Comparison of Ultrasound / Anatomical landmark guided technique for superior laryngeal nerve block along with Topical Anesthesia for awake nasal intubation in various Oral& faciomaxillary & Dental surgeries

ABSTRACT:Background: Endotracheal intubation is gold standard of general anesthesia. various oral,Maxillofacial, Dental surgeries are carried out in high-risk patients having chances ofdifficult intubation. If we give sedation or general anesthesia, we can be trapped in criticalairway accidents.Aims & objectives: To access & compare efficacy of anatomical landmark guided/Ultrasound guided superior laryngeal nerve block associated with topical Anesthesia &transtracheal block for awake blind nasal intubation.Method:Group A: Anatomical landmark guided superior laryngeal nerve block given(n=30)Group B: ultrasound guided superior laryngeal nerve block(n=30)In both groups topical Anesthesia & transtracheal block for awake blind nasal intubation wasgiven.Results: upper airway block provide clinical ease to facilitate blind nasal awake intubation.ultrasound guided block has less adverse reactions.Conclusion: Both methods provide good quality of Endotracheal intubation, but ultrasoundguided block is more efficient & scientific method to block superior laryngeal nerve forawake nasal intubation.

Variación de patrones morfológicos craneofaciales en relaciones esqueléticas Clase I, II y III / Variation of craniofacial morphological patterns in Class I, II, and III skeletal relationships

Introducción: tradicionalmente, los estudios de variaciones morfológicas de componentes craneofaciales para clasificar relaciones esqueléticas han considerado análisis univariados y multivariados mediante variables como distancias, ángulos y planos referenciales. Sin embargo, estos métodos no explican cambios generales de forma y proporcionan una descripción parcial y localizada de estas relaciones. En tanto, los métodos basados en Morfometría Geométrica (MG) en dos o tres dimensiones (2D o 3D,) permiten una comprensión detallada y un examen más sensible de variables. El objetivo fue identificar la variación de patrones morfológicos de la estructura CraneofacialGeneral(CFG) en relaciones esqueléticas I, II y III, utilizando MG-2D. Métodos: se hizo un estudio prospectivo mediante muestreo no probabilístico. Se tomaron 272 radiografías laterales de cráneo (140 hombres/132 mujeres) de individuos colombianos entre 17 y 25 años, y se determinó el error intraexaminador considerando la prueba F-ANOVA como estadístico de prueba. Se hizo Análisis Generalizado de Procrustes (AGP) y detección de datos atípicos por Cuantil Adaptativo. La variación en tamaño se analizó con prueba Kruskal-Wallis, considerando la matriz de Tamaño Centroide (CS) y las diferencias conformacionales con MANOVA. La identificación de patrones craneofaciales se determinó mediante Análisis de Componentes Principales (ACP) y Conglomerados/K-medias. Resultados: en la estructura CFG se encontraron diferencias conformacionales y una capacidad de buena clasificación del 89% (Clase I), 89% (Clase II) y 91% (Clase III). Se identificaron cuatro patrones craneofaciales; tres evidenciaron relaciones esqueléticas clásicas, y el otro identificó un nuevo grupo combinado de Clase I/II. Conclusiones: las diferencias morfológicas en los cuatro patrones identificados fueron evidentes, la MG permitió una visualización explicativa de patrones de variación morfológica, localizando sitios reales en donde ocurren cambios en tamaño y conformación.

Introduction: the studies on morphological variations of craniofacial components to classify skeletal relationships have traditionally included univariate and multivariate analysis using variables such as distances, angles, and reference planes. However, these methods fail to explain general changes in shape and provide partial localized descriptions of these relationships. Whereas methods using two- or threedimensional (2D or 3D) Geometric Morphometrics (GM) allow a detailed understanding and a more sensitive test of variables. The objective of this study was to identify morphological pattern variations of the Overall Craniofacial Structure (OCS) in skeletal relationships I, II, and III using GM-2D. Methods: this was a prospective study using non-probability sampling. It implied taking 272 lateral radiographs of the head of Colombian individuals (140 males/132 females) aged 17 to 25 years, determining intra-examiner error and using F-ANOVA as statistic test. Generalized Procrustes Analysis (GPA) was conducted as well as atypical data detection by Adaptive Quantile. Size variation was analyzed by the Kruskal-Wallis test considering Centroid Size matrix (CS) and conformational differences were analyzed with MANOVA. Craniofacial patterns were identified by Principal Components Analysis (PCA) and K-means/cluster. Results: the OCS showed conformational differences and a good classification capacity of 89% (Class I), 89% (Class II), and 91% (Class III). Four craniofacial patterns were identified; three of them showed typical skeletal relationships and the other pointed out to a new Class I/II combined group. Conclusions: the morphological differences in the four identified patterns were evident; GM allowed an explanatory display of morphological variation patterns, identifying actual sites where changes in size and shape take place.

