Tratamiento endovascular exitoso de aneurisma del arco aórtico en un paciente pediátrico / Successful endovascular treatment of aortic arch aneurysm in a pediatric patient

Resumen Antecedentes: Los aneurismas de la aorta ascendente son patologías poco frecuentes en la infancia, sobre todo en ausencia de enfermedades previas como el síndrome de Marfan. Objetivo: Dar a conocer la posibilidad del manejo endovascular exitoso de los aneurismas de grandes vasos, usando stent y micro catéter con embolización del saco aneurismático. Método: Presentamos el caso de una paciente de 10 años y 2 meses, previamente sana, en quien se documentó un pseudoaneurisma entre el origen de la arteria carótida común izquierda y la arteria subclavia izquierda, que logró manejarse de forma endovascular, inicialmente con un stent cubriendo el cuello del aneurisma con el fin de remodelarlo y posteriormente por medio de microcatéter se realizó embolización del saco del aneurisma con coils, con resultado exitoso. Resultados: Los aneurismas de los grandes vasos, como la arteria carótida común y la arteria subclavia, tienen riesgo de ruptura con complicaciones devastadoras; el manejo endovascular se plantea como una opción poco invasiva de manejo, con resultados favorables. Conclusión: El manejo de aneurismas de grandes vasos, por vía endovascular usando stent y microcatéter con embolización del saco aneurismático, es una opción novedosa de manejo que logra resultados exitosos.

Abstract Background: Ascending aortic aneurysms are rare pathologies in childhood, especially in the absence of previous diseases such as Marfan syndrome. Objective: Present the possibility of successful endovascular management of large vessel aneurysms, using stents and microcatheters with embolization of the aneurysm sac. Method: We present the case of a previously healthy ten-year-old patient, in whom a pseudoaneurysm was documented between the origin of the left common carotid artery and left subclavian artery, successfully managed endovascularly, initially with a stent covering the neck of the aneurysm to remodel it and later with embolization of the aneurysm sac using a microcatheter. Results: Aneurysms of large vessels, such common carotid artery and subclavian artery, are at risk of rupture with devastating complications; endovascular management is considered a minimally invasive management option, with favorable results. Conclusion: The endovascular management of large vessel aneurysms using stents and microcatheters with embolization of the aneurysmal sac is a novel management option that achieves successful results.

Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro / Superficial venous arterialization with the great saphenous vein in situ: a single-center experience

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Abstract Background Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment. Objectives The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique. Methods This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021. Results Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures. Conclusions We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

Patrón de variación de la forma del arco dentario mandibular en una muestra de la Región Metropolitana de Chile

Objetivos: Describir el patrón de variación de la forma de la arcada dentaria mandibular en una muestra de la Región Metropolitana mediante un estudio observacional, transversal. Métodos: Se digitalizaron 18 puntos de referencia en 134 fotografías estandarizadas de modelos de yeso y se realizó un análisis de Procusto para obtener los componentes de variación de la forma y el tamaño (tamaño del centroide= cs). Resultados: El tamaño de centroide en hombres es significativamente mayor que en mujeres. El análisis discriminante con validación cruzada no mostró diferencias significativas en los componentes de la forma según el sexo. Las diferencias en la forma de los arcos dentales, explicada por los dos primeros componentes de la forma correspondió al 73.4% de la varianza total (PC1= 50,14%, en el eje anteroposterior y PC2= 13,31% en el eje transversal). Conclusiones: De acuerdo con los resultados del presente estudio, se debe replantear el uso de plantillas preformadas en la determinación de la forma del arco dentario, dada la continuidad morfológica que se observa al realizar un análisis estadístico del patrón de variación en forma y tamaño del arco, como queda en evidencia al utilizar herramientas de morfometría geométrica.

Objetivos : Descrever o padrão de variação da forma do arco dentário mandibular em uma amostra populacional da Região Metropolitana, através de um estudo observacional transversal. Métodos : 18 pontos anatómicos em 134 fotografias padronizadas de moldes de gesso foram digitalizados e foi realizado uma análise Procrustes. Resultados : O tamanho do centróide nos homens é significativamente maior do que nas mulheres. A análise discriminante com validação cruzada de gênero não mostrou diferenças significativas nos componentes da forma. O padrão de variação na forma das arcadas dentárias é explicado principalmente por PC1 (50,1% da variação total, variação anteroposterior) e PC2 (13,3%, variação transversal). Conclusões : Dada a continuidade morfológica que se observa ao realizar uma análise estatística do padrão de variação da forma e tamanho da arcada, aplicando ferramentas morfométricas geométricas, o uso de templates pré-formados para determinação da forma da arcada dentária deve ser reconsiderado.

Objectives: Describe the pattern of shape variation of the mandibular dental arch in a sample from the Metropolitan Region through an observational, cross-sectional study. Methods: 18 landmarks on 134 standardized photographs of dental casts were digitized, and a Procrustes analysis was performed. Results: The size of the centroid in men was significantly larger than in women. Discriminant analysis with gender cross-validation did not show significant differences in the shape components. The variation pattern in the shape of the dental arches is mainly explained by PC1 (50.1% of the total variation, anteroposterior variation) and PC2 (13.3%, transverse variation). Conclusions: Given the morphological continuity that is observed when performing a statistical analysis of the variation pattern in shape and size of the arch applying geometric morphometric tools, the use of preformed templates for determining the shape of the dental arch should be reconsidered.

