Flexor tendon repair in the hand: the use of early postoperative therapeutic exercises alone versus its combination with laser

The aim of the study was to compare between early uses of therapeutic exercises alone versus the effect of its combination with the use of laser after hand flexor tendon repair in zone II. A prospective study was done on a thirty patients operated at Elsahel Teaching Hospital for a flexor tendon repair in zone II using a modified Kessler' technique. Patients have an average age of 25.26+ 6.37 years and they were randomly divided into two equal groups, the first group [A] received only therapeutic exercises, and the same program of exercises in addition to the use of laser therapy was applied in group [B] after operation. In both groups, results after 3 months showed a statistically significance increase as regards duration of post operative rehabilitation program in total active motion [TAM] of P.IP and DIP, [Group A at 3 weeks showed 53 +/- 45.85 and at 3 months 110.33 +/- 32.15, Group B showed at 3 weeks 102 +/- 34.37 and at 3 months 149.66 +/- 26.95]. the same significant results was also seen in case of maximal hand. grip strength [MI-IG], [Group A showed at 3 weeks a result of 17.56 +/- 3.96 and at 3 months 54.01 +/- 15.15 and Group B showed a mean results at 3 weeks of 23.02 +/- 7.06 and at 3 months 82.6 +/- 16, 48. In addition group [B] showed highly significant improvement in TAM and MHG as compared to group [A]. It was concluded that the addition of laser with early therapeutic exercises plays an important roles to improve results at postoperative rehabilitation after hand flexor tendon repair

Distraction osteogenesis and orthognathic surgery in the treatment of bilateral temporomandibular joint ankylosis

Bilateral temporomandibular joint TMJ ankylosis during the active growth period presents with a conglomerate of clinical features namely severe micrognathia, inability to open the mouth and upper airway obstruction. Early treatment is recommended to avoid the secondary affection of the maxilla and midface. Six patients with bilateral TMJ ankylosis were included in this study. They were divided equally into two groups. The standard treatment was followed in group I which consisted of the release of ankylosis as a primary procedure. After an appropriate period of physiotherapy, mandibular osteotomy with iliac bone grafts and advancement genioplasty was performed in the mandible and Le Fort I osteotomy in the maxilla to correct maxillary canting. As for the cases in group II, mandibular advancement by means of distraction osteogenesis were carried out first by means of two extraoral multi-guide distractors fixed bilaterally to the mandible followed by the release of ankylosis. Evaluation included clinical examination, photography and radiographic analysis [orthopantomogram, lateral and posteroanterior cephalometry]. The distraction gap was assessed by means of ultrasonography and ultrasonometry. Dexa was used in one case. The advantages of both procedures are discussed