Anatomical and Ultrasonographic Analyses of the Levator Labii Superioris Alaeque Nasi Muscle at the Level of the Nasal Ala / Análisis Anatómico y Ecográfico del Músculo Elevador Nasolabial a Nivel del Ala Nasal

SUMMARY: We aimed to determine the width of the levator labii superioris alaeque nasi muscle (LLSAN) at the level of the nasal ala through cadaveric dissections and ultrasonography (US), to provide essential anatomical information for use during both invasive and noninvasive procedures in the nasal ala region. The LLSAN was investigated in the 40 hemifaces of 20 Korean cadavers, comprising 10 males and 10 females with a mean age of 73.6 years. The LLSAN width of the 40 specimens at the level of the midpoint of the nasal ala was 5.02±2.35 mm (mean±standard deviation), and ranged from 1.45 mm to 10.11 mm. The LLSAN widths were 5.96±2.36 mm and 3.93±1.89 mm in males and females, respectively, with ranges of 2.40-10.11 mm and 1.45-6.96 mm, respectively. The LLSAN widths on the left and right sides were 4.77±2.72 mm and 5.26±1.99 mm, respectively. The proportions of the LLSAN fibers inserting into the nasal ala and upper lip were similar in 13 specimens (32.5 %), while more fibers inserted into the nasal ala in 11 specimens (27.5 %) and more fibers inserted fibers of the LLSAN into the upper lip in 16 specimens (40 %). When clinicians need to target or avoid the LLSAN, the present width and range data can be helpful for ensuring the efficacy and safely of both invasive and noninvasive procedures. In addition, the possibility of asymmetry in the width of the LLSAN in the nasal ala region should be confirmed by US before performing such procedures.

Nuestro objetivo fue determinar el ancho del músculo elevador nasolabial (MENL) a nivel del ala nasal mediante disecciones cadavéricas y ecografía, para proporcionar información anatómica esencial, para su uso durante procedimientos invasivos y no invasivos, en la región del ala nasal. El MENL se estudió en 40 hemicaras de 20 cadáveres coreanos (10 hombres y 10 mujeres) con una edad media de 73,6 años. El ancho de MENL de las 40 muestras a nivel del punto medio del ala nasal fue de 5,02 ± 2,35 mm (media ± desviación estándar) y osciló entre 1,45 mm y 10,11 mm. Los anchos de MENL fueron 5,96 ± 2,36 mm y 3,93 ± 1,89 mm en hombres y mujeres, respectivamente, con rangos de 2,40 a 10,11 mm y 1,45 a 6,96 mm, respec- tivamente. Los anchos de MENL en los lados izquierdo y derecho fueron 4,77 ± 2,72 mm y 5,26 ± 1,99 mm, respectivamente. Las proporciones de fibras de MENL que se insertaban en el ala nasal y en el labio superior fueron similares en 13 muestras (32,5 %), mientras que se insertaron más fibras en el ala nasal en 11 muestras (27,5 %) y además, se insertaron fibras de MENL en el labio superior en 16 ejemplares (40 %). Cuando los médicos necesitan apuntar o evitar el MENL, los datos actuales de ancho y rango pueden ser útiles para garantizar la eficacia y seguridad de los procedimientos, tanto invasivos como no invasivos. Además, la ecografía puede ser utilizada para confirmar una posible asimetría en el ancho del MENL en la región del ala nasal antes de realizar los procedimientos.

Research progress in pelvic floor ultrasound for assessing the morphology and function of levator ani muscle in women / 中南大学学报(医学版)

Pelvic floor ultrasound can clearly visualize the position and morphology of pelvic floor organs, observe the pelvic organ prolapse in real-time, and quantify and analyze the degree of the levator ani muscle injury, which is the most common imaging method to assess the morphology and function of the levator ani muscle to date. The different ultrasound imaging techniques provide a variety of indicators, each with its own advantages and limitations.Furthermore, two-dimensional ultrasound is the basis of imaging, but it fails to detect cross-sectional images of the pelvic floor; three-dimensional ultrasound can acquire the axial plane of the levator hiatus; tomographic ultrasound imaging allows real-time observation of the levator ani muscle injury; shear wave elastography can provide a quantitative assessment of the contractility and elastic characteristics of the levator ani muscle in real-time. It is of great significance to summarize the basic principles of various ultrasound imaging techniques, summarize the ultrasound image characteristics of levator ani muscle and its hiatus in different populations and different states, and explore the cut-off values and diagnostic criteria-related ultrasound parameters for improving the diagnostic efficiency of pelvic floor ultrasound for levator ani muscle injury, leading to reducing missed diagnosis and misdiagnosis of lesions.

Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging

Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves’ ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2?weighted, fat?suppressed fast spin echo imaging (T2WI?fs) and T1?weighted, fat?suppressed, contrast?enhanced fast spin echo imaging (T1WI?fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non?effective group. Independent t?test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t?test was used to compare SIR and T of LPS muscle before and after treatment. Then cut?off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty?two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non?effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI?fs and T1WI?fs + C decreased after treatment in the effective group (PT2 < 0.001, PT1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non?effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non?effective treatment group on T1WI?fs + C (P < 0.001). SIR of LPS muscle on T1WI?fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy

Efficacy of modified Park method in blepharoplasty / 中华医学美学美容杂志

Objective:To investigate the modified application of orbicularis oculi muscle-levator aponeurosis composite tissue flap fixation technique (modified Park method) in double-eyelid surgery.Methods:From June 2019 to March 2021, 823 patients included 92 males and 731 females, aged from 18 to 45 years with mean (31.4±7.9) years, in which 142 patients with slightly ptosis were selected to receive the treatment in the Department of Plastic Surgery of the Affiliated Hospital of Nangjing University of TCM. The symmetry of bilateral double eyelids after operation was evaluated by the third party. The marginal reflex distance (MRD1) was measured before and 6 months after operation, and the difference between preoperative and postoperative MRD1 (ΔMRD1) was calculated. And the postoperative complications were counted. The patients were followed up from 6 to 12 months after surgery to evaluate the long-term results.Results:The patients were followed up for 4-22 months (mean 10 months) after operation. And the incisions of all the 823 cases had primary healling. Most patients had smooth upper eyelid crease, upturned lashes and dynamic fold. The skin tended to spread evenly without dimple. The symmetry evaluation by the third party showed that there were 764 patients with symmetry and basic symmetry after operation, the symmetry rate was 92.8%; 59 patients with asymmetry, the asymmetry rate was 7.2%. The data of MRD1 increased significantly 6 months after operation, from (3.25±0.72) mm to (3.64±0.61) mm, and the ΔMRD1 was (0.38±0.76) mm ( t=-20.41, P<0.05). The difference between the two groups was statistically significant. The double eyelid line became shallow in 8 cases and disappeared completely in 3 cases. The double eyelid curve of the patients was natural and smooth after the operation. And there was no obvious sunken scar and pretarsal fullness. Conclusions:The " modified Park technique" blepharoplasty can obtain a more firm, symmetrical and natural appearance. And the mild ptosis could be corrected by this method. The anatomical structure can be identified clearly, and the surgical results are highly repeatable. It is worth promoting.

Comparison between frontalis suspension and levator resection in treatment of blepharoptosis: a meta-analysis / 中华医学美学美容杂志

Objective:To compare the postoperative efficacy and complications of frontalis suspension and levator resection in the treatment of blepharoptosis.Methods:According to the Cochrane systematic review method, we searched PubMed, Medline, Cochrane Library, Wanfang database, VIP Database, and China Knowledge Network database. The randomized and non-randomized controlled trials for comparing frontalis suspension and levator resection in the treatment of blepharoptosis were included. Revman 5.3 Meta analysis software was used.Results:A total of 13 clinical trials were involved in this study, including 1308 patients. Frontalis suspension was performed in the experimental group and levator resection was performed in the control group. The OR value of postoperative efficacy between the 2 groups was 2.91, 95% CI (1.57-5.39), P<0.01, the difference was statistically significant. Postoperative lagophthalmos after frontalis suspension was better [ MD=-1.05, 95% CI (-1.43--0.68), P<0.01], the difference was statistically significant. The OR value of undercorrection between the 2 groups was 0.24, 95% CI(0.16-0.36), P<0.01, the difference was statistically significant. Conclusions:The postoperative efficacy after frontalis suspension is higher. Postoperative complications after frontalis suspension are less.

