Obturator Nerve Block by Inguinal Approach in the Transurethral Resection of Lateral wall Bladder Tumor

Background: Single spinal anesthetic has been shown to be ineffective in preventing obturator nerve activation and adductor muscle contraction, which can lead to problems such as bladder perforation during transurethral resection of lateral wall bladder tumor (TURBT) under SA. To counteract this, numerous additional approaches are still being investigated, with the inguinal approach lately gaining traction. The aim of the study was to observe the incidence of jerk/ muscle spasm after obturator nerve block by Inguinal Approach in TURBT of lateral wall urinary bladder tumor under SA. Material & Methods: This retrospective observational study was conducted at the Department of Anesthesiology & ICU of National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh. The study duration was 6 months, from January 2022 to July 2022. During this period, a total of 20 cases of transurethral resection of lateral wall bladder tumor (TURBT) had been included as the study population, following inclusion and exclusion criteria. Results: Among the participants, 45% had been from the age group of 60-69 years, 30% had been from the age group of 50-59 years, 15% had been between the ages of 70-79, and 10% had been of 80 years or older. Hypertension was the most common comorbidity, observed in 70% of the participants. 45% had diabetes, 15% had chronic kidney disease, another 15% had chronic obstructive pulmonary disease, 10% had heart disease, and 15% had benign enlargement of prostate. During TURBT, majority of the patients had no jerk, while only 10% had minimal jerk and 1 patient had maximum jerk. During the 24-hour follow-up, 20% of patients regarded their outcome condition as excellent, while 60% had regraded their outcome as good. Only 1 patient regarded their outcome as poor, while follow-up data was unavailable for 15% of patients. Conclusion: The study observed very few incidence of muscle spasm or jerk during TURBT after using the inguinal approach. The study also found positive short-term outcome in most of the patients.

Abnormal obturator artery with ipsilateral inferior epigastric artery passed behind the femoral vein / Arteria obturatriz anómala con arteria epigástrica inferior ipsilateral que cruza posterior a la vena femoral

SUMMARY: Clear awareness of the vascular variations is critical in surgeries, which may cause massive hemorrhage during surgical procedures. During educational dissection of a male cadaver, we encountered a combined variation of the left obturator artery and ipsilateral aberrant inferior epigastric artery. The left obturator artery originated from the external iliac artery, then coursed inward, adherent to the superior pubic ramus. The left inferior epigastric artery originated from the femoral artery, and coursed behind the femoral vein. These anatomical variations shown in one person were extremely rare. This is particularly true with regard to these variations while performing pelvic and inguinal region surgeries.

El conocimiento claro de las variaciones vasculares es fundamental en las cirugías, ya que pueden causar una hemorragia masiva durante los procedimientos quirúrgicos. Durante la disección educativa de un cadáver de sexo masculino, encontramos una variación combinada de la arteria obturatriz izquierda y la arteria epigástrica inferior ipsilateral aberrante. La arteria obturatriz izquierda se originaba en la arteria ilíaca externa, luego discurrió hacia medial, adhiriéndose a la rama púbica superior. La arteria epigástrica inferior izquierda se originaba en la arteria femoral y discurría por detrás de la vena femoral. Estas variaciones anatómicas mostradas en una sola persona son extremadamente raras. Esto es importante de conocer estas variaciones cuando se realizan cirugías de las regiones pélvica e inguinal.

A Case of Prosthesis Penetrating the Bladder by Crossover Bypass in the Pelvic Cavity / 日本心臓血管外科学会雑誌

A 73-year-old man who had undergone right common iliac-right femoral-left femoral artery bypass, and left femoral-popliteal artery bypass at 60, and stent graft for abdominal aortic aneurysm at 69, had a pseudoaneurysm repaired at the left femoral artery anastomosis site at 72. Retention of fluid continued around the prosthesis, so drainage and sartorius muscle flap were carried out at 72. Due to the occlusion of the left popliteal bypass, a cross over bypass was performed from the right iliac artery position to the left above knee popliteal artery through the left obturator foramen route. One month later, CT revealed that the prosthesis had penetrated the bladder. In open surgery, the bladder was incised, and the prosthesis was taken out of it. The postoperative course was uneventful. Oral antibiotics were continued for 3 months. Currently, there are no signs of infection. There are very few opportunities to choose an obturator foramen route. It was necessary to identify the bladder wall under direct vision with great care.

