Alveolar Cleft Reconstruction Using Double Iliac Corticocancellous Bone Plates Grafting Technique in Mixed Dentition Phase.

OBJECTIVE: The primary goal of maxillary alveolar cleft reconstruction in patients with cleft lip/palate at the phase of mixed dentition is to build bone in the cleft area which in turn allows closure of the oronasal fistula, establishes arch continuity, and improve maxillary stability. This study aimed to evaluate the double iliac corticocancellous bone plates grafting technique for initial alveolar cleft grafting. DESIGN: This prospective study was conducted on 12 consecutive patients with unilateral complete alveolar cleft and previous cleft lip and palate corrective surgery. INTERVENTION: For all patients, the iliac crest graft was harvested and cut into 2 cortical bone plates and adapted labially and palatally. Both plates were fixed with screws then the gap between the 2 plates was filled with cancellous bone. The grafted side was compared to the contralateral side 9 months postoperatively regarding labio-palatal alveolar width and bone density, while the 9 months postoperative graft height was compared to the immediate postoperative height using computed tomography scans. RESULTS: All grafted sides showed similarity to the contralateral sides regarding both alveolar width and bone density with minimal crestal bone resorption. CONCLUSION: The double iliac corticocancellous bone plate grafting technique seems to be a reliable method for alveolar cleft reconstruction with adequate bone quality and contour.

Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis.

PURPOSE: The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. MATERIALS AND METHODS: To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). RESULTS: The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively. CONCLUSIONS: The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.

Computer-Guided Arthrocentesis Using Patient-Specific Guides: A Novel Protocol for Treatment of Internal Derangement of the Temporomandibular Joint.

PURPOSE: The aim of the present study was to evaluate the accuracy of 3-dimensionally (3D) printed patient-specific guides (PSGs) to direct the passage of inlet and outlet needles into the superior joint spaces of the temporomandibular joint (TMJ) in preparation for arthrocentesis. PATIENTS AND METHODS: The present study included 10 patients with 14 TMJs with anterior disc displacement with reduction. A 3D PSG was designed for each patient to lead the inlet and outlet needles into the superior joint space of the TMJ. The PSGs were implemented, and their accuracy for guiding the needles into the superior joint space was assessed. RESULTS: Both arthroscopic verification and clinical evaluation revealed that direct access to all the predetermined anatomic locations inside the TMJs had been obtained, except for 1 case, during which the patient had failed to maintain the maximum mouth opening during computed tomography scanning. CONCLUSIONS: The virtual computer-initiated PSGs were beneficial for directing the passage of the needles into the superior joint space.

Maxillary sinus lift using osteoinductive simvastatin combined with ß-TCP versus ß-TCP - a comparative pilot study to evaluate simvastatin enhanced and accelerated bone formation.

PURPOSE: The aim of this study was to evaluate available bone quality and quantity after performing sinus augmentation using simvastatin/ß-TCP combination versus ß-TCP alone. MATERIALS AND METHODS: This study included eight sinus lift procedures conducted on six patients. The sinuses were divided into two equal groups. The patients were recalled one, two weeks two, five, nine months post-operatively for post-operative evaluation. Radiographic evaluation involved cone beam computed tomography (CBCT) radiographs taken for every patient one week and nine months post-operatively to evaluate the changes in bone height, while histomorphometric evaluation involved transcortical bone biopsies taken after nine months during the second-stage surgery for implant placement. RESULTS: The histomorphometric results showed that the amount of newly formed bone was higher in the simvastatin group when compared to the ß-TCP group nine months after the surgery; the difference between the two groups was statistically significant. On the other hand, the radiographic evaluation showed that the rate of resorption of the simvastatin group was found to be higher than the control group; however, the difference between both groups was statistically insignificant. CONCLUSION: These results showed that Simvastatin is safe to be used in sinus lift with promising osteoinductive capacity, yet further studies using larger sample size is needed.

Stability and Clinical Outcomes of Angle Fracture Fixation Using Sagittal Split Plate (SSOP) Versus Two Miniplates: Randomized Clinical Trial.

The aim of this study was to compare the stability and clinical outcomes between the two miniplates and sagittal split plate (SSOP) in angle fracture fixation. Thirty-eight patients with a mandibular angle fracture were selected and divided randomly into two groups. Intervention was treated with SSOP, and the control group was treated with conventional two miniplates. Clinical evaluation included occlusion, edema, nerve affection, wound dehiscence and mouth opening. Radiographic parameters included the measurement of inter-ramus distance, inter-mental distance and bone density. All clinical parameters were evaluated at one week, one month and three months intervals. Radiographic parameters were evaluated immediately postoperative, and after three months. Results showed that SSOP had less postoperative complications (10.50%) than the two miniplates (31.60%). It can be concluded that both methods offered high performance in management of mandibular angle fractures. However, SSOP group had a significantly shorter operating time, increased bone density and less edema. Clinical trial registration number: NCT03839368.

