Impact of ligation versus repair of isolated popliteal vein injuries on Deep Vein Thrombosis and Pulmonary Embolism incidence in trauma patients: a meta-analysis.

BACKGROUND: Traumatic injuries affecting the veins in the lower extremities have been correlated with both mortality and severe complications. Venous injuries are recognized as a contributing factor to the development of venous thromboembolism, commonly treated through procedures involving either vein ligation or repair. Despite previous efforts, substantial uncertainty remains when it comes to choosing between the execution of ligation versus various reparative techniques. The aim of this study was to evaluate the short-term results of surgically treating traumatic venous injuries through repair compared to ligation, specifically examining the resulting impacts on trauma patients in relation to DVT and PE occurrences. METHOD: A comprehensive search strategy was employed until August 10, 2023, to systematically explore Scopus and PubMed databases. Following the removal of duplicates, two researchers independently assessed the titles and abstracts of the identified studies. Only studies meeting the project's requirements and inclusion criteria, as evaluated through their full texts, were included in our investigation. Our study exclusively focused on original articles, specifically those involving human trauma patients with isolated popliteal vein injuries. Excluded from consideration were review articles, meta-analyses, cellular and molecular research, animal studies, case reports, case series, letters to the editor, posters, duplicates, and publications in languages other than English. The implementation of this systematic review and meta-analysis conformed to the standards delineated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULT: Conducting a thorough search, the inquiry identified 248 records. The assessment of titles and abstracts led to 51 studies that had the potential for eligibility. After reviewing the full texts of the chosen studies, 4 studies involving 1521 patients constituted the ultimate findings. CONCLUSION: We concluded that the ligation procedure had a higher incidence of pulmonary embolism compared to the repair of vein injuries, while the repair procedure had a higher incidence of deep vein thrombosis than ligation. Additional large-scale randomized controlled trials are still necessary to further support the findings of this meta-analysis.

Impact of oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy: Systematic review and meta-analysis.

BACKGROUND: One of the most common complications of total thyroidectomy is post-operative transient or persistent hypoparathyroidism that can cause symptomatic hypocalcaemia. To prevent this complication, shorten the period of hospitalization and reduce morbidity, routine supplementation of oral vitamin D and calcium has been suggested. This systematic review and meta-analysis aims to critically assess the association between pre-operative calcitriol supplementation and post-operative hypocalcaemia. METHODS: Randomized controlled trial studies were identified by searching PubMed, Scopus, and Google Scholar databases up to 30 March 2023. Screening of titles, abstracts, and full texts of articles were performed, and data were extracted for a meta-analysis. RESULTS: This meta-analysis includes data from nine randomized controlled trials with a total of 1259 patients but with significant heterogeneity. The results demonstrate that calcium levels were higher in patients who had pre-operative calcitriol supplementation, with a weighted mean difference (WMD) 0.18 (95% confidence interval (CI) = 0.00, 0.37). Pre-operative calcitriol supplementation did not lead to significant changes in parathyroid hormone (PTH) levels, with WMD -0.49 (95% CI: -1.91, 0.94). CONCLUSION: Pre-operative calcitriol supplementation leads to higher calcium levels, but the high heterogeneity of the included studies (79% to 98.7%) could affect the results.

Survival Rates of Implants That Have Compromised the Adjacent Teeth and the Associated Complications: An Opg Retrospective Study.

