operative duration, positive margins and re-excision. Results were pooled into meta-analyses using a Mantel-Haenszel Random-Effects model as Odds Ratios for dichotomous data and Mean Difference for continuous data. Results Four eligible peer-reviewed cohort studies involving 808 patients were identified comparing SSL (n = 462) and WGL (n = 346). There was no significant difference between SSL and WGL in operative duration (95% CI -0.27, -7.89 to 7.34, p = 0.94), positive margins (OR 0.73, 0.36 to 1.45, p = 0.36) and re-excision (OR 0.62, 0.33 to 1.16, p = 0.13). Inclusion of two non-peer-reviewed cohort studies (additional SSL n = 143, WGL n = 424) altered statistical significance for re-excision in favour of SSL (OR 0.55, 0.36 to 0.83, p = 0.004). Conclusions This study demonstrates that SSL is a safe and effective alternative to WGL. SSL uncouples pre-operative localisation from surgery, reducing scheduling challenges. This is particularly useful in the current COVID-19 climate, with pre-operative patient self-isolation requirements. SSL may decrease re-excision rates. Randomised controlled trials are required to investigate this further.