No split, no tenotomy transposition procedure for complete abducens palsy.
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ABSTRACT:
SUBMITTER: Murthy SR
PROVIDER: S-EPMC5549426 | biostudies-other | 2017 Jul
REPOSITORIES: biostudies-other
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Project description:PURPOSE:Superior rectus transposition has been popularized for the treatment of abduction deficiencies. Potential complications include induced vertical deviation and torsion. A new procedure, the inferior rectus transposition (IRT), may be similarly beneficial for patients at risk for postoperative vertical deviation or incyclotropia. The purpose of this study is to describe the outcomes of patients undergoing IRT. DESIGN:Prospective, interventional case series. METHODS:Five patients in an academic pediatric ophthalmology and strabismus practice with a complete lateral rectus palsy who underwent IRT were studied. Changes in anomalous head posture, ocular rotations, ocular alignment, and torsion preoperatively to postoperatively were compared. RESULTS:The patients ranged in age from 19-89 years. There was a significant correction in the angle of esotropia (ET) from 39±17? (14-55?) to 12 ± 9.8? (0-22?) postoperatively (P = .02). Two of 5 patients had preoperative hypertropia of the affected eye (1.4 ± 2.2?; range, 2-5?). One of those had no vertical deviation postoperatively and 1 patient resulted in 2? hypotropia. One patient without vertical misalignment preoperatively developed a small postoperative vertical deviation. Torticollis significantly improved from 31.4 ± 11.6° to 5 ± 5.8° (P = .004). All patients improved abduction, with a mean of -4.4 ± 0.5 preoperatively to -3.4 ± 0.9 postoperatively (P = .07). CONCLUSION:Initial postoperative follow-up in patients with abducens palsy undergoing IRT shows a significant improvement in ocular alignment and torticollis. In patients with preoperative hypertropia, IRT resulted in a downward shifting effect on the operated eye. IRT may be a beneficial procedure for patients with preoperative hypertropia or intorsion requiring transposition procedures. Future studies with larger populations and longer durations of follow-up will be required before this procedure can be recommended.
| S-EPMC5410180 | biostudies-literature
Project description:Horizontal strabismus due to a weak rectus muscle can be treated with an augmented Hummelsheim procedure, in which both vertical rectus muscle tendons are split, resected by 4 mm, and reattached to the sclera adjacent to the weak rectus muscle. Compared with vertical rectus transposition, the procedure spares two ciliary vessels and does not require placement of augmentation sutures. In this study, we evaluated binocular alignment and ocular motility in patients with abducens nerve palsy treated with an augmented Hummelsheim procedure.The medical records of consecutive patients with complete abducens nerve palsy who underwent the augmented Hummelsheim procedure, usually combined with medial rectus muscle recession, were retrospectively reviewed. Binocular alignment, ocular motility, and complications were analyzed.Ten patients (age range, 12-57 years) met inclusion criteria for the study, of whom 9 of 10 had simultaneous medial rectus recession. Follow-up ranged from 1 week to 24 months. The augmented Hummelsheim procedure improved esotropia from 43(?) ± 5(?) preoperatively to 6(?) ± 7(?) postoperatively (P < 0.0001) and reduced abduction deficits from -4 to -3 (P < 0.0001). One patient with coexisting oculomotor nerve palsy developed consecutive exotropia; 2 had induced vertical deviations. There were no cases of anterior segment ischemia.The augmented Hummelsheim procedure combined with medial rectus muscle recession reduced mean primary position esotropia and improved abduction in patients with complete abducens nerve palsy.
