Preoperative localization of potentially invisible colonic lesions on the laparoscopic operation field: using autologous blood tattooing.

PURPOSE: Preoperative colonoscopic (POC) localization is recommended for patients scheduled for elective laparoscopic colectomy for early colon cancer. Among the various localization method, POC tattooing localization has been widely used. Several dyes have been used for tattooing, but dye has disadvantages, including foreign body reactions. For this reason, we have used autologous blood tattooing for POC localization. This study aimed to evaluate the safety and efficacy of the autologous blood tattooing method. METHODS: This study included patients who required POC localization of the colonic neoplasm among the patients who were scheduled for elective colon resection. The indication for localization was early colon cancer (clinically T1 or T2) or colonic neoplasms that could not be resected endoscopically. POC autologous blood tattooing was performed after saline injection, and 2 hemoclips were applied. RESULTS: A total of 45 patients who underwent autologous blood tattooing and laparoscopic colectomy were included in this study. All POC localization sites were visible in the laparoscopic view. POC localization sites showed almost perfect agreement with intraoperative surgical findings. There were no complications like bowel perforation, peritonitis, hemoperitoneum, and mesenteric hematoma. CONCLUSION: Autologous blood is a safe and effective agent for localizing materials that can replace previous dyes. However, a large prospective case-control study is required for the routine application of this procedure in early colon cancer or colonic neoplasms.

Clustering-based characterization of clinical phenotypes in obstructive sleep apnoea using severity, obesity, and craniofacial pattern.

OBJECTIVES: To identify and characterize the phenotypes of adult obstructive sleep apnoea (OSA) patients based on clustering using OSA severity, obesity, and craniofacial pattern. MATERIAL AND METHODS: The samples consisted of 89 adult OSA patients whose polysomnography and lateral cephalogram were available. With cluster analysis using apneahypopnea index (AHI, events/hour), body mass index (BMI, kg/m2), ANB (degree), and mandibular plane angle (MPA, degree), three clusters were identified. Cephalometric variables including craniofacial, soft palate, hyoid bone, and pharyngeal space compartments were compared among clusters by one-way analysis of variance or Kruskal-Wallis test. Multivariable linear regression analysis was performed to find contributing factors to OSA severity within each cluster. RESULTS: Cluster-1 (obesity type; 49.4 per cent) exhibited moderate OSA, obesity, and normal sagittal and vertical skeletal pattern (AHI, 22.4; BMI, 25.5; ANB, 3.2 degrees; MPA, 26.3 degrees) without significant upper airway abnormality. Cluster-2 (skeletal type; 33.7 per cent) was characterized by moderate OSA, severe skeletal Class II hyperdivergent pattern with narrow pharyngeal airway spaces, without obesity (AHI, 27.9; BMI, 23.5; ANB, 7.5 degrees; MPA, 36.6 degrees). Cluster-3 (complex type; 16.8 per cent) included severe OSA, obesity, skeletal Class II hyperdivergent pattern (AHI, 52.8; BMI, 28.0; ANB, 4.5 degrees; MPA, 32.2 degrees), with posteriorly displaced hyoid and retroclined soft palate. The main contributing factors to AHI were obesity in Cluster-1; hyperdivergent vertical pattern with narrow pharyngeal space in Cluster-2; and hyperdivergent pattern, obesity, displaced hyoid, and soft palate in Cluster-3. CONCLUSION: Three OSA phenotypes resulted from this study provide a clinical guideline for differential diagnosis and orthodontic intervention in the interdisciplinary treatment for OSA patients.

Correction to: Three-dimensional soft tissue changes according to skeletal changes after mandibular setback surgery by using cone-beam computed tomography and a structured light scanner.

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Three-dimensional soft tissue changes according to skeletal changes after mandibular setback surgery by using cone-beam computed tomography and a structured light scanner.

BACKGROUND: To evaluate the three-dimensional (3D) changes after mandibular setback surgery (MSS) in skeletal Class III malocclusion using cone-beam computed tomography (CBCT) and a structured light-based scanner. METHODS: Twenty-eight adult Korean patients with skeletal Class III malocclusion treated by MSS were evaluated. CBCT and facial scan images were recorded one week before and six months after surgery. To use an identical 3D coordinate system, superimposition was performed, and nine skeletal and 18 soft tissue landmarks were identified. Changes in the landmarks and correlation coefficients and ratios between hard and soft tissue changes were evaluated. Paired t test and Pearson's correlation test were performed. RESULTS: After MSS, the amount of transverse correction was 2.45 mm; mandibular setback, 5.80 mm; and vertical reduction, 1.64 mm at the menton, on average. In the transverse axis, there were significant changes and correlations in the lips and chin and an increasing gradient of ratios from the lower lip to the chin. In the anteroposterior axis, the lower lip and chin moved backward significantly and showed notable correlation with hard tissue movement. In the vertical axis, significant upward movement was observed in the landmarks related to the chin, but only lower facial height was significantly decreased. CONCLUSIONS: Soft tissue changes according to hard tissue movement after MSS exhibited a distinct pattern of an increasing gradient from the lips to the chin in a transverse aspect.