Traumatismo grave del miembro superior relacionado con el uso de una escalera mecánica. Reporte de caso pediátrico / Severe upper limb trauma related to escalator use. Pediatric case report

Las lesiones relacionadas con escaleras mecánicas suelen ser poco frecuentes, pero pueden constituir una emergencia médica con complicaciones potencialmente peligrosas. Se describe el grave compromiso en el miembro superior relacionado con una lesión ocurrida en una escalera mecánica. Paciente de 2 años, que sufrió una caída al bajar por una escalera mecánica, y terminó con el brazo izquierdo atrapado entre uno de los escalones y los peines del descenso del escalón terminal.Ingresó a Emergencias, donde, tras realizar las medidas de estabilización inicial, se trasladó a cirugía para el retiro del cuerpo extraño. No se encontró compromiso vascular o nervioso, pero sí pérdida grave de tejido celular subcutáneo. Se retiró el peine de metal, y se realizó la cirugía reparadora del miembro afectado. Requirió cuatro intervenciones más por Cirugía Plástica y Reparadora. La paciente tuvo buena evolución clínica y recibió el alta sin secuelas funcionales

Escalator-related injuries are rare but can be a medical emergency with potentially dangerous complications. The severe upper limb involvement related to injury occurred on an escalator is described.A two year-old patient suffered a fall going down an escalator; her left arm was caught between one of the steps and the comb of the last step.She was admitted to the Emergency Room for the initial stabilization. The foreign body was removed in the operating room. No vascular or nervous compromise was found, but there was severe loss of subcutaneous cellular tissue. The metal comb was removed, and repair surgery was performed on the affected limb. She required four more surgical interventions for plastic and reconstructive surgery. The patient had a good clinical evolution and was discharged without functional sequelae.

Perfil de resistencia genotípica y fenotípica presente en bacterias aisladas a partir de fómites en Armenia, Quindío-Colombia período junio-julio 2019 / Genotypic and phenotypic resistance profile present in bacteria isolated from fomites in Armenia, Quindío-Colombia period June-July 2019

Resumen Introducción: La antibiótico-resistencia es un fenómeno por el cual las bacterias logran sobrevivir al tratamiento con antimicrobianos; con incidencia en ambientes intra y extrahospitalarios como: fuentes hídricas, sector agrario/ganadero y fómites. Objetivo: Describir bacterias presentes en fómites de alta circulación en una región centro-occidental de Colombia junto a su perfil de sensibilidad fenotípica y presencia de genes para betalactamasas tipo TEM-full, OXA-3 y SHV-full. Metodología: Se aislaron cepas bacterianas de billetes, pasamanos de escaleras eléctricas y botones de cajeros automáticos; se evaluó su perfil de sensibilidad fenotípica por medio de concentración mínima inhibitoria-técnica automatizada/Vitek2® y genes para betalactamasas tipo TEM-full, OXA-3 y SHV-full mediante PCR convencional. Resultados: Se obtuvo 30 aislados; Acinetobacter baumannii complex, fue la más común; el fómite con mayor aislados y resistencia fueron los billetes; el 53% portó al menos uno de los genes estudiados. Se identificaron bacterias gramnegativas con resistencia frente a: Imipinem, Piperacilina/Tazobactam, Colistina, Ceftazidima, Tigeciclina y Ceftriaxona; bacterias grampositivas con resistencia frente a: Quinupristina/Dalfopristina, Minociclina, Tetraciclina, Teicoplanina, Nitrofuratoina, Oxacilina, Clindamicina, Trimetropina-sulfametoxazol, y Minociclina. Conclusión: Teniendo en cuenta la circulación de cepas con estas resistencias, es importante la educación en la comunidad para evitar la adquisición o propagación de infecciones por manipulación inadecuada de fómites.

