Patient outcomes and complications following various maxillomandibular fixation techniques: A systematic review and meta-analysis.

PURPOSE: Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and complications. In this study, we reviewed the literature to evaluate and compare all MMF methods. METHODS: A systematic review of all MMF types was conducted and post-operative outcome data were analyzed and compared among the different types. Conventional Erich arch bars were compared to hybrid arch bars, MMF screws, and eyelet interdental wiring. A random-effects meta-analysis was used to determine the mean differences, and 95% confidence intervals (CIs) with a statistical significance of P < 0.05. RESULTS: Among the 4234 articles identified, 24 were included, and 17 were meta-analyzed. Time to achieve MMF (-43.38 min; 95% CI, -58.20 to -28.56; P < 0.001), total operative time (-30.33 min; 95% CI, -61.05 to 0.39; P = 0.05), incidence of wire puncture injuries and glove perforations (0.11; 95% CI, 0.04 to 0.30; P < 0.001), and incidence of poor oral hygiene (0.08; 95% CI, 0.02 to 0.28; P < 0.001) were lower for alternative MMF interventions compared to those of the conventional Erich arch bars. CONCLUSIONS: Alternative MMF methods required shorter operative time to achieve MMF and demonstrated other increased efficiencies of practice such as shorter total operative time and decreased glove perforations, when compared to conventional Erich arch bars. If a patient is a candidate for MMF, the presented alternative MMF techniques should be considered depending on the clinical context and availability of institutional resources.

The Blue-Blood Porcine Chest Wall: A Novel Microsurgery Training Simulator for Internal Mammary Vessel Dissection and Anastomosis.

BACKGROUND: Preparation of the internal mammary artery (IMA) is a critical step in autologous breast reconstruction. Intraoperatively, there is limited opportunity for residents to practice this skill. Porcine models provide highly realistic simulation for vascular surgery; however, use of live laboratory pigs is expensive, inconvenient, and offers limited opportunity for repetitive training. We aimed to develop an inexpensive and effective training model for IMA preparation. This article describes creation of a novel microsurgical model using cadaveric chest walls of Wisconsin Miniature Swine embedded in a modified mannequin thorax and augmented with a blue-blood perfusion system. METHODS: Anatomic comparison: five porcine chest walls were dissected, and various anatomic measurements were made for anatomic comparison to existing human data in the literature. Model assembly: the chest wall is prepared by cannulating the proximal and distal ends of the internal mammary vessels with angiocatheters, which are then connected to the blue-blood perfusion system. The model is assembled in four layers including: (1) a mannequin thorax with a window removed to expose the first to fourth intercostal spaces, bilaterally, (2) a layer of foam simulating fat, (3) the perfused pig chest wall, and (4) a second mannequin shell placed posteriorly for support. RESULTS: The porcine chest walls are similar to humans with regards to vessel size and location. This model can be assembled quickly, with a one-time approximate cost of $55.00, and allows for six training sessions per specimen. The model allows residents to practice the key steps of IMA preparation including dissection, elevation of perichondria, and vascular anastomosis while working at a depth that closely simulates the human thorax. Continuous blue-blood perfusion provides immediate feedback on anastomosis quality. CONCLUSION: Overall, this novel model can provide inexpensive and realistic simulation of internal mammary vessel preparation and anastomosis.

Outcomes of adenoidectomy-alone in patients less than 3-years old.

OBJECTIVES: 1. Determine the percentage of patients under the age of 3 undergoing adenoidectomy-alone who require subsequent management of residual sleep disordered breathing (SDB).2. Characterize complications following adenoidectomy and determine if any perioperative factors are associated with intra-operative or post-operative complications and outcomes. METHODS: Case series with chart review was conducted including children seen at a tertiary care children's hospital between 2008 and 2012. Consecutive patients under the age of 3 who underwent adenoidectomy-alone were identified by billing codes. After excluding those with syndromes, partial adenoidectomies, and those without follow-up, 148 patients were included. Predictors of requiring additional surgery for SDB were evaluated using log-rank tests or Cox proportional hazards regression. RESULTS: Median age at time of initial adenoidectomy was 27.5 months (range 11-36 months) and the patient population was comprised of 66.2% males (n = 98/148) and 89.2% Caucasians (n = 132/148). 56.5% (n = 74/131) of patients continued to have residual symptoms of SDB and 34.5% (n = 51/148) underwent additional surgical intervention. Multivariable survival analysis revealed GERD (HR, 6.21; CI, 1.29-29.77, p = .022) and tonsil size (HR, 4.07; CI, 1.57-10.51, p = .004) were significant predictors of additional surgery in this group of patients under the age of 3. There was no observed difference in intra- and post-operative complication rates between patients with and without additional operative intervention. CONCLUSIONS: Residual SDB symptoms following adenoidectomy in patients less than 3 years of age are common and require additional surgery at a high rate. Medical comorbidities such as GERD and large tonsil size may help predict the need for additional surgery.

Deltoid Compartment Syndrome: A Rare Complication after Humeral Intraosseous Access.

We present a case of a 65-year-old woman who developed a delayed deltoid compartment syndrome after resuscitation via humeral intraosseous access. Initially she was treated conservatively but then was taken emergently for a fasciotomy. After confirming the diagnosis with compartment pressures, a 2-incision approach was employed and a large hematoma was evacuated from the inferior margin of the anterior deltoid. The rest of the deltoid was inspected and debrided to healthy bleeding tissue. Her fasciotomy wounds were left open to heal on their own due to her tenuous clinical condition. At most recent follow-up, she had full range of motion in her shoulder and no residual pain. Our unique case study is the first documented incidence of upper extremity compartment syndrome after intraosseous access. Additionally, our case supports using humeral access only as a second-line option if lower extremity access is not available and prolonged vigilant monitoring after discontinuing intraosseous access to prevent disastrous late complications.