Quiste odontogénico calcificante asociado a odontoma complejo en la región posterior del maxilar. Reporte de caso clínico y revisión de la literatura / Calcifying odontogenic cyst associated with complex odontoma in the posterior litera of the maxilla. A case report and review of the literature

El quiste odontogénico calcificante (QOC) es raro y representa <1% de todos los quistes odontogénicos, pertenece a las lesiones conocidas como "tumores de células fantasma", estos son una familia de lesiones que varían en presentación clínica de quiste o neoplasia sólida, en su comportamiento biológico de benigno a localmente agresivo o metastásico, esta diversidad ha generado extenso debate sobre la clasificación, terminología, manejo y pronóstico de estas patologías. Presentamos el caso clínico de un paciente masculino de 17 años de edad con diagnóstico de quiste odontogénico calcificante asociado a odontoma complejo situado en la región posterior del maxilar, en la literatura existen reportados solo 27 casos de QOC en esa zona. Fue tratado mediante enucleación quirúrgica, curetaje, rotación de almohadilla grasa bucal y colocación de malla de titanio para reconstruir la pared anterior del seno maxilar. El control postoperatorio clínico y radiográfico a 12 meses no muestra recidiva de la lesión además exhibe un excelente resultado funcional y estético, esto nos permite concluir que el tratamiento fue adecuado. Realizamos una revisión de la literatura en Science Direct, PubMed y Biblioteca Cochrane, con objeto de informar las características clínicas, histopatológicas, radiográficas y el tratamiento de estas lesiones.

The calcifying odontogenic cyst (COC) is rare and represents <1% of all odontogenic cysts, it belongs to the lesions known as "ghost cell tumors", these are a family of lesions that vary in clinical presentation of cyst or solid neoplasia, in their behavior biological from benign to locally aggressive or metastatic, this diversity has generated extensive debate on the classification, terminology, management and prognosis of these pathologies. We present the clinical case of a 17-year-old male patient with a diagnosis of calcifying odontogenic cyst associated with a complex odontoma located in the posterior region of the maxilla, in the literature there are only 27 reported cases of (COC) in that area, he was treated by surgical enucleation, curettage, rotation of the buccal fat pad and placement of titanium mesh to reconstruct the anterior wall of the maxillary sinus. The clinical and radiographic postoperative control at 12 months does not show recurrence of the lesion, in addition it exhibits an excellent functional and aesthetic result, this allows us to conclude that the treatment was adequate. We conducted a review of the literature in Science Direct, PubMed and Cochrane, in order to report the clinical, histopathological, radiographic characteristics and the treatment of these lesions.

Síndrome compartimental por extravasación de líquidos en paciente pediátrico, reporte de un caso y revisión de la literatura / Compartment Syndrome Due To Liquid Extravasation In A Pediatric Patient. Case Report And Bibliographic Review

El Síndrome Compartimental por Extravasación (SCE) es una patología poco frecuente, con una incidencia de 0,01-6,5%, 1.8-11% en niños. En niños pequeños la comunicación es difícil y aumenta el riego de desarrollo de SCE. Se presenta un caso de un masculino de 9 meses de edad, con Neumonía viral sobreinfectada que desencadena SCE; recibió descompresión compartimental del antebrazo y mano derecha; con desarrollo de secuelas leves. Aplicar tratamiento para lesión por extravasación no siempre es suficiente; existen complicaciones leves-moderadas o SCE. Reconocer manifestaciones clínicas y factores de riesgo es fundamental para el diagnóstico, con estudios auxiliares como precaución en niños. La faciotomía, tratamiento estándar de oro; no es inocua e impacta en la morbilidad. Se recomiendan protocolos oportunos para extravasación, valoración temprana por cirujano, investigaciones en pediatría.

Extravasation Compartment Syndrome (SCE) is an infrequent pathology, with an incidence of 0,01-6,5%, whom 1,8-11% are children. Communication in children is usually difficult, with high risk of development of SCE. A case about a 9 month old male patient with an over-infected viral pneumonia and a triggered SCE is presented. He received compartmental decompression of right forearm and right hand; however he presented mild sequelae. Treatment of extravasation injury is not always sufficient enough. Mild-to-moderate complications or SCE can be presented. Recognizing clinical manifestations and risk factors and the use of auxiliary studies is fundamental for a good diagnosis and as prevention in children. Faciotomies, gold standard for treatment, are not completely safe, and have an impact on morbidity. Early protocols against extravasation, early examination by surgeon and investigation about SCE in chil-dren are recommended.

