Carotid artery dissection and stroke complicating treatment of postmandibular distraction ankylosis: a case report.

Mandibular distraction osteogenesis is an increasingly accepted treatment option for severe upper airway obstruction in grade 3 Robin sequence. Complications are rarely reported but can include fracture, pin dislodgement, tooth bud damage, and temporomandibular joint ankylosis. Operative correction of these complications can carry inherent risks of their own. We present a patient who incurred carotid artery dissection and stroke after release of postdistraction coronoid-zygomatic ankylosis for the treatment of mandibular micrognathia.

Abdominoplasty-related nerve injuries: systematic review and treatment options.

BACKGROUND: Abdominoplasty is a common cosmetic procedure; nerve injury is an underexplored risk of the procedure. OBJECTIVE: The authors review existing literature to examine the incidence and treatment of nerve injuries after abdominoplasty procedures and provide a treatment algorithm based on their results. METHODS: A search of the literature on MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was undertaken. After full-text review, 23 articles met our criteria. Any mentions of nerve injury, including references to a lack of nerve injury, were documented. All data were pooled for analysis. From our combined data, we calculated the risks of postabdominoplasty nerve injury by dividing the total number of nerve injuries by the total number of patients. RESULTS: Pooled data showed that 1.94% of patients sustained specific nerve injury, and 1.02% of patients sustained permanent injury after abdominoplasty. In addition, 7.67% experienced decreased sensation, 1.07% reported chronic pain, and 0.44% reported temporary weakness or paralysis. Nerves directly injured were the lateral femoral cutaneous (1.36% of patients) and iliohypogastric (0.10%) nerves. Nerves injured from surgical positioning were the brachial plexus (0.10%), musculocutaneous (0.10%), radial (0.05%), sciatic (0.19%), and common peroneal (0.05%) nerves. CONCLUSIONS: Although our results showed a low incidence of postabdominoplasty nerve injury, the lasting impact on affected patients' quality of life can be significant. Appropriate and timely treatment by a multidisciplinary team is critical to optimize patient outcomes. Better reporting of nerve injuries in future studies of abdominoplasty will provide more accurate information about the incidence and consequences of these injuries. LEVEL OF EVIDENCE: 4.

Brief seizures cause dendritic injury.

Seizures may directly cause brain injury by disrupting the structure and function of synapses. Previous studies using in vivo time-lapse imaging have demonstrated an acute beading of dendrites and loss of dendritic spines immediately following status epilepticus, but the effects of brief seizures and the long-term evolution of this dendritic injury are unknown. Here, we examined the effects of seizures of varying durations on dendritic structure over several weeks using in vivo multiphoton imaging with kainate-induced seizures in mice. The degree of dendritic injury was directly dependent on the duration of the seizures, with seizures lasting more than 30 min (status epilepticus) resulting in a greater than 75% spine loss. However, even brief seizures (<5 min) induced moderate dendritic beading and spine loss. The dendritic injury from brief seizures usually recovered within 2 weeks, whereas status epilepticus-induced injury only partially reversed. These studies demonstrate that seizures of all durations may trigger at least transient neuronal injury.

Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D.

BACKGROUND: Uncontrolled studies have suggested that vitamin D insufficiency causes diffuse musculoskeletal pain. OBJECTIVES: Comparison of vitamin D levels in patients with diffuse musculoskeletal pain with controls; evaluation of the effect of treatment with vitamin D on diffuse pain. METHODS: 25-Hydroxyvitamin D levels were measured in patients with diffuse musculoskeletal pain and osteoarthritis (controls) recruited from a community rheumatology practice. The diffuse pain patients with 25-hydroxyvitamin D levels < or = 20 ng/mL were randomized to receive placebo or ergocalciferol 50,000 IU once weekly for 3 months. Outcomes assessed were pain measured by visual analog scale (VAS) and functional pain score (FPS). RESULTS: One hundred eighty-four patients with diffuse pain and 104 with osteoarthritis entered the study. Mean 25-hydroxyvitamin D levels did not differ between the groups (diffuse pain 29.2 ng/mL +/- 13.0, controls 28.8 ng/mL +/- 10.5; P = 0.78); nor did the percent of patients in each group with vitamin D levels < or = 20 ng/mL (diffuse pain 29%, controls 20%; P = 0.09). Fifty patients with diffuse pain who had 25-hydroxyvitamin D levels < or = 20 ng/mL were randomized to receive vitamin D or placebo for 3 months. Vitamin D treatment had no effect on pain in comparison to baseline (VAS P = 0.73; FPS P = 0.18) or at 3 months in comparison to placebo (VAS P = 0.12; FPS P = 0.05, in favor of placebo). CONCLUSIONS: Low vitamin D levels are not associated with diffuse musculoskeletal pain, and treatment with vitamin D does not reduce pain in patients with diffuse pain who have low vitamin D levels.