Simultaneous innervated and vascularized iliac bone flap for reconstructing mandible and nerve defects / 口腔疾病防治

@#The functional reconstruction of large maxillofacial defects is a major issue in oral and maxillofacial surgery, and autologous bone transplantation is the main method. However, bone is readily absorbed following an autologous bone transplant. Even with vascular anastomosis, spontaneous osteoporosis of transplanted bone is still serious, which affects dental implantation and functional recovery. Therefore, osteoporosis of the grafted bone has become one of the main complications of jaw reconstruction, and there is no preventive measure. The problem that autologous bone with sufficient blood supply cannot avoid osteoporosis suggests that systemic factors such as nerves, which have been neglected in traditional methods, may regulate the internal environment of the transplanted bone. Based on previous studies on the regulation of mesenchymal stem cells by the neural microenvironment, we initiated a new surgical procedure for innervated and vascularized iliac bone flaps based on animal model and cadaver studies. In the innervated and vascularized iliac bone flap, vascular microanastomosis was performed in conjunction with microneuronal anastomosis between the simultaneously harvested ilioinguinal nerve (which innervates the iliac bone and is usually sacrificed and neglected in the conventional vascularized iliac bone flap) and the inferior alveolar nerve proximally and with the mental nerve distally. By conducting clinical retrospective studies and prospective randomized controlled trials, we proved that the novel method of simultaneous innervated iliac bone transplantation can not only prevent bone resorption but also restore the sensation of adjacent soft tissues such as the lip. This may solve the key problems of sensory loss and osteoporosis after mandibular reconstruction, ensure the success of dental implant dentures, and put forward the new concept of "blood supply + innervation" bi-system bone transplantation.

Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

A Study Of Variations In Iliohypogastric And Ilioinguinal Nerves In Human Adults

Introduction: Lumbar plexus is one of the main nervous pathways supplying the lower limb which is bound toshow variations. Surgeons should be aware of these variations to avoid possible injuries to the structure andtheir consequences. This study was conducted to observe the formation of Iliohypogastric nerve and IlioinguinalnerveMaterial and methods: Dissection of 40 bilateral lumbar plexuses from formalin fixed adult human cadaversprocured from department of anatomy JJMMC Davangere.Results: Many significant variations were found in the anatomy of the iliohypogastric and ilioinguinal nerve.Conclusion: Knowledge of the variations in the branching pattern and formation of the lumbar plexus is essentialto prevent nerve injury during routine surgical procedures like inguinal hernia surgery, low transverse incisionof gynecological procedures

Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair / 대한마취과학회지

BACKGROUND: The transversus abdominis plane (TAP) block is a regional anesthesia technique that effectively reduces the pain intensity and use of analgesia in abdominal surgery. The aim of this study was to determine the utility of the ultrasound-guided TAP block in improving the efficacy of the ultrasound-guided ilioinguinal/iliohypogastric nerve (IIN/IHN) block for intraoperative anesthesia and postoperative pain control in day-case inguinal hernia repair (IHR). METHODS: We conducted a descriptive study of patients undergoing elective primary unilateral open IHR. Fifty-nine patients were divided into two groups according to the anesthetic technique used: ultrasound-guided TAP block plus ultrasound-guided IIN/IHN block (TAP group) vs. ultrasound-guided IIN/IHN block alone (IIN/IHN group). The outcome measures were the adequacy of anesthesia during surgery and postoperative analgesia. RESULTS: Four patients (12.5%) in the TAP group and 10 patients (37.0%) in the IIN/IHN group experienced inadequate anesthesia and needed systemic sedation (P < 0.05). No significant differences in additional local anesthetic volume were found between the two groups. Patients in the TAP group reported lower pain scores at the end of surgery (0.4 ± 0.8 vs. 2.1 ± 2.5, P < 0.01), at 2 hours after surgery (0.8 ± 1.3 vs. 3.0 ± 2.2, P < 0.01), at discharge (1.4 ± 1.2 vs. 4.3 ± 2.2, P < 0.01), and at 24 hours (1.5 ± 1.1 vs. 4.5 ± 2.3, P < 0.01). CONCLUSIONS: The combination of the TAP and IIN/IHN blocks is associated with better intraoperative anesthesia and lower postoperative pain scores compared with the IIN/IHN block alone.

Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques / Bloqueio dos nervos ílio-hipogástrico/ilioinguinal em correção de hérnia inguinal para tratamento da dor no pós-operatório: comparação entre a técnica de marcos anatômicos e a guiada por ultrassom / Bloqueo de los nervios ileohipogástrico/ilioinguinal en corrección de hernia inguinal para el tratamiento del dolor en el postoperatorio: comparación entre la técnica de marcas anatómicas y la guiada por ultrasonido

Objectives: The purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy. Methods: 40 patients, ASA I-II status were randomized into two groups equally: in Group AN (anatomical landmark technique) and in Group ultrasound (ultrasound guided technique), iliohypogastric/ilioinguinal nerve block was performed with 20 ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24 h postoperatively. Results: VAS scores at rest in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.01 or p < 0.001). VAS scores at movement in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.001 in all time points). While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p < 0.05, p < 0.001, p < 0.001 respectively). Conclusion: According to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block-related complications. .