Combination of conjoint fascia sheath suspension and levator palpebrae superioris shortening for treatment of congenital severe blepharoptosis / 中华医学美学美容杂志

Objective:To investigate the therapeutic effect of conjoint fascia sheath suspension and levator palpebrae muscle shortening on congenital severe blepharoptosis.Methods:From June 2014 to December 2018, 30 cases (40 eyes) of congenital severe ptosis were treated in Ningbo First Hospital and Shaoxing Women and Children＇s Hospital. All patients were corrected by conjoint fascia sheath suspension and levator palpebrae muscle shortening. Six months after operation, the distance between the middle point of upper eyelid margin and corneal reflex point was measured to evaluate the correction effect of blepharoptosis; the improvement of upper eyelid appearance was evaluated by 5-point Likert scale (LS), and the incidence of complications was counted.Results:Thirty patients (40 eyes) were followed up for 6-12 months. Correction effect showed that preoperative marginal reflex distance (MRD) was (0.10±0.05) and postoperative MRD was (3.80±0.55); the difference was statistically significant ( t=0.95, P<0.05); 38 eyes (95%) were corrected and 2 eyes (5%) were undercorrected; appearance of upper eyelid showed that preoperative LS was (0.50±0.05) and postoperative LS (3.80±0.55); the difference was statistically significant ( t=0.98, P<0.05). Only one case was complicated with keratitis caused by improper early nursing after incomplete closure exposure, and the patient was cured by sealing the eyes combined with drug conservative treatment. Conclusions:Combined conjoint fascial sheath suspension and levator palpebrae shortening in the treatment of severe blepharoptosis has significant effect, with the advantages of simple operation, small surgical trauma, low recurrence rate, low incidence of complications, high predictability of surgical results and high satisfactory rate of patients.

Clinical application of the full-stack smart pelvic floor ultrasound to acquire and measure the minimal levator hiatus plane / 中华超声影像学杂志

Objective:To evaluate the feasibility of Full-stack Smart Pelvic Floor Ultrasound (FSPFU) software in the acquisition and measurement of the minimal levator hiatus (LH).Methods:Transperineal pelvic floor ultrasonography was performed in 119 women of 6-month postpartum from Nov.2020 to Jan.2021 of Shenzhen Second People′s Hospital. Mid-sagittal plane of pelvic floor was set as the initial plane, and the three-dimensional volume data was acquired. The dataset was stored in the machine. The offline volume data was manually adjusted to obtain the minimal LH images and measured by four physicians (two junior physicians as the D1 group and two senior physicians as the D2 group). For comparison, the results were also obtained using the fully automated method—the FSPFU software by a junior physician (the D3 group). The obtained parameters of minimal LH included area, circumference, anterioposterior diameter, transverse diameter, left and right levator-urethral gap distance. Analysis time was recorded for each group. The contours of minimal LH were outlined by three groups and the overlapping rate was calculated. The quality of the resulted images was evaluated and scored by another two senior physicians(A and B) independently.Results:The D3 group had a significant shorter analysis time compared with the other two groups, and the D1 group took a longer time than the D2 group, regardless of the cystocele severity (D1: 82.97 s, D2: 62.51 s, D3: 2.71 s, all P<0.05). The intergroup agreements and correlations of the minimum LH area were good (all ICC>0.85, rs>0.70, P<0.001) and the outlined contours were largely overlapped (>92%). There was no significant difference in image quality among the three groups(all P>0.05). Conclusions:FSPFU software can automatically obtain and measure the minimum LH in an efficient and accurate way, which can improve the effectiveness of the present pelvic floor examination. FSPFU software can be an useful tool in the diagnosis of pelvic floor dysfunctional diseases.

Anatomical connections between the inferior fibers of the musculus orbicularis oculi and musculus levator labii superioris alaeque nasi / Conexiones anatómicas entre las fibras inferiores del músculo orbicular del ojo y levantador nasolabial

SUMMARY: This study aimed to determine the anatomical connections between the inferior fibers of M. orbicularis oculi (OOc inf.) and the M. levator labii superioris alaeque nasi (LLSAN), providing anatomical variations of the connecting fibers. This study examined the OOc and LLSAN of 44 specimens from 22 embalmed adult Korean cadavers. Connecting fibers between the OOc inf. and LLSAN were observed in 29.5 % of the specimens. Connecting patterns of the OOc inf. to the LLSAN were classified into three categories according to the directions of the connecting fibers; Type I (13.6 %), in which some of the OOc inf. coursed medially to blend with the lateral originating fibers of the LLSAN. Type II (11.4 %), in which some of the OOc inf. descended vertically to blend with the LLSAN. Type III (4.5 %), in which both types I and II were found simultaneously. Some of the OOc inf. coursed medially to blend with the lateral originating fibers of the LLSAN, and some of the OOc inf. descended vertically to blend with the LLSAN. These findings provide greater knowledge of the connecting fibers between the OOc inf. and LLSAN, thereby helping us understand complicated expressions, inject BoNT-A into related wrinkles, and analyze EMG activities.