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Project description:In the presence of bone loss, the Bristow or Latarjet procedure is used to alleviate anterior glenohumeral instability. The techniques have gradually improved under arthroscopy. However, such an arthroscopic procedure has a steep learning curve, lengthy operation time, and considerable risk of complications, inhibiting its rapid development. The current method of modified arthroscopic Bristow procedure with screw fixation without subscapularis split reduces surgical time, reduces the risk of nerve damage consequences, and is simple to apply. Technique Video Video 1 We present our modified arthroscopic Bristow procedure: screw fixation without subscapularis split. The patient is placed in the beach-chair position, and 5 portals are created. After performing a diagnostic arthroscopy examination, the coracoid process lower surface, tip, and base, and the conjoined tendon are identified. The soft tissue lateral to the conjoined tendon is released to a sufficient length to allow transferring the coracoid process. The coracoacromial ligament is excised at its coracoid insertion to expose its lateral and upper surfaces. Subsequently, the pectoralis minor muscle is released from the coracoid to ∼5 cm below the junctions between the pectoralis minor muscle and the conjoined tendon to ensure the transfer of the coracoid process will not be affected. A 1.2-mm K-wire is drilled into the coracoid under the guidance of a thin cannula. A PDS line is passed through the bone tunnel for traction and guidance. After ensuring an adequate length of the coracoid bone, it is osteotomized with a willow saw. Subsequently, the labrum and capsule are detached completely from the glenoid to the 6-o’clock position. The glenoid is refreshed by a burr. The upper edge of the subscapularis is pressed downwards by a switching stick until the 4-o’clock position of the anterior glenoid is exposed. A marking point is placed to assist in creating a tunnel at the 4-o’clock position. After drilling and measuring, a 1.2-mm K-wire is inserted into the tunnel to guide the screw. The coracoid is pulled out through portal D, its length is measured, and its osteotomy surface is trimmed to match the anterior glenoid surface. A hole is drilled from the center of the osteotomy surface to the tip of the coracoid with a 1.2-mm K-wire. The hole created by the 1.2-mm K-wire is drilled through with a 2.7-mm hollow drill. A cannulated screw with a diameter of 4 mm is implanted into the coracoid graft along the 1.2-mm K-wire, leaving 2 mm of the screw head above the osteotomy surface for the coracoid's final fixation. The lateral edge of the conjoined tendon is sutured with No. 2 ETHIBOND suture near the coracoid and kept sufficiently taut to prevent twisting during coracoid fixation. The coracoid with partial screw fixation is then inserted for the final fixation. The tip of the screw is positioned against the K-wire introduced through the glenoid tunnel in the previous phase. The K-wire is threaded through the screw, and the coracoid and screw are secured with a screwdriver. The final placement of the transferred coracoid is arthroscopically assessed through portal B. The postoperative anteroposterior radiograph shows that a single screw maintains the coracoid in place. The 3-dimensional computed tomography scan depicts the locations of the graft and screw. The transferred coracoid is seen at the 4-o’clock position, and the glenoid surface is well integrated with the coracoid graft’s surface. The scan also shows that the transferred coracoid is standing on the glenoid surface with a 90° rotation. (PDS, polydioxanone.).
| S-EPMC10466097 | biostudies-literature
Project description:Purpose:To present the results of bilateral superior rectus transposition with medial rectus recession in a case of chronic bilateral sixth nerve palsy. Observation:Bilateral superior rectus transposition with medial rectus recession resulted in full correction of esotropia with resolution of horizontal diplopia, improvement in abduction, and regain of stereoacuity in our case. There was minimal limitation of adduction, with no abnormal vertical or torsional changes. Conclusion and importance:Bilateral superior rectus transposition with medial rectus recession appears to be a useful procedure for surgical treatment of bilateral sixth nerve palsy with minimal side effects. Given its potential for reduced risk of anterior segment ischemia (ASI), it may have especially good value in the select group of patients at risk for ASI. Studies with larger sample size and longer follow up are needed to further evaluate this procedure and elucidate the variables in surgical technique for superior rectus transposition.
