Hydroperitoneum: A complication of mini PCNL in pediatric age group? -A case report

Renal stones constitute 40% of renal disorders in Pakistan with silent stones constituting up to 3%. Nephrolithotomy and Pyelolithotomy were the only surgical options available for the treatment of large renal stones, with high rate of complications. Percutaneous nephrolithotomy (PCNL) has now become the mainstay of treatment for large renal stones over the past 30 years. Recent advances in equipment and technology has made PCNL the gold standard for this disease, resulting in removal of stones with shorter recovery time and decreased morbidity and mortality, and with few complications Case Discussion A boy aged 13 years, underwent mini PCNL for treatment of left side renal stone causing hydronephrosis, previously evaluated by KUB X-Rray and non contrast CT scan. His retrograde-percutanous access to the collecting system was done under fluoroscopic guidance. At the end of procedure, patient revealed taut and distended abdomen. Aspiration revealed presence of intraperitoneal fluid. Patient was effectively treated with immediate placement of abdominal drain with improvement of clinical presentation Conclusion Hydroperitoneum is a rare complication of conventional PCNL. Based on our experience and review of published literature, our case of hydroperitoneum after mini PCNL, is the first of its kind. A high degree of sensitivity and knowledge of this complication during PCNL in children would help identify and manage this complication in future. We recommend examination of abdomen post-PCNL in every child before he/she is brought out of anesthesia.

Operative Procedure in a Suprasellar Paediatric Lesion of the Optic Chiasm with Hydrocephalus Caused by a Papillary Glioneuronal Tumour

<b><i>Introduction:</i></b> Paediatric tumours in the sellar and parasellar regions present clinical and surgical challenges due to anatomical position and behaviour. We illustrate a rare case which caused obstructive hydrocephalus. <b><i>Case Presentation:</i></b> The study included a 14-year-old girl with a glioneuronal tumour (40 mm) originating from the optic chiasm, obliterating the aqueduct, with consequent triventricular hydrocephalus. The patient underwent extended endoscopic endonasal surgery and repair of the skull-base deficiency using a multi-layer technique with fascia lata. The 12-month follow-up showed no complications or recurrences, with recovery in visual acuity. <b><i>Conclusion:</i></b> The immediate placement of external ventricular drainage, in combination with an extended trans-sphenoidal approach, is a safe and feasible option to treat suprasellar paediatric lesions with hydrocephalus.

Splitting expansion and palatal approach technique for implant placement in severely resorpted maxilla

The treatment of patients with atrophic maxillary alveolar ridge who need oral rehabilitation is a common problem in Implant Dentistry. One of the techniques used is the alveolar ridge splitting technique to expand alveolar ridges with a horizontal bone decrease. The palatal approach technique is also recommended in cases with an insufficient thickness of the alveolar ridge for the placement of implants in the bone envelope. The aim of this work is to describe the splitting expansion and palatal approach technique for the treatment of atrophic maxillary ridges with a horizontal bone deficit and rehabilitation with implant placement. This technique combines the alveolar ridge splitting/expansion technique and the palatal approach technique. It allows alveolar ridge expansion using piezosurgery and immediate placement of implants without thread exposure in the palatal aspect. With one surgical time, this technique avoids the fracture of the buccal bone plate due to the expansion, eliminates the need for bone graft and donor-site morbidity, is simple and effective, and shows great esthetic results and implant success.

Utilization of biphasic calcium sulfate as socket preservation grafting as a prelude to implant placement, a case report

Extraction of the natural tooth may be a prelude to implant placement. This may be done using an immediate placement protocol or require a delayed approach depending on multiple factors that include; residual infection related to the failed tooth being extracted, availability of bone to stabilize the implant at placement or soft tissue issues. Socket preservation is recommended when the delayed approach is selected to create an osseous bed that can accommodate the implant that is planned. This also helps preserve what crestal bone remains following the extraction that may resorb in the absence of socket preservation during the extraction socket healing phase. The use of osseous graft materials and guided bone-regeneration has demonstrated enhancement of socket healing by potentially modifying the resorption process, yielding preservation of the crestal bone while limiting resorption potential during healing. Various graft materials have been reported including, allografts, xenografts, non-biologics and synthetics. Calcium sulfate as a graft material has been used for many decades in maxillofacial surgeries, plastic surgery, oncologic and orthopedics in the treatment of osseous voids, traumatic or inflammatory bone deficiencies. This article will review a case using biphasic calcium sulfate with a delayed implant protocol and the histology demonstrating conversion of the graft material to host bone following healing.

