Comparing the clinical features of lateral and medial approaches of costoclavicular technique versus traditional lateral sagittal technique as infraclavicular brachial plexus block methods: a randomized controlled trial.

BACKGROUND: It is aimed to compare the block onset times and performance features of costoclavicular techniques (medial and lateral approach) versus lateral sagittal technique. METHODS: Patients were randomized into three groups. For costoclavicular techniques, ultrasound probe was placed parallel to clavicle obtaining nerve cords, axillary artery and axillary vein visual from lateral-to-medial, respectively. The block needle was advanced from lateral (Group CLB) or medial (Group CMB) to perform costoclavicular block. For lateral sagittal technique (Group LSB), ultrasound probe was placed sagittal and perpendicular below the coracoid process to obtain sagittal artery image with the cords around. Total 20 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine were deposited for all groups. Sensory and motor block onset times, block performance properties, complications, and patient/surgeon satisfactions were investigated. RESULTS: Among 56 patients, the primary outcome, sensory block onset time was shorter in Group CLB than Group CMB and Group LSB (10 [5-15], 10 [10-20], and 15 [10-15] minutes, respectively, p < 0.05). Motor block onset was also fastest in Group CLB (15 [10-20] mins for CLB, 20 [15-20] mins for LSB, and 22.5 [15-25] mins for CMB, p = 0.004). Block performance properties did not differ between the groups. The only complication observed was vascular puncture with an incidence of 28% in Group CMB. CONCLUSIONS: Lateral approach costoclavicular technique provides fastest block onset than the other techniques. Considering the success and safety profile, this technique stands as a good alternative in clinical practice. TRIAL REGISTRATION: This study is prospectively registered to clinicaltrials.gov on 20/02/2022 (NCT05260736).

Integrating artificial intelligence in orthognathic surgery: A case study of ChatGPT's role in enhancing physician-patient consultations for dentofacial deformities.

Orthognathic surgery, a multidisciplinary treatment for dentofacial deformities, presents complex preoperative preparations and follow-up procedures. This study aims to evaluate the effectiveness of ChatGPT-4, an artificial intelligence-based language model, as a supportive tool during patient consultations for orthognathic surgery. Nine critical questions that candidates for orthognathic surgery should ask during a consultation were identified and posed to ChatGPT-4. The responses were subsequently assessed by experienced plastic surgeons and collaborating orthodontists at a leading orthognathic surgery center. Evaluations focused on the accuracy, clarity, and comprehensibility of the information provided. ChatGPT-4 generated comprehensive, clear, and accurate responses, offering critical technical information to guide patients through the complexities of orthognathic surgery. However, it consistently underscored the necessity of individualized responses and emphasized that specialized medical consultation is crucial for treatment and follow-up plans. While ChatGPT-4 shows promise as a reliable informational resource, it cannot fully replace the nuanced physician-patient relationship, particularly in situations requiring emotional intelligence and specialized expertise. ChatGPT-4 can serve as an informative and guiding assistant during the consultation process for orthognathic surgery, although it cannot substitute for direct medical consultation. This tool could be an asset for both patients and physicians in managing the intricate treatment process of orthognathic surgery.

Evaluation of Shoulder Muscle Improvement in Patients Following Free Latissimus Dorsi Muscle Pedicle Flap Transfer.

Aim: This study aimed to evaluate the clinical outcomes, shoulder muscle strength, and donor site morbidity following the free latissimus dorsi (LD) muscle pedicle flap transfer. Materials: Patients with free LD muscle pedicle flap reconstructions and with asymptomatic shoulders (affected and contralateral side) were included. The follow-up duration was 12 months. The combined shoulder range of motion (ROM), Constant-Murley shoulder (CMS), and quick disabilities of the arm, shoulder, and hand (QuickDASH) scores were measured preoperatively and at 1 year postoperatively. The ratio of the isokinetic muscle strength and total work was measured with an isokinetic dynamometer (Cybex 350®) both preoperatively and at sixth month postoperatively. Results: Twenty patients with a mean age of 37.06 ± 9.74 years and a mean body mass index of 23.49 ± 8.6 kg/m2 were included. The difference in shoulder ROM and CMS and increase in QuickDASH were not significant at the first postoperative year. The peak torque and total work performed decreased by 13%-16% for the adductor and extensor functions at the six month postoperatively, and these differences were significant. Although the adductor peak torque was significantly lower in the postoperative test of the operated side, no significant difference was found between the operated and unaffected shoulder peak torque values. Moreover, no significant difference was noted between the operated and unaffected shoulders in all isokinetic tests pre- and postoperatively. Conclusion: The free LD muscle pedicle flap harvest did not decrease function and ROM at the first postoperative year. The muscle strength and total work of shoulders after the LD muscle transfer returned to the preoperative condition at the sixth month, except adductor and extensor muscle strengths. However, adductor and extensor muscle strengths of the operated shoulders were not significantly different postoperatively.