Abstract Introduction: Antibiotic-resistance is a phenomenon by which bacteria manage to survive antimicrobial treatment; with incidence in intra and extra hospital environments such as: water sources, agricultural / livestock sector and fomites. Aim: To describe bacteria present in high circulation fomites in a central-western region of Colombia, with their phenotypic sensitivity profile and presence of genes beta-lactamases (TEM, OXA3 and SHV). Methodology: We isolate bacterial strains from banknotes, escalator handrails and ATM buttons. We evaluated its phenotypic sensitivity profile by minimal inhibitory concentration automated technique using Vitek 2® and presence of genes for beta-lactamases type TEM-full, OXA-3 and SHV-full by conventional PCR. Results: A total of 30 isolates were obtained; Acinetobacter baumannii complex, was the most common; banknotes were the form with the highest number of isolates and resistance. Of the total isolates, 53% carried at least one of the genes studied. Phenotypically, gram-negative bacteria were identified with resistance against: Imipinem, Piperacillin / Tazobactam, Colistin, Ceftazidime, Tigecycline and Ceftriaxone; Gram-positive bacteria with resistance to: Quinupristin / Dalfopristin, Minocycline, Tetracycline, Teicoplanin, Nitrofuratoin, Oxacillin, Clindamycin, Trimethropine-sulfamethoxazole, and Minocycline. Conclusion: Taking into account the circulation of strains with these resistances, it is important to educate the community to avoid the acquisition or spread of infections due to the inappropriate handling of this type of inanimate elements.

Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture

Most orbital surgeons believe that it's difficult to restore the primary orbital wall to its previous position and that the orbital wall is so thin that cannot be firmly its primary position. Therefore, orbital wall fractures generally have been reconstructed by replacing the bony defect with a synthetic implant. Although synthetic implants have sufficient strength to maintain their shape and position in the orbital cavity, replacement surgery has some drawbacks due to the residual permanent implants. In previous studies, the author has reported an orbital wall restoring technique in which the primary orbital wall fragment was restored to its prior position through a combination of the transorbital and transantral approaches. Simple straight and curved elevators were introduced transnasally to restore the orbital wall and to maintain temporary extraorbital support in the maxillary and ethmoid sinus. A transconjunctival approach provided sufficient space for implant insertion, while the transnasal approach enabled restoration of the herniated soft tissue back into the orbit. Fracture defect was reduced by restoring the primary orbital wall fragment to its primary position, making it possible to use relatively small size implant, furthermore, extraorbital support from both sinuses decreased the incidence of implant displacement. The author could recreate a natural shape of the orbit with the patient's own orbital bone fragments with this dual approach and effectively restored the orbital volume and shape. This procedure has the advantages for retrieving the orbital contents and restoring the primary orbital wall to its prior position.

Study of the Residential Environment and Accessibility of Rehabilitation for Patients with Cerebral Palsy / 대한정형외과학회잡지

PURPOSE: This study examined the residential environment and accessibility of rehabilitation for cerebral palsy (CP) to identify the problems with residential laws pertaining to the disabled and provide basic data on the health legislation for the rights of the disabled. MATERIALS AND METHODS: The literature was searched using three keywords: residence, rehabilitation, and accessibility. Two items were selected: residential environment and rehabilitation accessibility. The questionnaire included 51 items; 24 were scored using a Likert scale and 27 were in the form of multiple-choice questions. RESULTS: This study included 100 subjects, of which 93 lived at home and seven lived in a facility. Of these 93 subjects, 65% were living in apartments, usually two or more floors above ground, and 40% of them were living without elevators. According to the Gross Motor Function Classification System, subjects with I to III belonged to the ambulatory group and IV, V were in the non-ambulatory group. Subjects from both groups who lived at home found it most difficult to visit the rehabilitation center by themselves. In contrast, among those who lived at the facility, the ambulatory group found it most difficult to leave the facility alone, while the non-ambulatory group found it most difficult to use the toilet alone. Moreover, 83% of respondents thought that rehabilitation was necessary for CP. On the other hand, 33% are receiving rehabilitation services. Rehabilitation was performed for an average of 3.6 sessions per week, 39 minutes per session. CONCLUSION: There is no law that ensures secure and convenient access of CP to higher levels. Laws on access routes to enter rooms are insufficient. The disabled people's law and the disabled person's health law will be implemented in December 2017. It is necessary to enact laws that actually reflect the difficulties of people with disabilities. Based on the results of this study, an investigation of the housing and rehabilitation of patients with CP through a large-scale questionnaire will necessary.