RESUMEN: Este estudio tuvo como objetivo determinar las conexiones anatómicas entre las fibras inferiores del músculo orbicular del ojo (MOO inf.) y el levantador nasolabial (Musculus levator nasiolabialis; M. levator labii superioris alaeque nasi) (LNL), proporcionando variaciones anatómicas de las fibras conectoras. Se examinó el orbicularis oculi (MOO) y LNL de 44 especímenes de 22 cadáveres coreanos adultos embalsamados. Se observaron fibras conectoras entre los MOO inf. y LNL en el 29,5 % de los especímenes. Patrones de conexión del OOc inf. a LNL se clasificaron en tres categorías según las direcciones de las fibras conectoras; Tipo I (13,6 %), en el que algunos de los MOO inf. cursaban medialmente para mezclarse con las fibras de origen lateral del LNL. Tipo II (11,4 %), en el que algunos de los MOO inf. descendían verticalmente para mezclarse con el LNL. Tipo III (4,5 %), en el que se encontraron simultáneamente los tipos I y II. Algunos de los MOO inf. cursaron medialmente para mezclarse con las fibras de origen lateral de la LNL y algunas de las MOO inf. descendían verticalmente para mezclarse con el LNL. Estos hallazgos aportan un mayor conocimiento de las fibras conectoras entre los MOO inf. y LNL, lo que nos ayuda a comprender expresiones complicadas, inyectar BoNT-A en las arrugas relacionadas y analizar las actividades de EMG.

Conjoint fascial sheath suspension in treatment of severe blepharoptosis caused by inadequate suspension system tension / 中华医学美学美容杂志

Objective:To evaluate the safety and efficacy of conjoint fascial sheath (CFS) suspension surgery for severe blepharoptosis caused by low-tension suspension system.Methods:A total of 62 cases with severe blepharoptosis caused by low-tension suspension system received CFS suspension correction surgery from September 2014 to September 2017 were collected and followed up with a range of 12-36 months. The MRD-1, curve of upper eyelid, appearance and complications were recorded and underwent statistical analysis to evaluate the effect based on functionality, aesthetics and complication.Results:The postoperative MRD-1 was + 1 mm ~+ 4 mm compared with preoperative -3 mm ~+ 1 mm. The difference in the mean change was statistically different ( t=5.893, P<0.05). The satisfactory rate was 92.1% (82 cases), 7.9% (7 cases) were improved, and no case was invalid. There were no cases of recrudescence. Conclusions:Severe blepharoptosis can be caused by the inadequate tension of the upper eyelid suspension system. Laxity and abnormality of fixed structures may be major cause of decreasing levator aponeurotic tone. CFS suspension prevents further damage to the previous fixed structures, so it should be the first choice for such cases.

Effect of shortening of levator palpebrae complex on combined fascial sheath suspension in severe blepharoptosis / 中华医学美学美容杂志

Objective:To explore the treatment of levator complex in conjoint fascial sheath suspension correction on severe ptosis, and to seek a reliable and less complications operation.Methods:From October 2016 to February 2020, 40 eyes of 24 patients with severe ptosis (6 males and 18 females, aged from 10 to 73 years, with an average of 34.4 years) were divided into study group and control group. 20 eyes in study group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction, while 20 eyes in control group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction The effects and complications of the two groups were compared.Results:Follow-up studies were conducted at 1 week, 3 month and 6 months after operation. There was no significant difference between the two methods at different time points after operation, and the incidence of complications in the study group was less than that in the control group at 1 week after operation.Conclusions:Combined with fascial sheath suspension and levator palpebrae muscle complex tension-free shortening in the treatment of severe blepharoptosis has less complications and reliable curative effect in the early postoperative period, but it still needs to be improved to obtain more lasting curative effect.