Relación entre la compresión maxilar y potencial impactación del canino superior: Scoping review

El canino maxilar permanente corresponde al segundo diente más frecuentemente impactado en el arco dental. La etiología de esta patología aún no está totalmente definida, sin embargo, investigadores plantean la deficiencia del ancho del hueso maxilar como una posible causa. Objetivo: Investigar la evidencia que asocia menores dimensiones transversales del maxilar a la ocurrencia de la impactación de caninos superiores y esclarecer la posible relación. Materiales y métodos: Se realizó una revisión sistemática exploratoria a partir de una búsqueda amplia de la literatura en bases de datos PubMed, Cochrane, EBSCO y Multibuscador UNAB. Los artículos fueron recopilados, identificados y filtrados según el diagrama de flujo de declaración PRISMA. Resultados: La búsqueda identificó 755 estudios, de los cuales 14 fueron incluidos. Los estudios varían en diseño, edad de estudio y métodos de diagnóstico. La mitad de los estudios reporta una asociación positiva entre compresión maxilar e impactación canina superior, mientras que la otra mitad una asociación negativa. Conclusiones: No hay evidencia suficiente para poder asociar compresión maxilar con impactación de caninos superiores. Estudios con métodos de diagnóstico rigurosos son necesarios para una mejor comprensión. No obstante, se enfatiza la importancia de un diagnóstico precoz, para garantizar mejores resultados y pronóstico más favorable.

The permanent maxillary canine is the second most frequently impacted tooth in the dental arch. The etiology of this disease is not completely defined, yet some researchers propose the deficiency of the width from the maxilla as a possible cause. Objective: To investigate available evidence correlating smaller transverse maxilla dimensions with the occurrence of potential impaction of upper canines and clarify the possible relation. Materials and methods: A systematic exploratory review was carried out based on comprehensive search of the literature in databases such as PubMed, Cochrane, EBSCO and UNAB multi search engine. The articles were compiled, identified and filtered systematically according to the PRISMA flow diagram. Results: Our search identified 755 studies, 14 of which were included. These studies vary in design, patients age, and methods for detection. Half of the studies show a positive correlation between maxillary compression and potential upper canine impaction, whereas the other half show a negative correlation. Conclusions: There is not enough evidence to link maxillary compression to upper canine impaction. Studies with rigorous diagnostic methods for detection are necessary for a better understanding of this relation. Nonetheless, the importance of early diagnosis must be emphasized to guarantee better results and a more favorable prognosis.

Evaluation the scanning accuracy of Blue-Light laboratory scanners in complete edentulous Maxilla with multiple implants with titanium scan bodies / Evaluación de la precisión de escaneado de los escáneres de laboratorio de luz azul en maxilares desdentados completos con implantes múltiples con cuerpos de escaneado de titanio

Abstract To evaluate the accuracy of complete arch scanning with multiple implant titanium scan bodies using laboratory scanners. A master model of an edentulous maxillary arch with 6 implants was fabricated. Titanium scan bodies were inserted into the model. Three laboratory scanners were used: D2000 (3Shape), Vinyl High Resolution (Smart Optics), and inEos X5 (Dentsply Sirona). The master model was consecutively scanned ten times using dental laboratory scanners (LS) without detaching and repositioning the scan bodies. Linear and angular accuracy between adjacent implants was measured using inspection software (Control X, Geomagic). The accuracy of the complete arch scans was calculated. Implant regions were defined as; parallel (R1: #24-26 and #16-14), angled (R2: #22-24 and #14-12), angled to occlusal plane (R3: #12-22), and cross-arch (R4: #16-26). The effect of LS and implant region on accuracy was compared using two-Way ANOVA (α=0.05). Significant greater linear distortion was noted in R4 (61.2±17.9µm) compared to R1 (23.4±15.5µm) and R2 (26±17.7µm) (p<0.01). Greater linear distortions were noted in R4 with D2000 (0.07±0.016 degrees) and Vinyl High Resolution (0.067±0.02 degrees) than inEos X5 (0.032±0.021 degrees) (p>0.05). Greater mean linear precisions were noted in R1 (9±8µm) and R3 (9.3±8.3µm) than R4 (12.6±10.3µm) (p<0.05). The highest linear precision was noted in D2000 (7.2±7.6µm) (p<0.05). The angular precision of D2000 (0.02±0.015 degrees) was the highest (p<0.01). The angular precisión of R4 (0.036±0.018 degrees) was the lowest (p<0.01). This study revealed that the trueness was affected by the implant region and the precision was affected by both LS and implant region.

Resumen Evaluar la precisión del escaneado de la arcada completa con cuerpos de escaneado de titanio de múltiples implantes utilizando escáneres de laboratorio. Se fabricó un modelo maestro de una arcada maxilar edéntula con 6 implantes. Se insertaron cuerpos de escaneo de titanio en el modelo. Se utilizaron tres escáneres de laboratorio: D2000 (3Shape), Vinyl High Resolution (Smart Optics) e inEos X5 (Dentsply Sirona). El modelo maestro se escaneó consecutivamente diez veces usando escáneres de laboratorio dental (LS) sin separar y reposicionar los cuerpos de escaneo. La precisión lineal y angular entre implantes adyacentes se midió utilizando un software de inspección (Control X, Geomagic). Se calculó la precisión de los escaneos completos del arco. Las regiones del implante se definieron como; paralelo (R1: #24-26 y #16-14), angulado (R2: #22-24 y #14-12), angulado al plano oclusal (R3: #12-22) y cruzado (R4: #16-26). El efecto de LS y la región del implante en la precisión se comparó mediante ANOVA de dos vías (α=0,05). Se observó una distorsión lineal significativamente mayor en R4 (61,2±17,9µm) en comparación con R1 (23,4±15,5µm) y R2 (26 ±17,7µm) (p<0,01). Se observaron mayores distorsiones lineales en R4 con D2000 (0,07±0,016 grados) y vinilo de alta resolución (0,067±0,02 grados) que en inEos X5 (0,032±0,021 grados) (p>0,05). Se observaron precisiones lineales medias mayores en R1 (9±8µm) y R3 (9,3±8,3µm) que en R4 (12,6±10,3µm) (p<0,05). La mayor precisión lineal se observó en D2000 (7,2±7,6 µm) (p<0,05). La precisión angular de D2000 (0,02±0,015 grados) fue la más alta (p<0,01). La precisión angular de R4 (0,036±0,018 grados) fue la más baja (p<0,01). Este estudio reveló que la veracidad se vio afectada por la región del implante y la precisión se vio afectada tanto por LS como por la región del implante.