Internal post-bariatric hernia due to hepatic adhesion: a case report

ABSTRACT Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.

Hernia obturatriz: Aspectos clínicos, imagenológicos y tratamiento / Obturator hernia: Clinical, imaging and treatment aspects

Introducción. Debido a la rareza de la hernia obturatriz y la imposibilidad para desarrollar estudios controlados de alto grado de evidencia, la mayoría de la literatura al respecto proviene de reportes de casos. Lo anterior, aunado al poco conocimiento del área anatómica de presentación y el cuadro clínico, la convierte en la hernia con mayor mortalidad. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos, ilustrado con pacientes manejados en el Servicio de Cirugía general de la Clínica Santa María de Sincelejo, Colombia. Discusión. La hernia obturatriz se puede descubrir en mujeres ancianas con antecedentes de cirugía abdominal o multiparidad. El signo de Howship­Romberg, que se presenta en la mitad de los pacientes, puede acompañarse de dolor abdominal en hipogastrio, vómitos y distensión progresiva. La radiografía de abdomen simple muestra tardíamente niveles hidroaéreos con ausencia de gas en ampolla rectal, pero como es poco específica para demostrar el sitio de obstrucción, es preferible la Tomografía computarizada. Conclusión. La hernia obturatriz requiere alto índice de sospecha, que ayude a la detección temprana e intervención quirúrgica inmediata, para evitar las complicaciones.

Introduction. Due to the rarity of the obturator hernia and the impossibility to develop controlled studies with a high degree of evidence, most of the reference in the literature comes from case reports. This, coupled with little knowledge of the anatomical area of presentation and clinical picture, makes it the hernia with the highest mortality. Methods. A literature search was carried out in the main databases, illustrated with patients managed in the General Surgery Service of the Clínica Santa María de Sincelejo. Discussion. Obturator hernia can be discovered in elderly women with a history of abdominal surgery or multiparity. The Howship ­ Romberg sign occurs in half of the patients, it can be associated with lower abdominal pain, vomiting, and progressive distension. Plain abdominal X-ray shows delayed air-fluid levels with absence of gas in the rectal ampulla, but since it is not very specific to demonstrate the site of obstruction, computed axial tomography is preferable. Conclusion. Obturator hernia requires a high index of suspicion, which helps early detection and immediate surgical intervention, to avoid complications.

Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate / Obturador faríngeo e resultados de fala em pacientes com fissura palatina

Abstract Introduction: Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective: This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods: Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results: Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion: The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.

Resumo Introdução: Indivíduos com fissura palatina podem apresentar disfunção velofaríngea após a palatoplastia primária e necessitam de um secundário devido à insuficiência velofaríngea. Nesses casos, o obturador faríngeo pode ser usado temporariamente enquanto se aguarda uma cirurgia secundária. Objetivo: Investigar o resultado do tratamento da hipernasalidade com o uso de obturador faríngeo em pacientes com histórico de fissura palatina que apresentam insuficiência velofaríngea após a palatoplastia primária. Nossa hipótese é que o uso do obturador faríngeo seja uma abordagem eficaz para eliminar a hipernasalidade relacionada à insuficiência velofaríngea em pacientes com fissura palatina Método: Participaram do estudo 30 indivíduos falantes do Português Brasileiro (15 homens e 15 mulheres) com fissura palatina operada, de 6 a 14 anos de idade (média: 9 anos; DP = 1,87 anos). Todos os pacientes receberam obturador faríngeo para o tratamento da insuficiência velofaríngea, enquanto aguardavam vaga para a cirurgia secundária. A análise perceptivo-auditiva da fala, realizada nas condições com e sem obturador faríngeo, foi realizada por três ouvintes, quanto à presença e ausência da hipernasalidade. Resultados: 70% dos pacientes eliminaram a hipernasalidade de fala com o uso do obturador faríngeo, enquanto 30% não eliminaram. A comparação foi estatisticamente significante (p < 0,001). Conclusão: O uso temporário do obturador faríngeo é uma abordagem efetiva para eliminar a hipernasalidade decorrente da insuficiência velofaríngea.

