Cumulative radiation exposure during thoracic endovascular aneurysm repair and subsequent follow-up

n/

Masseteric-facial nerve neurorrhaphy: results of a case series

OBJECTIVE: Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial nerve is not available, another nerve must be anastomosed to the facial nerve to reactivate its function. The masseteric nerve has recently gained popularity over the classic hypoglossus nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of masseteric-facial nerve neurorrhaphy for early facial reanimation. METHODS: Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent masseteric-facial nerve neurorrhaphy in which an interpositional nerve graft of the great auricular or sural nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial nerve dysfunction. Twelve months after the onset of postoperative facial nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS: Overall, 91.2% of the patients experienced facial nerve function reactivation. Facial recovery began within 2-12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of masseteric nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few patients complained about partial loss of sensitivity of the earlobe or a small area of the ankle and foot, depending on whether great auricular or sural nerves were harvested. CONCLUSIONS: The surgical technique described here seems to be efficient for the early treatment of facial paralysis and results in very little morbidity

Orbital medial wall fractures: Purely endoscopic endonasal repair with polyethylene implants

Our technique couples the stronger support granted by non-resorbable materials and the minimal invasiveness of the endoscopic approach without the need for long-term nasal packing

Virtual Surgical Reduction in Atrophic Edentulous Mandible Fractures: A Novel Approach Based on “in House” Digital Work-Flow

Featured Application: Virtual Surgical Planning in Cranio-Facial Traumatology. Atrophic edentulous mandible fractures are a challenge for maxillo-facial surgeons because of low vascularization, low bone regeneration, and lack of occlusion. Whereas occlusion is the main guide in the reduction of mandibular fractures, the aim of our study is to show the advantages of using virtual surgical planning (VSP) in surgery when the occlusal guide is absent. This work is a prospective study that shows the in-house digital workflow for the management of these fractures in the Maxillo-Facial Surgery Unit of Federico II University Hospital of Naples. Four patients who satisfied the criteria were included in the study. For each patient, the same defined CAD/CAM-based was applied. The workflow followed four steps: (1) bone segmentation and virtual reduction of fracture fragments; (2) three-dimensional printing of virtually reduced mandible and modelling of 2.4 reconstruction plate on printed resin model; (3) surgery aided by the pre-formed plate; (4) digital and clinical outcomes analysis. In the last step, a distance colour map was conducted to compare the virtual planning and postoperative CT outcome. In all cases, the discrepancies values between the two images were lower than 1.5 mm, and good clinical outcomes in terms of facial symmetry, absence of sensory disturbance, and possibility of prosthetic rehabilitation were obtained. In conclusion, the VSP, with our in-house workflow brings benefits in the management of atrophic edentulous mandible fractures in terms of the high accuracy of bone repositioning

Long-term outcome after inflammatory abdominal aortic aneurysm repair: case-matched study

The purpose of this study was to compare early and late outcomes after inflammatory and noninflammatory abdominal aortic aneurysm (AAA) repair with emphasis on graft-related complications. Of 625 consecutive patients submitted to AAA repair, 18 were classified as having inflammatory AAAs (group 1). The results of this group were compared with those of 54 patients (group 2) retrospectively drawn from patients who underwent aortic replacement for noninflammatory AAAs. A computer-assisted matching system was used to match patients according to date of birth, gender, and surgical priority. All patients of both groups were followed by periodic clinical and instrumental examinations. Patients in group 1 complained more frequently of aneurysm-related symptoms (72% vs. 20%; p = 0.0001), and their erythrocyte sedimentation rate was elevated more often (78% vs. 19%; p < 0.0001). Surgical morbidity and mortality rates were not different. The mean lengths of follow-up were 61 +/- 47 months (group 1) and 71 +/- 38 months (group 2). The 10-year overall survival rates did not differ significantly between the two groups (49.1% +/- 16.9% for group 1 vs. 61.6% +/- 13.8% for group 2; p = 0.26, log-rank test). In contrast, the free from paraanastomotic aneurysm survival rates were significantly lower in group 1 (57.3% +/- 20.2% vs. 97.8% +/- 2.5% at 10 years; p = 0.025, log-rank test). Long-term outcomes showed a higher incidence of graft-related complications in group 1. As inflammatory aneurysms might represent a risk factor for the development of paraanastomotic aneurysms, routine imaging surveillance of graft aortic healing after inflammatory AAA repair is warranted