Lateral and crestal bone planing antrostomy: a simplified surgical procedure to reduce the incidence of membrane perforation during maxillary sinus augmentation procedures.

This clinical report presents a simplified surgical procedure for accessing the maxillary sinus antrum via lateral and crestal approaches, which reduces the potential for sinus membrane perforation and subsequent complications when graft materials and dental implants are placed into the sinus. Due to visual limitations, perforations and associated complications can jeopardize the success rate of the graft and the implants. While there is a lack of clinical data, clinical observations suggest that the procedure, described by the authors as lateral/crestal bone planing antrostomy, can reduce the possibility of perforation of the maxillary sinus membrane during the lateral and crestal approaches to the grafting of the maxillary sinus floor. The technique involves the use of specially designed rotary instruments that plane away the bone in thinner layers, with less chance of excess bone removal and membrane perforation.

Precise hepatectomy based on the optimized technique of hepatic blood flow occlusion combined with the curettage and cut technique by electrotome.

BACKGROUND: The aim of this study was to evaluate the outcome of precise hepatectomy based on the optimized technique of hepatic blood flow occlusion combined with the curettage and cut technique by electrotome. METHODS: Hospitalized patients with primary liver cancer treated in our hospital were included in this study and all patients (N.=61) were numbered according to the inclusion sequence and were randomized into group A and group B: 1) group A: precise liver resection by using simplified blocking combining with electrotome; 2) group B: precise liver resection by using half-hepatic occlusion + CUSA assisting liver parenchyma transection+ lower central venous pressure controlled by the anesthesiologist. Postoperative laboratory examination data (blood routine, liver function, renal function, blood coagulation function, AFP quantitation) were collected, including WBC, alanine aminotransferase (ALT), total bilirubin (TBIL), prothrombin time (PT), creatinine (Cr), abdominal drainage volume, intra-abdominal hemorrhage, bile leakage, blood transfusion, time of postoperative passage of gas by anus, and length between postoperation and discharge. RESULTS: Five days postsurgery, the value of WBC between groups A and B were not significant different (8.9±2.2 vs. 8.3±2.8, P>0.05). The ALT, PT, Cr, abdominal drainage volume, abdominal drainage volume, intra-abdominal hemorrhage, bile leakage, blood transfusion, and time of postoperative passage of gas by anus between group A and B were not significant different postoperatively, respectively. And also, the length between postoperation and discharge were not significant different between two groups. CONCLUSIONS: Precise hepatectomy based on the optimized technique of hepatic blood flow occlusion combined with the curettage and cut technique by electrotome works well. This technology has a low requirement for hospital's operation condition and anesthetist, so it carries out a new route for the wide application of precise liver resection in basal hospitals.

Anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette.

OBJECTIVE: During cranial base surgery, use of a high-speed drill for osteotomy has become common. We performed anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette, and we report the advantages and clinical applications of this method. DESCRIPTION OF INSTRUMENTATION: The ultrasonic surgical equipment comprises a power supply unit, footswitch, and handpiece (weight, 110 g; diameter, 20 mm; length, 140 mm from tip to angled section). The handpiece tip is 2 mm wide, and the amplitude of longitudinal vibration can be varied from 120 to 365 microm at an ultrasonic frequency of 25 kHz. Cool-controlled irrigation fluid emerges near the tip, through the sheath. EXPERIENCE AND RESULTS: We performed anterior clinoidectomy in eight cases of paraclinoid aneurysm and opening of the internal auditory canal in six cases of acoustic neuroma without damage to the dura mater or nearby structures such as brain tissue, blood vessels, and cranial nerves. In addition, no damage to the facial nerve or labyrinthine organ resulted from heat or vibration caused by the ultrasonic bone curette. CONCLUSION: Ultrasonic bone curettage represents safe instrumentation for performance of anterior clinoidectomy and opening of the internal auditory canal without damage to surrounding structures. This technique allows surgeons to perform procedures on deep areas without incurring psychomotor stress.

[Arthroscopically assisted therapy of avascular necrosis of the femoral head]. / Arthroskopisch gestützte Behandlung der aseptischen Hüftkopfnekrose.