Osteonecrose dos maxilares relacionada ao uso demedicamentos: características patológicas, diagnóstico,prevenção e estratégias terapêuticas / Medication-related osteonecrosis of the jaws: pathological characteristics, diagnosis, prevention and therapeutic strategies

Objetivo: Este trabalho tem como propósito fornecer uma análise abrangente das características clínicas, etiológicas, radiográficas e histopatológicas da osteonecrose dos maxilares relacionada ao uso de medicamentos, além de abordar os métodos de diagnóstico, prevenção e estratégias terapêuticas. Materiais e métodos: foi realizada uma busca por artigos científicos publicados no período de 2015 a 2023, utilizando as bases de dados Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) e ScienceDirect. Conclusão: Embora infrequente, há um considerável potencial de ocorrência de osteonecrose dos maxilares em pacientes submetidos a terapia prolongada com medicamentos antirreabsortivos e antiangiogênicos, especialmente quando não são adotadas medidas preventivas adequadas. A implementação de práticas preventivas, a vigilância das condições bucais e a colaboração de uma equipe multidisciplinar são fundamentais para reduzir os riscos associados a essa condição patológica.(AU)

Objective: This work aims to provide a comprehensive analysis of the clinical, etiological, radiographic and histopathological characteristics of Medication-Related Jaw Osteonecrosis, in addition to addressing diagnostic methods, prevention and therapeutic strategies. Materials and methods: A search was carried out for scientific articles published between 2015 and 2023, using the Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) and ScienceDirect databases. Conclusion: Although infrequent, there is a considerable potential for osteonecrosis of the jaw to occur in patients undergoing prolonged therapy with antiresorptive and antiangiogenic medications, especially when adequate preventive measures are not adopted. The implementation of preventive practices, surveillance of oral conditions and the collaboration of a multidisciplinary team are essential to reduce the risks associated with this pathological condition.(AU)

A Clinical and Anatomical Study on the Localization of the Temporal Branch of the Facial Nerve Crossing the Zygomatic Arch / Estudio Clínico y Anatómico sobre la Localización del Ramo Temporal del Nervio Facial que Cruza el Arco Cigomático

SUMMARY: To clarify the path of the temporal branch of facial nerve (TB) crossing the zygomatic arch (ZA). Eighteen fresh adult heads specimens were carefully dissected in the zygomatic region, with the location of TB as well as its number documented. The hierarchical relationship between the temporal branch and the soft tissue in this region was observed on 64 P45 plastinated slices. 1. TB crosses the ZA as type I (21.8 %), type II (50.0 %,), and type III (28.1 %) twigs. 2. At the level of the superior edge of the ZA, the average distance between the anterior trunk of TB and the anterior part of the auricle is 36.36±6.56 mm, for the posterior trunk is 25.59±5.29 mm. At the level of the inferior edge of the ZA, the average distance between the anterior trunk of TB and the anterior part of the auricle is 25.77±6.19 mm, for the posterior trunk is 19.16±4.71 mm. 3. The average length of ZA is 62.06±5.36 mm. TB crosses the inferior edge of the ZA at an average of 14.67±6.45 mm. TB crosses the superior edge of the ZA at an average of 9.08±4.54 mm. 4. At the level of the ZA, TB passes on the surface of the pericranium while below the SMAS. The TB obliquely crosses the middle 1/3 part of the superior margin of the ZA and the junction of the middle 1/3 part and the posterior 1/3 part of the inferior margin of the ZA below the SMAS while beyond the periosteum. It is suggested that this area should be avoided in clinical operation to avoid the injury of TB.

El objetivo de estudio fue esclarecer el trayecto del ramo temporal del nervio facial (RT) que cruza el arco cigomático (AC). Se disecaron la región cigomática de 18 especímenes de cabezas sin fijar de individuos adultas y se documentó la ubicación del RT y su número de ramos. La relación jerárquica entre el ramo temporal y el tejido blando en esta región se observó en 64 cortes plastinados o P45. 1º El RT cruza el AC como tipo I (21,8 %), tipo II (50,0 %) y tipo III (28,1 %). 2º A nivel del margen superior del AC, la distancia promedio entre el tronco anterior de RT y la parte anterior de la aurícula fue de 36,36±6,56 mm, para el tronco posterior fue de 25,59±5,29 mm. A nivel del margen inferior del AC, la distancia promedio entre el tronco anterior del RT y la parte anterior de la aurícula era de 25,77±6,19 mm, para el tronco posterior era de 19,16±4,71 mm. 3º La longitud media de RT fue de 62,06±5,36 mm. EL RT cruzaba el margen inferior del AC a una distancia media de 14,67±6,45 mm. El RT cruzaba el margen superior del AC a una distancia media de 9,08±4,54 mm. 4º Anivel del AC, el RT pasaba por la superficie del pericráneo mientras se encuentra por debajo del SMAS. El RT cruza oblicuamente el tercio medio del margen superior del AC y la unión del tercio medio y el tercio posterior del margen inferior del AC por debajo del SMAS, más allá del periostio. Se sugiere que esta área debe evitarse en la operación clínica para evitar la lesión de la RT.

A Truncus Bicaroticus and an Aberrant Right Subclavian Artery. A Rare Case and Literature Review / Un Tronco Bicarótico y una Arteria Subclavia Derecha Aberrante. Un Caso Raro y Revisión de la Literatura

SUMMARY: An aberrant right subclavian artery described by David Bayford, is rare and one of the aortic arch anomalies. It gives usually incidental findings. We present the case of a 57-year-old woman who was admitted to a neurology outpatient clinic due to a headache and no obvious pathology was detected during a physical examination. In consequence of the brain and chest CT angiography, incidental anomalies of the aortic arch branches were found and asymptomatic aberrant right subclavian artery and bicarotid trunk was diagnosed. The presence of this anomaly is becoming increasingly important in avoiding vascular injuries and cerebral complications in patients undergoing endovascular intervention on the aorta aortic arch surgery, thyroidectomy, or cervicothoracic surgery. So, detailed knowledge of variations of the subclavian artery and bicarotid trunk is paramount for radiologists and surgeons operating on the region of the anterior neck.