Estenosis lumbar degenerativa: conceptos básicos, evaluación clínica y manejo / Degenerative lumbar spinal stenosis: basic concepts, clinical evaluation, treatment

La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente.

Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation. Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.

Migraña: efectividad del tratamiento quirúrgico: revisión de la literatura / Migraine headache: effectiveness of surgical treatment: review of the literature

Resumen La migraña afecta a un porcentaje importante de la población y los síntomas pueden interferir con calidad de vida de manera importante. A pesar de los avances en el manejo médico, existe una proporción de pacientes que no responden adecuadamente a la intervención farmacológica. En los últimos años, se han planteado nuevos enfoques en el tratamiento de la migraña. Éstos se basan en la teoría que ramas sensoriales extracraneales del trigémino y de los nervios espinales cervicales pueden irritarse, atraparse o comprimirse en algún punto a lo largo de su trayecto, generándose una cascada de eventos fisiológicos que finalmente resulta en la migraña. Se ha demostrado que la inyección diagnóstica y terapéutica de toxina botulínica y la descompresión quirúrgica de estos puntos gatillos reducen o eliminan las migrañas en pacientes que no responden adecuadamente a la intervención farmacológica y siguen sintomáticos. La evidencia que respalda la eficacia y seguridad de la descompresión quirúrgica de los puntos de gatillos periféricos se está acumulando rápidamente, y la tasa de éxito general de la cirugía se acerca a 90%. Este trabajo revisa la evidencia clínica y pretende proporcionar un artículo sobre el estado actual de la técnica en el tratamiento quirúrgico de las migrañas.

Migraine headaches affect a significant percentage of the population and the symptoms can interfere with quality of life in an important way. Despite advances in medical management, there is a proportion of patients who do not respond adequately to the pharmacological intervention. In recent years, new approaches have been proposed in the treatment of migraine. These are based on the theory that extracranial sensory branches of the trigeminal and cervical spinal nerves can become irritated, trapped or compressed at some point along their path, generating a cascade of physiological events that ultimately results in migraine. It has been shown that the diagnostic and therapeutic injection of botulinum toxin and the surgical decompression of these trigger points reduce or eliminate migraines in patients who do not respond adequately to the pharmacological intervention and remain symptomatic. The evidence supporting the efficacy and safety of surgical decompression of peripheral trigger points is rapidly accumulating, and the overall success rate of surgery approaches 90%. This paper reviews the clinical evidence and aims to provide an article on the current state of the art in the surgical treatment of migraines.

Basilar invagination associated with chiari malformation type I: A literature review

Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.

Schwannoma of the upper cervical spine-a case report / 中华创伤杂志(英文版)

Upper cervical schwannoma is rare, and belongs to benign tumors that is usually asymptomatic. It accounted for only ten percent of schwannomas cases and mostly occurs in 40-50 years old patients. Aggressive and total resection is the treatment of choice for this tumor. Preoperative diagnosis is difficult, relying on clinical suspicion, and confirmed by surgical pathology. We report a 54-year-old male patient with chief complain of progressive weakness and numbness of his right arm for four months. He had a history of lymph node tumor in 2007 and excised in 2011. Neurological decrease was found on the right arm. The radiographic examination showed lytic lesion on the second, third, and fourth cervical spine. Computed tomography scan showed destruction extending to the first cervical vertebra. Capsulated extradural and extramedullary mass and compression to the spinal cord was found from the magnetic resonance imaging. Two-stage operation was performed. The first stage was posterior decompression with occipitocervical fusion and instrumentation, while the second was anterior decompression and iliac strut graft. Both operations performed using the surgical ultrasonic dissector. During three months' follow-up, it showed neurological improving. Neurological deficit appears when there is compression on the spinal cord. Total resection is the treatment of choice for these tumors. Preoperative imaging should be performed to exclude malignant tumor and found tumor extension.