This retrospective study evaluated survival rates of implants compromising adjacent teeth and associated complications. Medical records and orthopantomographic images of 1132 patients and 1478 implants were retrospectively analyzed. Finally, 96 patients (52 females, 44 males) with 111 malpositioned implants were included in the study. The mean follow-up of the study was 32 ± 14 months. The patients were divided into 2 core groups: (1) adjacent teeth and dental implants were considerably close but tangent to each other (TAN), and (2) dental implant cutting the roots of the adjacent tooth (CUT). In addition, the CUT group was divided into 2 subcategories considering the possible cause of malangulation as angled implant (AI) or angled adjacent tooth (AT). Damage to adjacent teeth, future treatment requirements, and the survival rates of the implants were recorded. Among the 111 implants, 4 (3.6%) implants failed, all of which belonged to the CUT category and the AI subgroup. Among the 88 preoperatively vital adjacent teeth, root canal treatment was performed in 18 (20.5%) teeth, whereas 2 (2.3%) teeth were extracted due to malpositioned implanting in follow-ups. The placement of implants too close to the adjacent teeth and even cutting direction did not have a statistically significant effect on the survival rates of implants. However, this could cause adjacent teeth to undergo unnecessary root canal treatment or extraction. Patients with malpositioned adjacent teeth or dilacerated root(s) adjacent to the edentulous area are at a higher risk for malpositioned implant complications. Most implant malposition complications are observed in the first premolar region (37% cases). Therefore, more attention should be given while placing implants in the first premolar region.

Comparison of the effects of three different xenogeneic bone grafts used in sinus augmentation simultaneous with dental implant placement on the survival of the implants and the dimensional changes of the region.

BACKGROUND: Xenografts can be produced in various particle sizes by using different bone types. Currently, there is no consensus about the ideal type of xenograft for sinus augmentations, and this choice depends on the personal experience of clinicians. This retrospective study aimed to evaluate the effects of three different xenografts used in sinus augmentation simultaneously with implant placement on the survival of the implants and the dimensional changes of the region. METHODS: One hundred nine sinus augmentations and 164 implants were evaluated in 76 patients. Three different xenografts were used: 41 Gen-Os® (250-1000µm, Corticocancellous; Tecnoss, Giaveno, Turin, Italy), 35 Bio-Oss® (1000-2000µm, Cancellous; Geistlich Biomaterials italia S.r.l., Vicenza, Italy) and 33 Apatos-Cortical® (600-1000µm, Cortical; Tecnoss). The preoperative, postoperative, and follow-up (21±8.8 month) radiographs were evaluated for the dimensional changes and the implant survivals. The data were statistically analyzed. RESULTS: Among the implant failures; 3 (5.6%) in 53 implants in Apatos, 2 (3.6%) in 55 implants in Bio-Oss, 9 (16%) in 56 implants in Gen-Os, and 14 (8.5%) total implant failures were observed. This difference between the groups was statistically significant and was due to the high loss rate in the Gen-Os (P=0.044). There was a mean difference of -1.8±1.5mm between the measured bone heights on postoperative day (14.2±2.4mm) and the last follow-up (12.4±2.5 mm). While the loss of height was not affected due to the graft type (P=0.981), the general 12.6% vertical loss was statistically significant (P<0.0001), also the length of implants placed reduced this loss (P=0.036). CONCLUSIONS: Within the limits of this retrospective study, it can be concluded that: 1) The sinus augmentation procedures with thicker particle size grafts achieved higher success rate; and 2) over the time, 12.6% loss may occur in the height of grafted area.

New Concepts in Dorsal Nasal Augmentation.

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.

Treatment of mandibular angle fracture: Revision of the basic principles.

Biodynamics of mandibular angle fractures has been extensively discussed in the literature in search for the best way to fixate and expedite recovery of trauma patients. Pioneers like Michelet and Champy had the greatest impact on evolving of osteosynthesis in maxillofacial traumatology; they introduced their basic principles frequently used to describe the biomechanics of mandibular fixation. Their concept states when a physiologic load is applied on mandibular teeth a negative tension will be created at superior border and a positive pressure will appear at inferior border. These simple definitions are the basis for the advent of fixation modalities in mandibular angle fracture. This article sought to reassess these principals based on load location via finite elements method.

Immediate effects of different steps of rhinoplasty on nasolabial angle and tip projection.