The clinical usefulness of closed reduction of nasal bone using only a periosteal elevator with a rubber band

BACKGROUND: Closed reduction of nasal fracture with various instrument is performed to treat nasal fracture. Depending on the type of nasal fracture and the situation in which it is being operated, the surgeon will determine the surgical tool. The objective of this study was to investigate whether a periosteal elevator (PE) was a proper device to perform closed reduction for patients with simple nasal fractures. METHODS: From March 2018 to December 2018, 50 cases of simple nasal bone fracture underwent closed reduction performed by a single surgeon. These patients were divided into two groups randomly: nasal bone reduction was performed using only PE (freer) and nasal bone reduction was performed using Walsham, Asch forcep, and Boies elevator (non-freer, non-PE). RESULTS: The paranasal sinus computed tomography was performed on patients before and after operation to carry out an accurate measurement of reduction distance at the same level. According to the results, the interaction between instruments and fracture types had a significant influence on reduction distance (p = 0.021). To be specific, reduction distance was significantly (p= 0.004) increased by 2.157 mm when PE was used to treat patients with partial displacement compared to that when non-PEs were used. CONCLUSION: Closed reduction using PE and other elevator is generally an effective treatment for nasal fracture. In partial-displacement type of simple nasal fracture, closed reduction using PE can have considerable success in comparison with using classic instruments.

A useful additional medial subbrow approach for the treatment of medial orbital wall fracture with subciliary technique

BACKGROUND: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. METHODS: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. RESULTS: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. CONCLUSION: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

Full-mouth rehabilitation in a patient with inclined occlusal plane and reduced vertical dimension by an attrition: A case report / 대한치과보철학회지

A proper vertical dimension and a harmonious occlusal plane are essential to satisfy a patient esthetically and functionally. A maxillomandibular occlusal vertical dimension is determined by the elevators which repeatedly contracts to a certain length, and a tooth location is determined by a maxillomandibular vertical dimension. The patient of this case came in with the incongruity of the lips and the occlusal plane. The result of clinical test showed the lack of length of the lower anterior due to the reduction of vertical dimension, the deep overbite of anterior, the excessive attrition of anterior, and the incongruity of occlusal plane. After the diagnostic wax-up, the temporary restoration was installed, and final prosthesis was installed after 6 months. As a result, the patient obtained a functionally and esthetically satisfying result.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

Duodenoscope-Associated Infections: A Literature Review and Update / 대한췌담도학회지

A duodenoscope is complex instrument with an elevator and an elevator wire channel which are difficult to access and not readily amenable to cleaning and disinfection. Lapses in endoscope reprocessing have been regarded as a major cause of duodenoscope-associated transmission of infection. However, recent outbreaks of carbapenem-resistant Enterobacteriaceae or other multidrug-resistant organisms have emerged in spite of proper adherence to the manufacturer's reprocessing instructions. It is the time to reestablish reprocessing protocol appropriate for duodenoscope and revise a new design of duodenoscope that makes reprocessing easier in order to prevent cross-transmission of infection by duodenoscope. This manuscript reviews current state of duodenoscope-associated infections, recent measures from the United States government agencies and its limitations, and future strategies to prevent duodenoscope-associated infections.