Safety and efficacy of laparoscopic distal rectal transection by transanterior obturator nerve gateway / 中华胃肠外科杂志

Objective: To evaluate the safety and efficacy of distal rectal transection by using transanterior obturator nerve gateway (TANG) in laparoscopic radical resection for lower rectal cancers. Methods: A descriptive case series study was performed. Inclusion criteria: (1) patients with primary rectal adenocarcinoma, with the distance of 3-5 cm from tumor to anal verge, with normal anal function before surgery and a desire to preserve anus; (2) laparoscopic radical resection of rectal cancer was performed and the distal rectum was transected using TANG approach. Exclusion criteria: (1) patients with distant metastasis or receiving palliative surgery; (2) the distal rectum was transected using non-TANG approach; (3) patients receiving combined multiple organs resection; (4) patients complicated with other tumors requiring additional treatment during the study. Clinicopathological data of 50 patients with low rectal cancer undergoing laparoscopic resection using TANG approach between January 2019 and December 2020 in Peking University First Hospital were retrospectively collected. Perioperative conditions, length of specific pelvic lines, additional angle and postoperative short-term outcomes were observed and described. Additional angle was defined as the angle between the simulated stapling line with the traditional approach and the real stapling line with the TANG approach. Data following normal distribution were presented as Mean±SD, or M [quartile range (Q(R))] otherwise. Results: All the patients successfully completed laparoscopic surgery without transferring to open or transanal surgery. The median operative time was 193 (80) min and blood loss was 50 (58) ml. All tumors received R0 resection with the distance from the tumor to distal resection margin of 1.7 (0.4) cm and the anastomotic height of 2.0 (0.1) cm. Rectal transection was completed by one cartridge in 52.0% of the cases (26/50) and two cartridges in 48.0% (24/50). Length of the stapling line was 6.6 (1.5) cm. The time to construct the gateway was 8.0 (6.0) min. The vessel damage occurred in 4.0% of the cases (2/50) and none of the cases encountered obturator nerve damage. Inlets of the pelvis in TANG and traditional approach were (9.9±1.3) cm vs. (7.2±1.1) cm (t=24.781, P<0.001). Additional angle of TANG was (15±2) °. The transecting positions on the midline and right edge of the rectum specimen by TANG were 0.6 (0.2) cm and 1.0 (0.2) cm lower than those by the traditional approach. One case (2.0%) died of pulmonary infection on the 17th day after surgery, 2 cases (4.0%) received re-operation and 14 cases (28.0%) had postoperative complications, including anastomotic leakage (7/50, 14.0%), urinary retention (6/50, 12.0%), pelvic infection (2/50, 4.0%) and ileus (2/50, 4.0%). The median postoperative hospital stay was 12 (6) days. Conclusions: Laparoscopic distal rectal transection by using TANG approach is safe and effective in the treatment of low rectal cancer. As an alternative rectal transecting method, TANG has advantages especially for the obese and those with a contracted pelvis and ultralow rectal cancers.

Reabilitação de pacientes com comunicação buco nasal: relato de casos / Rehabilitation of patients with oral and nasal communication: case report

A sobrevivência de pacientes com câncer de cabeça e pescoço vêm melhorando, entretanto, algumas deformidades podem ocorrer devido dos tratamentos cirúrgicos que geram mutilações bucomaxilofaciais como perda de dentes, estruturas do palato, língua ou assoalho, resultando em alterações na fonética, mastigação e deglutição. Nesses casos há a necessidade que seja realizado uma reabilitação protética buscando torná-los indivíduos com menos problemas sociais, psicológicos e físicos, visto que mais procedimentos cirúrgicos estão contra indicados para solucionar os efeitos colaterais gerados pelo tratamento das neoplasias. Esse tipo de reabilitação protética com prótese ou placa obturadora possibilita benefícios na fonética, facilita a convivência social e atividades nutricionais como alimentação e deglutição, permitindo ao paciente uma vida com menos constrangimentos. Este trabalho tem como objetivo relatar dois casos clínicos onde os pacientes foram submetidos a reabilitação com placa obturadora palatina feitos após cirurgias oncológicas. Os pacientes de gêneros diferentes e com comunicações buco-nasal similares receberam o mesmo planejamento reabilitador que foram confeccionadas a partir de um molde que foi enviado ao laboratório. Após a instalação foi possível verificar que houve sucesso no tratamento, notando uma melhora imediata comprovando a eficácia do método reabilitador(AU)