Una arteria subclavia derecha aberrante descrita por David Bayford, es rara y es una de las anomalías del arco aórtico. Además, suele ser hallazgos accidentales. Presentamos el caso de una mujer de 57 años que ingresó a una consulta de neurología por dolor de cabeza, sin embargo, no se le detectó patología evidente al examen físico. En el angio-TC de cerebro y tórax, se encontraron anomalías incidentales de las ramas del arco aórtico y se diagnosticó arteria subclavia derecha aberrante asintomática y tronco bicarotídeo. Determinar la presencia de esta anomalía es cada vez más importante, para así evitar lesiones vasculares y complicaciones cerebrales en pacientes sometidos a intervención endovascular de la aorta, cirugía del arco aórtico, tiroidectomía o cirugía cervicotorácica. Por lo tanto, el conocimiento detallado de las variaciones de la arteria subclavia y el tronco bicarotídeo es primordial para los radiólogos y cirujanos que operan en la región anterior del cuello.

Williams?Beuren Syndrome with Pseudoaneurysm of Aortic Arch and Infective Vegetations for Modified Broms Procedure: Anesthetic Concerns & Echocardiographic Illustrations

Williams?Beuren syndrome is a rare genetic malformation with predilection for supravalvular aortic stenosis. Apart from cardiovascular malformation, hypocalcemia, developmental delay, and elfin facies, challenging airway make perioperative management more eventful. Association of infective endocarditis within the aortic arch and pseudoaneurysm formation is infrequent. We, hereby report a case of pseudoaneurysm formation and infective vegetation within the aortic arch in a patient with Williams syndrome and the role of transthoracic echocardiography in its perioperative management.

Dentoalveolar effects of skeletally anchored extrusion arch in anterior open bite patients: A prospective clinical trial

ABSTRACT Objective: The purpose of this prospective clinical trial was to explore the dental and soft tissue changes accompanying the use of skeletally anchored nickel-titanium (NiTi) extrusion arch in the correction of anterior open bite (AOB). Material and Methods: Twenty female patients with a mean age of 16.5 ± 1.5 years and a mean dentoalveolar AOB of 2.38±0.7 mm participated in this study. All patients were treated with an maxillary 0.017×0.025-in NiTi extrusion arch, with the aid of miniscrews inserted between the maxillary second premolars and first molars bilaterally, to act as indirect anchorage. Three-dimensional digital models and lateral cephalometric radiographs were taken just before the insertion of the extrusion arch (T0) and after 10 months (T1). Paired-sample t-tests were used in analyzing the data, to evaluate the changes after treatment (T1-T0). A significance level of p < 0.05 was used. Results: AOB was successfully closed in all patients, with a 4.35 ± 0.61 mm increase in the overbite. Maxillary incisors significantly extruded (2.52 ± 1.02 mm) and significantly reclined (5.78 ± 0.77°), with a resultant decrease in the overjet of 1.58 ± 0.5mm. A significant intrusion of maxillary first molars with no change in their inclination was observed. The upper lip showed a significant retraction tendency to the E-plane, and a significant increase in the nasolabial angle was observed. Conclusion: The skeletally anchored NiTi extrusion arch was an effective technique in treating AOB, with no adverse effects on the molars.

RESUMO Objetivo: O objetivo deste ensaio clínico prospectivo foi avaliar as alterações dentárias e em tecidos moles que acompanham o uso de arco de extrusão de níquel-titânio (NiTi) com ancoragem esquelético na correção da mordida aberta anterior (MAA). Material e Métodos: Participaram deste estudo 20 pacientes do sexo feminino com idade média de 16,5 ± 1,5 anos e MAA dentoalveolar (média de 2,38 ± 0,7 mm). Todos os pacientes foram tratados com arco de extrusão de NiTi 0,017×0,025" superior, com auxílio de mini-implantes inseridos entre os segundos pré-molares e primeiros molares superiores bilateralmente, para atuar como ancoragem indireta. Modelos digitais tridimensionais e radiografias cefalométricas laterais foram realizados imediatamente antes da inserção do arco de extrusão (T0) e após 10 meses (T1). Testes t para amostras pareadas foram utilizados na análise dos dados, para avaliar as alterações após o tratamento (T1-T0). Um nível de significância de p< 0,05 foi usado. Resultados: A MAA foi fechada com sucesso em todos os pacientes, com aumento de 4,35 ± 0,61 mm na sobremordida. Os incisivos superiores foram significativamente extruídos (2,52 ± 1,02 mm) e significativamente reclinados (5,78 ± 0,77°), com uma consequente diminuição na sobressaliência de 1,58 ± 0,5 mm. Foi observada intrusão significativa dos primeiros molares superiores, sem alteração na sua inclinação. O lábio superior apresentou tendência significativa de retração em relação ao plano E, e foi observado aumento significativo do ângulo nasolabial. Conclusão: O arco de extrusão de NiTi esquelético foi uma técnica eficaz no tratamento da MAA, sem efeitos adversos nos molares.

How does arch form and interproximal contact size affect the 3D displacements and rotations of teeth: a finite element analysis

ABSTRACT Objective: The objective of this study was to determine how arch form and interproximal contact size displace mandibular teeth subjected to an anterior component of force (ACF). Methods: Nine finite element models (FEM) of the mandibular arch were developed using Ansys® v. 16.0 software. They were designed to evaluate the effects of three arch forms (triangular, oval, and square) and three contact sizes (point-to-point, 1 mm diameter, and 2 mm diameter). All nine models were subjected to an ACF of 53.8 N (5486 gm). Three-dimensional tooth rotations and displacements of the mandibular teeth were evaluated, from the right first molar to the left first molar. Results: Arch form had a greater effect on tooth movements than contact size. Triangular arches and point-to-point contacts produced the greatest displacements and rotations of teeth. Oval arches with 2 mm wide interproximal contact points showed the greatest stability. The right first premolar showed the greatest displacements in all of the models. Conclusions: Arch form and contact size affect interproximal tooth stability. Teeth are least stable in narrow arches with point-to-point interproximal contacts, and most stable in wider arches with larger contacts.