Maximum Decompressive Hemicraniectomy for Patients with Malignant Hemispheric Infarction

OBJECTIVE: The authors applied maximum external decompression for malignant hemispheric infarction and investigated the functional outcome according to the patient age.METHODS: Twenty-five patients with malignant hemispheric infarction were treated using a hemicraniectomy with maximum external decompression, comprising a larger (>14cm) hemicraniectomy, resection of the temporalis muscle and its fascia, spaciously expansive duraplasty, and approximation of the skin flap. The medical and diagnostic imaging records for the patients were reviewed, and 1-year functional outcome data obtained for the younger group (aged ≤ 60 years) and elderly group (aged > 60 years).RESULTS: The patients (n=25) who underwent maximum surgical decompression revealed a minimal mortality rate (n=2, 8.0%). The patients (n=14) in the younger group all survived with mRS scores of 2 (n=1, 7.1%), 3 (n=7, 50.0%), 4 (n=3, 21.4%), or 5 (n=3, 21.4%). A majority of the younger patients (57.1% with mRS ≤3) lived with functional independence. When the 1-year mRS scores were dichotomized between favorable (mRS ≤3) and unfavorable (mRS ≥4) outcomes, the younger group had significantly more patients with a favorable outcome than the elderly group (57.1% versus 9.1%, p=0.033). In contrast, in the elderly group, most patients showed unfavorable outcomes with the mRS scores of 4 (n=5, 45.5%), 5 (n=3, 27.3%), or 6 (n=2, 18.2%), whereas only one patient showed favorable outcome (mRS 3). A majority of the elderly patients (45.5% with mRS 4) survived with moderately severe disability.CONCLUSION: For malignant hemispheric infarction, a hemicraniectomy with maximum external decompression was found to considerably increase survival with a favorable outcome in functional independence (mRS ≤3) for younger patients aged ≤60 years. It can be optimal surgical treatment for younger patients.

Neurological Recovery Pattern in Cervical Spondylotic Myelopathy after Anterior Surgery: A Prospective Study with Literature Review

STUDY DESIGN: Prospective clinical study. PURPOSE: The present study aimed to examine the neurological recovery pattern in cervical spondylotic myelopathy (CSM) after anterior cervical decompression and compare it with the existing reports in the literature. OVERVIEW OF LITERATURE: Neurological recovery and regression of myelopathy symptoms is an important factor that determines the outcomes of surgical decompression. The present findings contribute to the literature on the pattern of neurological recovery and patient prognosis with respect to the resolution of myelopathy symptoms after surgery. METHODS: This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total of 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively followed up for 1 year and were evaluated for their neurological recovery pattern. The postoperative outcome was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. The recovery rate was calculated using Hirabayashi's method. The JOA score was assessed before the operation and postoperatively at 1 week, 2 weeks, 1 month, 3 months, 4 months, 6 months, and 1 year. RESULTS: The postoperative mJOA score was 0 in the 1st month, 12.90±3.57 in the 3rd month, 13.50±3.55 in the 4th month, 14.63±3.62 in the 6th month, and 14.9±3.24 at the final follow-up of 1 year. The average recovery rate during the 1st month follow-up was 0%, and that during the 3rd month follow-up was 12.91% with a range of 0%–50%. The average recovery rate during the 4th month was 32.5%, with a range of 0%–60%, while that during the 6th month was 72.83%, with a range of 0%–100%. The average recovery rate during the final follow-up of 1 year was 54.3%. CONCLUSIONS: Neurological recovery after surgical decompression starts from the 3rd postoperative month and progresses until the 6th postoperative month; thereafter, it gradually plateaus over the subsequent 6 months until it steadies. Symptom duration is an important factor that requires consideration while determining postoperative neurological recovery.

Intra-individual evaluation of results between open and endoscopic release in bilateral carpal tunnel syndrome / Avaliação intraindividual dos resultados entre as técnicas aberta e endoscópica de um portal na síndrome do túnel do carpo bilateral

ABSTRACT Objective: The authors performed an intra-individual comparison of surgical results between the open and endoscopic surgical techniques in patients with bilateral carpal tunnel syndrome. Each hand was submitted to surgery using one of these techniques. Methods: Fifteen patients (30 hands) were evaluated by the Boston Questionnaire, visual analogue pain scale, palmar grip strength, and for tip, key, and tripod pinch strengths. These measurements were taken before surgery and at two weeks, one month, three months, and six months after the procedure. Scores for each evaluation tool in each evaluation time period were compared. Results: In comparison to the group submitted to open surgery, the group submitted to endoscopic surgery had worse scores in the evaluation of the 1st and 6th postoperative months regarding the severity of the symptoms. The authors found no differences in the functional status of the hand. Regarding the intensity of pain evaluated by the visual analogue pain scale, no difference was found between the averages in all time periods evaluated. No differences in palmar grip strength and in fingertip, key (lateral), and tripod pinch strengths were found in all time periods. There were no differences between averages in the preoperative period at two weeks, one month, and three months after surgery. After six months, the group of patients submitted to open surgery presented greater tripod force than the group of patients who underwent endoscopic surgery. Conclusion: No differences were observed by using the intra-individual evaluation in the results between open and endoscopic techniques for the treatment of carpal tunnel syndrome.

