Factors Affecting Functional Sensory Recovery After Inferior Alveolar Nerve Repair Using the Nerve Sliding Technique.

PURPOSE: The nerve sliding technique (NST) was introduced for repairing inferior alveolar nerve (IAN) defect and overcoming the disadvantages of conventional surgical treatment methods such as nerve graft. This study was conducted to identify factors associated with functional sensory recovery (FSR) following inferior alveolar nerve repair using the NST. PATIENTS AND METHODS: This was a retrospective cohort study including all patients who underwent IAN repair using the NST at Seoul National University Dental Hospital, Department of Oral and Maxillofacial Surgery from February 2009 to March 2020. The damaged part of the IAN was excised, and the incisive branch was transected intentionally to perform direct anastomosis without tension. Cox proportional hazard analysis was utilized to determine the relationships between predictor variables (age, gender, chief complaints, preoperative sensory results, duration from injury to repair, length of nerve tissue resected during the procedure, and neuroma formation) and outcome variable (time to FSR). RESULTS: The sample was composed of 16 patients with a mean age of 56.1 ± 10.1 years, 25% were males and 75% were females. The mean nerve gap deficit was 7.69 mm (3-15 mm). Ten patients (62.5%) achieved FSR with a median time from operative treatment to FSR of 84.5 days. Dental implant placement was found as the main cause for IAN injury (93.8%) and 56.2% of patients complained of hypoesthesia and dysesthesia. Factors associated with time to FSR at 1 year were age, chief complaint, and early repair. Younger patients (P = .041) and patients without dysesthesia (P = .019) were more likely to achieve FSR. Higher proportion of early repair group achieved FSR, although not statistically significant (P = .068). CONCLUSIONS: The use of NST in repair of IAN defects up to 15 mm achieved 62.5% FSR. Younger age and absence of dysesthesia were associated with higher FSR.

A case of discordant monochorionic diamniotic twin with umbilical cord entanglement after spontaneous rupture of the dividing membrane.

Spontaneous antepartum rupture of the dividing membrane in monochorionic diamniotic twins with discordancy is extremely rare. The rupture is difficult to diagnose prenatally and has a poor outcome. The authors report a case of cord entanglement after spontaneous rupture of the dividing membrane within discordant monochorionic diamniotic twins. The subject was a 30-year-old woman pregnant with discordant monochorionic diamniotic twin at 27+4 gestational weeks. The relatively thin dividing membrane was sound until it passed parallel to the two umbilical cords where it then became ill-defined. The patient was managed cautiously due to the possibility of spontaneous rupture of the dividing membrane and potential cord entanglement. Upon delivery at 29+3 weeks due to fetal compromise, the patient presented with a monochorionic diamniotic placenta, a remnant of the disrupted dividing membrane, and entangled umbilical cords. The authors report this subject with literature review.

A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study.

BACKGROUND: We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. METHODS: We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. RESULTS: The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. CONCLUSIONS: The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Congenital sudoriferous cyst within the orbit followed by esotropia.

PURPOSE: To report a case of congenital sudoriferous cyst of the orbit with esotropia. METHODS: A 20-day-old male, born prematurely presented with a palpable lump on left upper lid. Orbital ultrasonography including color doppler image and orbital magnetic resonance image were performed to evaluate the lid lesion. The mass was excised and histologically examined. Complete ocular examination including visual acuity, duction, version, and the presence of strabismus were performed. RESULTS: A well circumscribed round cystic mass, measuring 1.4 x 1.3 cm was noted at medial superior aspect of the left orbit. It compressed and displaced the left globe to inferior posterior position with intact optic nerve. Histopathologic examination showed the lesion to be a solitary sudoriferous cyst lined by two layers of cuboidal epithelial cells with eosinophilic cytoplasm. After the excision of the mass, limitations of extraocular muscle movements, esotropia, and amblyopia were noted. CONCLUSIONS: If an orbital cyst affects the globe or extraocular muscles, it should be excised as soon as possible to prevent strabismus and amblyopia especially in infant.

A meningomyelocele with normal intracranial signs on ultrasound and false-negative amniotic fluid alpha-fetoprotein and acetylcholinesterase.

Neural tube defects are the major targets of prenatal diagnoses, along with Down syndrome. Prenatal diagnosis of spina bifida is possible at second trimester of gestation through α-fetoprotein and acetylcholinesterase biochemistry assays and ultrasound. In particular, the discovery of characteristic intracranial signs on ultrasound leads to a very high diagnosis rate. However, it is rare for spina bifida to present without intracranial signs while also showing normal values of maternal serum α-fetoprotein, amniotic fluid α-fetoprotein, and acetylcholinesterase. In our hospital, a fetus with spina bifida was delivered at 37+5 weeks' gestation by cesarean section, and was continually followed up over 2 years to date.