Intraoperative Facial Nerve Involvement in Parotid Tumours - A Retrospective Analysis in a Tertiary Care Centre.

Purpose: The study aims to provide a comprehensive overview of the various malignant and benign parotid tumours and evaluate the predictive factors for intraoperative nerve involvement leading to facial palsy (FP). Methods: It is a single-centre retrospective analysis for reviewing the involvement of facial nerve in post- parotidectomy patients. The clinical database from January 2012 to December 2020 was included in the study with a follow-up period of a minimum of 2 years. To maintain homogeneity, all squamous cell carcinomas of level 2 nodes involving parotid or residual/recurrent disease of the oral cavity requiring parotid dissection were excluded. Results: A total of 248 patients (171 benign; 77 malignant) were evaluated with a mean age of 46.48 ± 10.76 years. The presence of malignancy increases the risk of FP (p = 0.027). 37 (14.92%) patients with FP were detected which included 34 with partial [32.35% in malignant; 62.16% in recurrent pleomorphic adenoma (RPA)] and 3 with total paralysis (66.67% in malignant; 33.33% in RPA). The recurrence of pleomorphic adenoma increases FP. While old age, larger size, hard fixed swelling with masseteric space (MS) infiltration appeared as risk factors for FP in malignant tumours (p = 0.047; p = 0.004; p < 0.00001 respectively). Conclusion: Tumour size, malignancy, hard fixed mass, masseteric space infiltration, recurrence, and age > 45yrs have been statistically significant predictive factors for intraoperative facial nerve involvement leading to FP. The study also revealed that FP occurred more commonly when there was concurrent involvement of both superficial and deep lobes but was not statistically significant.

Analyzing Interaction of Rhodacyanine Inhibitor 'MKT-077' with Plasmodium falciparum HSP70s.

INTRODUCTION: MKT-077 and its derivatives are rhodacyanine inhibitors that hold potential in the treatment of cancer, neurodegenerative diseases and malaria. These allosteric drugs act by inhibiting the ATPase action of heat shock proteins of 70 kDa (HSP70). MKT-077 accumulates in the mitochondria and displays differential activity against HSP70 homologs. METHODS: The four Plasmodium falciparum HSP70s (PfHSP70) are present in various subcellular locations to perform distinct functions. In the present study, we have used bioinformatics tools to understand the interaction of MKT-077 at the ADP and HEW (2-amino 4 bromopyridine) binding sites on PfHSP70s. Our molecular docking experiments predict that the mitochondrial and endoplasmic reticulum PfHSP70 homologs are likely to bind MKT-077 with higher affinities at their ADP binding sites. RESULTS: Binding analysis indicates that the nature of the identified interactions is primarily hydrophobic. We have also identified specific residues of PfHSP70s that are involved in interacting with the ligand. CONCLUSION: Information obtained in this study may form the foundation for the design and development of MKT-077-based drugs against malaria.

Squamous Cell Carcinoma of Scalp: Our Experience in a Single Tertiary Care Centre.

Cutaneous cancer is a rare entity accounting for less than 1% of all diagnosed cancers in India. In contrast to the West, squamous cell carcinoma is the commonest skin cancer in India, often affecting the scalp. However, due to their rarity, not much is known regarding their biological behavior and prognosis. The present study is a retrospective cohort study undertaken in a tertiary cancer centre on 19 consecutive cases of squamous cell carcinoma of the scalp over a period of 5 years. Patients with non-sqamous histology and those associated with xeroderma pigmentosum were excluded. Nineteen patients were evaluated with a mean age of 52.7 years. Majority presented with a swelling (11 patients; 57.9%) in the parieto-occipital region (13 patients; 68.4%). All patients underwent wide excision with or without excision of underlying bone or dura, depending on involvement. Only 4 (21%) required major reconstruction. On histopathology, 8 (42.1%) were poorly differentiated, while 3 (15.8%) had presence of perineural invasion (PNI). The mean duration of follow-up was 38.14 months. Three of the 4 (75%) and 2 of 3 (66.67%) patients with poorly differentiated histology and PNI respectively developed recurrence, while only 1 of the 6 (16.67%) with close or positive base margin developed recurrence. Hence, to conclude, poorly differentiated histology and PNI are poor prognostic indicators, while in the event the mucoperiosteum is clinically uninvolved, the underlying bone may be preserved in select cases, even if the base margin is close.