Comparing Dual-zone Immediate Implant Placement and Socket-shield Technique for Ridge Width Changes in Maxilla: a Prospective Cohort Study

Background: The socket-shield technique still requires more scientific based evidence to be recommended as everyday clinical practice, the aim of this prospective cohort study was to assess the facial-palatal ridge dimensional changes that occurred after a minimum of 8 months following flapless dual-zone (DZ) immediate implant placement and socket-shield (SS) immediate placement in the maxilla.Methods: A total of 19 patients who received 20 implants were included with 10 implants (MegaGen AnyRidge) were placed for each treatment, DZ and SS. Cast models were made at least 8 months after implant placement to assess the dimensional ridge changes by measuring the facial palatal ridge width on implant sites (T) at six designated points starting from gingival margin (0, 1, 2, 3, 5 and 7) and comparing it with the corresponding measurement on contralateral tooth site (C). Results: All 20 placed implants demonstrated successful osseointegration and survived 9-24 months following implantation (survival rate 100%). Two out of ten cases of SS group presented with minor manageable complications of external shield exposure. DZ group showed an average facial-palatal reduction of nearly 0.3 mm; however, there were no significant differences between T and C (P =.47), while SS group revealed a mean gain in ridge contour of approximately 0.2 mm with also no significant differences existed between T and C (P = .64) in the 8-months follow-up. When comparing between the two treatments, there were significant differences in ridge width changes (P < .05), indicating better preservation of the ridge contour at 8-months for SS treatment.Conclusion: The socket shield immediate implant placement produced better preservation of the ridge contour at 8-months post-extraction; however, the dual-zone technique yielded non clinically significant reduction in the ridge contour at the same follow-up.

A novel fully tapered, self-cutting tissue-level implant: non-inferiority study in minipigs

Objectives To assess the osseointegration and crestal bone level maintenance of a novel fully tapered self-cutting tissue-level implant for immediate placement (test) compared to a clinically established tissue-level implant (control) in moderate bone quality. Materials and methods Test and control implants were compared in 3 groups, i.e., small-, medium-, and large-diameter implants in an edentulous mandibular minipig model with moderate bone quality after 12 weeks of healing. Histometrically derived bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC) were subjected to statistical non-inferiority testing. Maximum insertion torque values in artificial bone were assessed for comparison. Results BIC values for the tests and control implants for all 3 diameters were comparable and non-inferior: small diameter (61.30 ± 10.63% vs. 54.46 ± 18.31%) (p=0.99), medium diameter (60.91 ± 14.42 vs. 54.68 ± 9.16) (p=0.55), and large diameter (45.60 ± 14.67 vs. 52.52 ± 14.76) (p=0.31). fBIC values for test implants were higher and non-inferior compared to control implants in all three groups. Test implants further showed distinctly higher maximum insertion torque values compared to control implants. Conclusion The investigated novel tissue-level implant is able to achieve high levels of primary and secondary implant stability under simultaneous preservation of crestal bone levels. This qualifies the studied implant as an attractive candidate for immediate placement in bone of limited quality. Clinical relevance This pilot pre-clinical study investigated a novel tissue-level implant for immediate placement. With the aim of translating the studied prototype into clinical application pre-clinical models, procedures and controls have been chosen with the aim of reflecting its future clinical indication and use.

Full Mouth Rehabilitation Using Alveolar Ridge Splitting Technique with Immediate Implant Placement in the Maxilla and Delayed Implant Placement in the Mandible: A Case Report with 4 Years Follow-Up

The bone split technique is used to increase the width of a narrow ridge for implant placement with high success rates. This technique was performed on a 53-year-old patient with bilateral mandibular posterior edentulous and fully edentulous maxilla. Implants placement was performed afterward with two-step modus operandi on the mandible and immediate placement on maxilla. A successful prosthetic rehabilitation was done following the healing phase. This approach led to full restoration of function and esthetic with a predictable outcome.