Pathological study of the levator palpebrae superioris muscle in patients with different severities of simple congenital ptosis / 中华实验眼科杂志

Objective:To observe the pathological changes of levator palpebrae superiors muscle in patients with different severities of simple congenital ptosis (SCP).Methods:Levator palpebrae superiors muscle specimens from 102 eyes of 68 patients with SCP who received levator palpebrae superiors muscle shortening surgery at Wuhan Aier Hankou Eye Hospital from August 2018 to October 2019 were collected as the observation group.According to the severity of ptosis, the specimens were divided into three groups, coverage ≤4 mm group (n=35), coverage >4 mm to ≤6 mm group (n=30), and coverage >6 mm group (n=37). Fresh levator palpebrae superiors muscle tissues from 8 normal donors in Aier Eye Bank of Wuhan Red Cross were selected as the control group.All specimens were performed with Masson trichrome staining and immunohistochemical staining for α-smooth muscle actin (α-SMA), and ImageJ software was used to measure the collagen fiber area ratio, skeletal muscle fiber area ratio and the integrated absorbance (IA) value of α-SMA.Seventeen specimens (2 from the control group, 5 from coverage ≤4 mm group/coverage >4 mm to ≤6 mm group/coverage >6 mm group) were observed with a transmission electron microscope (TEM). This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Wuhan Aier Hankou Eye Hospital (No.HKAIER2018IRB-005-01). All patients and their legal guardians were well informed about the treatment method and the purpose of sampling and voluntarily signed informed consent.Results:Compared with the control group, the skeletal muscle fiber was reduced in number and was in disordered arrangement, and the striation of some muscle fibers disappeared, and hyperplastic fibrous connective tissue was found in intercellular substances in the observation group.The collagen fiber area ratio of the coverage ≤4 mm group, coverage >4 mm to ≤6 mm group, coverage >6 mm group were significantly higher than that of the control group, and the skeletal muscle fiber area ratio of the three groups was significantly lower than that of the control group (all at P<0.008 3). There were more smooth muscle fibers and positive expression of α-SMA found in the specimens of the observation group.The IA value of α-SMA of the coverage ≤4 mm group, coverage >4 mm to ≤6 mm group, coverage >6 mm group was 7 195.28(5 935.69, 14 058.29), 55 584.18(33 861.88, 80 419.32), 166 507.76(119 121.95, 187 890.86), respectively, which were all higher than 5 543.03(4 867.67, 8 312.02) of the control group, among which, there were statistically significant differences between the control group and the coverage >4 mm to ≤6 mm group, coverage >6 mm group (both at P<0.008 3). Abundant organelles and some damaged mitochondria were found in smooth muscle cytoplasm in the observation group with a TEM.But no characteristic structure of smooth muscle cells such as dense patch and dense body was detected.Conclusions:There are abnormal smooth muscle cells in the levator palpebrae superiors muscle of SCP patients, and the dysgenesis of the levator palpebrae superiors muscle may be related to this abnormal muscle cell.

Understanding pelvic floor in women

Change from quadruped to erect posture has resulted in changes in the human pelvis. This has resulted in pelvis supporting the abdominal viscera. The bony pelvis is deficient on inferior aspect. Muscles covered by fascia on superior and inferior aspect. A good knowledge of pelvic floor is very basic and mandatory for any gynecologist as pelvic floor is crucial to support the pelvic organs and is required to maintain urinary and fecal continence.

Correlation Between Upper Trapezius, Levator Scapulae And Pectoralis Minor Muscle Length In Frozen Shoulder – A Cross-Sectional Observational Study