RESUMO Objetivo: O objetivo deste estudo foi determinar como o formato da arcada e o tamanho do contato interproximal deslocam os dentes inferiores submetidos a um componente anterior de força (CAF). Métodos: Nove modelos de elementos finitos (MEF) da arcada inferior foram desenvolvidos utilizando o software Ansys® v. 16.0. Eles foram projetados para avaliar os efeitos de três formatos de arcada (triangular, oval e quadrado) e três tamanhos de contato interproximal (ponto a ponto, 1 mm de diâmetro e 2 mm de diâmetro). Todos os nove modelos foram submetidos a um CAF de 53,8 N (5486 gm). Foram avaliados tridimensionalmente as rotações dentárias e os deslocamentos dos dentes inferiores, do primeiro molar direito ao primeiro molar esquerdo. Resultados: A forma da arcada teve um efeito maior no movimento dos dentes do que o tamanho do contato interproximal. Arcadas triangulares e contatos ponto a ponto produziram os maiores deslocamentos e rotações dos dentes. Arcadas ovais com pontos de contato interproximal de 2 mm de largura apresentaram maior estabilidade. O primeiro pré-molar direito apresentou os maiores deslocamentos em todos os modelos. Conclusões: O formato da arcada e o tamanho do contato interproximal afetam a estabilidade dos dentes. Os dentes foram menos estáveis nas arcadas estreitas com contatos interproximais ponto a ponto, e mais estáveis nas arcadas mais largas com contatos maiores.

Long-term outcomes after endovascular aortic treatment in patients with thoracic aortic diseases / Resultados a longo prazo após tratamento endovascular da aorta em pacientes com doenças da aorta torácica

Abstract Background Endovascular treatments for thoracic aortic diseases have been adopted rapidly, and long-term studies are relevant for durability evaluation. Objective To evaluate the long-term results of a prospective observational study of endovascular treatment in patients with thoracic aortic diseases who underwent percutaneous implantation of self-expandable endoprostheses. Methods Procedural success was defined as the absence of endoleak into the aneurysm or dissection-induced false lumen, no migration, and no conversion to open surgery. Intraoperative, postoperative, and late postoperative outcomes were evaluated in terms of complications, mortality, and evolution of the endoprosthesis over a follow-up of up to 179 months (median: 46 months). Results A total of 150 endoprostheses were implanted in 112 patients. Primary success was observed in 100 (82.14%) patients. Immediate mortality occurred in 7 patients (6.25%). Late mortality occurred in 31 patients (27.68%), 10 (8.93%) of whom died from cardiovascular causes, 12 (10.71%) from non-cardiovascular causes, and 2 (1.78%) from natural causes, while 7 (6.25%) had no diagnosis for cause of death. Types I, II, and IV endoleaks occurred during hospitalization in 4 (3.57%), 5 (4.46%), and 3 (2.68%) patients, respectively. Late types I and IV endoleaks occurred in 5 (4.46%) and 3 (2.68%) patients respectively. Twenty-two patients (19.64%) had clinical complications in the immediate postoperative period. Actuarial survival free from death from cardiovascular causes was 79.3% (95% confidence interval, 67.0-91.7%) at 132 months. Conclusions The low levels of intraoperative and postoperative complications demonstrate that endovascular treatment is safe and effective. The high rate of late survival for these critically ill patients indicates that the endovascular technique is beneficial for treatment of thoracic aortic diseases in terms of long-term outcomes.

Resumo Contexto Os tratamentos endovasculares para doenças da aorta torácica têm sido adotados rapidamente e estudos de longo prazo são relevantes para avaliação de durabilidade. Objetivo Avaliar através de estudo observacional e prospectivo, os resultados a longo prazo do tratamento endovascular em pacientes com doenças da aorta torácica submetidos a implante percutâneo de endoprótese autoexpansível. Métodos O sucesso do procedimento foi definido como ausência de vazamento interno para o aneurisma ou falso lúmen induzido por dissecção, ausência de migração e sem necessidade de conversão para cirurgia aberta. Os resultados intraoperatórios, pós-operatórios e tardios foram avaliados quanto a complicações, mortalidade e evolução da endoprótese em um seguimento de até 179 meses (mediana de 46 meses). Resultados Um total de 150 endopróteses foram implantadas em 112 pacientes. Sucesso primário foi observado em 100 (82,14%) pacientes. Mortalidade imediata ocorreu em sete pacientes (6,25%). A mortalidade tardia ocorreu em 31 pacientes (27,68%), dos quais 10 (8,93%) morreram por causas cardiovasculares; 12 (10,71%), por causas não cardiovasculares; dois (1,78%), por causas naturais e sete (6,25%) não tiveram a causa da morte diagnosticada. Vazamentos tipo I, II e IV ocorreram durante a internação em quatro (3,57%), cinco (4,46%) e três (2,68%) pacientes, respectivamente. Vazamentos tardios tipo I e IV ocorreram em cinco (4,46%) e três (2,68%) pacientes, respectivamente. Complicações clínicas no pós-operatório imediato foram observadas em 19,64% dos pacientes. A sobrevida atuarial por causas cardiovasculares foi de 79,3% em 132 meses. Conclusões Os baixos índices de complicações intra e pós-operatórias demonstram que o tratamento endovascular é seguro e eficaz. A alta taxa de sobrevida em 132 meses em pacientes críticos indica que a técnica é benéfica para o tratamento de doenças da aorta torácica em resultados a longo prazo.