RESUMO Objetivo: Foi feito um estudo de comparação intraindividual dos resultados cirúrgicos entre as técnicas cirúrgica aberta e endoscópica de um portal em pacientes com síndrome do túnel do carpo bilateral, cada uma das mãos operada por uma das técnicas citadas. Métodos: Quinze pacientes (30 mãos) foram avaliados no pré-operatório, na segunda semana e no primeiro, terceiro e sexto mês pós-operatório pelo questionário de Boston, escala visual analógica da dor, força de preensão palmar, pinça lateral, pinça polpa-polpa e pinça trípode. Foram comparados os escores de cada ferramenta de avaliação obtidos com as cirurgias endoscópica e aberta em cada um dos tempos de seguimento. Resultados: Em comparação com o grupo submetido a cirurgia aberta, o grupo submetido a cirurgia endoscópica apresentou piores escores na avaliação do primeiro e sexto meses pós-operatório quanto à gravidade dos sintomas. Não foram observadas diferenças quanto ao estado funcional da mão. Quanto à intensidade da dor avaliada pela escala visual analógica da dor, não foram observadas diferenças entre as médias em todos os períodos de tempo avaliados. Não foram observadas diferenças nas forças de preensão palmar, pinça polpa-polpa, polpa-lateral em todos os períodos de tempo. Quanto aos escores da força de preensão trípode, não foram observadas diferenças entre as médias nos períodos pré-operatório, duas semanas, um mês e três meses após a cirurgia. Aos seis meses de pós-operatório, o grupo de pacientes submetido a cirurgia aberta apresentou força trípode maior do que o grupo de pacientes submetidos a cirurgia endoscópica. Conclusão: Com o uso da avaliação intraindividual não foram observadas diferenças entre os resultados das técnicas aberta e endoscópica para o tratamento da síndrome do túnel do carpo.

Diagnóstico y tratamiento conservador de quiste dentígero: seguimiento a 3 años / Diagnóstico e tratamento conservador em cisto dentígero: acompanhamento de 3 anos / Diagnosis and conservative treatment of dentigerous cyst: 3-year follow-up

Resumen El quiste dentígero es el quiste de desarrollo odontogénico más común. Aunque puede afectar cualquier diente incluido, los molares y caninos son los más afectados, seguidos por los premolares e incisivos. Este trabajo tiene como objetivo relatar el caso de una paciente de 11 años de edad quien refería ausencia del segundo premolar inferior derecho (45) en el arco dental. De esa manera, se hizo una revisión de literatura abordando el diagnóstico y tratamiento de esta condición. Luego del el exámen clínico y radiográfico se pudo observar una imagen compatible con un de quiste dentígero, cuyo diagnóstico fue confirmado por el examen histopatológico y tomografía computarizada de haz cónico (cone beam). Fue realizado un procedimiento quirúrgico conservador de descompresión utilizando el resultado de la tomografía como guía quirúrgica. Después de 4 meses de seguimiento clínico y radiográfico, se realizó la enucleación de la lesión por curetaje. Se hizo seguimiento de la paciente durante 3 años hasta la erupción completa del diente 45 y su alineación en el arco. No se observaron lesiones y el tratamiento ortodóntico fue eficaz. La técnica de descompresión quirúrgica fue segura, evitó daños de otras estructuras importantes y proporcionó una rápida recuperación de la paciente.

Resumo O cisto dentígero é o cisto de desenvolvimento odontogênico mais comum. Pode envolver qualquer dente incluso, embora molares e caninos sejam os mais afetados, seguidos pelos pré-molares e incisivos. Este trabalho tem como objetivo relatar o caso de uma paciente de 11 anos de idade com queixa de ausência do segundo pré-molar inferior direito (45) no arco dentário. Assim, uma revisão da literatura abordando o diagnóstico e tratamento desta condição é apresentada. No exame clínico e radiográfico pode-se notar imagem sugestiva de cisto dentígero, entretanto o diagnóstico foi confirmado por exame histopatológico e tomografia computadorizada de feixe cônico (cone beam). Optou-se por procedimento cirúrgico conservador de descompressão utilizando o exame cone beam como guia cirúrgico. Depois de 4 meses de acompanhamento clínico e radiográfico foi realizada a enucleação da lesão por curetagem. A paciente foi acompanhada durante 3 anos até a erupção completa do dente 45 e seu alinhamento no arco. Nenhuma lesão foi registrada e o tratamento ortodôntico mostrou-se eficaz. A técnica de descompressão cirúrgica foi segura, evitou danos a estruturas nobres e proporcionou uma rápida recuperação da paciente.