OBJECTIVE: Preservation of the hip joint function by treatment of the avascular necrosis of the femoral head in adults or at least avoiding progression. INDICATIONS: Avascular necrosis of the femoral head in adults in Steinberg stages I-III. In patients with Steinberg stage IVa (subchondral collapse ≤ 15% of the articular surface, depression < 2 mm) hip joint salvage therapy in early stages of femoral head collapse. CONTRAINDICATIONS: Manifest osteoarthritis of the hip joint. Joint infection. Relative contraindications: subchondral collapse > 15% of the articular surface or depression > 2 mm (Steinberg stage IVb and above). Persisting risk factors for a progression of avascular necrosis (e.g., alcohol abuse, chemotherapy, local irradiation, high-dose cortisone therapy) and obesity (BMI > 40). SURGICAL TECHNIQUE: Arthroscopy of the hip joint in case of cartilage defects and/or potential collapse of the femoral head. Without collapse of the femoral head and absence of severe damage of the cartilage: core decompression using a guiding sleeve through a lateral approach (Steinberg II, III). Subsequently curettage of the necrotic area through a central drill hole and insertion of autogenic bone cylinders using an OATS harvester (Steinberg II b/c, III b/c). In Steinberg stage IVa, reconstruction of the outline of the femoral head is attempted by reduction of the impressed portion (under intraoperative fluoroscopy). POSTOPERATIVE MANAGEMENT: Limited weight bearing (10 kg) of the operated leg for 6 weeks. In cases of large necrotic defects located directly beneath the subchondral bone (Steinberg IIIc) as well as subchondral collapse with flattening of the femoral head (Steinberg IVa) limited weight bearing (10 kg) for 12 weeks. RESULTS: Early results of femoral head preserving therapy in 53 patients (56 hips, consecutively treated between June 2004 and December 2009) after 33 ± 20 months: success rate (no arthroplasty, no reoperation, no radiological progress associated with clinical symptoms) 86% for patients treated with Steinberg stages I-III. Failure of the head preserving therapy with concern to the mentioned criteria depending on the initial Steinberg stage: 0 (0%) for stage I, 2 (10%) for stage II, 3 (25%) for stage III, and 4 (31%) for stage IVa.

Treatment of benign bone tumours of the hand using osteoscopy.

Curettage and bone grafting are used traditionally to treat benign bone tumours of the hand. Some authors are proposing minimally invasive treatment using endoscopy. Our purpose is to standardise this technique based on a study of the number and locations of entry points. This is a report on three benign metacarpal bone tumours treated with three different endoscopic approaches: multiportal, extended uniportal and oblique uniportal. In theory, the multiportal approach has several drawbacks: weakening of the bone cortex, a limited visual field and seepage of injectable phosphocalcic cement. The extended uniportal approach causes cortical defects, unacceptable in a minimally invasive technique. The oblique uniportal approach seems less troublesome; vision of the bone cavity is good, curettage of the tumour is complete, the bone cortex is undamaged and there is no leakage of injectable phosphocalcic cement. All things considered, the oblique osteoscopic uniportal approach seems to be the best option for the management of benign bone tumours of the hand.

Minimizing trauma during tooth removal: a systematic sectioning approach.

A prerequisite for immediate implant placement is fully intact osseous and soft tissue, which can only be achieved by a careful and less-traumatic tooth removal that minimizes damage to the soft and hard tissue structures of the extracted tooth socket. Traditional methods of tooth extraction using forceps and elevators often results in some degree of soft and hard tissue damage, which ranges from slight soft tissue laceration to complete loss of the buccal bony plate and interdental bone crest. This paper describes an extraction technique that utilizes a systematic tooth sectioning approach to help minimize soft and hard tissue loss in the extracted tooth socket.

Bone removal with a new ultrasonic bone curette during endoscopic endonasal approach to the sellar-suprasellar area: technical note.

BACKGROUND: Accessing intradural lesions via an extended endoscopic endonasal approach requires a relatively large bony removal over the skull base. OBJECTIVE: We describe the Sonopet ultrasonic bone curette with a new dedicated endonasal hand-piece. MATERIALS AND METHODS: We used this ancillary device in 27 nonconsecutive endonasal procedures for different skull base lesions (18 standard pituitary operations and 9 extended approaches for either meningiomas or craniopharyngiomas). RESULTS: The ultrasonic bone curette with endonasal hand-piece was easy to use and effective during the removal of the bone covering or when close to the carotid and optic prominences, as well as in preserving the integrity of the superior intercavernous sinus. In only 1 case was small tearing of the dura mater observed during the bony removal. No cases of injury to the major neurovascular structures occurred. CONCLUSION: The Sonopet ultrasonic bone curette is a useful tool during endoscopic endonasal skull base surgery.

[Use of curettage in the treatment of skin tumors]. / Bruk av kyrette ved behandling av hudtumorer.

Many skin tumours can be diagnosed and treated with minimal equipment in general practice. The author describes the indications and technique of curettage for treatment of seborrhoeic warts, simple warts, and molluscum contagiosum, and basal cell carcinomas.