Objetivo: Comparar a eficácia de bloqueios dos nervos ílio-hipogástrico/ilioinguinal feitos com a técnica guiada por ultrassom e a de marcos anatômicos para o manejo da dor no pós-operatório em casos de herniorrafia inguinal em adultos. Métodos: Foram randomicamente divididos 40 pacientes, estado físico ASA I-II, em dois grupos iguais: nos grupos AN (técnica de marcos anatômicos) e US (técnica guiada por ultrassom), o bloqueio dos nervos ílio-hipogástrico/ilioinguinal foi feito com 20 mL de levobupivacaína a 0,5% antes da cirurgia com as técnicas especificadas. Escore de dor na avaliação pós-operatória, tempo de primeira mobilização, tempo de internação hospitalar, escore de satisfação com a analgesia no pós-operatório, efeitos colaterais induzidos por opiáceos e complicações relacionadas ao bloqueio foram avaliados durante 24 horas de pós-operatório. Resultados: Escores EVAem repouso na sala de recuperação e todos os valores clínicos durante o acompanhamento foram significativamente menores no grupo ultrassom (p < 0,01 ou p < 0,001). Escores EVA em movimento na sala de recuperação e todos os valores clínicos durante o acompanhamento foram significativamente menores no grupo ultrassom (p < 0,001 em todos os tempos avaliados). Enquanto os tempos de internação e da primeira mobilização foram significativa-mente menores, os índices de satisfação com a analgesia foram significativamente maiores no grupo ultrasom (p<0,05, p< 0,001, p< 0,001, respectivamente). Conclusão: De acordo com o nosso estudo, o bloqueio dos nervos ílio-hipogástrico/ilioinguinal guiado por US em herniorrafias inguinais em adultos proporciona uma analgesia mais eficaz e maior satisfação com a analgesia ...

Objetivo: El objetivo de este estudio fue comparar la eficacia de bloqueos de los nervios ileohipogástrico/ilioinguinal realizados con la técnica guiada por ultrasonido y la de marca anatómicas para el manejo del dolor en el postoperatorio en casos de herniorrafia inguinal en adultos. Métodos: 40 pacientes, estado físico ASA I-II, fueron aleatoriamente divididos en 2 grupos iguales: grupos con técnica de marcas anatómicas) y grupo con técnica guiada por ultrasonido. El bloqueo de los nervios iliohipogástrico/ilioinguinal fue realizado con 20 mL de levobupivacaína al 0,5% antes de la cirugía con las técnicas especificadas. La puntuación de dolor en la evaluación postoperatoria, tiempo de primera movilización, tiempo de ingreso hospitalario, puntuación de satisfacción con la analgesia en el postoperatorio, efectos colaterales inducidos por opiáceos y complicaciones relacionadas con el bloqueo fueron evaluados durante 24 h de postoperatorio. Resultados: Las puntuaciones EVA en reposo en la sala de recuperación y todos los valores clínicos durante el seguimiento fueron significativamente menores en el grupo con técnica guiada por ultrasonido (p < 0,01 o p < 0,001). Las puntuaciones EVA en movimiento en la sala de recuperación y todos los valores clínicos durante el seguimiento fueron significativamente menores en el grupo con técnica guiada por ultrasonido (p < 0,001 en todos los tiempos calculados). Mientras que los tiempos de ingreso y de la primera movilización fueron significativamente menores, los índices de satisfacción con la analgesia fueron significativamente mayores en el grupo ultrasonido (p < 0,05; p < 0,001; p < 0,001 respectivamente). Conclusión: De acuerdo con nuestro estudio, el bloqueo de los nervios iliohipogástrico/ilioinguinal guiado por ultrasonido en herniorrafias ...

Unusual Path of Branches of Ilioinguinal Nerve: A Clinically Important Anatomic Variant

Ilioinguinal nerve is a collateral branch of lumbar plexus. Its anatomical variations in relation to adjacent musculoaponeurotic structures play a crucial role in the development of neuropathies associated with lower abdominal surgeries. In this report, we present a rare case of unusual course and branches of the ilioinguinal nerve, in a 55-year-old male cadaver. In the lateral part of inguinal canal ilioinguinal nerve gave three branches. Two of its branches pierced the external oblique aponeurosis, about 6 cm above the pubic symphysis, to supply the skin of the lower part of the anterior abdominal wall. Another branch pierced the conjoint tendon, in the medial part of the inguinal canal about 2 cm above the superficial inguinal ring. Knowledge of unusual path of these branches may be important to avoid injuries during the surgical repair of groin hernias. Further care should be taken while dealing with the conjoint tendon in the Bassini procedure.

Ultrasound-Guided Pain Interventions: A Review of Techniques for Peripheral Nerves

Ultrasound has emerged to become a commonly used modality in the performance of chronic pain interventions. It allows direct visualization of tissue structure while allowing real time guidance of needle placement and medication administration. Ultrasound is a relatively affordable imaging tool and does not subject the practitioner or patient to radiation exposure. This review focuses on the anatomy and sonoanatomy of peripheral non-axial structures commonly involved in chronic pain conditions including the stellate ganglion, suprascapular, ilioinguinal, iliohypogastric, genitofemoral and lateral femoral cutaneous nerves. Additionally, the review discusses ultrasound guided intervention techniques applicable to these structures.