Use of a smartphone platform for temporomandibular joint arthroscopy.

Temporomandibular joint (TMJ) arthroscopy, a diagnostic and therapeutic procedure involving the introduction of a small-calibre optical scope into the joint compartments for the treatment of internal derangement, has been gaining prominence and is now being recommended as the first therapeutic option due to the good results obtained and minimal invasiveness. However, the technical difficulty, high cost, need for specific instruments, and video tower system remain limiting factors for the implementation of TMJ arthroscopy by practicing professionals. The objective of this study was to examine the possibility of using a smartphone optical adaptation platform in TMJ arthroscopy. Ten qualified examiners with different levels of expertise in TMJ arthroscopy located four points of interest in the upper TMJ compartment of a validated realistic simulator and assessed the resolution of the images obtained and ergonomics of the smartphone platform for each point of interest, assigning a score of 0-2 (0 = poor, 1 = intermediate, and 2 = good performance in comparison to the video tower). For image quality, 77.5% of scores were 'good', while 22.5% were 'intermediate'. For ergonomics, 62.5% of scores were 'good' and 37.5% were 'intermediate'. In conclusion, the platform appears to be safe for TMJ arthroscopy in humans.

Squamous-cell carcinoma of the lower lip: a retrospective study of 58 patients.

The charts of 58 patients with squamous-cell carcinomas of the lower lip, treated at the General Hospital of the University of São Paulo Medical School from January 1980 to December 1989, were retrospectively analyzed. In addition to regular demographic data, all available information was collected regarding: smoking and drinking habits; sun exposure; clinical stage; macroscopic features of the primary lesions; type of treatment; and follow-up. A meticulous pathological analysis, comprising the histologic differentiation grade, maximal tumor thickness, sun elastosis, perineural spread, vascular and muscular invasion, surgical margins, peritumoral inflammatory infiltrate, and positive lymph nodes, with or without extracapsular spread, was undertaken as well. The evaluation of the overall 5-year survival showed significant statistical differences, with prognostic implications, for the following variables: maximal tumor thickness, T-stage and positive nodes.

Prospective study using skin staplers in head and neck surgery.

BACKGROUND: A prospective trial was undertaken to investigate the advantages and disadvantages of stapled skin closure versus conventional nylon sutures in head and neck surgery. PATIENTS AND METHODS: The study included 20 consecutive patients who underwent extensive surgery in which their skin was closed with staples. Another group of 20 matched patients receiving a noncontinuous nylon suture closure was followed in parallel. RESULTS: The complications recorded occurred in 5 patients in the stapled group and 3 in the sutured group. Analysis of cosmetic results showed 16 patients (80%) in the stapled group with good wound appearance and 17 (85%) in the sutured group. The mean closure time was 5 minutes for the stapled group and 25 minutes for the sutured group. Cost was $19.75 for conventional closure and $22.00 for mechanical suture. CONCLUSION: The use of skin staples speeds up closure time by 80%, yields similar cosmetic results with no increase in complications, although at a slightly higher cost.

Identification of the external branch of the superior laryngeal nerve (EBSLN) in large goiters.

BACKGROUND: Intraoperative injury to the external branch of the superior laryngeal nerve (EBSLN) can result in significant postoperative voice problems. This injury can be avoided by intraoperative nerve identification. The EBSLN has a close anatomic relationship with the superior thyroid pedicle. According to the previous anatomic classification, the type 2b nerve, which crosses the vessels below the superior thyroid pole and is considered high risk, is found in 14% to 20% of persons with normal or slightly enlarged thyroid glands. OBJECTIVE: To analyze the frequency of this type 2b nerve in a population with large goiters and to compare it with the previously mentioned proportions. DESIGN: Nonrandomized prospective study. PATIENTS AND METHODS: During a 15-month period, patients with large uninodular or multinodular goiters were entered in the study. The EBSLN was searched with the help of a nerve stimulator and the type was annotated. If the patient had to be submitted to a bilateral thyroidectomy, each superior thyroid pole, with the correspondent nerve, was considered as a separate unit. RESULTS: Nine patients, all women, underwent surgery. The average size of the goiters was 10.9 cm x 7.3 cm x 5.0 cm, and the average weight of the specimens was 431 g. There were four bilateral procedures, totalling 13 nerves analyzed. Seven (54%) were type 2b. CONCLUSION: The frequency of the type 2b EBSLN is considerably higher in large goiters. This finding suggests that it is even more advisable to try to positively identify the nerve in these situations, in order to prevent its injury, which is permanent and troublesome for voice professionals.

Identification of the external branch of the superior laryngeal nerve during thyroidectomy.

Seventy-six patients underwent preoperative vocal evaluation and were randomized into 3 groups: (1) those with the superior thyroid pole dissected by the first author, with the external branch of the superior laryngeal nerve (EBSLN) identified by means of a nerve stimulator; (2) those patients whose dissection was executed by a resident, with no nerve search; and (3) those whose dissection was undertaken by the first author, without any nerve search. Postoperative analysis consisted of voice evaluation and electromyography of the cricothyroid muscle. No lesion occurred in patients in group 1. Twenty-eight percent of patients in group 2 and 12% in group 3 experienced a complete lesion of the EBSLN (p = 0.0123). When the patients in group 1 were compared with the patients with 62 nerves corresponding to nonoperated thyroid lobes, patients in group 1 exhibited no increased risk, whereas a significantly increased hazard was evident in both groups 2 (p = 0.0002776) and 3 (p = 0.0346393). In this study, effective prevention of iatrogenic EBSLN lesions during thyroidectomies was achieved only by the intraoperative identification of the nerve with the nerve stimulator.

Surgical anatomy of the external branch of the superior laryngeal nerve.

Iatrogenic lesions of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomies are not infrequent due to the possibility of anatomic variations of the relationships of this nerve with the superior thyroid vessels. Therefore, based on an anatomic analysis of 30 superior thyroid poles from 15 fresh cadavers, a new classification of the EBSLN was proposed, considering the jeopardy during a thyroidectomy. Thirty-seven percent of the nerves were type 2, ie, crossing the superior thyroid pedicle less than 1 cm above the superior thyroid pole. It is notable that 20% were type 2b, ie, crossing the vessels below the upper border of the pole, having been considered "high risk." This incidence was comparable with other series, which found dangerous anatomic variations of the EBSLN in the range of 15% to 68%, confirming that a significant proportion of these nerves might be at risk during surgery on the superior thyroid pole.

Quantitative study on the inferior vena cava between the renal vein and diaphragm.

50 dissections of the human inferior V. cava have been performed in order to measure its right renal vein - diaphragm, retrohepatic, and suprahepatic segments. We conclude that some individual parameters as skin type, age, height, weight did not influence the magnitude of the studied segments. The average measurements of the different parameters proposed for the inferior V. cava are: 1. The distances between the right renal vein and the diaphragm and between the right renal vein and the right atrium are 113.94 mm and 135.16 mm, respectively; 2. the length of the retrohepatic portion of the inferior V. cava and the suprahepatic one were 78.34 mm and 19.34 mm respectively; 3. the valve of the inferior V. cava is present in 46% of the observations; its length and width averages are 31 mm and 10.22 mm, respectively.