Abstract Dentigerous cyst is the most common developmental odontogenic cyst. It can involve any included tooth, although molars and canines are most frequently affected, followed by premolars and incisors. The aim of this article was to report the case of an 11-year-old female patient complaining of an eruption delay of a mandibular second premolar (45). Therefore, a literature review regarding the diagnosis and treatment of this condition is presented. At clinical and radiographic examination, the image suggested a dentigerous cyst; however, the diagnosis was confirmed by histopathological and cone-beam computed tomography (CBCT) exams. Surgical planning was carried out using a conservative method involving surgical decompression. CBCT was used as a surgical guide. At 4-month clinical and radiographic follow-up, cystic enucleation was performed by curettage. The patient was followed for 3 years until complete eruption and alignment of the teeth occurred. No lesion was recorded, and orthodontic treatment was proven to be successful. The surgical decompression was completely safe, avoiding damage in important structures, and resulted in rapid recovery of the patient.

Segmental decompressive fasciotomy for acute non-traumatic compartment syndrome in a professional soccer player: case report / Síndrome compartimental aguda não traumática em atleta de futebol tratada por fasciotomia descompressiva segmentar: relato de caso

ABSTRACT Acute compartment syndrome in athletes is a rare orthopedic emergency associated with strenuous exercise. It is often diagnosed late and can lead to severe complications and high morbidity. This report describes the case of a young soccer player with acute compartment syndrome with no history of trauma, diagnosed and treated 24 h after the onset of symptoms, through minimally invasive decompressive fasciotomy, with good postoperative evolution.

RESUMO A síndrome de compartimento aguda não traumática em atletas é uma emergência ortopédica rara associada ao exercício físico extenuante. Apresenta diagnóstico difícil, frequentemente tardio, pode levar a complicações graves e alta morbidade. Os autores relatam o caso de uma atleta de futebol juvenil com uma síndrome compartimental aguda sem história de trauma, diagnosticada e tratada 24 horas após início dos sintomas, através de fasciotomia descompressiva minimamente invasiva, com boa evolução pós-operatória.

Tratamento de cisto radicular de grande extensão: relato de caso clínico / Treatment of radicular cyst of extension: case report

Objetivo: Relatar o caso clínico de um cisto radicular extenso em maxila. Relato do caso: Paciente do sexo masculino, feoderma, 28 anos de idade, compareceu ao serviço de estomatologia queixando-se de "uma bolha no dente". O paciente relatou evolução da lesão há 15 dias e ter sido submetido a um tratamento endodôntico prévio no dente 21. No exame físico intraoral observou-se um discreto aumento de volume em palato anterior na região do dente 21. Os dentes ântero superiores responderam negativamente ao teste de vitalidade pulpar (TVP). A radiografia panorâmica e tomografia computadorizada odontológica revelaram uma imagem hipodensa expansiva unilocular, estendendo- -se da região do dente 16 até do dente 25, com limites parcialmente definidos e rechaçamento do soalho do seio maxilar direito e da cavidade nasal. Tratamento: Foi realizada biópsia incisional sendo o resultado do exame anatomopatológico sugestivo de um cisto radicular. A abordagem terapêutica inicial foi o tratamento endodôntico dos dentes que apresentaram necrose pulpar preconizando a utilização do hidróxido de cálcio como medicação intracanal. Posteriormente ao tratamento endodôntico foi feita a marsupialização da lesão objetivando a descompressão cística. Após 3 meses de descompressão cirúrgica novos exames imaginológicos revelaram uma pequena regressão da lesão, no entanto, não satisfatória. Optou-se por realizar a curetagem da lesão sob anestesia geral. Confirmou-se novamente o diagnóstico de cisto radicular. Conclusão: Atualmente, 18 meses após a cirurgia, novos exames radiográficos demonstraram o processo de neoformação óssea no local da lesão.