Acciones motivacionales para promover actividad física en la comunidad que asiste a un Hospital Universitario / Taking action for promoting physical activity in the community attending a university hospital

Introducción: el sedentarismo ha llegado para quedarse. Cualquier tipo de acción para combatirlo será de gran utilidad; solo bastará con conocer su eficacia y con que la gente se adhiera. Métodos: se ha realizado un estudio cuasi experimental antes-después no controlado, con 3 intervenciones aditivas sobre la población que concurre al Hospital Italiano de Buenos Aires (Hospital Universitario). Se comparó la proporción de personas que usaban la escalera mecánica con aquellas que subían por la escalera convencional, antes y después de las siguientes intervenciones: con autoadhesivos que anunciaban las calorías perdidas al subir cada escalón, luego se agregaron carteles acerca del beneficio de hacer actividad física y, por último, se entregaron folletos sobre los beneficios de hacer actividad física. Resultados: se realizaron 39 967 observaciones. Cada intervención significó un aumento de personas que subían por la escalera convencional (P < 0,001). Con la intervención de los autoadhesivos se produjo un incremento del 2,39% frente al basal (11,07% - 8,68%, p=0,001) de personas que subieron por la escalera convencional. La intervención autoadhesivos + cartel aumentó 2,33% (13,4% -11,07%, p=0,001) y la intervención autoadhesivos + cartel + folletos produjo un aumento del 1,09% (14,49%-13,4%, p=0,03). Interpretación: en este estudio se midió cuál era el beneficio de las intervenciones para promover que más gente utilizara la escalera convencional; cada una de ellas proveyó una mayor cantidad de personas que, adoptando una actitud más activa, subieron por la escalera convencional. Medidas sencillas y económicas muestran un gran cambio en promover la actividad física. (AU)

Background: The sedentary lifestyle has become predominant in our society. Any measures taken to fight it are useful, it's just necessary to know their effectiveness and get people to stick with them. Methods: we performed a quasi-experimental pre-post study testing three persistent interventions on the population that attends a university hospital. Its main entrance allows the access to different areas through stairs, escalators or an elevator. We took baseline data on the number of people who took the escalator or the stairs. Then we performed progressive interventions designed to promote the use of the stairs. First, we used stickers placed on in each step that announced the amount of calories burned per step climbed. Then, we placed banners which informed the benefits of physical activity. Lastly, brochures were handed out with a list of benefits of doing physical activity. We quantified the number of people taking the stairs or the escalator with each intervention. Results: in eight weeks 39·967 observations were performed. Each intervention found an increase in the number of people that decided to take the stairs. At baseline, 880 people used the escalator and 9264 people took the stairs. With the first intervention, i.e. the use of stickers on the steps, there was an increase of 2·39% in the number of people that took the stairs compared to baseline data (from 8·68% to 11·07%, p=0.001). With the second intervention, i.e. stickers plus physical activity promotion banners, there was an additional increase of 2·33% (from 11·07% to 13·40%, p=0.001) in the proportion of people taking the stairs. Finally, the intervention of stickers in addition to the banners and brochures about benefits of physical activity, was associated with an increase of 1·09% (from 13·40% to 14·49%, p=0.03). Discussion: in this study we aimed to measure the benefits of multiple interventions to promote physical activity in a university hospital setting. Each intervention was associated with a larger number of people that decided to take the stairs instead of taking the escalator or the elevator. The interventions were simple, cheap and very effective to promote change independently from gender, age or health conditions. (AU)

Usefulness of modified BRB technique in treatment to ablate uterine fibroids with magnetic resonance image-guided high-intensity focused ultrasound

OBJECTIVE: If bowels and other structures are in the pathway of high-intensity focused ultrasound (HIFU) beam during magnetic resonance image-guided HIFU (MRgFUS) therapy, filling to the bladder and the rectum and then emptying the bladder (i.e., the BRB technique) is used to avoid them. A modified BRB technique might be useful method to using a uterine elevator method or by inducing uterus downward traction to lower the position of the uterus. METHODS: A total of 156 patients who had undergone MRgFUS surgery treatment for uterine fibroids from March 2015 to February 2016 were included in this retrospective study. Of the 156 patients, 40 were treated using a uterine elevator while 29 were treated using downward traction of uterus. HIFU was performed using Philips Achieva 1.5 Tesla MR and Sonalleve HIFU system. RESULTS: MRgFUS surgery was feasible with modified BRB technique in 69 cases. Using uterine elevator method, the intensity of HIFU for group with antefletxio uteri was significantly lower than that for the group without antefletxio uteri (105.37±17.62 vs. 118.71±26.88 W). The group with downward traction of uterus induced was found to have significantly lower intensity of HIFU compared to the group without downward traction of uterus induced (110.26±22.60 vs. 130.51±27.81 W). CONCLUSION: Modified BRB technique was useful in avoiding bowels and other structures located in HIFU beam pathway during MRgFUS treatment to ablate uterine fibroids.