Accuracy of Classical Anatomical Landmark Technique ( Anterior, Central, and Posterior Approach) for Internal Jugular Vein by Ultra-sound Technique / 医学研究杂志

Objective To explore the accuracy rate of classical anatomical landmark technique ( anterior , central , and posterior ap-proach) for internal jugular vein (IJV) by ultrasound technique.Methods Sixty-four patients with selective operation were included in this study.The anesthetist marked the anterior approach , central approach, and posterior approach for internal jugular vein at 0°(neu-ral), 30°,and 80°of head rotation, respectively.The accuracy of each anatomical landmark were examined by other anesthetist with ul -trasound technique .Results The accuracy rate of anterior approach and central approach were significantly higher than posterior ap -proach at 0°of head rotation, respectively.The accuracy rate of anterior approach was higher than posterior approach at 30°of head rota-tion.The accuracy rate was similar among anterior , central, and posterior approach at 80°of head rotation.Conclusion The accuracy rate was different in different approach of anatomical landmark for internal jugular vein .

The Efficacy of Carotid Tubercle as an Anatomical Landmark for Identification of Cervical Spinal Level in the Anterior Cervical Surgery: Comparison with Preoperative C-arm Fluoroscopy

BACKGROUND: In cervical anterior approach, transverse skin incision is preferred due to cosmetic reasons. Precise skin incision is required to reach the surgery segment while minimizing soft tissue injury. Skin incision site is frequently identified using C-arm fluoroscopy or the carotid tubercle. Accordingly, this study was conducted to investigate the efficacy of skin incision using the carotid tubercle as a marker. METHODS: This study was retrospectively conducted on 114 patients who underwent anterior cervical surgery by the same surgeon from April 2004 to June 2012. The rate of the appropriate insertion of K-wire, which was inserted into the disc after anterior approach, into the surgery segment was compared between 62 patients where skin incision site was identified using C-arm fluoroscopy before skin incision and 52 patients where skin incision site was identified using carotid tubercle palpitation before surgery. RESULTS: The needle was shown to have been inserted into the planned site in 106 patients out of the total 114 patients. The appropriate insertion of the needle was shown in 59 patients of group I (95.2%) and in 47 patients of group II (90.4%). Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of one-segment surgery was shown to be 89.7% in group I and 82.6% in group II. Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of two-segment surgery was shown to be 100% in group I, and 96.4% in group II due to one case of the failure at C3-4 and C5-6. The success rate of three- and four-segment surgeries was shown to be 100% in both groups. CONCLUSIONS: The identification of skin incision site via carotid tubercle palpation was useful for surgeries involving two or more segments. Furthermore, it could be useful for one-segment surgery if surgical site is identified using vertebral body or soft tissues such as longus collis rather than insertion into the disc.

Laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach / 中华消化外科杂志

Lapareseopic colectomy is commonly performed,but laparoscopic extended right hemicolectomy with D3 lymphadenectomy for cancer located at hepatic flexure of the colon is a complex procedure,even in the hands of experts.Laparoscopic dissection of the lymph nodes around the middle colonic and right gastroepiploic vessels are so complicated that precise vascular anatomy and surgical plane are essential to complete this procedure safely.We herein describe a standard technique for performing laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach.The main surgical plane of this procedure is the right Toldt's space.The superior mesenteric vein (SMV) is the most important anatomical landmark of vascular dissection.Medial-to-lateral approach makes it easy to locate the right Toldt's space and the SMV.