Mucormycosis in COVID-19 pandemic and its neurovascular spread.

PURPOSE: Rhinocerebral mucormycosis is a rapidly progressive angioinvasive fungal infection commonly seen in diabetics. In the COVID-19 pandemic we have witnessed a sudden surge in these cases. We aimed to evaluate the disease presentation, patterns of spread, and any association with the COVID-19 virus. METHODS: This prospective study was conducted on mucormycosis patients operated between March and July 2021. The diagnosis was confirmed either on KOH staining, fungal culture or histopathological examination. RESULTS: Thirty one cases (21 males, 10 females) with a mean age of 53.3 years were included, of which 9 (29.1%) were COVID positive on presentation, 17 (54.8%) were post-COVID, while 5 (16.1%) had radiological evidence of COVID sequelae. Most common symptoms were cheek numbness (87.1%), headache (83.9%), visual disturbances (77.4%), and palate involvement (58.1%). Blackening of turbinates was uncommon (22.6%). Ethmoid sinus was involved in all patients. Pterygopalatine fossa involvement was present in 77.4%, and was accurately diagnosed on contrast enhanced MRI scan. There were 8 (25.8%) deaths, while the remaining are discharged or under treatment. CONCLUSION: An increase in the incidence of mucormycosis in the COVID-19 pandemic is probably due to a compromise in host immunity along with a synergistic effect in thrombotic microangiopathy. Spread of infection to the soft tissues of the infratemporal fossa, orbit or palate occur via neurovascular structures rather than by bone erosion. The pterygopalatine fossa is involved in most individuals.

Bone Metastases in Follicular Carcinoma of Thyroid.

Though the association between follicular carcinoma and bone metastasis is well established, the site-wise distribution is not known. One hundred seventy-three patients of follicular carcinoma presenting between 2003 and 2011 were selected from 1093 patients of follicular lesions presenting at a single institution. Of these, 59 (34%) with bone metastasis were included in the study. Fifty of the 59 patients (84.7%) had metastasis at presentation, while 9 developed bone metastasis during follow-up. Sixty-one percent had solitary metastasis, 15 (25.4%) had multiple bone involvement, while 8 patients (13.6%) had synchronous lung metastasis. Overall, the spine was the commonest site of bone metastases, seen in 20 patients (33.9%), followed by the pelvis, skull, long bones and sternum. Bone metastasis is a known phenomenon in follicular carcinoma. The spine is the commonest site followed by the pelvis.

Outcome Of Distally Based Sural Artery Flap For Distal Third Of Leg And Foot Defects.

BACKGROUND: Due to precarious blood supply, skin coverage for defects of leg, heel, dorsum of foot and the ankle has been a complicated task for plastic surgeons & orthopaedic surgeons. The present study aimed to prospectively evaluate the outcome of distally based sural flap for coverage of defects distal third of leg, ankle & foot. METHODS: In this study 15 patients with soft tissue defects on distal third of leg in (n=2), heel (n=4), medial malleolus (n=3), lateral malleolus (n=1), Achillis tendon (n=2), anterior ankle (n=2) and in dorsum of foot (n=1) were operated for coverage of defect by distally based sural flap. All the cases were done as secondary procedures. RESULTS: All the flaps showed good results except five minor complications. Three flaps showed superficial skin necrosis and two showed partial tip necrosis. CONCLUSIONS: Distally based sural artery flap is very useful in covering the defects of lower leg, heel and dorsum of foot. It is reliable, easy to raise with minimal morbidity to the patient. This flap does not sacrifice any of the major vessels of the limb and hence it is very safe flap.

Spinal arteriovenous malformations: Is surgery indicated?