Use of elevator instruments when luxating and extracting teeth in dentistry: clinical techniques

In dentistry, elevator instruments are used to luxate teeth, and this technique imparts forces to tooth particles that sever the periodontal ligament around tooth roots inside the socket and expand alveolar bone around tooth particles. These effects can result in extraction of the tooth particles or facilitate systematic forceps extraction of the tooth particles. This article presents basic oral surgery techniques for applying elevators to luxate teeth. Determination of the optimal luxation technique requires understanding of the functions of the straight elevator and the Cryer elevator, the concept of purchase points, how the design elements of elevator working ends and tips influence the functionality of an elevator, application of forces to tooth particles, sectioning teeth at furcations, and bone removal to facilitate luxation. The effectiveness of tooth particle luxation is influenced by elevator tip shape and size, the magnitude and the vectors of forces applied to the tooth particle by the tip, and sectioning and bone removal within the operating field. Controlled extraction procedures are facilitated by a dental operating microscope or the magnification of binocular surgical loupes telescopes, combined with co-axial illumination.

A New Technique for Conchal Cartilage Harvest

The goal of auricular cartilage harvest is to obtain a sufficient amount for reconstruction and to minimize the change in ear shape. The cartilage can be harvested by a posterior or anterior approach, and each method has advantages and disadvantages. The posterior approach presents the advantage of scar concealment, but there are limits to the amount of cymba cartilage that may be harvested. In contrast, the anterior approach may cause a noticeable scar. However, as cartilage is collected, the anterior approach provides a view that facilitates the preservation ear structure. In addition, it is possible to obtain a greater amount of cartilage. From January 2014 to December 2015, we harvested auricular cartilage graft material in 17 patients. To prevent the development of trapdoor scars or linear scar contracture, short incisions were made on the superior border of the cymba and cavum. Two small and narrow incisions were made, resulting in suboptimal exposure of the surgical site, which heightens the potential for damaging the cartilage when using existing tools. To minimize this, the authors used a newly invented ball-type elevator. All patients recovered without complications after surgery and reported satisfaction with the shape of the ear.

Reduction of Zygomatic Arch Isolated Fracture Using Ultra Sound and Needle Marking

BACKGROUND: Zygomatic arch is a bony arch constituting the lateral midface, which consists of 25% of all midface fractures. There are a number of ways to evaluate the extent of zygomatic arch fracture. Some authors have reported successful treatment outcomes using ultrasound (U/S). To add to the previous methods, we have considered ways to accurately display the location of the fracture line while using U/S with 23 gauge needle marking. We introduce our method, which provided satisfactory results for reduction using a portable U/S, and it can evaluate the fracture line simultaneously when reduction of an isolated zygomatic arch fracture is necessary, and needle marking, which can easily point out the fracture line on U/S. METHODS: We studied 21 patients with an isolated zygomatic arch fracture who underwent closed reduction using U/S and needle marking between 2013 and 2015. RESULTS: We achieved satisfactory results in all our cases with respect to reduction by using the Dingman elevator after performing a temporal approach incision, while confirming relative positioning between needle marking and zygomatic fracture at the same time, after insertion of a 23 gauge needle in the skin above the zygomatic arch fracture line parallel to it. CONCLUSION: We treated 21 patients with an isolated zygomatic arch fracture using U/S and the needle marking method, which provided satisfactory results because the extent of reduction of the fracture could be evaluated in real-time during the operation and exposure to radiation was reduced.

Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy

Pancreaticobiliary complications following various surgical procedures, including liver transplantation, are not uncommon and are important causes of morbidity and mortality. Therapeutic endoscopy plays a substantial role in these patients and can help to avoid the need for reoperation. However, the endoscopic approach in patients with surgically altered gastrointestinal (GI) anatomy is technically challenging because of the difficulty in entering the enteral limb to reach the target orifice to manage pancreaticobiliary complications. Additional procedural complexity is due to the need of special devices and accessories to obtain successful cannulation and absence of an elevator in forward-viewing endoscopes, which is frequently used in this situation. Once bilioenteric anastomosis is reached, the technical success rates achieved in expert hands approach those of patients with intact GI anatomy. The success of endoscopic therapy in patients with surgically altered GI anatomy depends on multiple factors, including the expertise of the endoscopist, understanding of postoperative anatomic changes, and the availability of suitable scopes and accessories for endoscopic management. In this issue of Clinical Endoscopy, the focused review series deals with pancreatobiliary endoscopy in altered GI anatomy such as bilioenteric anastomosis and post-gastrectomy.

Surgical Management of Superior Oblique Muscle Palsy in Hypertropia 16 Prism Diopters or More

PURPOSE: Isolated inferior oblique weakening procedure is an effective treatment for patients with superior oblique muscle palsy who had up to 15 prism diopters (PD) of vertical deviation in the primary position, but 2-muscle surgery is needed for patients with larger deviations. Herein, we report the surgical results of simultaneous 2-extraocular muscle surgery for large primary position hypertropia 16 PD or more caused by superior oblique palsy. METHODS: This study was a retrospective review of the records of patients who presented with central gaze hypertropia 16 PD or more and underwent simultaneous 2-extraocular muscle surgery between January 2003 and June 2014 in Severance Hospital. The patients were divided into 3 groups: 43 patients who underwent inferior oblique (IO) myectomy and contralateral inferior rectus (IR) recession (Group 1), 10 patients who underwent IO myectomy and superior rectus (SR) recession (Group 2), and 8 patients who underwent SR recession and contralateral IR recession (Group 3). Criteria for success included correction of head posture and a primary position alignment within 5 PD of vertical deviation. RESULTS: Mean preoperative alignment at primary gaze was 25.5 ± 7.1 PD (range, 16-60 PD) compared to the postoperative value of -1.3 ± 6.8 PD (range, -20~25 PD) (p < 0.001). Surgery was successful in 49 (80%) patients. Nine (15%) patients were overcorrected and the other 3 (5%) patients were undercorrected. Success rate was the highest in subjects who underwent IO myectomy and contralateral IR recession. Among the 24 patients who did not receive combined horizontal muscle surgery, horizontal deviations decreased from 10.4 ± 2.7 PD to 1.5 ± 5.5 PD (p < 0.001) CONCLUSIONS: Two-muscle surgery can be effective in patients with large hypertropia 16 PD or more. Additionally, horizontal deviations are more likely to be resolved with vertical muscle surgery alone. However, IO myectomy combined with ipsilateral SR recession can cause overcorrection postoperatively, so surgical dose should be reduced when performing weakening procedure of two elevators in one eye.

Effects of fresh mineralized dentin and cementum on socket healing: a preliminary study in dogs

OBJECTIVES: Dentin is composed of many minerals and growth factors. Based on this composition, we studied its effect as a possible regenerative material for alveolar healing. MATERIALS AND METHODS: This study was conducted using four 2.5-year-old mongrel dogs (male; weight, 25 to 30 kg). The third mandibular premolars were carefully mobilized with a dental elevator and then removed using forceps. The crown portions of the extracted teeth were removed with cutters, and the root portions of the remaining teeth were collectively trimmed as closely as possible to 350 to 500 microm. Dentin and cementum (DC) chips harvested from the extracted teeth were soaked in blood and packed into the fresh sockets (autograft). Biopsies were performed at the ends of day 14 and day 56 following implantation. Data were expressed as mean+/-standard deviation and compared with t-test results. RESULTS: The ratio of SA(bone) to total area of each probe was determined and was 170+/-16 microm2 for the control group and 71+/-14 microm2 for the DC group, a significant difference (P<0.05). CONCLUSION: DC particulate grafts offered no improvement in bone regeneration in alveolar extraction sockets.