Objective: To present the case of a large radicular cyst in the maxilla. Case report: Male patient, feoderma, 28 years old, attended the stomatology service complaining of "a bubble in the tooth." The patient reported the evolution of the injury for 15 days and has undergone previous endodontic treatment on the tooth 21. In intraoral physical examination it was observed a mild increase in the volume on anterior palate in the tooth 21 region. The anterior superior teeth responded negatively the pulp sensitivity test (PST). The panoramic radiography and dental CT scan revealed a hypodense image expansive unilocular extending from the region of the tooth 16 to tooth 25 with partially defined limits and move away of the right maxillary sinus floor and the nasal cavity. Treatment: Incisional biopsy was performed and the result of the pathological examination suggested a radicular cyst. The initial therapeutic approach had been the endodontic treatment of teeth presented pulp necrosis prioritizing the use of calcium hydroxide as intracanal dressing. Histopathological analysis showed a cystic lesion of inflammatory origin. After the endodontic treatment was made marsupialization of the lesion, aiming the cystic decompression. After 3 months of surgical decompression new imaging examination revealed a small regression of the lesion, however, is not satisfactory. We chose to realize curettage of the lesion under general anesthesia, reconfirming the diagnosis of radicular cyst. Conclusion: Currently, 10 months after surgery, new radiographs demonstrated the process of bone formation at the site of injury.

Total Transcanal Endoscopic Facial Nerve Decompression for Traumatic Facial Nerve Palsy

A few approaches can be used to decompress traumatic facial nerve paralysis including the middle cranial fossa approach or transmastoid approach depending on the site of injury. In some specific situation of treating traumatic facial nerve palsy whose injured site was confined from the geniculate ganglion to the second genu, transcanal endoscopic approach for facial nerve decompression can be used. We performed two cases of total endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve palsy. After a six month follow-up, both patients showed improvement in facial function by 2 grades according to House-Brackmann grade system. In terms of treatment outcomes, total transcanal endoscopic facial nerve decompression for traumatic facial nerve palsy is an alternative for lesions limited to the tympanic segment I, and has an advantages of being minimally invasive and is cosmetically acceptable without an external scar or bony depression due to drilling.

Development of Delayed Acute Subdural Hematoma after Mild Traumatic Brain Injury: A Case Report / 대한신경손상학회지

We report a case involving the development of a delayed acute subdural hematoma (ASDH) after trauma, with the absence of any abnormal radiological and clinical findings at initial examination. A 54-year-old male visited the emergency department after a minor trauma. The patient only complained of mild headache after head injury. He presented no abnormal findings on neurological examination, and brain computed tomography (CT) did not show any intracranial lesion or skull fractures. However, he developed seizure with disorientation eight hours after trauma, and ASDH with midline shift was found during a follow-up CT. He recovered without neurological deficits after immediate primary care and admission to the neurosurgery department. On serial follow-up CT images, a gradually increasing mass effect of hematoma was detected, and removed by craniotomy. The patient recovered without neurologic deficits.

Avaliação clínica de cães com doença do disco intervertebral (Hansen tipo I) submetidos à descompressão cirúrgica: 110 casos / Clinical evaluation of dogs with intervertebral disc disease (Hansen type I) submitted to surgical decompression: 110 cases

O objetivo deste estudo foi identificar cães com doença do disco intervertebral toracolombar (Hansen tipo I) submetidos ao tratamento cirúrgico em um serviço de rotina em neurologia de um hospital veterinário universitário no período de 2006 a 2014, e obter informações a respeito da idade, do sexo, da raça, local da extrusão, interpretação da mielografia, avaliação dos graus de disfunção neurológica, recuperação funcional desses cães e observar a ocorrência de recidiva dos sinais clínicos da doença. A raça mais frequente foi Dachshund (69%), seguida dos cães sem raça definida (14,5%). Os locais mais afetados foram entre T12-T13 (31,9%) e L1-L2 (19,1%). Dos 110 cães, 74 (67,3%) tiveram melhora dos sinais clínicos após o procedimento cirúrgico, sendo 54 (49,1%) considerados satisfatórios e 20 (18,2%), parcialmente satisfatórios. Destes cães, seis (8,1%) cães estavam em grau II, 19 (25,7%) em grau III, 35 (47,3%) em grau IV e 14 (18,9%) em grau V. Pode-se concluir que o tratamento cirúrgico promove recuperação funcional satisfatória na maioria dos cães com extrusão de disco toracolombar. O prognóstico para recuperação funcional após o tratamento cirúrgico é tanto melhor quanto menor for o grau de disfunção neurológica e o percentual de recidiva é baixo em animais submetidos a este tipo de terapia.(AU)