PURPOSE: To identify clinico-radiological distinguishing features in various types of spinal arteriovenous malformations (AVM) with an aim to define the role of surgical intervention. MATERIALS AND METHODS: Hero's modified Di Chiro classification differentiated four types of spinal AVMs on digital subtraction angiogram (DSA) in 74 patients: I. Dural arteriovenous fistulae (n = 35, 47.3%); II. Glomus/intramedullary (n = 13, 17.6%); III. Juvenile/metameric (n = 4, 5.4%); and, IV. Ventral perimedullary fistula (n = 21, 28.4%). A patient with extradural AVM remained unclassified. Demographic profiles, DSA features and reason for surgical referral were recorded. Statistical comparison of discrete variables like gender, spinal cord level, presentation and outcome was made using Chi-square test; and, continuous variables like age, feeder number, duration of symptoms and number of staged embolizations by one way analysis of variance with Boneferoni post hoc comparison. Embolization alone (n = 39, 52.7%), surgery alone (n = 16, 21.6%), and combined approach (n = 4, 5.4%) were the treatments offered (15 were treated elsewhere). RESULTS: Type I-AVM occurred in significantly older population than other types (P = 0.01). Mean duration of symptoms was 13.18 ± 12.8 months. Thoracic cord involvement predominated in type-I and III AVMs (P = 0.01). Number of feeding arteries were 1 in 59.7%; 2 in 29.0%; and, multiple in 11.3% patients, respectively. Staged embolization procedures in type-III AVM were significant (P < 0.01). Surgical referral was required due to: Vessel tortuosity/insufficient parent vessel caliber (n = 7); residual AVM (n = 4); low flow AVM (n = 3); and, multiple feeders (n = 2). Check DSA (n = 34) revealed complete AVM obliteration in 26 and minor residual lesion in eight patients. Neurological status improved in 26 and stabilized in 25 patients. CONCLUSIONS: Differentiating between Type I-IV AVMs has a significant bearing on their management. Surgical intervention should be considered as an important adjunct/alternative to therapeutic embolization.

Squamous cell carcinoma of tongue and buccal mucosa: clinico-pathologically different entities.

The objective of this study was to examine the clinical and pathological features of squamous cell carcinoma of the Tongue and Buccal Mucosa and understand their differences. This is a retrospective analysis of prospectively collected data of 735 patients with squamous cell carcinoma of the tongue and 665 cases of carcinoma of the buccal mucosa treated by surgery at our hospital. Statistical analysis was done to examine clinical and pathological differences between carcinoma of the tongue and the buccal mucosa with regards to age, gender, clinical T stage/N stage, pathological T stage/N stage, overall stage, grade, thickness, perinodal extension (PNE), lymphovascular emboli (LVE) and perineural invasion (PNI). Statistically significant differences were found for factors like age (p < 0.001), gender (p < 0.001), clinical T staging (p < 0.001) and pathological stage (p < 0.001), grade of tumor (p < 0.001) and perineural invasion (p < 0.001) between carcinoma of the tongue and the buccal mucosa. Forty-eight percent patients in either subsite had pathologically proven node negative necks (pN0, p = 0.88). Multivariate analysis for occult nodal metastases revealed that predictive factors were different for the two subsites. There are significant differences between cancers of the tongue and buccal mucosa for various clinical and pathological factors. This may be a reflection of the underlying differences in their causation and pathophysiology. Squamous cell carcinoma in these two subsites should therefore be regarded as clinico-pathologically distinct entities.

Effect of different packaging films on shelf life and quality of peach under super and ordinary market conditions.

Peach (Prunus persica L. Batsch) fruits of cultivar 'Shan-i-Punjab' were harvested at colour break stage and packed in paper moulded trays followed by wrapping with different packaging films viz. cryovac heat shrinkable RD-106, cling and low density polyethylene (LDPE) film. After packaging, the fruits were stored under two different conditions i.e. super-market conditions (18-20 °C; 90-95 % RH) and ordinary market conditions (28-30 °C; 60-65 % RH). The fruits were evaluated for various quality attributes periodically. The shrink film helped in reducing the loss in weight, firmness, decay incidence and maintained the various qualities attributes like total soluble solids, sugars, acidity and ascorbic acid content of the fruits during shelf-life better than unwrapped control fruits. The pectin methyl esterase enzyme activity was also found to be lower in shrink film packed fruits over the unwrapped control fruits. The in-package gaseous composition (O2 and CO2) in shrink film packed fruits was found to be at desired level which resulted in maintenance of pleasant flavour of the fruits. On the other hand LDPE film accumulated very high level of CO2, which led to formation of fermenting odour and decay of fruits in the package. The data revealed that RD-106 film proved quite effective in prolonging the shelf-life and maintaining the quality of peach fruits for 9 and 4 days under super market conditions (SMC) and ordinary market conditions (OMC), respectively as against 6 and 2 days only in case of unpacked control fruits under both the marketing conditions. The results suggest that shrink film could be used in packaging of peach without negative effects on quality.

Extraintestinal manifestations of inflammatory bowel disease and intestinal tuberculosis: Frequency and relation with disease phenotype.