Wire or Hook Traction for Reducing Zygomatic Fracture

BACKGROUND: Variable methods have been introduced for reduction of the zygomatic fractures. The Dingman elevator is used widely to reduce these fractures but is inappropriate in certain types of fractures which require atypical traction vectors. We introduce and examine an alternate method of reducing zygomatic fractures using wire and hook traction. METHODS: A retrospective study was performed for all zygomatic fracture patients admitted between 2008 and 2014. Medially rotated fractures were reduced by using a wire looped through an intermaxillary screw secured on the medial side of the zygoma. Laterally rotated fractures were reduced using a hook introduced through an infrazygomatic skin incision. RESULTS: No accidental bleeding or incomplete reduction was observed in any of the cases. Postoperative imaging demonstrated proper reduction immediately after the operation. Follow-up computed tomography study at 1 month after operation also demonstrated proper reduction and healthy union across the previous site of fracture. CONCLUSION: The hook and wire method allowed precise application of traction forces across zygomatic fractures. The fractured bone fragment could be pulled in the direction precisely opposite to the vector of impact at the time of trauma. Soft tissue damage due to dissection was minimized. In particular, this method was effective in reducing rotated bone fragments and can be an alternative option to using the zygoma elevator.

Clinical Manifestations and Surgical Outcomes of Double Elevator Palsy

PURPOSE: To evaluate the clinical manifestations of double elevator palsy and describe the surgery outcomes in patients. METHODS: We performed a retrospective chart review of all patients who were treated surgically for double elevator palsy between 1999 and 2012 at Yonsei University, Severance Hospital in Seoul, Korea. RESULTS: Overall, 15 subjects (7 males and 8 females) with a mean age of 14.6 years (range, 3-40 years) underwent their first surgery during the study period. All patients received inferior rectus recession as a primary procedure. Nine patients (60.0%) underwent a secondary procedure which included 4 cases of horizontal muscle transposition, 2 cases of correction of exotropia, and 3 cases of correction of hypotropia and exotropia simultaneously. The mean preoperative hypotropia was decreased from 29.9 +/- 8.4 prism diopter (PD) to 4.7 +/- 5.3 PD postoperatively. Mean follow-up period was 40.9 +/- 48.2 months. Seven patients (46.7%) underwent eyelid surgery for true ptosis. At last follow-up, a majority of patients showed mild or no amblyopia. CONCLUSIONS: Primary inferior rectus recession and additive secondary horizontal muscle transposition surgery was effective in treatment of double elevator palsy. The clinical manifestations and surgical outcomes of monocular elevation deficiency in the present study can help in the treatment of Korean patients.

Treatment and retention of relapsed anterior open-bite with low tongue posture and tongue-tie: A 10-year follow-up / 대한치과교정학회지

The purpose of the current report is to present 6-year long-term stability and 10-year follow-up data for an adult patient who was treated with a tongue elevator for relapsed anterior open-bite. The 19-year-old male patient presented with the chief complaint of difficulty in chewing his food. Collectively, clinical and radiographic examinations revealed an anterior open-bite, low tongue posture, and tongue-tie. The patient opted for orthodontic treatment alone, without any surgical procedure. A lingual frenectomy was recommended to avoid the risk of relapse, but the patient declined because he was not experiencing tongue discomfort. Initial treatment of the anterior open-bite with molar intrusion and tongue exercises was successful, but relapse occurred during the retention period. A tongue elevator was used for retreatment, because the approach was minimally invasive and suited the patient's requirements regarding discomfort, cost, and time. The appliance changed the tongue posture and generated an altered tongue force, which ultimately resulted in intrusive dentoalveolar effects, and a subsequent counterclockwise rotation of the mandible. The results showed long-term stability and were maintained for six years through continual use of the tongue elevator. The results of this case indicated that a tongue elevator could be used not only as an alternative treatment for open-bite, but also as an active retainer.