This paper relates two clinical cases where patients were recovered with a palatal splint made after oncological surgeries. Survival of patients and necks can occur, however, some deformities can occur during oral and maxillofacial treatment, such as the appearance of teeth, palate structures, mutilations or posterior jaws, leading to changes in aesthetics, surgery and swallowing. If the need to perform a prosthetic rehabilitation is necessary so that the results are seen with less problems, psychological and physical, that more procedures are performed so that the effects of neoplasms are contraindicated by the treatment. This type of prosthetic rehabilitation with prosthesis or obturator plate provides benefits in phonetics, facilitates social coexistence and nutritional activities such as eating and swallowing, allowing the patient a life with less constraints. Patients of different genders and with similar oral and nasal communications received the same rehabilitation plan that were made from a mold that was sent to the laboratory. After installation, it was possible to verify that the treatment was successful, noting an immediate improvement, proving the effectiveness of the rehabilitation method(AU)

Case management of a patient with gingival cancer who took the obturator prosthesis combined with orofacial myofunctional therapy to promote the rehabilitation of oral and maxillofacial function / 中国实用护理杂志

Objective:To summarize the case management of promoting the rehabilitation of oral and maxillofacial function of a patient with gingival cancer.Methods:The patient took the obturator prosthesis and orofacial myofunctional therapy to promote the rehabilitation of oral and maxillofacial function. The key points of nursing included: nursing of obturator prosthesis, orofacial myofunctional therapy, psychological nursing and evaluation of oral and maxillofacial function rehabilitation.Results:after one year of case management, the total score of the Chinese version of the obturator functioning scale was 18 points, the mouth opening was 4cm, and the speech distinctness was 98%. The quality of life of the patient was good.Conclusions:When the obturator prosthesis and orofacial myofunctional therapy are taken, all-round cooperation of the medical staff of different specialties from the perioperative period to the discharge follow-up should be strengthened in order to promote the rehabilitation of oral and maxillofacial function.

Evaluation of a 3D printed female anatomical model for the hands on training of trans-obturator tape (TOT) and tension free vaginal tape (TVT) sling procedures / Evaluación de un modelo anatómico femenino impreso en 3D para el entrenamiento práctico de los procedimientos de cinta trans-obturadora (TOT) y cinta vaginal sin tensión (TVT)

Trans-obturator tape (TOT) and tension free vaginal tape (TVT) procedures are efficient treatment options, which reduce the surgical complications and provide adequate support to urethra in case of increased abdominal pressure to prevent stress urinary incontinence (SUI). The aim of this study is to evaluate the effect and efficacy of 3D printed female anatomical model on the training of TOT and TVT procedures. A 3D printed female anatomical model was produced for MedTRain3DModSim, Erasmus+ European Union project led by Turkey with the participation of Greece, Italy, Czech Republic and South Korea. Face and content validities of the model evaluated by the participants and the experts respectively. During two learning & teaching & training activities and a multiplier event of the project between 2016 and 2018; 41 medical students, 30 residents and 19 specialists of urology and gynecology were educated and performed TOT and TVT procedures with this model under the mentorship of 3 experts. All participants were assessed and scored for their achievement on both procedures with model according to 7 parameters by the experts. There was no statistical difference between the students and residents for each parameter. All the parameters of the students and specialists were statistically different. 3D anatomical models produced from real data and mimicking different types of tissues are suitable for basic anatomy education of students and residents, hands on training for junior surgeons before cadaveric courses in hybrid education system, surgical planning of the surgeons and informing the patients before the operation.