BACKGROUND: Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD), as well as intestinal tuberculosis (ITB) from Asia, are underreported. We, therefore, describe the prevalence of EIMs in Indian IBD and ITB patients and study their relationship with disease extent and severity in IBD. METHODS: This retrospective single-center study included all IBD and ITB patients evaluated from January 2005 to July 2012. Disease profile and frequencies of arthropathies (peripheral and central) and ocular (episcleritis, iritis/uveitis), oral (aphthous stomatitis), skin (erythema nodosum, pyoderma gangrenosum, psoriasis), hepatobiliary (primary sclerosing cholangitis), and thromboembolic manifestations were analyzed. RESULTS: Of 1,652 patients (1146 UC, 303 CD, 203 ITB), frequency of any EIM was 33.2 %, 38.3 %, and 14.3 % in UC, CD, and ITB patients, respectively. Thromboembolism was more common among UC patients with pancolitis than proctitis (p < 0.001) and left-sided colitis (p = 0.02). Primary sclerosing cholangitis was seen in 0.4 % UC patients. Steroid-dependent UC patients had higher frequency of any EIM, peripheral arthropathy, or thromboembolism than patients with no or infrequent steroid requirement (p < 0.05). Peripheral arthropathy (p = 0.02), erythema nodosum (p = 0.01), and aphthous stomatitis (p = 0.004) were more common with CD than with UC patients. Patients with colonic CD had higher frequency of peripheral arthropathy, any EIM, and multiple EIMs than ileal or ileocolonic disease (p < 0.05). Relative to ITB, CD patients had higher frequencies of peripheral arthropathy (p < 0.001), aphthous stomatitis (p = 0.01), any EIM (p < 0.001), and multiple EIMs (p < 0.001). CONCLUSIONS: In Indian IBD and ITB patients, EIMs appear to be related to disease severity in UC and disease location in CD and are significantly more common in CD than in ITB. Overall prevalence of EIMs in these patients is similar to that of the West.

Unusual parapharyngeal lipoma.

Lipomas of the parapharyngeal space (PPS) are extremely rare. CT scan and MRI are indispensable tools to investigate these hard to access tumors. PPS lipomas are confined to either the prestyloid or post styloid compartments. We report an unusual parapharyngeal lipoma involving both the compartments of the PPS.

Ipsilateral neck nodal status as predictor of contralateral nodal metastasis in carcinoma of tongue crossing the midline.

BACKGROUND: In squamous cell carcinoma of the tongue, when lesions reach or cross the midline, there is a higher risk of contralateral nodal metastasis. Identifying factors that are associated with higher risk of nodal metastasis may help in optimizing the treatment. METHODS: A retrospective analysis was conducted of all patients with squamous cell carcinoma of the tongue who had undergone bilateral neck dissection at Tata Memorial Hospital between January 2007 and June 2010 for a lesion crossing or reaching the midline. RESULTS: Contralateral nodal metastases were present in 71 of 243 patients (29%) who underwent bilateral neck dissection. Of these 71 patients, 69 patients (97%) had ipsilateral nodal metastasis. CONCLUSION: In carcinoma of the tongue, where lesions reach or cross the midline, the chance of contralateral nodal metastases without ipsilateral nodal metastasis is extremely rare. Frozen section of ipsilateral neck dissection can be a pointer for addressing the contralateral neck.

Head and neck squamous cell carcinoma in chronic areca nut chewing Indian women: Case series and review of literature.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is an important public health problem in India. Several risk factors such as tobacco, human papilloma virus, alcohol, areca nut usage have been extensively studied as causative agents. Though Areca nut chewing is known cause of oral cancer, its association with hypopharynx cancer has not been previously reported. Since areca nut is mostly consumed along with tobacco, it is uncommon to find patients who consume the areca nut alone. MATERIALS AND METHODS: This is a prospective case series of ten women who presented to us with HNSCC with history of chewing of areca nut alone for several years. We have excluded all those cases where areca nut was consumed along with tobacco in any form. The data were prospectively collected with regard to clinical parameters, duration and frequency of areca nut usage, the socio-economic status and education level. RESULTS: All ten females had varying degree of submucous fibrosis and coexisting squamous cell carcinoma either in the oral cavity or hypopharynx. Submucous fibrosis was characterized by burning mouth, unhealthy oral mucosa, buried third molars, trismus, poor oral hygiene, etc. The disease presented in an advanced stage in majority of the cases. All patients were unaware of areca nut's deleterious effects. CONCLUSION: Areca nut chewing is an important risk factor for HNSCC in females. Despite plethora of information, little importance is given to areca nut control in cancer prevention campaigns in India.

