The Outcomes of Mini-Plate Fixation for Unstable Wagstaffe Tubercle Fracture, an Indirect Syndesmosis Injury in Rotational Ankle Fracture.

Background: Wagstaffe fracture constitutes an indirect injury to the AITFL and can precipitate syndesmotic instability. The prevailing fixation methods often involve the use of mini-screws or K-wires, with absorbable suture repair reserved for cases with small or comminuted fragments exhibiting instability. In this study, we devised a mini-plate fixation method capable of securing the fracture fragment irrespective of its size or condition. Methods: A retrospective chart review was conducted on patients who underwent surgery for ankle fractures between May 2022 and October 2023. The surgical technique involved direct fixation of the Wagstaffe fracture using mini-plate fixation. Radiologic evaluation was performed using postoperative CT images, and clinical outcomes were assessed using the OMAS and VAS. Results: Fourteen patients with an average age of 62.5 years were included. Most fractures were associated with the supination-external rotation type. The average preoperative OMAS significantly improved from 5.95 to 83.57 postoperatively. The average VAS score decreased from 7.95 preoperatively to 0.19 postoperatively. Conclusions: The mini-plate technique for Wagstaffe fractures exhibited dependable fixation strength, effective fracture reduction, a minimal complication rate, and judicious surgical procedure duration.

Tongue-in-Groove: A Novel Implant Design for a Blow-Out Fracture.

Background: During blow-out fracture surgery, restoration of the orbital volume and rigid implant fixation are essential. The migration of an implant is a concern of most surgeons. The purpose of this study was to introduce a simple idea of molding and fixing an orbital implant. Methods: In the tongue-in-groove method, an incision of about 2 mm was made on the edge of the implant and it was bent to form a slot. A hole was made in the center of the implant for fitting a bone hook, and the implant was firmly fit into the remaining intact bone. Before and after surgery, computed tomography (CT) was used to evaluate changes in the orbital volume and the location of the implant. Statistically significant restoration of the orbital volume was confirmed on postoperative CT. Results: Compared with the unaffected orbital volume, the affected orbital volume was increased from 87.06 ± 7.92% before surgery to 96.14 ± 6.11% after surgery (p < 0.001). There was one case of implant migration during follow-up. However, the degree of movement was not severe, and there were no events during the follow-up period. Conclusions: The tongue-in-groove technique offers advantages, such as easy fixation of the implant, with minimal trauma to the surrounding tissues. In addition, the method offers advantages, such as being easy to learn, requiring little time for trimming the implant, and being relatively low cost. Therefore, it can be one of the options for implant fixation.

Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?

BACKGROUND: Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors. AIM: To evaluate the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs). METHODS: TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery. RESULTS: Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg. CONCLUSION: Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.

Successful reconstruction using a buccal fat pad flap in misdiagnosed buccinators intramuscular synovial sarcoma: A case report.

INTRODUCTION: Synovial sarcoma (SS) is a subtype of soft tissue sarcoma that primarily usually occurs in the lower extremities but rarely arises in the head and neck areas, including the oral cavity. Due to its variable presentation and similarity to benign masses in terms of age at onset, growth rate, and favorable outcomes, SS is often misdiagnosed as a benign tumor. However, it is a malignant tumor. PATIENT CONCERNS: We report the case of intramuscular SS in the oral cavity. Initially, the lesion was clinically suspected as a benign mass but was ultimately confirmed as malignant SS. DIAGNOSIS: Although histopathological examination is the first step in diagnosing SS, molecular testing to confirm the presence of SYT-SSX fusion can provide a definitive diagnosis when the histopathology is inconclusive. In this patient as well, the postoperative pathological report confirmed the diagnosis of biphasic SS, and molecular testing revealed positive SYT/SSX fusion. THERAPEUTICS INTERVENTIONS: Following the recommendation of multidisciplinary care system, a wide excision was performed including the buccinators muscle, and reconstruction was performed using a buccal fat pad flap to prevent cheek depression. OUTCOMES: On the final pathologic report, SS was removed margin-free, and there were no metastatic lymph nodes. No evidence of cheek dimpling was observed, and follow-up neck CT showed no significant changes in the lymph nodes. As a result of observation up to several months after surgery, there were no functional and aesthetic complications. CONCLUSIONS: We report a successful case of intramuscular SS resection, initially misdiagnosed as a benign mass, using a buccal fat pad flap. We also highlight the importance of correctly diagnosing SS, especially in the craniofacial region where it can be mistaken for benign masses.

Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture.

BACKGROUND: The nasal bone, being the most protruding bone in the center of the facial bones, is particularly susceptible to damage. Nasal bone fractures can often result in secondary deformation and dysfunction of the nose, including septal fractures. Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction. AIM: To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty. METHODS: We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010. All patients underwent preoperative Computed tomography evaluation, and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the Stranc classification. RESULTS: Before reduction, the mean MCA for all cases was 0.59 ± 0.06 cm2, which represented an 11% decrease compared to the average size of a Korean adult (0.65 ± 0.03 cm2). The MCA for frontal impact was 0.60 ± 0.02 cm2 and for lateral impact, it was 0.58 ± 0.03 cm2. After reduction via inferior turbinoplasty, the MCA improved to 0.64 ± 0.04 cm2. CONCLUSION: This study suggests that turbinoplasty is helpful in addressing nasal obstruction. Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.

Evaluating the Efficacy of Tension Band Wiring Fixation for Chaput Tubercle Fractures.

BACKGROUND: Chaput tubercle fractures, located at the attachment site of the anterior inferior tibiofibular ligament (AITFL) on the distal tibia, have the potential to destabilize the syndesmosis joint. This study aims to assess the effectiveness of tension band wiring (TBW) as a surgical intervention for managing Chaput fractures and the consequent syndesmosis instability. METHODS: A retrospective review of patient charts was undertaken for those who had undergone ankle fracture surgery from April 2019 through May 2022. The surgical procedure involved direct fixation of the Chaput fractures using the TBW method. Radiological assessments were performed using postoperative simple radiographs and computed tomography (CT) scans, while clinical outcomes were evaluated using the Olerud-Molander Ankle Score (OMAS) and the visual analog scale (VAS). RESULTS: The study included 21 patients. The average OMAS improved significantly, rising from 5.95 preoperatively to 83.57 postoperatively. Similarly, the average VAS score dropped from 7.95 before the surgery to 0.19 thereafter. Minor wound complications were reported by three patients, and one case of superficial infection was resolved with antibiotic therapy. CONCLUSIONS: Our findings suggest that the TBW technique is an effective surgical approach for treating Chaput fractures and associated syndesmosis instability. It provides reliable fixation strength and leads to improved long-term functional outcomes. Further research is needed to compare the TBW technique with alternative methods and optimize the treatment strategies for these complex ankle fractures.

Removal of unexpected schwannoma with superficial parotidectomy using modified-Blair incision and superficial musculoaponeurotic system folding: A case report.

BACKGROUND: When a firm facial mass in the cheek region is associated with a high index of clinical suspicion of its being of parotid gland origin, preventive parotidectomy is invariably performed. We report a rare case of a schwannoma that was suspected to be of parotid gland origin in a patient, who underwent successful surgical management using a modified-Blair incision and superficial musculoaponeurotic system (SMAS) layer folding method. CASE SUMMARY: A 27-year-old woman presented to the hospital for evaluation of a firm, fixed, non-tender mass (2.5 cm × 3.5 cm), located anterior to the right ear, of 1 year's duration. Contrast-enhanced facial computed tomography revealed a well-encapsulated, low-density mass adherent to the superficial lobe of the right parotid gland, with a high index of clinical suspicion of an accessory parotid gland mass. The patient was scheduled to undergo resection of the mass and superficial parotidectomy. She underwent surgery using a modified-Blair incision, and the SMAS layer was folded posteriorly to reconstruct the defect. Histopathological examination confirmed the diagnosis of a schwannoma., and we observed no postoperative complications such as hematoma, infection, or abnormal facial expressions. The incision scar was unnoticeable 2 mo postoperatively, and the facial contour was maintained without any differences between the affected and unaffected sides. CONCLUSION: We used a modified-Blair incision and SMAS layer folding method to achieve aesthetically good results following resection of a rare schwannoma with superficial parotidectomy in the cheek region.

