Transoral Complete vs Partial Excision of the Sublingual Gland for Plunging Ranula

Objectives Plunging ranula is a pseudocyst of saliva extravasated from the sublingual gland (SLG) to the submandibular space. This is treated by transoral excision of the SLG or transcervical cyst excision that might differently affect surgical morbidity and recurrence. This study compared the clinical outcomes of complete vs partial excision of the SLG for plunging ranula. Study Design A nonrandomized comparative study. Setting Academic medical center. Methods This study included 42 patients with plunging ranula who underwent complete or partial excision of the SLG with the evacuation of cystic content. Two surgical methods of complete or partial SLG resection were alternatively allocated to consecutive patients without randomization. The primary outcome was a postoperative recurrence. Secondary outcomes were operation time and complications. Results Complete and partial excision of the SLG was performed in 22 and 20 patients, respectively, without injury to the Wharton’s duct or the lingual nerve. Postoperative complications in 42 patients were minor with temporary events: hematoma, 1 (5%); tongue numbness, 2 (5%); dysgeusia, 4 (9%); and dysphagia, 2 (5%), which did not differ between patients with complete and partial excision of the SLG ( P > .1). However, recurrence occurred in only 5 of 20 patients with partial SLG excision but none of 22 patients with complete SLG excision for a median follow-up of 36 months. Conclusions Complete SLG excision is preferred over partial SLG excision to treat plunging ranula for reducing postsurgical risks of complications and recurrence.

Paralytic stenosis of the larynx

The aim of the study was to evaluate the effectiveness of various types of surgical treatment of patients with bilateral paralytic stenosis of the larynx. Study involved 28 patients aged 18 to 75 years, suffering from paralytic stenosis of the larynx, who was treated at the ENT department of the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2015 to 2020. The results of treatment with the use of laterofixation of the vocal fold, partial excision of the vocal fold in the posterior third and the vocal process of the arytenoid cartilage showed that after the above methods of surgical intervention, recurrence of stenosis occurs in 20-25% of cases, therefore it is necessary to develop tactics of surgical treatment and postoperative management of this category patients.

Eyelid Lipoma

Purpose: To report a rare case of eyelid lipoma. Case summary: A 41-year-old female presented with a palpable mass in her left upper eyelid. Diffuse hard mass was palpable at preaponeurotic fat layer of left upper eyelid, and there was no inflammatory sign. Under local anesthesia, a left upper eyelid mass partial excision was performed and a biopsy specimen was collected. The mass was yellower and harder than surrounding normal eyelid fat. A lipoma was diagnosed based on histopathological findings such as proliferation of mature adipocytes. Conclusions: Lipoma is a benign tumor commonly found around trunk and limbs, but rarely occurs at eyelid. Eyelid lipoma should be considered as a differential diagnosis of diffuse mass at eyelid fat layer. Diagnosis and treatment can be achieved by partial excision and histopathological examination.

Total Infrapatellar Fat Pad Excision Leads to Worse Isokinetic Performance in Total Knee Arthroplasty: A Randomized Controlled Trial

There are concerns that total infrapatellar fat pad (IPFP) excision in total knee arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture, but individual preference of the surgeon is still the main determinant between total or partial excision. The aim of this randomized controlled study was to compare isokinetic performance and clinical outcome of TKAs with total and partial excision of the IPFP. Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a single surgeon were randomly assigned to either total or partial excision group. Patients were evaluated preoperatively and at postoperative 1 year, with Knee Society Score (KSS) and isokinetic measurements. The physiatrist performing isokinetic tests and patients were blinded to the study. There were no significant differences between the groups in respect of age, body mass index, gender, and preoperative KSS and isokinetic performance. Postoperatively, both groups had improved KSS knee and KSS function scores, with no difference determined. Knee extension peak torque was significantly higher postoperatively in the partial excision group at postoperative 1 year (p = 0.036). However, there were no significant differences in knee flexion peak torque following TKA (p = 0.649). The results of this study demonstrated that total excision of the IPFP during TKA is associated with worse isokinetic performance, which is most likely due to changes in the knee biomechanics with the development of patella baja. Partial excision of the IPFP appears to be a valid alternative to overcome this potential detrimental effect without impeding exposure to the lateral compartment. This is a Level I, therapeutic study.

Paediatric bladder neurofibroma on bilateral ureterostomy: rare case report—strategic management

Urogenital involvement in neurofibromatosis is extremely rare and thus is less documented. Herein, we discuss a 11-year-old boy who was referred with a diagnosis of neurofibroma bladder on bilateral flank ureterostomy with mild renal failure. A diagnosis of neurofibroma of the bladder with ureterohydronephrosis had been made and partial excision had been attempted, followed by bilateral ureterostomy because of increasing ureterohydronephrosis. He was 13 years and wanted to be dry as he wanted to go to school. With the plan of attaining dryness with stable upper tracts, he was posted for surgery. Near-total excision followed by a sigmoid conduit was performed. The biopsy was reported as plexiform neurofibroma and is on regular follow-up, dry on a stoma bag with stable renal parameters.

Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor

Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), <i>en-bloc</i> resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

THE NPWT USE IN PATIENTS WITH PURULENT COMPLICATIONS AFTER PROSTHETIC REPAIR OF ABDOMINAL WALL

Aim: to evaluate the prospects of using systems with negative pressure in purulent-inflammatory complications of prosthetic abdominal wall repair.Materials and methods: 51 patients were observed with purulent - inflammatory complications of prosthetic repair performed for abdominal wall hernias. Group I included 32 patients who developed an acute para-prosthetic inflammatory process (abscesses, phlegmon, infarction of the abdominal wall with infection, suppuration of the wound) up to 30 days after the intervention, group II included 19 patients with signs of chronic infection associated with with a previously implanted mesh (purulent fistulas, chronic abscesses of the abdominal wall). All patients underwent revision and debridement of the purulent site, if necessary, necrectomy, for some individuals complete or partial excision of endoprostheses, some patients used negative pressure therapy (NPWT), others performed only standard procedures generally accepted for purulent infection.Results: It was found that in individuals with acute inflammatory process (group I), the use of NPWT made it possible in all cases to preserve the network in situ. The need for repeated operations using this technology in acute surgical infection was significantly less (p = 0.00063, Fisher). The strength of the link between the risk factor (refusal to use NPWT) and the outcome (repeated intervention) is relatively strong (C = 0.514, Pearson, V = 0.599, Cramer). In a chronic purulent process, a decrease in the need for repeated interventions was not significant (Fisher, p = 0.26213), and the strength of the relationship between the risk factor and outcome was average (Pearson, C = 0.325, Cramer, V = 0.344).Conclusion: using of NPWT in chronic mesh infection involves partial excision of the endoprosthesis, and the possibilities of the technique require further study.