Nasolabial angle (NLA) and nasal tip projection (NTP) play an important role in aesthetic nose surgery. Little deviations can determine success and failure. The goal of this study was to analyze the immediate effect of different steps of open rhinoplasty on NLA and NTP. In this prospective single-blind study, 50 consecutive rhinoplasty cases were considered. The study consisted of 38 women and 12 men. The mean age was 28 years, ranging from 17 to 37 years. A standard life-size photograph was taken in each step of a classic open rhinoplasty during surgery. Nasolabial angle and NTP were measured and analyzed. Nasolabial angle: average increase after skeletonization (2.26 degrees), strut insertion (4 degrees), and tip spanning (0.17 degrees), whereas cephalic resection caused a decrease (1.9 degrees). Nasal tip projection: average increase after skeletonization (0.1 mm), strut insertion (0.31 mm), and tip spanning (0.84 mm), whereas cephalic resection caused a decrease (0.53 mm). Whereas strut insertion caused the highest mean increase in NLA, tip spanning was the most effective regarding change of NTP. Expectably cephalic resection was associated with decrease in NLA and NTP.

Augmentation of the upper lip with temporalis fascia: a quantitative analysis.

BACKGROUND: Lip augmentation is a very common cosmetic procedure. A wide variety of materials have been used to enhance and contour the lips, including alloplastic and autogenous substances. OBJECTIVES: The authors describe their experience with augmentation of the upper lip using an autologous graft from the temporalis fascia. METHODS: Patients were enrolled prospectively. Upper-lip projection and vermilion show were measured preoperatively and 6 months postoperatively for 19 patients who were candidates for lip augmentation with temporalis fascia. RESULTS: Six months postoperatively, the mean values for upper-lip projection and lip vermilion were significantly greater than preoperative measurements. CONCLUSIONS: Augmentation of the upper lip with temporalis fascia appears to be safe and effective. Larger patient series, longer follow-up, and comparative studies are needed to corroborate these preliminary results. LEVEL OF EVIDENCE: 4.

Dorsal hump surgery and lateral osteotomy.

Lateral osteotomy is a controversial step in rhinoplasty, which is usually performed to narrow a wide nose, widen a narrow bony pyramid, straighten a deviated nose, or close an open roof deformity. The osteotomy is performed using several methods, although the internal continuous and external perforator are the main ways to perform the lateral osteotomy. Most other techniques are modifications of these basic methods. The purpose of this article is to review the essential concepts of nasal hump surgery and lateral osteotomy as used in cosmetic rhinoplasty.

Nasal base surgery.

The nasal base is an important aspect of the nose with a complex anatomic architecture comprising a combination of cartilages, skin, connective tissues, and ligaments. Recent studies show that all nasal base deformities cannot be corrected by simple excision and suturing techniques. Alar release and medialization would be effective in some of these deformities. This article presents an overview of conventional concepts of alar base surgeries, which have remained unchanged over many years. Indications and limitations of each technique are discussed, followed by a more detailed description of alar release and medialization.

Analysis of stress distribution on fixation of bilateral sagittal split ramus osteotomy with resorbable plates and screws using the finite-element method.

PURPOSE: To determine the most appropriate stress distribution in fixation with resorbable screws and plates after bilateral sagittal split ramus osteotomy using the finite-element method. MATERIALS AND METHODS: This experimental study was performed on simulated human mandibles using computer software. The osteotomy line was applied to the simulated model and experimental loads of 75, 135, and 600 N were exerted on the model in accordance with the vector of occlusal force. The distribution pattern of stress was assessed and compared in 8 fixation methods: 1 resorbable screw, 2 resorbable screws in a vertical pattern, 2 resorbable screws in a horizontal pattern, 3 resorbable screws in an L pattern, 3 resorbable screws in a backward-L pattern, 1 miniplate with 2 screws, 1 miniplate with 4 screws, and 2 parallel miniplates with 4 screws each. RESULTS: Among the simulated fixations, 2 parallel miniplates showed the greatest primary stability and the single screw and the 2-hole miniplate showed the least tolerance to posterior forces. CONCLUSIONS: This study showed the 2-miniplate/4-hole plate pattern was the strongest and the single-screw and 2-hole plate patterns were the weakest of fixations in this bilateral sagittal split ramus osteotomy model. The finite-element method showed that polymer-based resorbable screws and plates (polyglycolic acid and d,l-polylactide acid) provide satisfactory primary stability in this model.