Background: Frozen shoulder is defined as the painful and disabling condition with unknown etiology. It has a limited shoulder range of motion due to decreased capsular flexibility and altered muscle function. Assessment on the frozen shoulder is needed, and it is vital to know the alteration in scapular muscles in the shoulder range of motion during arm elevation. The intention of conducting this study is to reach conclusions of tightness of a muscle in the upper trapezius, pectoralis minor muscle, and frozen shoulder levator scapulae showing limited ranges. Methods: In this cross-sectional observational study, 50 subjects of age 30 and above were assessed for muscle length in the frozen shoulder and unaffected shoulder. Subjects with shoulder pain with frozen shoulder stage 2 and above are allotted into the affected shoulder, and unaffected shoulder; both groups were assessed. The following parameters were measured: ROM of the shoulder, SPADI ratings, short pectoral thickness, levator scapulae length, and upper trapezium muscle length. Results: Decreased shoulder flexion, extension, abduction, and limited rotations were the problems associated with frozen shoulder. Pearson correlation coefficient for PMI and LSI shows Positive Correlation r = 40.6% on the affected side. Pearson correlation for PMI and UTI shows Positive Correlation r = 13.4%. Pearson Correlation for LSI and UTI shows Positive Correlation r= 28.1% on the affected side. Conclusion: There was a correlation between upper trapezius, levator scapulae, and pectoralis minor muscle length. Most of the affected side shoulder showed the tightness in the pectoralis minor muscle.

Treatment of mild congenital ptosis by plication of the levator complex / 中华整形外科杂志

Objective@#To investigate the clinical effect of the plication of the levator complex for the treatment of mild congenital ptosis.@*Method@#From October 2017 to October 2018, 33 patients with mild congenital ptosis were treated with the method of the plication of the levator complex. The postoperative ptosis correction upper eyelid curvature and the occurrence of postoperative complications were analyzed.@*Results@#All patients were followed up for 3 to 12 months. 31 patients had complete correction and 2 patients were mild under-correction. Thirty-one patients had good surgical results, eyelid symmetry, natural curvature of the upper eyelid, and all patients had natural closure of the eyelid within 3 months after surgery. All patients had no serious complications such as keratitis. Two patients with undercorrection had revision surgery after 3 months, and the results were satisfactory.@*Conclusions@#The operation of under through plication of the levator complex for the mild congenital ptosis is simple, the operation is satisfactory, and the complications are few.

Morphology of thyroid gland- a comparative study between male and female thyroid glands

Introduction: Thyroid gland surgery is one of the most common surgical interventions in the head and neckregion. The gland is located low down in front of the neck. It consists of two symmetrical lobes united by anisthmus. A small portion of the gland substance often projects upwards from the isthmus, generally to the left ofthe midline as the Pyramidal lobe (PL). The Levator glandulae thyroidea(LGT) descends from the hyoid body to theisthmus or apex of Pyramidal lobe, innervated by branch of external laryngeal nerve. Hence this study onmorphological analysis of the gland will hopefully help to minimise the complications during the surgeries.Materials and methods: The study was done in 50 specimens which included glands dissected out of adultcadavers, specimens used for teaching in the department and rest of them were collected from fresh cadavericworkshops.statistical analysis was done between male and female thyroid glands using spss software 20version, dependant variables were compared using chi square test.Result: The shape of the gland was mostly normal, Isthmus was related to 2,3,4 th tracheal rings and in 6% casesit was absent. The pyramidal lobe was seen mostly to the left in 38% cases, LGT was absent in 36% cases,muscular LGT was seen on left side in 18% cases and STA was seen related to the medial border of apex in 52%cases.Conclusion: In the present study we observed variation in the morphology between the male and female thyroidglands

The levator scapulae muscle – morphological variations

Introduction: Anatomical variations of the levator scapulae are important and therefore clinically relevant. Thelevator scapulae are now believed to be the leading cause of discomfort in patients with chronic tension-typeneck and shoulder pain and a link between anatomical variants of the muscle and increased risk of developingpain has been speculated. The results obtained were compared with previous studies.Materials and methods: The study was conducted on 32 levator scapulae muscle of 16 cadavers over a period of3 years. The dissection of head and neck was done carefully to preserve all minute details, observing themorphological variations of the muscle in the department of Anatomy, Viswabharathi Medical College,Penchikalapadu, and Kurnool.Results: Total 32 levator scapulae muscles were used. All the sample values were measured to 2 decimal places.The average age of the cadavers in the sample was 82.87 years. The oldest cadaver in the sample was 100 yearsold and the youngest 61 years. Measurements of the proximal and distal attachments and the total length of themuscles were taken. Between 3 and 6 muscle slips were reported at the proximal attachment. Differences werealso observed between sides. The first report of a levator scapula muscle with 6 muscle slips at the proximalattachment was described.Conclusion: In our study we report 3 to 6 muscle slips in our study group. In order to improve the reliability of theresults of this study a greater number of specimens should be used, either through further dissection or inclusionof results from imaging techniques. The findings of the study should still be of great interest to cliniciansassociated with this area of the body. By doing this the speculated link between muscle variation and clinicaloutcomes such as myofascial pain syndrome could be investigated further. The potential applications andexpansions of this study are exciting and may begin to uncover the unexplained mechanisms behind myofascialpain syndrome.