Comparative evaluation of displacement and stress distribution pattern during mandibular arch distalization with extra and inter-radicular mini-implants: a three-dimensional finite element study

ABSTRACT Objective: To compare the initial stress distribution and displacement on mandibular dentition using extra and inter-radicular mini-implants for arch distalization, by means of finite element analysis. Methods: For this study, two finite element models of the mandible were designed. The models consisted of periodontal ligament (PDL) and alveolar bone of all teeth until second molars. In the Case 1, bilateral extra-radicular buccal-shelf stainless steel mini-implants (10.0-mm length; 2.0-mm diameter) were placed between first and second permanent molars. In the Case 2, bilateral inter-radicular stainless steel mini-implants (10.0-mm length; 1.5-mm diameter) were placed between second premolar and first permanent molar. Power hook was attached between canine and first premolar at a fixed height of 8mm. In the two cases, 200g of distalization force was applied. ANSYS v. 12.1 software was used to analyze and compare von Mises stress and displacement in the mandibular dentition, PDL and bone. Results: Higher stresses were observed in mandibular dentition with the inter-radicular implant system. The amount of von Mises stress was higher for cortical bone (85.66MPa) and cancellous bone (3.64MPa) in Case 2, in comparison to cortical bone (41.93MPa) and cancellous bone (3.43MPa) in Case 1. The amount of arch distalization was higher for mandible in Case 1 (0.028mm), in comparison to Case 2 (0.026mm). Conclusion: Both systems were clinically safe, but extra-radicular implants showed more effective and controlled distalization pattern, in comparison to inter-radicular implants, in Class III malocclusion treatment.

RESUMO Objetivo: Comparar a distribuição da tensão inicial e o deslocamento na dentição inferior usando mini-implantes extra e inter-radiculares para distalização da arcada, por meio da análise de elementos finitos. Métodos: Dois modelos de elementos finitos da mandíbula foram criados, os quais consistiram de ligamento periodontal (PDL) e osso alveolar de todos os dentes até os segundos molares. No Caso 1, mini-implantes extra-radiculares de aço inoxidável (10,0 mm de comprimento; 2,0 mm de diâmetro) foram colocados bilateralmente na buccal-shelf entre o primeiro e o segundo molares permanentes. No Caso 2, mini-implantes de aço inoxidável inter-radiculares (comprimento de 10,0 mm; diâmetro de 1,5 mm) foram colocados bilateralmente entre o segundo pré-molar e o primeiro molar permanentes. Um Power hook foi preso entre o canino e o primeiro pré-molar a uma altura fixa de 8mm. Nos dois casos, foi aplicada força de distalização de 200g. O software ANSYS v. 12.1 foi usado para analisar e comparar a tensão de von Mises e o deslocamento na dentição inferior, ligamento periodontal e osso. Resultados: Maiores tensões foram observadas na dentição inferior com o sistema de implantes inter-radiculares. A quantidade de tensões de von Mises foi maior para osso cortical (85,66MPa) e osso esponjoso (3,64MPa) no Caso 2, em comparação com osso cortical (41,93MPa) e osso esponjoso (3,43MPa) no Caso 1. A quantidade de distalização da arcada inferior foi maior no Caso 1 (0,028 mm), em comparação com o Caso 2 (0,026 mm). Conclusão: Ambos os sistemas foram clinicamente seguros, mas os implantes extra-radiculares mostraram um padrão de distalização mais eficaz e controlado, em comparação com os implantes inter-radiculares, para tratamento da má oclusão de Classe III.

Correlation between cleft width and dental arch symmetry in cleft lip and palate: a longitudinal study

Abstract This study aimed to evaluate the influence of cleft width on dental arch symmetry of children with unilateral cleft lip and palate. Forty-one children were subjected to impression preoperatively (T1; mean age = 0.31 ± 0.07 years) and postoperatively (T2; mean age = 6 .73 ± 1.02 years). Eighty-two digitized dental casts were analyzed by stereophotogrammetry software. The cleft palate width was measured in the anterior (P-P'), middle (M-M'), and posterior (U-U') regions. Also, the following measurements were obtained: anterior intersegment (I-C') and intrasegment (I-C); total intersegment (I-T') and intrasegment (I-T); cleft-side (C'-T') and non-cleft-side (C-T) canine tuberosity. Paired t test and Pearson correlation coefficient were applied (α = 5%). Cleft width had the following means: 10.16 (± 3.46) mm for P-P', 12.45 (± 3.00) mm for M-M', and 12.57 (± 2.71) mm for U-U'. In the longitudinal analysis, I-C' had a significant reduction, while the other measurements significantly increased (p < 0.001). Asymmetry was verified in the following analyses at T1: I-C' vs. I-C and I-T' vs. I-T (p < 0.001); at T2, only in I-C' vs. I-C (p < 0.001). At T1, P-P' vs. I-C' (r = 0.722 and p < 0.001), P-P' vs. I-T' (r = 0.593 and p < 0.001), M-M' vs. I-C' (r = 0.620 and p < 0.001), and M-M' vs. I-T' (r = 0.327 and p < 0.05) showed a positive and significant correlation. At T2, there was a correlation between M-M' and I-C' (r = 0.377 and p < 0.05). In conclusion, the anterior and middle cleft widths influenced palatal asymmetry in the first months of life, while middle width influenced residual asymmetry.

Configurações dentárias reduzidas no contexto de estudos epidemiológicos: associação com desfechos de saúde e validação de critério diagnóstico / Shortened dental configurations in the context of epidemiological studies: association with health outcomes and validation of diagnostic criteria