Los procedimientos de cinta transobturadora (TOT) y cinta vaginal sin tensión (TVT) son opciones de tratamiento eficientes, que reducen las complicaciones quirúrgicas y proporcionan un soporte adecuado a la uretra en caso de aumento de la presión abdominal para prevenir la incontinencia urinaria de esfuerzo (IUE). El objetivo de este estudio fue evaluar el efecto y la eficacia del modelo anatómico femenino impreso en 3D en el entrenamiento de los procedimientos TOT y TVT. Se produjo un modelo anatómico femenino impreso en 3D para MedTRain3DModSim, proyecto Erasmus + de la Unión Europea dirigido por Turquía con la participación de Grecia, Italia, la República Checa y Corea del Sur. Validez facial y de contenido del modelo fueron evaluados por los participantes y los expertos respectivamente. Durante dos actividades de aprendizaje, enseñanza y capacitación y un evento multiplicador del proyecto entre 2016 y 2018; 41 estudiantes de medicina, 30 residentes y 19 especialistas en urología y ginecología fueron capacitados y realizaron procedimientos TOT y TVT de este modelo bajo la tutoría de 3 expertos. Todos los participantes fueron evaluados y calificados por los expertos, por su logro en ambos procedimientos con el modelo de acuerdo con 7 parámetros. No hubo diferencia estadística entre los estudiantes y los residentes para cada parámetro. Todos los parámetros de los estudiantes y especialistas fueron estadísticamente diferentes. Los modelos anatómicos en 3D producidos a partir de datos reales e imitando diferentes tipos de tejidos son adecuados para la educación básica de anatomía de estudiantes y residentes. Además de ofrecer una capacitación práctica para los cirujanos antes de los cursos cadavéricos en el sistema educativo, y una planificación quirúrgica de los cirujanos e información para los pacientes antes de la cirugía.

Schwannoma anciano del nervio obturador: una rara causa de neuralgia / Ancient schwannoma of the obturator nerve: an uncommon cause of pelvic neuralgia

Los tumores retroperitoneales son lesiones infrecuentes. Las tumoraciones nerviosas benignas como los schwannomas representan menos del 3% de ellos, siendo extremadamente raros los que afectan el nervio obturador. Presentamos el caso de un paciente con importante afectación funcional en miembro inferior izquierdo y dolor pélvico, al que se le diagnosticó neoplasia retroperitoneal. Fue intervenido por vía laparoscópica objetivándose la dependencia de la lesión del nervio obturador. Se llevó a cabo una exéresis completa de la lesión preservando parcialmente el nervio. El paciente tuvo una evolución funcional y álgica muy favorable. La anatomía patología reveló la presencia de schwannoma, del denominado subtipo "anciano", sin datos de malignidad. Consideramos que el informe de un caso como este puede ayudar a conocer una patología muy infrecuente y a tener en consideración algunos puntos clave como la técnica de abordaje y la necesidad de preservación de las estructuras nerviosas.

Retroperitoneal tumors are uncommon; benign tumors originating in the nerve cells as schwannomas represent less than 3%, while schwannomas of the obturator nerve are extremely rare. We report the case of a male patient with significant functional compromise of the left lower limb and pelvic pain who was diagnosed with a retroperitoneal tumor. The patient underwent laparoscopic surgery during which the compromise of the obturator nerve was evident. The lesion was completely resected with partial preservation of the nerve. The patient progressed with favorable functional recovery and pain relief. The histopathological examination reported a benign ancient schwannoma. We believe that this case report can help to understand a very rare condition and consider some key points such as the technique of approach and the need for preservation of the nerve structures.

Fabrication of closed hollow obturator for hard palate defect patient undergone maxillectomy / 대한치과보철학회지

Maxillectomy is performed to remove the tumor in the palate, maxillary sinus, buccal mucosa or nasal cavity. The resection range depends on the size and the extent of the tumor and it affects speech production or cause nasal regurgitation during feeding. Obturator can occlude an opening such as an oro-nasal fistula and protect the defect area. Successful reconstrucion of the patient's oral cavity who have gone over the maxillectomy is a difficult task. The condition and number of teeth, the remaining support area, and the extent of the defect area have a great influence on manufacturing the obturator. If these factors are disadvantageous, the prognosis of the prosthesis is uncertain. The final obturator must have a sufficient retention in the patient's oral cavity and must not irritate the surrounding tissue and support area where the resection was performed.In this case, a 55 year old female went through the maxillectomy and the only 3 teeth remained. And the retention of the maxillary prosthesis seems to be poor. So that, we fabricated the closed hollow obturator which has reduced weight compared to the conventional obturator. Consequently the closed hollow obturator can give better sealing and the adaptation.