The Zuckerkandl's Tubercle is a Useful Anatomical Landmark for the Detection of Both the Recurrent Laryngeal Nerve and the Superior Parathyroid during Thyroid Surgery / 대한내분비외과학회지

PURPOSE: Zuckerkandl's tubercle (ZT) of the thyroid gland is a well-documented anatomical structure. This study evaluated the anatomical relationship of the ZT in terms of the recurrent laryngeal nerve (RLN) and the superior parathyroid gland (SP). METHODS: The study included 325 patients (ten patients with benign tumors and 315 patients with malignancies) who underwent thyroid surgery between February and June 2007. Tubercles were classified according to size: Grade 0 (unrecognizable), Grade I (≤ 5 mm), Grade II (6~10 mm) and Grade III (>10 mm). The incidence and size of the ZT and its positional relationship to the RLN and SP were investigated during thyroid surgery. RESULTS: ZTs were identified in most patients (right thyroid 89.3%, left thyroid 85.6%). The percentageof tubercles according to grade and location was as follows: Grade 0, right thyroid 10.7% and left thyroid 14.4%; Grade I, right thyroid 7.9% and left thyroid 11.1%; Grade II, right thyroid 43.5% and left thyroid 38.5%; Grade III, right thyroid 37.9% and left thyroid 35.9%. The most common RLN course was in a groove between the ZT and the main body of the thyroid. Most of the SPs are situated cranial to the ZTs and were located at the 1 or 2 o'clock position (96.1%) in the left thyroid and at the 10 or 11 o'clock position (95.2%) in the right thyroid. A greater distance between the ZT and the SP was seen with a decreasing size of the ZT. CONCLUSION: The ZT was identified during most thyroidectomies, and there was a constant relationship between the ZT and either the RLN or SP. Therefore, identification of the ZT and an understanding of the relationship between the ZT and either the RLN or SP are essential for the performance of safe thyroid surgery.

CT Findings in Revision Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When performing a revision endoscopic sinus surgery, operators should pay close attention due to the altered sinonasal anatomy or defects of anatomical landmarks. Careful preoperative evaluation of altered anatomy is important, however, little has been reported on its structural changes. We investigated status of anatomical structures and mucosal pathology by reviewing OMU CT in revision sinus surgeries. MATERIALS AND METHODS: A total of 117 operated sides (right: 59, left: 58) from 62 patients who received revision endoscopic sinus surgeries were evaluated. They had history of previous sinus surgeries such as Caldwell-Luc operation, polypectomy, or endoscopic sinus surgery. We investigated the following 5 parameters by reviewing preoperative OMU CT; Sinus mucosal pathology, bony thickening, absence of superior or middle turbinate, structural changes of superior or middle turbinate, and defects of anatomical landmarks. RESULTS: Sinus mucosal pathology was most commonly found in the maxillary sinuses, and was followed by the anterior ethmoid, the posterior ethmoid, the frontal, and the sphenoid sinuses. Out of 117 sides, 47 showed bony thickening and 7 showed absence of superior or middle turbinate. Eleven revealed structural changes in the superior or middle turbinate, and three showed defects in the lamina papyracea. However, there was no complete absence of the middle or superior turbinates, all of which were partially preserved. CONCLUSION: Significant bony thickening, defects or changes of anatomical structures and associated mucosal pathology were frequently found in revision endoscopic sinus surgeries. Preoperative review of OMU CT, identification of structural changes, and close attention during surgery would be necessary.

A STUDY ON THE ANTIMICROBIAL SUSCEPTIBILITY OF ORAL MICROFLORA IN CHILDREN SUSCEPTIBLE TO INFECTIVE ENDOCARDITIS

The present study has been performed to evaluate 20 cardiopathy children and 20 healthy children's oral micorbes at the point of antimicrobial susceptibilities for antimicrobial prophylaxis to prevent bacterial endocarditis. The results were as follows: 1. Both groups had similar oral microbes. 2. The antimicrobial susceptibility of S. viridans were: Penicillin< Oxacillin< Ampicillin< Cephalothin< Erythromycin< Clindamycin< Gentamicin< Ciprofloxacin< Vancomycin=Imipenem. The cardiopathy group was slightly lower antimicrobial susceptibility rates than healthy group. 3. The antimicrobial susceptibility of Neisseriaceae were: Clindamycin< Erythromycin< Vancomycin< Penicillin< Gentamicin< Cephalothin< Ciprofloxacin< Imipenem. The antibiotics of bacterial endocarditis antibiotic prophylaxis regimens for dental procedures according to the American Heart Association were generally lower antimicrobial susceptibilities, so they were considered inadequate for the first selective antibiotics and Imipemem was best suitable antimicrobials. Conclusively, when choose antimicrobials for treatment or antimicrobial prophylaxsis for bacterial endocarditis, surveillant culture must be performed to evaluated personal antimicrobial susceptibilities of intraoral microbes for proper antimicrobial choice for dental procedures.