Objetivou-se mapear os conceitos de configuração dentária reduzida empregados em estudos epidemiológicos associados com desfechos em saúde (estudo 1), bem como avaliar a validade de uma configuração utilizada em estudos epidemiológicos (pares de dentes antagonistas) (Estudo 2). Para o estudo 1 realizou-se uma revisão de literatura do tipo Scoping review com busca nas bases de dados PubMed/Medline, Scopus, Web of Science, Scielo e Cochrane. Dois pesquisadores treinados realizaram a seleção e extração de dados de estudos que avaliaram a associação entre configuração dentária reduzida (exposição) e desfechos em saúde clínicos e centrados na pessoa (saúde geral e saúde bucal), relacionados ao comportamento em saúde (padrões de dieta), além de mortalidade. Desfechos foram classificados de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde e com a Classificação Internacional de Doenças da Organização Mundial de Saúde (OMS). Configurações dentárias reduzidas basearam-se na contagem de dentes presentes, na posição dos dentes considerando estética, oclusão dentária e condições periodontais. A busca inicial resultou em 12525 referências, sendo 283 incluídos. A atualização da busca incluiu 117 artigos (ntotal=400). Saúde geral (n=186) e saúde bucal (n=192) foram abordadas em número semelhante de estudos. A maioria dos desfechos foram clínicos de saúde geral (n=169), sendo as doenças endócrinas, nutricionais ou metabólicas (n=55) frequentes. Em 144 estudos foram abordadas medidas centradas na pessoa, sendo a qualidade de vida relacionada a saúde bucal (QRSB) a mais frequente (n=60). Os desfechos clínicos de saúde bucal foram predominantemente relacionados às funções de ingestão (n=42) e doenças ou distúrbios do complexo orofacial (n=23). Padrões de dieta (n=39) e mortalidade (n=34) também foram estudados. A configuração dentária reduzida definida como meta pela OMS foi a mais frequente (n=181). Para o estudo 2 avaliou-se a acurácia de pares de dentes antagonistas para mensurar a presença de pares de pré-molares e molares em contato oclusal e a concordância entre a prevalência de Arco Dental Reduzido (ADR) e Dentição funcional (DF) quando unidades oclusais dentárias (UOs)/pares de oclusão posterior (POPs) foram definidas por pares de dentes antagonistas ou pares de dentes em contato oclusal. Dados obtidos em inquérito epidemiológico de saúde bucal realizado em município de Minas Gerais, Brasil. UOs e POPs foram definidos pelo critério epidemiológico (condição da coroa dentária) ou critério clínico "padrão ouro" (registro em papel carbono dos contatos oclusais durante a máxima intercuspidação habitual). Foram calculados sensibilidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia do critério epidemiológico. Sensibilidade, especificidade, VPP e VPN foram 88,5, 87,9, 92,5 e 81,9%, respectivamente, e acurácia foi de 88,3%. Os resultados sobre a concordância observada, coeficientes Kappa e valores estatísticos ß em relação à prevalência de ADR e DF (antagonista e contato oclusal) variaram de 0,82 a 0,98, indicando alto índice de concordância. Efeitos das configurações dentárias reduzidas têm sido investigados principalmente em relação às doenças endócrinas, nutricionais ou metabólicas e medidas de QVRSB. Há diversidade de desfechos em saúde. Critério epidemiológico mostrou-se válido e pode ser utilizado em estudos epidemiológicos para calcular a prevalência de configurações dentárias reduzidas que consideram POPs.

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies (Study 1), as well as to evaluate the validity of a configuration used in epidemiological studies (pairs of antagonistic teeth) (Study 2). For study 1, a literature review of the Scoping review type was carried out with a search in PubMed/Medline, Scopus, Web of Science, Scielo and Cochrane databases. Two trained researchers performed the selection and data extraction of studies that evaluated the association between reduced tooth configuration (exposure) and clinical and person-centered health outcomes (general health and oral health), related to health behavior (dietary patterns), in addition to mortality. Outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were based on the number of teeth present, the position of the teeth regarding esthetics, dental occlusion and periodontal conditions. The initial search resulted in 12525 references, 283 of which were included. The search update included 117 articles (ntotal=400). General health (n=186) and oral health (n=192) were addressed in a similar number of studies. Most outcomes were general health clinics (n=169), with endocrine, nutritional or metabolic diseases (n=55) being frequent. In 144 studies, person-centered measures were addressed, with oral healthrelated quality of life (OHQoL) being the most frequent (n=60). Clinical oral health outcomes were predominantly related to eating functions (n=42) and diseases or disorders of the orofacial complex (n=23). Diet patterns (n=39) and mortality (n=34) were also studied. The shortened dental configuration defined as a goal by the WHO was the most frequent (n=181). For study 2, the accuracy of pairs of antagonistic teeth was evaluated to measure the presence of pairs of premolars and molars in occlusal contact and the agreement between the prevalence of Shortened Dental Arch (SDA) and Functional Dentition (FD) when units occlusal (UOs)/posterior occlusion pairs (POPs) were defined by pairs of antagonistic teeth or pairs of teeth in occlusal contact. Data obtained from an epidemiological survey of oral health carried out in the municipality of Minas Gerais, Brazil. UOs and POPs were defined by epidemiological criteria (condition of the dental crown) or clinical "gold standard" criteria (carbon paper recording of occlusal contacts during maximum habitual intercuspation). Sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the epidemiological criterion were calculated. Sensitivity, specificity, PPV and NPV were 88.5, 87.9, 92.5 and 81.9%, respectively, and accuracy was 88.3%. The results on observed agreement, Kappa coefficients and ß statistical values in relation to the prevalence of SDA and FD (antagonist and occlusal contact) ranged from 0.82 to 0.98, indicating a high level of agreement. Effects of reduced tooth configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and OHQoL measures. There is a diversity of health outcomes. Epidemiological criteria proved to be valid and can be used in epidemiological studies to calculate the prevalence of reduced dental configurations that consider POPs.

Safety and effectiveness of proximal aortic repair versus total arch replacement for the treatment of acute type A aortic dissection: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods     An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. Results    A total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P<0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P<0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P<0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P<0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P<0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion     Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.

Clinical effect of integrated prosthesis on eyebrow arch augmentation / 中华医学美学美容杂志