Objectif: La présente étude visait à évaluer les résultats cliniques, la force musculaire de l'épaule et la morbidité au site donneur après un transfert du lambeau pédiculaire libre du grand dorsal. Matériaux: Des patients ayant subi une reconstruction du lambeau pédiculaire libre du grand dorsal et dont les épaules étaient asymptomatiques (côté touché et côté controlatéral) ont participé à l'étude. Le suivi a duré 12 mois. Les chercheurs ont évalué l'amplitude de mouvement (AM) combinée de l'épaule, le score de Constant-Murley (SCM) et le score rapide des incapacités du bras, de l'épaule et de la main (QuickDASH) avant l'opération, puis un an plus tard. Ils ont mesuré le ratio entre la force musculaire isocinétique et le travail total au moyen d'un dynamomètre isocinétique (Cybex 350®) avant l'opération, puis six mois plus tard. Résultats: Au total, 20 patients d'un âge moyen de 37,06 ± 9,74 ans et à l'indice de masse corporelle moyen de 23,49 ± 8,6 kg/m2 ont été inclus dans l'étude. La différence de l'AM et du SCM de l'épaule et l'augmentation du QuickDASH étaient légères pendant l'année suivant l'opération. Le couple de pointe et le travail total effectués avaient diminué de 13 % à 16 % pour la fonction des adducteurs et des extenseurs six mois après l'opération, ce qu'on peut qualifier de différences importantes. Même si le couple de pointe des adducteurs était beaucoup plus faible au test postopératoire du côté opéré, aucune différence importante n'a été observée entre les valeurs du couple de pointe de l'épaule opérée et de celle non touchée. De plus, lors de tous les tests isocinétiques exécutés avant et après l'opération, ils n'ont pas remarqué de différence importante entre l'épaule opérée et l'épaule non atteinte. Conclusion: Le lambeau musculaire pédiculaire libre du grand dorsal ne diminuait pas la fonction et l'AM pendant l'année suivant l'opération. La force musculaire et le travail total des épaules après le transfert du grand dorsal avaient retrouvé leur état préopératoire au sixième mois, sauf la force des muscules adducteurs et extenseurs. Cependant, la force des muscles adducteurs et extenseurs des épaules opérées n'avait pas tellement changé après l'opération.

Electric Scooter-related Craniofacial Injuries.

OBJECTIVES: Injuries associated with the use of electric scooters are a serious problem in modern society and traffic in relation to their increasing frequency of use. Although injuries involving all body parts are seen in such injuries, craniofacial ones are also very common. The aim of this study was to evaluate the craniofacial and other accompanying injuries in electric scooter-related accidents in Istanbul. MATERIALS AND METHODS: Between January 2020 and December 2022, patients with electric scooter-related trauma among the patients admitted to the emergency unit for trauma were evaluated retrospectively. All electronic medical records, CT scans, other examinations, and treatments were retrospectively reviewed, and craniofacial fractures and other injuries seen in the patients were classified. RESULTS: A total of 20.358 patients were admitted to the trauma unit between January 2020 and December 2022. Two hundred ten patients (142 male, 68 female) had electric scooter-related trauma and 58.1 % of them had craniofacial injuries. Thirty patients (14.3 %) (23 male, 7 female) had craniofacial fractures, whereas 43.8 % of them had craniofacial soft tissue injuries. The nasal fracture was the most common craniofacial fracture (14 patients, 46.7%). Orbital wall and zygomaticomaxillary complex fractures were found to be the second most common fractures. CONCLUSIONS: The rate of electric scooter-related injuries among all trauma patients admitted to the emergency trauma unit during the mentioned period was 1.03%. The results of this study were found to be in accordance with the data in the literature. The craniofacial region is the most frequently injured body part in patients with electric scooter-related trauma, and patients should be comprehensively evaluated for possible soft tissue injuries, craniofacial fractures, and other accompanying system injuries.

The effect of botulinum toxin application on latissimus dorsi and teres major muscles in patients with brachial plexus birth palsy: An electron microscopic and clinical study.

BACKGROUND: In brachial plexus birth palsy (BPBP), botulinum toxin may be utilized to prevent glenohumeral dysplasia and to maintain the stable growth of the glenohumeral joint. Repeated injections may cause muscular atrophy and their functional effects are uncertain. The aim of this study was to compare the microstructure and the function of the muscles that received two injections before transfer with the muscles that were not injected. METHODS: BPBP patients that were operated between January 2013 and December 2015 were included in the study. Latissimus dorsi and teres major muscles were transferred to humerus in standard fashion. Patients were divided in two groups according to bo-tulinum toxin status. Group 1 was toxin negative whereas Group 2 was toxin positive. For each patient, mean latissimus dorsi myocyte thickness (LDMT) was measured with electron microscopy and pre-operative and post-operative active shoulder abduction, flexion, external and internal rotation, and Mallet scores were evaluated with goniometry. RESULTS: Fourteen patients (seven patients per group) were evaluated. Five patients were female whereas nine were male. Mean LDMT was not affected significantly (p>0.05). The operation improved shoulder abduction, flexion, and external rotation significantly (p<0.05), independent of the toxin status. The internal rotation decreased significantly only in Group 2 (p<0.05). The Mallet score increased in both groups, but it was not significant (p>0.05), independent of the toxin status. CONCLUSION: Botulinum toxin that was applied twice prevented glenohumeral dysplasia and it did not cause permanent latissimus dorsi muscle atropy and function loss in late period. It augmented upper extremity functions by alleviating internal rotation contracture.