The aim of this study was to identify dogs with thoracolumbar intervertebral disc disease (Hansen type I) submitted for surgical treatment on a routine service in neurology in a university veterinary hospital in 2006-2014, and to get information about age, sex, breed, site of extrusion, interpretation of myelography, evaluation of the degree of neurological dysfunction, functional recovery of these dogs, and to verify the recurrence of clinical signs of disease. The most common breed was Dachshund (69%), followed by mixed breed (14.5%). The most affected sites were between T12-T13 (31.9%) and L1-L2 (19.1%). Of the 110 dogs, 74 (67.3%) improved clinical signs after surgery, 54 (49.1%) satisfactory and 20 (18.2%), in part satisfactory. From these dogs, six (8.1%) dogs were in grade II, 19 (25.7%) in grade III, 35 (47.3%) in grade IV, and 14 (18.9%) in grade V. It can be concluded that satisfactory surgical treatment promotes functional recovery in most dogs with thoracolumbar disk extrusion. The prognosis for functional recovery after surgical treatment is better the lower the degree of neurological dysfunction and the recurrence percentage is lower in dogs subjected to this type of therapy.(AU)

Should We Check the Routine Postoperative MRI for Hematoma in Spinal Decompression Surgery?

BACKGROUND: A postoperative magnetic resonance imaging (MRI) is performed as a routine to assess decompression of the spinal cord as well as to evaluate postoperative complications. The purpose of this study is to analyze the efficacy of postoperative MRI for hematoma in spinal decompression surgery. METHODS: Between January 1, 2008 and January 31, 2015, 185 patients who underwent postoperative MRI after spinal decompression surgery were included in this study. We checked the history of the use of an anticoagulant or antiplatelet agent, withdrawal period, blood platelet count, and prothrombin time (international normalized ratio [INR]). We measured the total amount of suction drainage and duration until removal. We retrospectively reviewed the presence of hematoma and thecal sac compression. Postoperative prognosis was evaluated by a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: Hematomas were found on postoperative MRI scans in 97 out of 185 patients (52.4%). Thirty patients had a thecal sac compressing hematoma: 7 in the cervical spine, 1 in the thoracic spine, and 22 in the lumbar spine. The occurrence of hematoma did not show significant difference according to the use of an anticoagulant (p = 0.157). The blood platelet count, prothrombin time (INR), and suction drainage duration did not have a statistically significant correlation with the occurrence of hematoma (p = 0.562, p = 0.506, and p = 0.429, respectively). The total amount of suction drainage was significantly different according to the presence of hematoma (p = 0.022). The total 185 patients had a significant decrease in the postoperative VAS score (p < 0.001), and the diminution of VAS score was not significantly different according to the occurrence of hematoma (p = 0.243). Even in the cases of thecal sac compressing hematoma, the reduction of VAS score was not significantly different (p = 0.689). CONCLUSIONS: Postoperative MRI for hematoma in spinal decompression surgery has little effect on prognosis or management. Therefore, indiscriminate postoperative MRI should be avoided and MRI should be performed depending on the patient's status.

Síndrome compressiva de múltiplos nervos na dermatopolimiosite: relato de caso / Multiple Nerve Compression Syndrome in Dermatopolymyositis: Case Report

A dermatopolimiosite émiopatia inflamatória de etiologia provavelmente autoimune e comportamento heterogêneo, afetando principalmente pele e músculos e ocasionando manifestações exantemáticas características, como o eritema heliótropo e a pápula de Gottron, e fraqueza muscular proximal simétrica. A associação dessa patologia a neuropatias periféricas é pouco conhecida, podendo raramente ocorrer neuropatia múltipla. O objetivo deste artigo é relatar um caso de síndrome compressiva de múltiplos nervos em portador de dermatopolimiosite. O paciente apresentava fraqueza muscular proximal e exantema característico e foi submetido à revisão laboratorial, ressonância magnética de abdome e eletroneuromiografia, que mostraram alterações. Foi então tratado através da neurólise do nervo mediano ao nível do túnel do carpo e do nervo ulnar ao nível do túnel cubital. Trata-se de importante possibilidade terapêutica em casos como o descrito,mas estudos de maior porte sobre a descompressão simultânea dos túneis carpal e ulnar são necessários.