Objective:To explore the feasibility and advantages of integrated prosthesis of expanded polytetra-fluoroethylene (e-PTFE) in eyebrow arch augmentation.Methods:The clinical data of 45 patients with low or flat brow arch and glabellar zone from June 2019 to October 2020 in Chengdu High-tech Zone Xinyuerong Medical Aesthetic Clinic were analyzed retrospectively, in which it included 45 women, whose ages ranged from 20 to 39 years with average 29.8 years. Forty-three cases underwent primary surgery, and 2 cases underwent repair. The e-PTFE was sculpted to be personalized integrated prosthesis according to the shape of the patient's eyebrow arch and glabellar zone. The incision was designed on the medial and lateral sides of the lower margin of the bilateral eyebrow to avoid the supraorbital foramen, and the lacunae were striped under the frontal periosteum, and the two sides were connected to cover the glabellar zone and inverted triangle area between the eyebrows. The carved e-PTFE was implanted into one side and pulled out from the other side. The prosthesis was smoothed by Venn pliers of the ventral and dorsal sides.Results:The 45 patients in this group were followed up for 6-18 months. The incisions of all the patients were healed Ⅰ/A, and the scar of the incisions was concealed. Slight scalp numbness occurred in 4 patients and returned to normal 3 months later. The prosthesis in the glabellar zone appeared in 1 case 3 months after operation and returned to normal after reoperation. The symmetry, radian, fullness, convexity and tactility of bilateral eyebrow arch were all satisfactory in 45 cases. 39 cases were very satisfied, accounting for 86.7%; 6 cases (13.3%) were satisfactory. The sagittal distance of the anterior surface of the cornea to the soft tissues overlying the supraorbital rims was (2.02±1.72) mm preoperatively and (6.5±1.19) mm in the last follow-up. The difference was statistically significant ( t=14.49, P<0.01). Conclusions:This design of integral e-PTFE in eyebrow arch augmentation is safe, effective and easy to operate. It can significantly increase the bony beauty and stereoscopic sense of the eyebrow arch and glabellar zone, effectively deepen the eye socket, improve the eye protrusion, and reduce the risk of asymmetry and prosthesis displacement, and therefore it is one of the ideal methods for eyebrow arch augmentation.

Facial shaping filled with autologous high density fat in zygomatic arch area / 中华医学美学美容杂志

Objective:To explore a simple and effective method to improve the facial shape coordination for patients.Methods:From May 2015 to May 2020, 36 female patients (aged 24-32 years, mean 26.8 years) who were required to change face shape were enrolled in Zhengzhou Mylike Medical Cosmetology Hospital to improve face shape by adjusting frontaI arch width combined with autologous high-density fat transplantation.Results:Thirty-three patients (91.7%) were satisfied (31 satisfied, 2 basically satisfied). Three patients were not satisfied with the filling effect, and two of them were satisfied after the second filling (3 months after operation). 35 of the 36 patients were satisfied, accounting for 97.2%, only 1 case was dissatisfied. No other compIications such as fat liquefaction were observed. The mean morphological surface index of patients was 90.2 before operation and 88.1 after operation, showing significant improvement.Conclusions:Autologous high density fat transplantation is a good method to adjust the coordination of the frontal arch.

Digital measurement of anatomical morphology of a zygomatic arch / 中华医学美学美容杂志

Objective:To analyze the anatomical morphology of the zygomatic arch for reduction malarplasty.Methods:Computed tomography (CT) data were obtained from the electronic records of 45 patients in the Tianjin Stomatological Hospital from January 2018 to February 2020. Among them, there were 30 patients with normal protrusion of zygoma (group A) and 15 patients with prominent protrusion of zygoma (group B). The data were imported into modeling and analysis software (Mimics). Left and right three-dimensional (3D) zygoma models were created through standard procedures. In the 3D models, a vertical cut of the zygomatic arch was done, and anatomical morphological characteristics of the zygomatic arch were obtained through bone data measurement and morphological observation. Mean values with 95% confidence intervals ( CI) were calculated for the positional data. Independent sample T-test was conducted on the positional data and anatomical morphology data of the zygomatic arch in the two groups. P< 0.05 was considered as statistically significant. Results:In group B, the anterior edge of the stabilization area was located in front of the articular tubercle point (15.12 mm, 17.16 mm). The posterior edge of the stabilization area was located in front of the articular tubercle point (7.11 mm, 8.24 mm). The posterior edge of the enlarged area was located in front of the articular tubercle point (3.17 mm, 3.94 mm). There were significant differences between group A and group B in the posterior edge of the stabilization area ( t= 2.41, P= 0.018), the posterior edge of the enlarged area ( t=2.58, P= 0.012), and the width of the unilateral face ( P<0.01). Conclusions:There exists a stabilization area of bone morphology and enlargement area in zygomatic arch. The anatomical morphology of the zygomatic arch is different in width of the unilateral face and location of the enlarged area between populations with normal protrusion and prominent protrusion of the zygoma.

Midterm clinical results of Sun's procedure with median resternotomy / 中华胸心血管外科杂志

Objective:To summarize the clinical data of Sun's procedure(total aortic arch replacement with frozen elephant trunk technique) in the treatment of complex aortic arch disease after previous cardiac surgery.Methods:From January 1, 2018 to December 31, 2020, a total of 55 patients underwent resternotomy Sun's procedure in the Aortic Surgery Center of Beijing Anzhen Hospital, including 41 males and 14 females, with a mean age of(45.4±12.7) years old, were retrospectively analyzed. The indications of primary cardiac surgery included type A aortic dissection, aortic root or ascending aortic aneurysm, heart valve surgery, and coronary heart disease. Indications for reoperation included residual aortic dissection larger than 55 mm in diameter, aortic aneurysm dilation, new type A aortic dissection, anastomotic leakage with symptoms, and pseudoaneurysm. All the operations were performed under general anesthesia and median resternotomy, total aortic arch replacement with the stented elephant trunk implantation and were performed by anterograde unilateral or bilateral cerebral perfusion.Results:There was no intraoperative death, and the postoperative mortality was 9.1%(5/55). The causes of death were 2 cases of low cardiac output, 1 case of respiratory failure, 1 case of cerebral complications, and 1 case of gastrointestinal bleeding. Except death, there were 2 cases of postoperative cerebral complications(2/50, 4%), 5 cases of spinal cord injury(transient paraplegia)(5/50, 10%), the median duration of ventilator use was 17 hours(14-42 h). Other postoperative complications included respiratory insufficiency requiring ventilatory support longer than 48 hours(8/50, 16%), renal insufficiency requiring temporary dialysis(2/50, 4%). The follow-up time was(25.9±11.2) months(10-47 months), during which 1 case died due to cerebral complication, 4 cases underwent total thoracoabdominal aorta replacement, and 1 case underwent anastomotic leakage repair.Conclusion:It is safe and effec to perform Sun's procedure(total aortic arch replacement with frozen elephant trunk technique) in the treatment of complex arch disease after previous cardiac surgery.