Courtyard geometry's effect on energy consumption of AlKharga city residential buildings, Egypt.

The research aim is to clarify the effect of courtyard placement, the ratio between length and width, and courtyard orientation on energy consumption in residential buildings in hot and dry climates, to seek planning and designing alternatives for new cities and new residential complexes that are consistent with the environment and climate and save the consumption of energy used in the buildings. The research method was conducted through Design Builder software for simulation purposes. The reference model with the 157.25 m2 which accommodates a central square courtyard measuring 5 m × 5 m, on a residential building model in the New Valley Governorate of Kharga City, Egypt. The courtyard simulation is aimed to determine Less energy consumption inside the different case studies, in 9 courtyard placements The studied alternatives for Courtyard Placement, are (the center of the building, sub facades, and main facades). The different ratios are (1:1, 1.25:1, 1.5:1-1.75:1, 2:1, 2.25:1, 2.5-1). The longitudinal axis of the Courtyard has been oriented to the east-west direction for all placements, and north-south direction for all placements. Also, (orientation angle is Zero), it offered the percentages of better and worst cases in each position of the courtyard. The research findings suggest that the best Placement of the Courtyard that achieved the highest rate of saving of energy consumed inside the used building model was at the southwestern façade, with a saving rate of 18.73%. Then, the Placement of the Courtyard at the northwestern and southeastern facades with a saving rate of 17.91%, with a length-to-width ratio (2.5:1) if the longitudinal axis of the Courtyard is oriented in the north-south direction, Through the study, we conclude that the placement and orientation of the courtyard and its regular formation have contributed to rationalizing energy consumption in residential buildings, the study reached some important standards that could represent a methodological framework for designing contemporary residential buildings with an energy-efficient inner courtyard.

Computer Guided Generated Dual-Purpose Splint for Bilateral Sagittal Split Osteotomy.

Purpose: to evaluate the efficacy of dual-purpose computer-generated splint in guiding the proximal and the distal segment in bilateral sagittal split osteotomy. Patients and Method: It was a prospective case series study directed on 8 class III patients indicating the need of maxillary advancement and mandibular set back by bilateral sagittal split osteotomy. A CAD/CAM splint is generated to guide the distal segment to the stable maxilla and at the same time a grooved extension to engage the proximal segment ensuring the condyle in its planned position during fixation. The primary outcome was measured by calculating the difference between the pre- and post-operative condylar segment position. Results: The present study included five female patient and three male patient with mean age of 28.4 ± 5.1 years. The accuracy of the splint in positioning the mandibular proximal segment showed promising results ranging from 2.59 to 0.49. Conclusion: The dual-purpose splint introduced in this study showed satisfied results in maintaining the pre-operative condylar position while securing the distal segment in the desired plan.

Maxillary vertical alveolar ridge augmentation using sandwich osteotomy technique with simultaneous versus delayed implant placement: A proof of principle randomized clinical trial.

BACKGROUND: The sandwich osteotomy technique usually requires high surgical skills and prolonged intraoperative time and had some technical drawbacks with a subsequent deficient amount of vertical bone gain. The aim of this study was to evaluate the final vertical bone gain using sandwich osteotomy with simultaneous versus delayed implant placement in the anterior maxilla. MATERIAL AND METHODS: This study included 16 patients having multiple missing maxillary anterior teeth with a vertically deficient alveolar ridge. Patients were randomly assigned into two equal groups. Both groups were treated using sandwich osteotomy with interpositional particulate bovine bone graft. In the study group (8 patients, 17 implants), the transport mobilized bone segment was fixed in position using simultaneous implant placement. Whereas in the control group (8 patients, 18 implants), micro-plates and screws were used, followed by a second-stage surgery for plates removal and delayed implant placement. Radiographic assessment included 4 months postoperative mean of vertical gain in alveolar ridge height, taken from cross-sectional cuts of cone beam CT. RESULTS: The mean vertical bone gain in the study group was 4.04 ± 0.59 mm compared to 3.86 ± 0.52 mm in the control group with no statistically significant difference (p = 0.518). The mean value of bone gain percentage in the study group was 33.02% compared to 31.75% in the control group, with no statistically significant difference (p = 0.656). CONCLUSION: The sandwich osteotomy technique with simultaneous implant placement is a reliable method for vertical ridge augmentation that eliminates the need for a secondary surgery.

Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study.

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients' groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn't statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.

Historique et objectif: L'intérêt de la colostomie pour prendre en charge la maladie de Fournier (MF) n'est pas consensuel. Presque toutes les études pertinentes sont rétrospectives et portent sur des groupes de patients hétérogènes. La présente étude prospective visait à évaluer le rôle de la colostomie pour prendre en charge la MG qui touche la région périanale dans deux groupes bien appariés de patients atteints de la MF. Patients et méthodologie: La présente étude comparative prospective portait sur 30 patients atteints de la MF associés à une atteinte importante de la région périanale. Elle était composée de 15 patients soumis à une colostomie et à 15 patients qui avaient refusé l'intervention. La colostomie a été effectuée après le premier débridement. Le temps jusqu'à la guérison de la plaie, la durée du séjour hospitalier et la mortalité en milieu hospitalier étaient les résultats primaires de la présente étude. Résultats: La comparaison des caractéristiques préopératoires des groupes à l'étude n'a révélé aucunes différences statistiquement significatives. Après l'opération, les patients du groupe ayant subi une colostomie présentaient beaucoup moins de débridements (1,3 ± 0,5 par rapport à 2,7 ± 1,2, p<0,001) et avaient été hospitalisés moins longtemps (9,5 ± 3,3 par rapport à 29,9 ± 6,2 jours, p <0,001) et leur plaie avait guéri plus vite (16,5 ± 3,9 par rapport à 42,9 ± 6,9 jours, p <0,001). De plus, les patients qui faisaient partie du groupe ayant subi une colostomie présentaient un taux beaucoup plus bas de déhiscences ou d'infections de la plaie et d'ischémies du lambeau. Cependant, cette différence n'était pas statistiquement significative. Conclusions: Un traitement énergique de la MF assisté par colostomie après le premier débridement de meilleurs résultats cliniques.

Computer-guided contouring of craniofacial fibrous dysplasia involving fronto-orbital or fronto-cranial region using patient specific surgical depth guide: A prospective case series.

The aim of this study was to introduce a new computer guided technique for debulking and contouring the craniofacial fibrous dysplasia involving the fronto-orbital and fronto-cranial regions. Computer-guided contouring was performed using a modified patient-specific surgical depth guide for six patients with craniofacial fibrous dysplasia involving the fronto-orbital and fronto-cranial regions. Virtual planning was performed to determine the desired amount of bone removal and construct the patient-specific surgical depth guide. Then, the guide was printed using rapid prototyping. In the surgical theatre, the guide was seated in position. Implant drills were inserted through the created depth holes according to the planned fixed depth to create depth holes. Finally, the bone in between the created holes was removed using cutting discs, bone chisels and surgical burs. Satisfaction with facial aesthetics was evaluated by the patients using a Likert scale, and by the surgeons using the Whitaker rating scale. The surgical procedures were uneventful for all the patients. All the patients were satisfied with the post-operative facial esthetics and categorized as category I Whitaker rating scale. Patient-specific surgical guide technique for recontouring of fronto-orbital and fronto-cranial fibrous dysplasia can be considered an accurate substitution technique that overcomes the drawbacks of the unpredictable conventional one. Further investigations are required.

Cholecalciferol-load films for the treatment of nasal burns caused by cauterization of the hypertrophied inferior turbinate: formulation, in vivo study, and clinical assessment.