Utility of frozen section in assessment of margins and neck node metastases in patients undergoing surgery for carcinoma of the tongue.

OBJECTIVE: The aims of this study are to evaluate the impact of frozen section in achieving adequate surgical margin and to study the accuracy of frozen section in detection of occult metastases. MATERIALS AND METHODS: This was a retrospective review of prospectively collected data of 877 patients with squamous cell carcinoma of the tongue who underwent surgery and intra-operative frozen section at our center from January 2007 to June 2010. RESULTS: Frozen section was found to have very high accuracy in assessment of margin as well nodal status. On frozen section, 2% of our patients had positive margins and 21% had close margins. Most of these underwent intra-operative revision and at final pathology, 1.2% patients had positive margins and 11% were close. Of the 651 supraomohyoid neck dissections performed, one third were found to have occult metastases on frozen section. Of those reported positive on frozen section, 68% got additional removal of level 4 ± 5. Interestingly, 11% of these additionally removed nodes harbored metastases at final pathology. However, 7% of the patients were wrongly declared negative on frozen section. Tumor thickness was predictor of margin positivity as well as occult metastases. Tumor volume did not correlate with occult metastases or margin status. CONCLUSIONS: Frozen section nearly halves the rates of positive margin and close margins which certainly translates into clinical benefits. The incidence of 11% positive nodes in the frozen section guided removal of lower levels is an important finding in our study that questions the ability of supraomohyoid neck dissection to completely eradicate the nodal burden in such patients.

Foreign bodies in bronchus--2 years experience at IPGME&R, Kolkata.

Foreign body in the bronchus is one of the life saving emergency in the ENT department. Most patients of foreign body bronchus are kids. Common presentation is respiratory distress or noisy respiration of sudden onset. Proper clinical examination and suspicion needed for proper diagnosis. In this report, 52 cases of foreign body bronchus were included. All patients underwent straight x-ray chest after taking proper history and while aroused suspicion. All of them received antibiotic and steroid. Foreign body was removed by rigid bronchoscope, flexible bronchoscope and by rigid telescope along with rigid bronchoscope. Most foreign bodies lodged in the left bronchus. Only one patient had died in the process for anaesthetic hazards.

Corticosteroids as an adjunct to antibiotics and surgical drainage for the treatment of pyogenic flexor tenosynovitis.

BACKGROUND: Many similarities exist between pyogenic flexor tenosynovitis and other closed-space infections such as septic arthritis. Previous studies have demonstrated that corticosteroids in conjunction with antibiotics considerably improve treatment outcomes in patients with septic arthritis. Using a chicken model, we investigated whether or not corticosteroids in combination with antibiotics and/or surgical drainage could minimize the loss of range of motion typically associated with pyogenic flexor tenosynovitis. METHODS: We inoculated the flexor tendon sheath of the right long toe of broiler chickens with Staphylococcus aureus (American Type Culture Collection 29523 NA) (6 × 10(9) colony-forming units/mL) and twenty-four hours later administered one of six treatments to groups of fourteen or fifteen chickens. Treatment combinations included systemic or intrasynovial antibiotics, surgical drainage with catheter irrigation or no surgical drainage, and local corticosteroid injections or no corticosteroid injections. Measurements of active digital flexion at the proximal and middle interphalangeal joints were performed before inoculation and treatment and at seven, fourteen, and twenty-eight days after treatment. Flexion measurements were compared between groups as well as with similar measurements in the contralateral, uninfected, control long toe. RESULTS: At twenty-eight days, two of three groups treated with locally administered corticosteroids and the group treated with intrasynovial antibiotics alone (without surgery) regained significantly more active flexion in comparison with chickens treated with systemic antibiotics and surgical drainage (the current standard of care). Pooled data revealed that the corticosteroid-treated groups regained significantly more active flexion at all post-treatment time points. CONCLUSIONS: Our data support the hypothesis that adding locally administered corticosteroids to the treatment regimen for pyogenic flexor tenosynovitis in a chicken model can significantly decrease loss of motion resulting from the infection. Furthermore, locally administered antibiotics may be effective for the treatment of pyogenic flexor tenosynovitis.