Comparison of Two Different Photobiostimulation on Pain and Functional Ability in Patients with Myofascial Trigger Points (Levator Scapulae Muscle)

Objective: Myofascial trigger point (MTP) is a characteristic of myofascial pain syndrome (MPS) which is the most common muscle pain disorder. Myofascial pain syndrome is pain arising from one or more trigger points (TP) which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in taut bands. Aim of the present study is to compare the effectiveness of 780 nm Ga-Al-As LLLT and 904 nm Gallium Arsenide laser therapy on a trigger point in the levator scapulae muscle. Methods: Total of 50 subjects were selected on the basis of the inclusion and exclusion criteria and were recruited randomly to the 3 groups (A, B, C). Group A (experimental group) received 780 nm low-level laser therapy and stretching exercises. Group B (experimental group) received 904 nm low-level laser therapy and stretching exercises. Group C (controlled group) received only stretching exercises. Results: No significant difference in VAS and NDI from 0 to 2nd week in all the 3 groups i.e. Group A, B, and C indicating that rate of improvement in all the 3 groups was the same. Conclusion: Present study does not conclude that stretching is an effective intervention as a significant difference in the rate of improvement was found in the group which received Ga-As laser with stretching. Since the duration over which accumulation of rate of improvement took place was small thus it could not produce any significant difference overall at the end. Hence Ga-As LLLT can be used in adjunct with stretching exercises as cost-effective conservative treatment of MTP in levator scapulae muscle.

Patología oculoplástica: experiencia de 7 años en Hospital del Sistema de Salud Público de Chile / Oculoplastic Pathology: experience of 7 years in Hospital of the Public Health System of Chile

INTRODUCCIÓN: La cirugía oculoplástica estudia y trata los trastornos de párpados, órbita y vías lagrimales. Entre las patologías más importantes por frecuencia e impacto tenemos: ptosis palpebral, blefarochalasis, ectropión y entropión. OBJETIVO: Analizar la experiencia del Hospital El Pino en cuanto al manejo de patología oculoplástica en manos de un cirujano plástico. MATERIALES Y MÉTODO: Estudio descriptivo y retrospectivo. Se revisaron fichas de pacientes operados con diagnóstico de blefarochalasis, ptosis palpebral, ectropión y entropión entre los años 2010 y 2017. Se analizaron datos como edad, sexo, comorbilidades, causa del defecto, cirugía oculoplástica, tipo de anestesia, complicación posoperatoria, tiempo de seguimiento y resultados. RESULTADOS: Entre los años 2010 y 2017 se operaron 79 pacientes con patología oculoplástica, 17 por ptosis palpebral, 42 por blefarochalasis, 14 por ectropión y 6 por entropión, siendo la principal causa senil (93,7%). Las cirugías realizadas fueron: pexia del elevador para Ptosis palpebral, blefaroplastía para blefarochalasis y para ectropión-entropión tarsal strip. La principal técnica anestésica utilizada fue anestesia local + sedación (54,4%). Entre el total de complicaciones posoperatorias tenemos: lagoftalmo (2 casos), ectropión residual (3 casos), conjuntivitis (3 casos), dehiscencia de herida (2 casos) y hematoma palpebral (1 caso). Se reintervinieron 6 pacientes por complicaciones. Los resultados obtenidos según la evaluación subjetiva del cirujano plástico y pacientes fueron regular (5 casos), bueno (20 casos) y muy bueno (54 casos). CONCLUSIÓN: El manejo de la patología oculoplástica requiere en su mayoría de cirugías ambulatorias con buenos resultados y poca morbilidad, lo cual es factible de realizar en un hospital público. Creemos necesario el uso de algún instrumento objetivo para evaluar de mejor manera los defectos palpebrales y su corrección.