The predictive effect of neutrophil-lymphocyte and platelet-lymphocyte ratios in the post-operative recurrence of temporomandibular joint ankylosis.

BACKGROUND: Reankylosis is a frequent pathology in patients who are operated for post-traumatic temporomandibular joint (TMJ) ankylosis. In the current practice, ankylosing spondylitis attacks are monitored with the increases in neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). In this study, such a relation between TMJ reankylosis and increase in these ratios was evaluated. METHODS: Patients who were operated between January 2010 and December 2019 for unilateral or bilateral TMJ ankylosis were included in this study. Temporomandibular gap arthroplasty with an interpositional silicone block was performed for each patient by the same operative team. Each patient had standard physiotherapy. All ages and genders were included in the study. Due to the complete blood count differences between children and adults, 18 years of age was used as a cutoff between the groups. A need for reoperation was accepted as reankylosis. The NLR and PLR of children without and with reankylosis and adults without and with reankylosis were compared. RESULTS: Twenty-nine children and 38 adults were included in the study. Mean age of the children and adults were 10.8 and 37.3 years, respectively. Eleven children and eight adults had reankylosis. In patients with reankylosis, NLR and PLR were high significantly, regardless of age. In children, PLR was significantly higher in reankylosis patients. In adults, NLR was significantly higher in reankylosis patients. CONCLUSION: PLR and NLR may be utilized for predicting reankylosis, respectively, in children and adults who were operated for ankylosis due to TMJ fractures.

Single axillary incision endoscopic surgery and liposuction for gynecomastia.

Gynecomastia is a common type of breast tissue hypertrophy in men. Surgical excision is the most effective treatment for this condition. Minimally invasive surgical techniques can be used to avoid visible chest scarring. In this study, we evaluated the efficacy and safety of single-axillary-incision endoscopic mastectomy and liposuction for the treatment of gynecomastia. Nipple-sparing mastectomy via a single-port axillary incision was successfully performed in all patients. Twenty-four bilateral procedures were performed in total. Twenty patients underwent liposuction concomitantly. The median weight of the mastectomy pieces was 88.5 g (range: 42.5-440 g), and the median amount of liposuction was 262.5 cc (range: 25-350 cc). The median duration of surgery was 120 minutes (range, 73-195 minutes). Two patients developed a seroma, and 1 patient developed a hematoma in the early postoperative period. The mean satisfaction levels related to physical appearance, mental status, and social environment were 8.75 (standard deviation [SD]: 1.19), 9.17 (SD: 1.44), and 9.33 (SD: 0.76) points, respectively, on a 10-point visual analog scale. Endoscopic single-port nipple-sparing mastectomy combined with liposuction is a technically feasible method to avoid anterior chest wall scarring with good cosmetic results. Between June 2021 and June 2022, 30 patients underwent endoscopic single-port nipple-sparing mastectomy through a small axillary incision, while 20 underwent concomitant liposuction. The demographic information of the patients, duration of surgery, amount of tissue removed, and complications were recorded. Patients' levels of satisfaction with their physical appearance, mental status, and social environment were measured.

The relationship between fixation method and early central condylar sagging after bilateral sagittal split ramus osteotomy in orthognathic surgery.

PURPOSE: There is no consensus about the ideal fixation methods and their effects on the condyle after the sagittal split ramus osteotomy (SSRO) procedure. The aim of this study was to compare the incidence, clinical presentation, and treatment of condylar sagging between different fixation methods following SSRO. METHODS: Patients who underwent double jaw surgery between 2007 and 2017 were evaluated retrospectively. Mandibular fixation was maintained using one of three different options: a miniplate and a single bicortical screw, three bicortical screws, or a single bicortical screw. Some patients had malocclusion relapse in the early postoperative period due to condylar sagging, and needed reoperation. The reoperated condylar sagging patients were analysed statistically with respect to their fixation methods. RESULTS: 233 patients (134 females, 99 males) with a mean age of 23.3 years were enrolled in the study. The patients fixated with a single bicortical screw had lower revision surgery rates than those with three bicortical screws or with miniplate with a single bicortical screw (p = 0.034 and p = 0.032, respectively). These differences in central condylar sagging with a need for revision were statistically significant. CONCLUSION: Although a miniplate and a single bicortical screw and three bicortical screws are widely used after SSRO, if the priority is to avoid sagging then it seems that a single screw should be preferred for osteosynthesis.