The role of trans obturator tape as a surgical procedure for female stress urinary incontinence and its impact on quality of life in Jammu region

Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.

Luxación anterior obturatriz traumática de cadera en la edad pediátrica: reporte de un caso / Anterior dislocation traumatic hip obturator in pediatric age: a case report / Obturador traumático de cadeira com luxação anterior em idade pediátrica: relato de caso

La luxación de cadera de tipo anterior-obturatriz es una patología inusual en la ortopedia pediátrica pero con complicaciones potencialmente graves en la evolución. A propósito, presentamos el caso de una niña de 14 años que sufrió una luxación anterior-obturatriz secundaria a un traumatismo de alta energía. Se le realizo reducción cerrada en block quirúrgico bajo anestesia general, con buena evolución y sin complicaciones, con un seguimiento 24 meses.

Hip dislocation of the anterior-obturator type is an unusual pathology in pediatric orthopedics, but with potentially serious complications in evolution. By the way, we present the case of a 14-year-old girl who suffered a secondary anterior-obturator dislocation and high-energy trauma. A closed reduction was made in the surgical block under general anesthesia, with good evolution and without complications in a follow-up of 24 months.

A luxação anterior-luxação do quadril obturador é uma patologia incomum em ortopedia pediátrica, mas com complicações potencialmente graves na evolução. A propósito, apresentamos o caso de uma menina de 14 anos que sofreu um deslocamento obturador prévio secundário a trauma de alta energia. Uma redução fechada foi realizada no bloco cirúrgico sob anestesia geral, com boa evolução e sem complicações no seguimento de 24 meses.

Obstructed Obturator Hernia: A Diagnostic Dilemma.

Obturator hernia is a rare type of pelvic hernia which accounts for less than 1% of all abdominal hernias. It generally occurs in elderly emaciated patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common clinical symptom is strangulation combined with mechanical intestinal obstruction. Abdominal CT scan can precisely confirm the diagnosis and early surgical intervention is essential for better outcome.

Obturator nerve injury and repair during laparoscopic lymphadenectomy. Case report and review of the literature / Lesión y reparación laparoscópica de nervio obturador en linfadenectomía laparoscópica. reporte de caso y revisión de la literatura

RESUMEN Objetivo: presentar el caso de una lesión del nervio obturador durante linfadenectomía laparoscópica y su reparación por la misma vía en el mismo tiempo quirúrgico, y realizar una revisión de la literatura de la presentación de este tipo de lesiones, así como de la técnica utilizada, el momento de su reparación y los resultados de la rehabilitación. Materiales y métodos: se presenta el caso de una mujer de 29 años atendida en el Instituto Nacional de Cancerología en Bogotá, Colombia, con diagnóstico clínico de carcinoma escamocelular de cérvix estadio Ib1, a quien se le practicó traquelectomía radical más linfadenectomía pélvica bilateral por el deseo de preservar la fertilidad. Durante el procedimiento se advirtió una sección completa del nervio obturador, la cual se reparó inmediatamente por vía laparoscópica. Se realizó una búsqueda de la literatura en la base de datos Medline vía PubMed. Los términos utilizados para la búsqueda fueron: "Obturator Nerve", "Lymph Node Excision", "Trauma", "Nervous System". Se buscaron series y reportes de caso, cohortes y artículos de revisión desde 1968 hasta septiembre 2018. La búsqueda se limitó a idiomas español e inglés. Resultados: se incluyeron ocho estudios, todos reportes de caso. Un total de seis de los casos presentaron sección completa del nervio advertida intraquirúrgicamente. En cuatro casos se realizó la reparación por medio de anastomosis términoterminal, tres casos con reconstrucción utilizando injerto de nervio sural y un caso con neurolisis y anastomosis término-terminal, todos por vía laparoscópica. En el seguimiento a nueve meses, tres pacientes recuperaron totalmente la función. Conclusión: los estudios encontrados fueron reportes de caso, la lesión más frecuente es la sección completa del nervio; se encuentran varias técnicas de reparación del nervio. La recuperación al año no es total en un importante número de casos reportados