Nasal turbinate hypertrophy is among the most common nasal obstruction disorders, affecting the patient's quality of life significantly. Endoscopic submucosal diathermy is a prevalent cauterization procedure for treating turbinate hypertrophy. Regrettably, the nasal burn associated with diathermy typically heals slowly causing facial pain and nasal bleeding and possibly resulting in synechiae formation. In the current study, we have developed, for the first time, a polymeric film loaded with cholecalciferol for local treatment of nasal burns. The casting method was used to prepare films of different compositions of polymers such as chitosan, polyvinyl alcohol (PVA), Carbopol 971p (CP971p), and hydroxypropyl methylcellulose (HPMC) as well as a plasticizer. Several characterizations were performed for the cholecalciferol-loaded films (e.g. weight, thickness, content uniformity, surface pH, folding endurance, disintegration time, and in vitro release) to select the optimal formulation. The optimal formulation (F4) displayed compatibility between the used polymers and the drug. In vivo animal study was carried out to assess the healing efficacy of the formulated cholecalciferol-loaded film. The rabbits treated with the cholecalciferol-loaded film demonstrated significantly higher mRNA expression of the growth factor TGF-ß and significantly lower mRNA expression of the proinflammatory cytokine TNF-α and IL-1ß compared to the plain film treated group and the untreated control group. A randomized, single-blinded, parallel, controlled clinical trial was conducted on 20 patients scheduled to undergo endoscopic submucous diathermy. The results of the clinical study demonstrated significant reductions in facial pain and nasal bleeding scores for the nostrils treated with cholecalciferol-loaded films in comparison to the nostrils treated with plain films. Furthermore, the endoscopic examination showed good healing for 95% of the cholecalciferol-loaded film-treated nostrils. In conclusion, the optimized film can be considered an opportune approach for enhancing the healing rate of nasal burns and thus reducing the downsides of the diathermy procedure.

Computer-guided buccal cortical plate separation for removal of calcified benign odontogenic tumors affecting the mandibular angle region.

PURPOSE: Surgical removal of intra-bony calcific benign lesions is technically challenging regarding its accessibility, proximity to vital structures, and deteriorating effect on the remaining bony structures. METHODS: Computer-guided buccal cortical plate separation was performed for ten patients using patient-specific osteotomy locating guides and pre-bent plates. The guide was designed to outline the osteotomy, the buccal cortical plate was separated, the lesion was removed, and finally, the pre-bent plates were used to fix the separated cortex. RESULTS: Surgical procedures were uneventful for all patients, operation time was 39.5 ± 13.01 min, postoperative pain decreased within the follow-up time intervals, and there was a statistical significant difference between the time intervals (P value < 0.001). Edema and trismus were acceptable. One case showed nerve affection which resolved after 4 weeks. CONCLUSION: Computer-guided buccal cortical plate separation for removal of intra-bony calcified benign lesions provides a promising approach, especially for inexperienced surgeons. TRIAL REGISTRATION: ClinicalTrials.gov NCT05329974 . Registered on 6 April 2022-retrospectively registered.

Computer guided calvarial bone grafting for reconstruction of orbital floor blow out fracture.

BACKGROUND: Calvarial grafts represents a superior option for orbital floor reconstruction, however the difficulty of intraoperative moulding and placement remains as a major limitation. We used patient specific guides and sterolithographic models to facilitate this procedure. METHODS: The study was conducted on 10 patients with orbital floor blow out fracture. A graft harvesting guide was virtually constructed based on the defect using mirroring of the normal side. The virtual guide and the defective orbital floor were then printed. The graft was harvested using the guide and adjusted to the defect using the model, finally seated in place. RESULTS: All patients showed no enophthalmos or diplopia. Orbital volume was comparable for both traumatised and normal orbits with no statistical significance difference (p value 0.28), and orbital volume ratio was 101.76 ± 4.7%. CONCLUSION: The use of graft harvesting guide and orbital floor models for intraoperative graft moulding showed promising results.

Patient-specific PEEK implants for immediate restoration of temporal fossa after maxillary reconstruction with temporalis muscle flap.

BACKGROUND: Temporal hollowing is a common complication following the rotation of the temporalis muscle that leaves the patient with a cosmetic impairment. Several alloplastic materials have been used to reconstruct the donor site; however, these implants need meticulous adaptation to conform the periphery of the defect and restore the contour of the temporal area. The aim of this study was to assess the use of patient-specific polyetheretherketone (PEEK) temporal implants to prevent temporal hollowing following the use of full temporalis muscle flap for large maxillary defects reconstruction. METHODS: This was a prospective study conducted on eight patients with major maxillary defects indicating the need of reconstruction with full temporalis muscle flap or any lesion indicating major maxillary resection and immediate reconstruction with total temporalis muscle flap. For each patient, a patient-specific PEEK implant was fabricated using virtual planning and milled from PEEK blocks. In the surgical theater, the temporalis muscle was exposed, elevated, and transferred to the maxilla. After the temporalis muscle transfer, PEEK implants were fixed in place to prevent temporal hollowing. RESULTS: The surgical procedures were uneventful for all patients. The esthetic result was satisfactory with no post-operative complications except in one patient where seroma occurred after 2 weeks and resolved after serial aspiration. CONCLUSION: Patient-specific PEEK implant appears to facilitate the surgical procedures eliminate several meticulous steps that are mainly based on the surgeon's experience. TRIAL REGISTRATION: Clinical trials registration: NCT05240963 .