Effectiveness of buccal fat in closing residual midpalatal and posterior palatal fistulas in patients previously treated for clefts.

PURPOSE: The present retrospective study assessed the outcome and effectiveness of the buccal fat pad flap for closure of postoperative midpalatal fistulas and fistulas of the posterior palate in patients previously treated for cleft palate. PATIENTS AND METHODS: The charts of 29 patients with residual midpalatal and posterior palatal fistulas treated using buccal fat pad flaps were assessed. Of the 29 patients, 18 were males and 11 were females, aged 2.5 to 19 years. The fistula size was 10 to 20 mm. RESULTS: Full epithelialization of the flap had occurred within 4 weeks in all 29 patients. The fistulas had completely closed in 28 patients. In 1 patient, a 2-mm defect was noted in the anterior part of the fistula repair that had healed after 2 months without intervention. CONCLUSION: The buccal fat pad flap can be used to repair any remaining postoperative palatal fistulas that are 10 to 20 mm in size.

Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report.

OBJECTIVE: Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment. STUDY DESIGN: We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software. RESULTS: Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P < .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P < .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P < .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients. CONCLUSION: This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.

Biomechanical stress distribution on fixation screws used in bilateral sagittal split ramus osteotomy: assessment of 9 methods via finite element method.

PURPOSE: The aim of this study was to assess the biomechanical stress tolerance of screws used in 9 fixation methods after bilateral sagittal split ramus osteotomy to determine which configuration leads to lesser force load on the cortical bone at fixation points. MATERIALS AND METHODS: A 3-dimensional computerized model of a human mandible with posterior teeth was generated. The bilateral sagittal split ramus osteotomy was virtually performed on this model. The separated model was assembled with 9 fixation methods: single screw, 2 screws one behind the other, 2 screws one below the other, 3 screws in an L configuration, 3 screws in an inverted backward L configuration, miniplate with 2 screws, miniplate with 4 screws, 2 parallel plates (upper + lower border), and square miniplate with 4 screws. Then, 75-, 135-, and 600-N vertical loads were applied on the posterior teeth of these models. The stress distribution on the screw sites on the buccal cortex was measured by the finite element method. RESULTS: In this model all the fixation methods withstood forces between 75 and 135 N. However, the single-screw and the 2-hole miniplate models showed that the stress distributions in the configurations were intolerable when 600 N of posterior force was applied. The results of this study indicated that the inverted backward L configuration with 3 bicortical screws was the most stable. CONCLUSION: Although this study indicated that the inverted backward L configuration with 3 bicortical screws was the most stable pattern, most of the patterns had adequate stability for clinical applications (mean, 125 N).

Causes and incidence of miniplate removal following Le Fort I osteotomy.

AIM: This study assessed the causes and incidence of miniplate removal during a 5-year period after Le Fort I osteotomy. PATIENTS AND METHODS: One hundred forty-two patients had plates inserted for fixation of the maxilla after Le Fort I osteotomy between 2001 and 2004. The Le Fort I segment was rigidly fixed with four 2-mm titanium miniplates and 16 screws. They were followed 1 to 5 years for plate complications and need for plate removal. RESULTS: Fifteen of 142 patients (10.6%), 9 females and 6 males, required plate removal. The minimum time period between insertion and removal was 4 months and the maximum period was 18 months. Causes for removal were as follows: infection (40%), pain (13.3%); sinusitis (13.3%); sensitivity to temperature change (13.3%); palpability of plate (13.3%); and phobia (6.8%). CONCLUSION: In this study, the number of miniplates removed was small and required removal no sooner than 4 months postoperatively (after complete bony union), thus not compromising healing. There is no evidence from this study to support the routine removal of titanium miniplate after Le Fort I osteotomy, rather they should be removed when indicated.