Coronectomy of the wisdom teeth: the dental extraction alternative

Background. Coronectomy of the wisdom teeth is an alternative surgical procedure to tooth extraction, which aims to preserve the roots of the wisdom teeth in the dental socket after surgical separation of the crown, in order to avoid the injury of the inferior alveolar vascular-nervous bundle. Purpose. Minimizing the damage to the inferior alveolar nerve when extracting lower third molars caused by the intimate relationship between the nerve and the roots of the teeth, by using the technique of coronectomy, or intentional root retention. Material and Methods. Patients who reported to University Dental clinic during the period 2020–2021 for surgical removal of impacted L3M were screened for nerve–root relationship with OPG or CBCT. 15 patients underwent coronectomy as a procedure to remove the crown and upper third of the roots of a lower third molar to reduce the risk of damage to the inferior alveolar nerve. Results. 15 patients were enrolled in this study, with a total of 17 lower third molars. Sixteen sites healed primarily, but in 1 case the sockets on both sides opened and failed to close secondarily. In this case, the root fragments were later removed and found to be mobile. Conclusion. Coronectomies are safer to perform than complete extractions in situations in which the third molar is in close proximity to the mandibular canal. The technique appears to be associated with a low incidence of complications and the removal of remaining roots is required in around 6-7% of cases due to the mesial migration of the fragment and not any symptoms or reinfection.

The role of rapid tissue expansion in separating xipho-omphalopagus conjoined twins in Vietnam

Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm2, which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.

An unusual case of labial fusion in a post pubertal girl

Labial fusion is defined as either partial or complete adherence of the labia minora. It is also known as vulvar fusion, labial adhesion, labial agglutination or synechia of the vulva. This condition is common in pre-pubertal girls when estrogen levels are low and commonly resolves spontaneously post-puberty. This condition is usually asymptomatic and can be treated with topical application of estrogen or betamethasone cream or by manual or surgical separation of adhesions. We present a case of labial fusion in post pubertal girl which was managed surgically.

Successful anesthetic management of separation surgery for pygopagus conjoined twins: a case report

Background Conjoined twins are an extremely rare congenital occurrence, and anesthetic management for surgical separation presents unique challenges for anesthesiologists. Case presentation Five-month-old male pygopagus conjoined twins underwent separation surgery. We performed anesthesia induction in the supine position and surgery in the prone position. This presented a challenge because the transition from supine to prone position reversed the positional relationship between the two babies, resulting in crossing of the respiratory circuits and monitors. To solve the problem, we used anesthesia machines and monitors on the opposite side of each baby during anesthesia induction. The positional relationship between the twins and anesthesia machines and monitors normalized after the change to the prone position. Following the separation surgery, the twins were discharged without any complications. Conclusions Our method of using opposite side anesthetic machines and monitors for anesthesia induction was useful for the safe anesthetic management of pygopagus conjoined twins.

Professor Ian Aird: Master of surgical education

Ian Aird (1905–1962) was a Scottish surgeon renowned for his textbook: “A companion in surgical studies”, a uniquely single-author work of thousands of pages. It was an essential study for young surgeons aspiring to pass the FRCS (Edin) examination. He was appointed Chair of Surgery of the Royal Postgraduate Medical School at Hammersmith Hospital in London. Under his direction, his faculty developed a pump oxygenator, used it successfully for the first time in a patient and introduced cardiac surgery in Russia. They also pioneered kidney transplantation in Britain. Aird himself discovered the relationship of blood groups to cancer and peptic ulceration. He became famous for the surgical separation of conjoined twins from Nigeria, fame that created conflicts with medical authority on the issue of cooperating with the press. He became frustrated when the medical council refused to support and sponsor funding for research. Sadly, even his indomitable energy and brilliance could not see him through his depression. He committed suicide at the age of 57.

Twins Reared Apart: Zygotic Division After Artificial Insemination/Twin Research Reviews: Selective Resuscitation of Premature Twins; Scientist Jailed for Editing Twins’ Genes; Sexual Arousal Patterns in MZ Twins Discordant for Sexual Orientation; MZ Twins With Jejuno-Ileal Atresia/Media Reports: Twin Girls’ Search for a Bone Marrow Donor; Puppy with a Possible Parasitic Twin; Twins in Silicon Valley; Surgical Separation of Craniopagus Twins; Twin-Based New Yorker Magazine Cartoon; Twin Tragedies

This article opens with the brief life histories of reared-apart monozygotic (MZ) male twins. A New York City program that helped childless couples conceive via artificial insemination from the 1930s to the 1950s is examined as it related to these twins. The frequency with which pregnancies following assisted reproductive technology resulted in MZ twin pairs is also provided. Next, summaries of twin research concerning selective resuscitation, gene editing, sexual arousal and jejuno-ileal atresia are presented. The article ends with media reports of twin girls’ efforts to find a bone marrow donor for their father, possible parasitic twinning in a puppy, identical female twins’ business venture, the surgical separation of craniopagus twins, a twin-themed magazine cartoon and tragic events involving identical male twins.

A rare case of conjoined twins presenting as dicephalus parapagus: a case report

Conjoined twinning is a congenital abnormality resulting in various presentations of the fetuses in utero. It is a rare embryological developmental disorder occurring in one in 100,000 births. We present a case of conjoined twinning, which is characterized by the presence of two heads, single vertebral column and single symphysis pubis, with single genitor-urinary tract and single gastro intestinal tract. The present condition, referred to as dicephalus parapagus, is a rare entity among the conjoined twinning and has seldom positive outcomes. The mechanism of occurrence of conjoined twinning has been proposed either through fusion or fission of the embryos. In either case, surgical separation of the conjoined twins is often unsuccessful and results in increased morbidity and mortality. However, it is essential to screen for the presence of such congenital anomalies early during pregnancy, in order to terminate and provide parental counselling.

Prepubertal Vulvovaginitis

Vulvar and vaginal irritation/redness and vaginal discharge are common referrals to the pediatric and adolescent gynecologist. In nearly 75% of cases the etiology of the pre-pubertal patient’s signs and symptoms is non-specific and resolves with proper vulvar hygiene. Infections, ulcerations, labial adhesions, foreign bodies, constipation, voiding dysfunction, and trauma are other causes of vulvar and vaginal complaints. Gathering a detailed history and performing a thorough physical exam help to determine the etiology and best treatment. Staphylococcal aureus and Streptococcus pyogenes infections are frequently isolated on vaginal cultures and treated with organism specific antibiotics. Ulcerations are usually from a self-limiting viral infection (EBV, CMV, influenza) and heal with supportive cares—acetaminophen and sitz baths. Labial adhesions recede with topical estrogen cream in up to 89% of cases and rarely need surgical separation. When vulvovaginitis persists despite hygiene measures and no evidence of infectious etiology assessment and treatment of constipation and voiding dysfunction can provide relief of symptoms. This review contains 1 table and 28 references. Key words: Vulvovaginitis, vulvar hygiene, vagina hygiene, vaginal infection, labial adhesions, vulvar trauma, genital ulcer, vaginal foreign body, constipation, pre-pubertal voiding dysfunction