The Pronating Radius Osteotomy for Correcting the Supination Deformity in Brachial Plexus Birth Palsy

Objective: Severe supination deformity may be seen in brachial plexus birth palsy (BPBP). The aim of this study was to determine the efficacy of pronating radius osteotomy in the management of this deformity.Material and Methods: BPBP patients with severe supination deformity were included in this study and they were operated between November 2003 and December 2015, by the same operative team. Pronating radius osteotomy was performed and internal fixation was maintained either by Kirschner wires or semitubular plates. In some patients, tendon transfers were performed during the same operation for the restoration of shoulder and thumb abduction and wrist extension.Results: Forty one patients had supination deformities caused by BPBP. The mean age was 9.2 years (4-22). The mean follow-up was 5 years (1-7). The mean active pronation was -60° before the operation, and the passive one was -10°. The mean active pronation of the patients was 9° after the operation, and the passive one was 45°. The mean active supination of the patients was 75° before the operation, and the passive one was 85°. The mean active supination of the patients was 45° after the operation,and the passive one was 65°. One malunion was detected at the second year after the operation (1/41). Three patients had low pronation degrees during the follow-up (3/41).Conclusion: Satisfactory postural and functional improvement can be achieved with the use of pronating radius osteotomy for patients with severe supination contractures

Temporomandibular eklem ankilozunun ameliyat sonrası nüksünde nötrofil lenfosit ve trombosit lenfosit oranlarının öngörü etkisi 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

A Novel Training Alternative in Orthognathic Mandibular Osteotomy: Air Dried Clay Model

Objective: Patient safety and low complication rates are indispensa ble in surgical training and models are among the main educational tools. The aim of this study is to assess the efficiency of a novel model for orthognathic mandibular osteotomy.Material and Methods: A template and seventeen partial mandibular models (MM-17) were manufactured with air dried clay. The dimensions of the models were feasible for sagittal split ramus osteotomy (SSRO). Model surgery was performed by surgeons with a minimum of three years’ experience in orthognathic surgery. Each surgeon operated four separate models and the following data were recorded: corticotomy and SSRO completion time, MM-17 fracture type, similarity value of MM-17 with native mandible, representation value of MM-17, and the training compatibility value of MM-17.Results: IThe cost was 0.6 American Dollars. The mean corticotomy time was 126.75 seconds (110-150). Mean cortical resistance similarity value was 8.75 (8-10). The mean SSRO time was 288 seconds (205-401). Sixty percent of the fractures were seen in the outer cortex. The mean medullary resistance similarity value was 5 (4-6) and mean mandibular representation value was 5.25 (4-7). The training compatibility value was 8.25 (7-10)

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

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

Abstract 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)