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Project description:Biceps tenotomy is a common procedure performed in arthroscopic shoulder surgery. Numerous studies have demonstrated the effectiveness of both biceps tenotomy and tenodesis to relieve pain and restore function for the diagnoses of bicipital tenosynovitis, SLAP tears, rotator interval pulley lesions, and failed SLAP repairs. It is also frequently performed as a concomitant procedure with arthroscopic rotator cuff repair. We report a technique to improve the efficiency of arthroscopic bicep tenotomy using a biceps squeeze maneuver. This is a simple method of manually squeezing the biceps muscle belly while performing the arthroscopic biceps tenotomy. This shortens and tensions the intra-articular portion of the tendon to facilitate a more safe and efficient procedure.
| S-EPMC7695749 | biostudies-literature
Project description:The long head of the biceps tendon is frequently involved in shoulder pathologies, often in relation to inflammatory or degenerative damage to the rotator cuff. Biceps tenodesis in the bicipital groove and tenotomy are the main treatment options. Tenotomy of the long head of the biceps tendon is a simpler and quicker procedure than tenodesis, and it does not require the use of implants. However, retraction of the biceps tendon, leading to Popeye deformity, and biceps muscle cramps are common complications after tenotomy. Therefore we propose an arthroscopic technique for tenotomy that limits the risk of Popeye deformity. This procedure consists of creating a loop at the severed end of the biceps tendon, which prevents the tendon from retracting into the bicipital groove.
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Project description:The presence of integrons was assessed in gut bacteria isolated from wild-caught prawns. A pseudomonad was recovered that contained a Tn402-like class 1 integron with a complete transposition module and two gene cassettes. One cassette was identical to a previously described cassette from a chromosomal class 3 integron in Delftia tsuruhatensis.
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Project description:PURPOSE: To report the postoperative results of full-tendon vertical rectus transposition (VRT) augmented with lateral fixation suture for the treatment of type 1 Duane syndrome and sixth nerve palsy and to determine whether there was a decrease in the effect of the Foster suture over time. METHODS: This retrospective, consecutive case series included patients who underwent a full-tendon VRT transposition with lateral fixation for type 1 Duane syndrome or sixth nerve palsy. The primary outcome measures included deviation, abnormal head posture(AHP), abduction deficiency, and postoperative binocular single visual field (BSVF). RESULTS: Eighty-seven patients (87 eyes: 40 eyes with Duane syndrome and 47 eyes with sixth nerve palsy) were included in this study. In Duane syndrome patients, the deviation was reduced by a mean of 95%, the AHP was eliminated in 86% of patients, the abduction was improved by 42%, and a useful BSVF of ≈ 67% of normal was achieved at 1 year post operation. In sixth nerve palsy patients, the deviation was reduced by 99%, the abduction was improved by 59%, and a useful BSVF of ≈ 71% of normal was achieved at 1 year post operation. In both groups, the improvements in deviation angle and abduction were stable postoperatively. Sixteen patients needed reoperation for undercorrection. CONCLUSION: VRT surgery with posterior fixation is an effective treatment method for complete sixth nerve palsy and Duane syndrome with esotropia, AHP, and abduction deficiency. The procedure carries a small risk of reoperation for undercorrection. The effect of the Foster suture did not decline over time.
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Project description:The aim of this systematic review was to evaluate instrumentation procedures of the alveolar ridge expansion technique (ARST) with or without Guided Bone Regeneration (GBR) and to identify the most used instruments for successful outcome. An electronic as well as manual literature search was conducted in several databases including Medline, Embase, and Cochrane Central Register of Controlled Trials, for articles written in English up to September 2016. The question in focus was to identify the type of device for ridge expansion that is most frequently used and provides adequate bone expansion and implant success rate. To meet the inclusion criteria, the studies were analysed for the following parameters: prospective or retrospective studies, cohort or case studies/series, cases with 5 or more human subjects, type of device used for surgery, location of defect, and minimum follow up period. The frequency of osteotome usage in this study was approximately 65%, and on average, the implant success was 97%. The motorized expanders and ultrasonic surgery system are easier to use and cause less trauma to the bone compared to the traditional/conventional instruments like mallets and osteotomes. However, their cost is a limiting factor; hence, osteotomes remain a popular mode of instrumentation.
| S-EPMC5521746 | biostudies-literature