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A simple method for the repair of frontal sinus fracture: the bone mesh pull-up technique.

ABSTRACT: Accurate reduction and stable fixation are important in the treatment of frontal sinus fracture. In this article, we introduce a rapid and simple method for the treatment of frontal fractures and restoration of normal forehead contour, named the "bone mesh pull-up technique" (BMPUT). We describe our experience with this technique in frontal trauma cases, with emphasis on the technical aspects and clinical results of this simple method. Postoperative computed tomography scans showed adequate reduction of displaced bone fragments in all cases. Esthetic results were satisfactory and no complications related to this procedure, such as uncontrollable sinus bleeding, infection, and posterior table and brain injuries, were observed. Follow-ups ranged from 1 to 24 months, with an average of 12 months. Contour deformities were effectively restored and cosmetic results were very good. The BMPUT is a safe procedure that can be performed with minimal morbidity and offers, good access, and excellent esthetic results.

SUBMITTER: Robiony M

PROVIDER: S-EPMC3931769 | biostudies-other | 2014 Mar

REPOSITORIES: biostudies-other

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Mesh-fixation technique for inguinal hernia repair: umbrella review.

Project description:BackgroundMesh-based repair is the standard of surgical care for symptomatic inguinal hernias. Many systematic reviews and meta-analyses (SRMAs) addressed various aspects of these procedures. This umbrella review aimed to report the evidence from all previous SRMAs for open and laparoscopic inguinal hernia repair.MethodsSRMAs were identified from MEDLINE, Scopus, Cochrane, Embase, DARE, PROSPERO, CINAHL, JBISRIS, EPPI-Centre, Wiley Online Library and ScienceDirect database according to PRISMA guidelines. Data including mesh-fixation techniques and surgical approach were extracted from selected SRMAs. The corrected covered area was calculated to address study overlap across reviews, and an excess significance test was used to assess potential bias. The outcomes of interest were hernia recurrence, chronic groin pain, operating time, postoperative pain, duration of hospital stay, return to daily life activities, and postoperative complication.ResultsThirty SRMAs were included between 2010 and 2019: 16 focused on open repair, and 14 focused on laparoscopic repair, with a high degree of overlap (open repairs, 41 per cent; laparoscopic repairs, 30-57 per cent). Sufficient evidence was available on hernia recurrence, chronic groin pain, and operative time. Effects of glue on hernia recurrence were inconclusive in open and laparoscopy approaches, P = 0.816 and 0.946 respectively. Glue was significantly associated with lower persistent groin pain, in open repair (versus suture) and in laparoscopic repair (versus tack). SRMAs suggested that self-gripping mesh was associated with shorter operating time in open surgery, although with only a few minutes of improvement (0.36-7.85 min, P < 0.001).ConclusionIn this umbrella review, chronic groin pain and operating time were the only outcomes for which there was sufficient evidence supporting the effectiveness respectively of glue and self-gripping mesh.

| S-EPMC9271883 | biostudies-literature

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak.

Project description:Introductionand Objectives: Leakage of cerebrospinal fluid (CSF) from the frontal sinus is a challenging condition facing the ENT surgeon. Repair of this condition has been changed nowadays due to the newer instruments and techniques of nasal endoscopy. This study aims to evaluate the outcome of frontal sinus CSF leak endoscopic repair.Patients and methodsTwenty-seven patients who had frontal sinus CSF leaks were included in this study. They were 9 females and 18 males. They underwent endoscopic repair of the leak site at the period of five years from 2015 to 2020. A retrospective evaluation of these patients includes reconstructive procedures, complications, and postoperative follow-up.ResultsThe frontal leaks were present in the frontal recess (8 patients, 29.6%), ethmoidal roof (5 patients, 18.5%), and the majority was in the posterior wall (14 patients, 51.9%); 11 in the medial side and 3 in the lateral side. All cases, 27 (100%) were treated successfully, no failed treatment was observed. Postoperative complications were minimal; two patients had elevated intracranial pressure (ICP), infection with fever were found in four patients (7.4%), and meningitis was observed in only two cases (7.4%), treated conservatively.ConclusionFor frontal sinus CSF leak repair, the endonasal endoscopic approach is the treatment of choice due to higher success rates and lower morbidity profile. A favorable result is possible with proper diagnosis, precise localization, and an appropriate strategy.

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Unilateral endoscopic approach for repair of frontal sinus cerebrospinal fluid leak.

Project description:Cerebrospinal fluid (CSF) leak closure remains one of the most difficult surgeries for skull base surgeons, particularly with frontal sinus involvement. Technological advances in endoscopic surgery increasingly allow for less morbid approaches to the frontal sinus. We describe a series of patients who underwent endoscopic frontal sinus CSF leak repair utilizing a unilateral approach, to evaluate the utility and outcomes of this method. We performed a retrospective review of four cases in tertiary care centers. Participants included patients with CSF leak involving the frontal sinus. Main outcome measures included cessation of CSF leak and frontal sinus patency. Three patients were closed on the first surgical attempt; one with a communicating hydrocephalus required a revision procedure. Leak etiologies included prior craniotomy for frontal sinus mucopyocele, spontaneous meningoencephalocele, erosion due to mucormycosis, and prior endoscopic sinus surgery. The frontal sinus remained patent in three of four patients. No patients have evidence of a leak at a minimum of 1 year after surgery. The repair of frontal sinus CSF leaks is possible in specific cases with an endoscopic unilateral approach in leaks with multiple etiologies. Surgeons should consider this approach when selecting the appropriate procedure for repair of frontal sinus CSF leaks.