Local Autograft Versus Iliac Crest Bone Graft PSF-Augmented TLIF in Low-Grade Isthmic and Degenerative Lumbar Spondylolisthesis.

STUDY DESIGN: Prospective randomized controlled cohort study. OBJECTIVE: To compare the outcome of local autograft versus iliac crest bone graft (ICBG) stand-alone transforaminal lumbar interbody fusion (TLIF) in lumbar spondylolisthesis. METHODS: One hundred eight patients with low-grade single-level spondylolisthesis underwent operation with pedicular screw fixation (PSF)-augmented stand-alone TLIF. Patients were randomly divided into groups according to bone graft: group I, autograft group; and group II, ICBG group, with 54 patients each. Fifty-nine patients had isthmic spondylolisthesis and 49 had degenerative spondylolisthesis. Clinical outcome parameters included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and patient's satisfaction, while the radiological parameters included fusion rate, slip reduction, segmental angle, and disc height. The mean follow-up period was 38 ± 19 months, with a minimum 24 of months. RESULTS: The preoperative VAS of back pain improved from 8 ± 3.1 to 3.4 ± 2.9 and from 8 ± 3.2 to3.6 ± 2.6 in group I and group II, respectively. The preoperative ODI improved from 41.4 ± 8 to 12.3 ± 7 and from 39 ± 9 to 13 ± 8 in group I and group II, respectively. The fusion rate was 93% in group I and 94.5% in group II. The percentage of slip was reduced from 26.7 ± 7.1% to 16.5 ± 6.1% in group I and from 27.4 ± 8.25 to 15.8 ± 5.2% in group II. Intervertebral disc height increased from 25.27 ± 14.62 to 46.38 ± 15.41 in group I and from 22.29 ± 13.72 to 45.15 ± 16.77 in group II. Segmental angle improved from 10.5 ± 8.1° to 16.7 ± 5.4° in group I and from 11.6 ± 5.3° to 15.9 ± 6.2° in group II. There was no significant difference of the above-mentioned parameters between the 2 groups. CONCLUSION: Patients with single-level low-grade spondylolisthesis can be effectively treated with PSF-augmented stand-alone TLIF using either local autograft or ICBG with no outcome differences between the 2 groups.

Maxillary horizontal alveolar ridge augmentation using computer guided ridge splitting with simultaneous implant placement versus conventional technique: A randomized clinical trial.

BACKGROUND: Ridge splitting technique is considered one of the successful horizontal bone augmentation procedures especially for the maxillary bone, the aim of this study was to compare marginal bone loss using a novel ridge splitting protocol versus the conventional technique. MATERIAL & METHODS: This was a randomized clinical trial including 20 patients who were randomly assigned to ridge splitting with simultaneous implant placement at the anterior maxillary aesthetic zone (10 patients, 29 dental implant) using patient specific guides (PSGs) or conventional technique (10 patients, 29 dental implant). In the control group free hand ridge splitting was done, while in the study group all the splitting and drilling procedures were done through specific slits and sleeves at the patient specific guides. Radiographic Assessment included measurements of linear changes in the vertical dimensions of the labial plate of bone on cross sectional cuts of computed tomography (CBCT) using mimics software. RESULTS: Wound healing was uneventful for all the patients except one patient in the control group that showed bad split and another showed buccal fenestration. The study group showed lower bone loss (1.38 ± 0.61 mm) compared to the control group (2.42 ± 0.63 mm), with statistical significance difference (P value = 0.001). The loss percentage also was higher in the study group (10.99 ± 4.76%) compared to the control group (19.12 ± 4.53%), and there was statistical significance difference between the two groups (P value = 0.001). CONCLUSION: Ridge splitting using PSGs appear to be efficient and promising than the free hand technique.

Maxillary vertical alveolar ridge augmentation using computer-guided sandwich osteotomy technique with simultaneous implant placement versus conventional technique: A pilot study.