Breast filler granuloma mistaken for implant rupture: A case report.

RATIONALE: Breast augmentation is usually performed by inserting implants into the breasts. However, injectable fillers are sometimes used for the convenience of both patients and surgeons. If foreign substances, such as biomaterials, are injected into the body, complications such as inflammation, granuloma, and tissue necrosis can occur owing to foreign body reactions. PATIENT CONCERNS: A 39-year-old female patient visited our hospital complaining of tenderness, redness, and swelling in both breasts. The patient had undergone bilateral breast augmentation using implants 4 years prior to current consult. DIAGNOSES: On magnetic resonance imaging (MRI), cystic lesions and fluid collections were observed, with findings suggesting implant rupture; hence, surgery was planned to remove both implants. INTERVENTIONS: Intraoperatively, the implant was malpositioned in the upper lateral portion without rupture. Capsular contracture findings were also not prominent. A large amount of inflammatory granuloma was observed and removed in the prepectoral plane, and the implants were immediately inserted into a new subpectoral plane. OUTCOMES: The volume of the new implant was 175 mL, which was smaller than the previous one, as per the patient preference. Cytology of the fluid from the previous implant pocket showed no evidence of malignancy, and the granuloma was identified as inflammatory tissue caused by a foreign body reaction on biopsy. The excessive protrusion of both breasts was corrected after surgery, and the patient was satisfied with the aesthetic outcomes without any complications up to 3 months after surgery. LESSONS: The use of injectable fillers for breast augmentation carries the risk of misdiagnosis, and, therefore, surgeons should always exercise caution.

Recurrent intramuscular lipoma at extensor pollicis brevis: A case report.

BACKGROUND: This report describes and discusses recurrent intramuscular lipoma (IML) of the extensor pollicis brevis (EPB). An IML usually occurs in a large muscle of the limb or torso. Recurrence of IML is rare. Recurrent IMLs, especially those with unclear boundaries, necessitate complete excision. Several cases of IML in the hand have been reported. However, recurrent IML appearing along the muscle and tendon of EPB on wrist and forearm has not been reported yet. CASE SUMMARY: In this report, the authors describe clinical and histopathological features of recurrent IML at EPB. A 42-year-old Asian woman presented with a slow-growing lump in her right forearm and wrist area six months ago. The patient had a history of surgery for a lipoma of the right forearm one year ago with a scar of 6 cm on the right forearm. magnetic resonance imaging confirmed that the lipomatous mass, which had attenuation similar to subcutaneous fat, had invaded the muscle layer of EPB. Excision and biopsy were performed under general anesthesia. On histological examination, it was identified as an IML showing mature adipocytes and skeletal muscle fibers. Therefore, surgery was terminated without further resection. No recurrence occurred during a follow-up of five years after surgery. CONCLUSION: Recurrent IML in the wrist must be examined to differentiate it from sarcoma. Damage to surrounding tissues should be minimized during excision.

Sebaceous carcinoma arising from sebaceoma.

Sebaceous neoplasms are rare adnexal tumors that can present a challenge to clinicians. Only four cases of sebaceous carcinoma with sebaceoma have been reported in the literature. Herein, we describe the case of a sebaceous carcinoma originating from a sebaceoma in a solitary nodule of the posterior neck. Immunohistochemically, the tumor cells were strongly positive for epithelial membrane antigen and p53. It is possible that adnexal carcinomas may arise from malignant transformation of their benign counterparts as well as de novo. Malignant transformation was likely in this case because the lesion was composed of distinct benign and malignant components, and the benign component showed the typical histopathological features of sebaceoma. This case underscores the fact that partial and superficial biopsies sometimes may not provide the correct diagnosis. If a surgeon suspects malignancy based on a clinical examination, then it is mandatory to perform a deep biopsy.