Dermatopolymyositis is an inflammatory myopathy ­ whose etiology is probably autoimmune ­ that has heterogeneous manifestations that occur mainly in skin and muscles and cause characteristic rash, such as heliotrope rash, Gottron's sign and symmetric proximal weakness. The association between this pathology and peripheral neuropathies is little known and multiple neuropathies rarely occur. The purpose of this article is to report a case of multiple nerve compression syndrome in a patient with dermatopolymyositis. The patient had proximal weakness and characteristic rash and underwent a laboratorial review, abdominal MRI and electromyography, which showed changes. So he was treated by neurolysis of median and ulnar nerves at carpal and cubital tunnels levels, respectively. It is an important therapeutic possibility in cases like this, but larger studies on simultaneous decompression of carpal and cubital tunnels are necessary.

Impact on Neurological Recovery of Transforaminal Debridement and Interbody Fusion versus Transpedicular Decompression in Combination with Pedicle Screw Instrumentation for Treating Thoracic and Lumbar Spinal Tuberculosis

STUDY DESIGN: Retrospective study. PURPOSE: To compare the neurological outcome of transforaminal debridement and interbody fusion with transpedicular decompression for treatment of thoracic and lumbar spinal tuberculosis. OVERVIEW OF LITERATURE: Few articles have addressed the impact of neurological recovery in patients with tuberculosis who were treated by two different operative methods via the posterior-only approach. METHODS: Clinical and radiographic results of one-stage posterior instrumented spinal fusion for treatment of tuberculous spondylodiscitis with neurological deficits were reviewed and analyzed from 2009 to 2013. The extensive (E) group consisted of patients who received transforaminal debridement and interbody fusion, whereas transpedicular decompression was performed on limited (L) group. Rapid recovery was improvement of at least one Frankel grade within 6 weeks after operation. Otherwise, it was slow recovery. RESULTS: All 39 patients had improved neurological signs. The median follow-up period was 24 months. Proportionately younger patients (under 65 years of age) received extensive surgery (15 of 18, 83.3% vs. 11 of 21, 52.4%; p=0.04). The mean operative time and blood loss in the group E were higher than in the group L (both p<0.01). With regard to type of procedure, especially at thoracic and thoracolumbar spine, patients who underwent extensive surgery had rapid neurological recovery significantly different from those of limited surgery (p=0.01; Relative Risk, 3.06; 95% Confidence Interval, 1.13 to 8.29). CONCLUSIONS: Transforaminal debridement and interbody fusion provides more rapid neurological recovery in patients with thoracic and thoracolumbar spinal tuberculosis compared to transpedicular decompression.

Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

The double compression syndrome of the ulnar nerve is a rare condition. Herin, we experienced double compression of ulnar nerve at cubital tunnel and Guyon's canal by re-evaluation after surgical decompression of cubital tunnel. We might suspect the double compression lesion in cases of worsening of symptom or nerve conduction velocity findings in a relative short duration of symptom as in our case. Meticulous physical examination might be needed to detect the Guyon's canal syndrome as a comorbidity in the treatment of cubital tunnel syndrome and re-evaluation for dual compression might be recommended if the resolution of symptom was not achieved after surgical decompression of single nerve lesion.

Delayed Improvement after Endoscopic Carpal Tunnel Release

OBJECTIVE: In most patients with carpal tunnel syndrome (CTS), pain and/or paresthesia disappeared or decreased in a month after endoscopic carpal tunnel release (ECTR). However, subpopulation of patients showed delayed improvement following ECTR. We analyzed the delayed improvement hands to investigate the characteristics of those patients and to determine the predictable factors of delayed improvement. METHODS: Single-portal ECTRs were performed in 1194 hands of 793 CTS patients from 2002 to 2011. Five-hundred seventy hands with minimal 1-year postoperative follow-up were included. We divided the 545 satisfied hands into early (group A) and delayed (group B) groups according to improvement period of 1 month. Demographic data, clinical severity and electrodiagnostic abnormality were compared between groups. RESULTS: Group A included 510 hands and group B included 35 hands. In group B, 11 hands improved in 2 months, 15 hands in 3 months and 9 hands in 6 months, respectively. In group A/B, according to clinical severity, 60/1 hands were graded to I, 345/24 hands to II, 105/10 hands to III. In group A/B, based on electrodiagnostic abnormality, 57/3 hands were classified to mild, 221/11 hands to moderate and 222/21 hands to severe group. Statistical analysis between groups did not reach significance but electrodiagnostic or clinical severity had a tendency to affect the delayed response. CONCLUSION: It is difficult to predict the factors contributing to postoperatively-delayed response in subpopulation of CTS patients. However, we recommend that postoperative observation for at least 6 months is necessary in patients without symptomatic improvement.