BACKGROUND: Sandwich osteotomy technique (Inlay bone grafting) is considered as a highly reliable procedure for vertical bone augmentation in the maxillary anterior esthetic zone. The aim of this study was to compare vertical bone gain and palatal tipping using computer-guided inlay technique versus the conventional technique. MATERIAL AND METHODS: This was a randomized clinical trial including 12 patients who were randomly divided into two groups: sandwich osteotomy with simultaneous implant placement at the anterior maxillary esthetic zone (six patients) using patient-specific guides (PSGs) in the study group versus conventional technique (six patients). In the control group, free-hand sandwich osteotomy was done, while in the study group all the procedures were performed with two sequential PSGs with cutting slits, guiding holes, and implant sleeves. Radiographic assessment included measurements of linear changes in the vertical dimensions of the labial plate of bone and palatal tipping on cross-sectional cuts of cone-beam computed tomography using special software. RESULTS: All the procedures were uneventful except one case of the study group showed a cracked bony segment that did not affect the final outcome. Radiographic results showed comparable bone gain in both groups with no statistical significance difference (study group 4.4 mm, control group 3.9 mm). To the contrary, the computer-guided approach significantly reduced the palatal tipping to 0.4 mm compared to 2.1 mm in the conventional group, and there was a statistically significant difference between the two groups (p-value <0.001). CONCLUSION: Sandwich osteotomy using PSGs appears to be efficient and showed promising results regarding improving the palatal tipping compared to the free-hand technique.

Far-Lateral Approach for Ventral and Ventrolateral Upper Cervical Meningiomas: A Case Series and Literature Review.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To evaluate the safety and efficacy of the far-lateral approach in the resection of ventral and ventrolateral upper cervical meningiomas. OVERVIEW OF LITERATURE: Upper cervical meningiomas are a common disease entity. These lesions can be surgically treated via many accesses. The far-lateral approach is a very appealing technique for these lesions. METHODS: We assessed 23 patients with a mean age of 57.3±15 years. According to the Japanese Orthopedic Association (JOA) scale; eight patients had grade 0, nine had grade I, and six had grade II. All patients underwent plain radiography and magnetic resonance imaging of the cervical spine. The foramen magnum was involved in 10 patients, C1-2 in seven, C2-3 in four, and C3-4 in two. All patients were operated via the far-lateral approach. RESULTS: Gross total resection was achieved in 21 patients. Sixteen lesions were psammomatous, five were fibroblastic, and two were meningothelial meningiomas. The mean operative duration was 135±40 minutes, while the mean operative blood loss was 450±210 mL, and the mean hospital stay was 4.3±2.2 days. At the final follow-up that was conducted at 27.6±21 months and as per the JOA score; 16 patients were classified into grade 0 and 7 into grade II. The condition of none of our patients deteriorated postoperatively. There was no significant correlation of the clinical outcome with tumor level, pathological subtype of the tumor, symptom duration, age, and sex. There was no significant correlation of tumor resection completeness with tumor level, tumor pathological subtype, or tumor topography (ventral or ventrolateral). CONCLUSIONS: The far-lateral approach is a safe and effective access for ventral and ventrolateral cervical meningiomas. It allows direct access to tumor with no spinal cord or nerve roots traction, and thus may yield a fairly better outcome than the standard posterior approach.

Feasibility and Safety of Goel-Harms Posterior C1-C2 Fusion in the Management of Pediatric Reducible Atlantoaxial Instability.

BACKGROUND: Pediatric atlantoaxial instability (AAI) is not common and could be a serious clinical condition. The Goel-Harms technique is one of the most used techniques in adults and needs more evaluation in pediatric populations. This study reports the feasibility and safety of the Goel-Harms technique in the treatment of pediatric reducible AAI. METHODS: In this retrospective cohort study we reported all pediatric patients who underwent Goel-Harms technique for AAI with a minimum 1-year follow up. Patients were clinically assessed using the Japanese Orthopedic Association (JOA) score and radiologically with plain radiographs, computed tomography scan, and magnetic resonance imaging of the craniocervical region. Postoperatively, patients were followed up according to our clinical and radiographic imaging protocol. The following parameters were recorded: JOA score, construct stability, fusion, and abnormal events. RESULTS: A total of 25 patients have completed a 1-year follow-up and fulfilled our criteria. The mean age was 10.68 ± 4.47 (range, 3-17) years. Fifteen patients were male and 10 were female. The final diagnosis included Down syndrome (DS) in 8, type II dens fracture in 7, os odontoideum in 3, and atlantoaxial rotatory fixation in 7. The mean follow-up was 21.76 ± 8.22 months. The preoperative JOA score improved from 15.96 ± 1.46 to 16.76 ± 1.92 at the last follow-up. Sound bone fusion was reported in 92% of patients. CONCLUSIONS: Our data suggest that the Goel-Harms technique is a safe, feasible, and effective procedure in managing pediatric reducible AAI. Special perioperative care should be offered to young AAI patients with DS.