ABSTRACT Objective: To report a case of obturator nerve injury during laparoscopic lymphadenectomy and repair through the same approach during the same surgical procedure; and to present a review of the literature on this type of injury, techniques used, timing of the repair, and rehabilitation outcomes. Materials and Methods: Case presentation of a 29-year-old woman seen at the National Cancer Institute (Instituto Nacional de Cancerología) in Bogotá, Colombia. The patient had a clinical diagnosis of stage Ib1 squamous cell carcinoma of the cervix and was taken to radical trachelectomy plus bilateral pelvic lymphadenectomy because of her wish to preserve fertility. During the procedure, a complete dissection of the obturator nerve was recognized and repaired immediately through the laparoscopic approach. A literature search was conducted in the Medline database via PubMed. The terms used for the search were "Obturator Nerve," "Lymph Node Excision," "Trauma," "Nervous System". The search was limited to publications in Spanish and English and included case series and reports, cohorts and review articles published between 1968 and September 2018. Results: Eight studies were included, all of them case reports. In six cases, complete sectioning of the nerve was recognized during surgery. In four cases, end-to-end anastomosis was used for repair; three cases were reconstructed using sural nerve grafting; and one case was managed with neurolysis and end-to-end anastomosis. All cases were approached laparoscopically. Over a nine-month follow-up period, three patients recovered full nerve function. Conclusion: The studies retrieved were all case reports, the most frequent injury being complete nerve sectioning. Several nerve repair techniques were used. Recovery after one year was not complete in a significant number of the cases reported.

Prosthetic Rehabilitation Of Hemimaxillectomy Patient: A Case Report

Rehabilitation of hemimaxillectomy patients can be challenging. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. Maxillary obturator prosthesis is most commonly fabricated for patient's undergone surgical maxillectomy. It helps in mastication, deglutition and aids in speech. Various methods have been described in literature to make it hollow for reduction of weight of prosthesis. This case report describes another method of making a hollow prosthesis.

Obstrucción intestinal por hernia obturatriz: serie de casos / Intestinal obstruction caused by obturator hernia: case series

OBJETIVO: Se presentan 3 casos de obstrucción intestinal por hernia obturatriz atascada, su manejo y una breve revisión de la literatura. MATERIALES Y MÉTODOSles y Métodos: Discusión del cuadro clínico, imágenes y manejo. Todos los casos fueron operados dentro del mismo día del diagnóstico y se confirmó la presencia de hernia obturatriz. El manejo de la hernia y su contenido fue ajustado a la situación de cada paciente. RESULTADOS: Los tres casos de hernia obturatriz aquí discutidos tienen la presentación clásica del cuadro, cuando se los revisa en forma retrospectiva y con imagenología compatible. Los tres pacientes evolucionaron en forma satisfactoria con alta precoz y control posoperatorio sin incidentes. Discusión: Nuestros 3 casos se condicen tanto en hallazgos clínicos, imagenológicos y en manejo con lo descrito en la literatura internacional. CONCLUSIÓN: La hernia del agujero obturatriz siendo infrecuente, se presenta en un tipo particular de pacientes y con sintomatología clásica. La tomografía axial computada es de gran ayuda y suele hacer el diagnóstico preciso en el preoperatorio. Es importante recordar este diagnóstico diferencial al momento de estudiar pacientes con obstrucción intestinal.

OBJECTIVE: 3 cases of intestinal obstruction that resulted in diagnosis of obturator hernia, their management and a brief international literature review are presented. MATERIAL AND METHODS: Discussion of the presentation, images, and management. In all cases surgery was performed the same day from the diagnosis of intestinal obstruction and confirmation of obturator hernia. The management of the hernia and it's content was adjusted to each patient's situation. RESULTS: Our 3 patients, when reviewed retrospectively, had the classic presentations and images of obturator hernia. All of them had a favourable evolution with an early discharge and no complications on follow up. DISCUSSION: Our 3 cases had clinical presentations and imaging studies that correlated well with international literature. CONCLUSION: Obturator hernia is an infrequent pathology, but appears in a particular type of patient and with classic presentation. Axial computed tomography is an important tool and usually makes the diagnosis previously to surgical exploration. It is important to consider this diagnosis when being faced with patients with intestinal obstruction.

Surgical retention for immediate obturator in maxillectomy patients

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.