Rare Report of Unilateral Postauricular Dermoid Cyst.

Dermoid cysts are benign developmental anomalies that occurred as a result of the sequestration of the skin along the lines of embryonic closure. Those occurring in the cervicofacial region are uncommon, accounting for about 7% of all dermoids and its presence in postauricular region is further exceptionally rare. A healthy 19-year-old Asian boy presented with a unilateral postauricular cyst that had been present since childhood without any symptom. The computed tomography scan revealed an encapsulated tumor with no intracranial extension. Histological examination of a biopsy taken from the lesion revealed a unilocular cyst found in the deep dermis and subcutaneous tissue. Multinuclear giant cells and fragments of hair shaft are infiltrated in the cystic wall. Some keratin materials are seen in the intracystic area. However, the lining cells are not found. These histologic findings were suggested of the dermoid cyst. Patients with postauricular dermoid cysts usually seek medical advice for the cosmetic reasons because of the embarrassing look of the prominent unilateral or bilateral ears. The treatment of postauricular dermoid cyst is complete surgical excision of the cyst wall. Incomplete removal may result in recurrence or infection; thus, complete surgical excision is necessary. The prognosis is excellent without further complication.

Orbital Cellulitis Following Orbital Blow-out Fracture.

Orbital cellulitis and abscess have been described in the literature as complication that usually occur secondary to infection in the maxillary, ethmoidal, and frontal sinuses. If left untreated, it can lead to blindness, cavernous sinus thrombosis, meningitis, or cerebral abscess. Orbital fractures are a common sequela of blunt orbital trauma, but are only rarely associated with orbital cellulitis. So, the authors present rare orbital cellulitis after orbital blow-out fracture. A 55-year-old Asian complains of severe orbital swelling and pain on the left side. These symptoms had started 2 days earlier and worsened within the 24 hours before hospital admission resulting in visual disturbances such as diplopia and photophobia. Contrast-enhanced computed tomography scan showed considerable soft tissue swelling and abscess formation on the left side. Patient was subjected to surgical drainage under general anesthesia in the operation room. In this case, the postoperative period was uneventful and the rapid improvement of symptoms was remarkable. In conclusion, the abscess of the orbit is a surgical emergency in patients whose impairment of vision or ocular symptoms cannot be controlled with medical therapy using antibiotics. In our case, orbital cellulitis can occur after blunt orbital trauma without predisposing sinusitis. Early and prompt diagnosis and surgical drainage before severe loss of visual acuity rescue or recover the vision in case of orbital cellulitis.

Symptomatic Intraoral Submuscular Lipoma Located Nearby Mental Foramen.

This report describes and discusses the clinical investigations available for the investigation of intraoral fatty tumors of the chin, with a focus on lipomas. Lipomas are relatively uncommon tumors in the oral cavity; only 1% to 4% of cases occur at this site. The presence of lipoma in the head and neck area may raise problems in surgical resection. Treatment of lipoma needs wide excision to reduce recurrence. But there are important structures on mental foramen, especially mental nerve. So careful dissection must be done to avoid nerve injury. Importantly, the development of sarcomatous change within the lipoma cannot be ruled out at imaging and requires a histologic specimen. Because of the histologic similarity between normal adipose tissue and lipoma, accurate clinical and surgical information is very important in making a definitive diagnosis. Thus, a clinician sending a surgical specimen for microscopic analysis must provide the oral pathologist with all available clinical and surgical information. The treatment of oral lipomas, including all the histologic variants, is simple surgical excision. No recurrence is observed. Although the growth of oral lipomas is usually limited, they can reach great dimensions, interfering with speech and mastication and reinforcing the need for excision. In this study, the authors describe the clinical and histopathologic features of symptomatic 2 patients of oral lipomas.