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Fracture Fixation Technique and Chewing Side Impact Jaw Mechanics in Mandible Fracture Repair.

Project description:Lower jaw (mandible) fractures significantly impact patient health and well-being due to pain and difficulty eating, but the best technique for repairing the most common subtype-angle fractures-and rehabilitating mastication is unknown. Our study is the first to use realistic in silico simulation of chewing to quantify the effects of Champy and biplanar techniques of angle fracture fixation. We show that more rigid, biplanar fixation results in lower strain magnitudes in the miniplates, the bone around the screws, and in the fracture zone, and that the mandibular strain regime approximates the unfractured condition. Importantly, the strain regime in the fracture zone is affected by chewing laterality, suggesting that both fixation type and the patient's post-fixation masticatory pattern-ipsi- or contralateral to the fracture- impact the bone healing environment. Our study calls for further investigation of the impact of fixation technique on chewing behavior. Research that combines in vivo and in silico approaches can link jaw mechanics to bone healing and yield more definitive recommendations for fixation, hardware, and postoperative rehabilitation to improve outcomes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Frontal sinus fractures.

Project description:The management of frontal sinus fractures has changed over the past 20 years. Whereas the indications for an invasive procedure had been much broader in the past, it has become more common to treat these fractures conservatively, due to improved imaging modalities, the advent of endoscopic surgical treatment of the nasofrontal outflow tracts, and the improved understanding of frontal sinus physiology. A variety of algorithms have been proposed for the management of frontal sinus fractures; however, we present a simplified treatment algorithm, which uses cranialization, obliteration, reconstruction, observation, and endoscopic sinus surgery.

| S-EPMC3324222 | biostudies-other

A Simple Technique for Capsular Repair After Hip Arthroscopy.

Project description:Capsulotomy is typically performed during arthroscopic treatment for femoroacetabular impingement. As the frequency of hip arthroscopy continues to expand rapidly, increased attention is being paid to the implications of interportal capsulotomy and the need for repair. To minimize the risk of postoperative instability, capsular closure has been recommended to restore the anatomy and biomechanical function of the capsule. We present a reliable, efficient, and effective method for arthroscopic closure of the interportal capsulotomy after hip arthroscopy.

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The "Pull-Over" Technique for All Arthroscopic Rotator Cuff Repair With Extracellular Matrix Augmentation.

Project description:Despite the vast improvement in techniques for arthroscopic rotator cuff surgery, repairs of massive and large tears remain an issue as they are associated with significantly high failure rates, particularly in the elderly population. As a result, there has been a focus of attention to improve rotator cuff repair healing rates. One of the strategies is augmentation of the repair with a patch. Arthroscopic augmentation is, however, technically demanding with challenges in introduction and stabilization of the patch. The purpose of this Technical Note is to describe a technique for arthroscopic rotator cuff repair with augmentation, which offers additional advantages over previous techniques because it facilitates the passage of the patch as well as providing a more robust medial stabilization of the augment and therefore possibly a stronger construct.

| S-EPMC5495004 | biostudies-literature

Tibial Eminence Fracture Repair With Double Hewson Suture Passer Technique.

Project description:Displaced tibial eminence fractures are commonly encountered in pediatric patients and are often considered to be functionally equivalent to an anterior cruciate ligament (ACL) rupture. While a variety of techniques are available for fixation of this injury, we describe an anchorless technique relying on suture fixation tied over a bone bridge. This technique also relies on two intra-articular Hewson suture passers to quickly and effectively pass and shuttle sutures through the ACL and tibial bone tunnels in order to reduce and fix the fracture fragment. We also briefly review various types of fixation used for tibial eminence fractures.

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ACL femoral avulsion repair using suture pull-out technique: A case series of thirteen patients.

Project description:PurposeAnterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort.MethodsThirteen consecutive patients of acute Type 1 (proximal ACL avulsion) were treated with arthroscopic ACL repair using a suture pull out technique. At the latest follow-up the patients were evaluated for Lysholm score, KT-1000 measurement and clinical assessment for any laxity.ResultsAt a mean follow-up of 31.3 months, none of the patients had any subjective laxity. The mean Lysholm score was 95 and instrumented laxity measurement did not reveal any significant laxity compared to the opposite knee.ConclusionThe proximal ACL avulsion has healing potential similar to proximal MCL injuries. Performing microfracture of the lateral wall of the notch optimizes the healing environment by negating the effects of the synovial fluid. Performing ACL repair in a carefully selected patient leads to good short term results and saves the patient of a reconstruction procedure, at least in the immediate future.

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An inhibitory pull-push circuit in frontal cortex.

Project description:Push-pull is a canonical computation of excitatory cortical circuits. By contrast, we identify a pull-push inhibitory circuit in frontal cortex that originates in vasoactive intestinal polypeptide (VIP)-expressing interneurons. During arousal, VIP cells rapidly and directly inhibit pyramidal neurons; VIP cells also indirectly excite these pyramidal neurons via parallel disinhibition. Thus, arousal exerts a feedback pull-push influence on excitatory neurons-an inversion of the canonical push-pull of feedforward input.

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