Effectiveness of two different HDR brachytherapy regimens with the same BED value in cervical cancer.

PURPOSE: To analyze the effectiveness of biologically effective dose (BED) in two different regimens of HDR brachytherapy keeping the same total BED to point A and to compare the relationship of overall treatment time in terms of local control and bladder and rectal complications. MATERIAL AND METHODS: The study included two groups comprising a total of 90 cervical cancer patients who underwent external beam radiotherapy (EBRT) followed by HDR intracavitary brachytherapy (ICBT). EBRT treatment was delivered by a Co-60 teletherapy unit to a prescribed dose of 45 Gy with 1.8 Gy per fraction in 25 fractions over a period of five weeks. Parallel opposed anterior-posterior (AP/PA) fields with no central shielding were used, followed by the HDR ICBT dose, to point A, of either two fractions of 9.5 Gy with a gap of 10 days, or three fractions of 7.5 Gy with a gap of 7 days between the fractions. Gemcitabine (dose of 150 mg/m2) was given weekly to all the patients as a radiosensitizer. The calculate BED3 to point A was almost the same in both groups to keep the same late complication rates. The doses, and BED10 and BED3, were calculated at different bladder and rectal point as well as at the lymphatic trapezoid points. During and after treatment patients were evaluated for local control and complications for 24 months. RESULTS AND CONCLUSIONS: Doses and BEDs at different bladder, rectal and lymphatic trapezoid points, local control, and complications in both HDR ICBT groups did not have statistically significant differences (p > 0.05). Both HDR ICBT schedules are well tolerable and equally effective.

Quantifying normal ankle joint volume: An anatomic study.

BACKGROUND: Many therapeutic and diagnostic modalities such as intraarticular injections, arthrography and ankle arthroscopy require introduction of fluid into the ankle joint. Little data are currently available in the literature regarding the maximal volume of normal, nonpathologic, human ankle joints. The purpose of this study was to measure the volume of normal human ankle joints. MATERIALS AND METHODS: A fluoroscopic guided needle was passed into nine cadaveric adult ankle joints. The needle was connected to an intracompartmental pressure measurement device. A radiopaque dye was introduced into the joint in 2 mL boluses, while pressure measurements were recorded. Fluid was injected into the joint until three consecutive pressure measurements were similar, signifying a maximal joint volume. RESULTS: The mean maximum ankle joint volume was 20.9 +/- 4.9 mL (range, 16-30 mL). The mean ankle joint pressure at maximum volume was 142.2 +/- 13.8 mm Hg (range, 122-166 mm Hg). Two of the nine samples showed evidence of fluid tracking into the synovial sheath of the flexor hallucis longus tendon. CONCLUSION: Maximal normal ankle joint volume was found to vary between 16-30 mL. This study ascertains the communication between the ankle joint and the flexor hallucis longus tendon sheath. Exceeding maximal ankle joint volume suggested by this study during therapeutic injections, arthrography, or arthroscopy could potentially damage the joint.

Changes in length of the first ray with two different first MTP fusion techniques: a cadaveric study.

BACKGROUND: First metatarsophalangeal joint (MTP) fusions are performed as salvage procedures for a variety of conditions ranging from osteoarthritis, rheumatoid arthritis, hallux valgus, and failed first MTP arthroplasty. A number of bone preparation techniques have been described to fuse the first MTP joint, with varying degrees of success. The aim of this study was to characterize and compare the average shortening of the first ray with a conical reamer fusion technique versus flat bone cut technique. MATERIALS AND METHODS: Six paired cadaver feet were divided into two groups with one foot from each pair in each group. Preoperative first ray lengths were measured radiographically. Each group then underwent arthrodesis of first MTP joint with one of two different bone cut techniques: flat cuts or conical reaming. The postoperative lengths of the first rays were measured and the data analyzed using a two-tailed Student's t-tests. RESULTS: The average shortening that occurred in both groups after the procedure was 7.1 mm for the flat cut group (Group I) and 5.7 mm for the machined conical reaming group (Group II). Comparing both groups, there was no statistically significant difference in the shortening between the groups. CONCLUSION: Both flat bone cut and conically reamed techniques caused shortening of the first ray after first MTP fusion. However, there was no statistically significant difference in the postprocedure lengths of the first ray between the two groups. CLINICAL RELEVANCE: Neither technique is more likely to lead to transfer metatarsalgia since the shortening was similar.