INTRODUCTION: The oculoplastic surgery studies and treats disorders of the eyelids, orbit and lacrimal ways. Among the most important pathologies by frequency and impact are: palpebral ptosis, blepharochalasis, ectropion and entropion. AIM: Analyze the experience of El Pino Hospital regarding the management of oculoplastic pathology in the hands of a plastic surgeon. MATERIALS AND METHOD: Descriptive and retrospective study. We reviewed files of patients operated with diagnosis of blepharochalasis, palpebral ptosis, ectropion and entropion between the years 2010 and 2017. Data were analyzed as age, sex, comorbidities, cause of the defect, oculoplastic surgery, type of anesthesia, postoperative complication, follow-up time and results. RESULTS: Between the years 2010 and 2017, 79 patients with oculoplastic pathology operated, 17 for palpebral ptosis, 42 for blefarochalasis, 14 for ectropion and 6 for entropion, being the main senile cause (93,7%). The surgeries performed were: elevator pexis for palpebral ptosis, blepharoplasty for blefarochalasis and for ectropion-entropion tarsal strip. The main anesthetic technique used was local anesthesia + sedation (54,4%). Among the total postoperative complications, we have: lagophthalmos (2 cases), residual ectropion (3 cases), conjunctivitis (3 cases), wound dehiscence (2 cases) and palpebral hematoma (1 case). Six patients were reoperated due to complications. The results obtained according to the subjective evaluation of the plastic surgeon were regular (5 cases), good (20 cases) and very good (54 cases). CONCLUSION: Management of oculoplastic pathology requires mostly ambulatory surgeries with good results and low morbidity, which is feasible to perform in a public hospital. We believe it is necessary to use some objective instrument to better evaluate the palpebral defects and their correction.

A Study Of The Variations In The Morphology Of The Thyroid Gland And Its Surgical Correlations

Introduction: Being a highly vascular and one of the essential endocrine glands, the knowledge of the variationsin the morphology of the thyroid gland stands an important role with respect to their identification, isolation orpreservation, and prevention of any untoward complication during the surgeries around the neck region, thusincreasing the chances of favourable surgical outcome.Aim: The aim of the present study was to identify the frequent variants in the structure of the thyroid gland, andto compare the same with the work of other authors.Materials and Methods: The present study was conducted on total 86 thyroid glands with morphological variations,out of which 42 were of males and 44 were of females. These were obtained during routine dissection of the neckin the adult human cadavers aged above 50 years.Results: The most common variation in the present study was the presence of pyramidal lobe (50% in males and65.9% in females), followed by the levator glandulae thyroidae (45.2% in males and 52.3% in females), absenceof the isthmus (7.1% in males and 20.5% in females), accessory thyroid tissue (2.4% in males and 2.8% infemales), and the least common was presence of groove in the thyroid tissue (0% in males and 2.8% in females).There were also combination of variants in some thyroids.Conclusion: The study emphasizes on the common anatomical variations in the thyroid gland morphology andtheir surgical correlations.

Clinical efficacy of "flexible suspension technique" in double-eyelid blepharoplasty / 中华医学美学美容杂志

Objective The mechanism of traditional double-eyelid blepharoplasty is adhering skin to tarsus,by which the skin below the incision could be elevated along with the tarsus and produce the crease.But the anatomic basis of native double-eyelids is not the same,which depends on the connection of levator aponeuroses with muscle and skin.That is,the elevations of tarsus and skin is based on the different branches of levator aponeuroses to skin.According to this,the authors have developed a modified blepharoplasty suturing levator aponeuroses to the obicularis occuli muscle to mimic the native double eyelid.Methods The surgical procedures were modified from traditional surgery.The major improvements were:keeping obicularis occuli muscles intact,dissecting the levator aponeuroses and suturing them together.Since the suturing was performed between mobilized tissues of muscle and aponeurosis,the method was named as "flexible suspension technique".Five-hundred patients were performed with this method.Forty cases randomly selected from them were compared with 40 cases performed with traditional method,and the results were investigated using questionnaire survey.Results The results of the modified surgery were more natural than traditional technique.Majority of patients were satisfactory,whereas 15 cases (3％) had asymmetry,narrowing and even fold loss.All these 15 cases were puffy eyelids.Statistical results indicated that the satisfaction rate was significantly high (P =0.003),and the adverse effects (edema,bruise and scar) were significantly lighter than traditional technique;whereas the asymmetry and fold loss were higher than traditional technique.Conclusions The flexible suspension technique of blepharoplasty can obtain more natural double eyelid appearance,and is suitable for primary blepharoplasty but not applicable for severe puffy eyelids.