Improvement of coracoid process union rates: a comparative study of conventional open and arthroscopic-assisted Bristow procedures for treating anterior shoulder instability in rugby players.

BACKGROUND: The Bristow coracoid transfer procedure is a reliable technique for treating anterior shoulder instability in patients with large glenoid bone loss or those involved in collision sports. However, its success is marred by its inferior bone union rate of the coracoid process as compared to the Latarjet procedure. This study aimed to evaluate whether arthroscopic confirmation of the secured coracoid fixation during the Bristow procedure improves the bone union rate and clinical outcomes as compared to the open procedure. METHODS: We retrospectively reviewed 104 rugby players (n = 111 shoulders) who underwent an open (n = 66 shoulders) or arthroscopy (AS)-assisted (n = 45 shoulders) Bristow procedure at our center from 2007 to April 2019. In the AS-assisted group, the screw fixation and coracoid stability and contact were confirmed under arthroscopic visualization. Graft union was evaluated through computed tomography at 3 months, 6 months, and 1 year postoperatively. Patient-reported outcome measures were assessed based on the American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate. Recurrence, the rate of return to play (RTP), and the frequency of pain after RTP were also assessed. RESULTS: The mean follow-up period was 73.5 (range: 45-160) months for the open group and 32.3 (range: 24-56) months for the AS-assisted group. In the former, the rates of bone union were 50%, 72.7%, and 88.9% at 3 months, 6 months, and 1 year, respectively. In contrast, the AS-assisted group had significantly greater bone union rates-88.9%, 93.3%, and 95.6% at 3 months, 6 months, and 1 year, respectively. Both groups showed significant improvement in the American Shoulder and Elbow Surgeons and Rowe scores compared to preoperative values as well as high satisfaction rates (open: 92%; AS-assisted: 95.7%). There were no statistically significant differences in the recurrence and RTP rates as well as the frequency of pain after RTP between the 2 groups. CONCLUSION: The AS-assisted procedure allows early and high bone healing without compromising the clinical outcomes.

Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction.

This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.

Recurrent cellulitis and bacteremia in a patient with Noonan syndrome: A case report.

A 28-year old Japanese man with Noonan syndrome (NS) presented to our emergency department with painful erythema of the trunk and lower extremities since the previous day. He had been diagnosed with protein-losing enteropathy (PLE) with intestinal lymphangiectasia at age 25 years, and undergone lymphaticovenular anastomosis (LVA) twice. Three episodes of cellulitis of both lower extremities had occurred in the past 2 years. Extensive cellulitis with sepsis was diagnosed and piperacillin/tazobactam was started, which was de-escalated to ceftriaxone. He was discharged after 13 days of antibiotic therapy. After discharge, low-dose trimethoprim-sulfamethoxazole (SMZ-TMP) was started as the primary prophylaxis, but three episodes of cellulitis occurred in the next year and were treated with other antibiotics. NS, an autosomal dominant disease known as a RASopathy, is caused by germline mutations in RAS-MAPK pathway genes. Lymphedema resulting from lymphatic abnormalities is a concomitant manifestation in 20 % of patients with NS, and can be a risk factor for cellulitis. Hypoalbuminemia and hypoglobulinemia associated with PLE facilitate infections such as cellulitis. As a treatment for lymphedema in the extremities, LVA has shown objective and subjective improvements in most patients, and some studies have also reported its efficacy for lymphedema in patients with NS. Targeted molecular therapy with mitogen-activated protein kinase enzyme (MEK) inhibitor is used in treatment of cancers with activation of the RAS/MAPK pathway. MEK inhibitors have recently been tried in patients with RASopathies and severe lymphatic disorders, and can lead to rapid resolution of symptoms.

PHACE(S) Syndrome with Ocular Involvements and No Periocular Hemangioma.

PHACE(S) syndrome is a neurocutaneous disorder with a hallmark finding of an infantile facial hemangioma (IFH) >5 cm. Eye examination of patients with PHACE(S) syndrome with no IFH at periorbital region is reported to be of low yield. We report a unique case of the syndrome with ocular manifestations without periorbital IFH or systemic findings. A 3-week-old female infant with right periauricular IFH >5 cm, extending to the neck and cheek and lower lip IFH was presented. Examination revealed pseudoptosis due to microphthalmia with esotropia and hypertropia. Both corneas were clear with diameters of 5 mm and 10 mm, right eye (RE) and left eye (LE), respectively. There was a posterior polar cataract with a poor view of the fundus RE. Ocular B-scan and magnetic resonance imaging (MRI) findings were suggestive of a dysmorphic globe, vitreous hemorrhage, spherophakia and persistent fetal vasculature RE and normal findings LE. Clinical evaluation, MRI, and MR angiography revealed no other systemic abnormalities. Subsequent follow-up visits revealed progressive clouding of the cornea with neovascularization and the development of phthisis bulbi RE at which point an ocular prosthesis was placed. The IFH was managed with dye laser and with oral propranolol. At 1 year, the patient has remained stable with no development of new local or systemic anomalies, regression of the periauricular and lip IFH, and normal development of the orbital structure RE with an ocular prosthesis in situ. Ocular involvement in patients with PHACE(S) syndrome may be present without periorbital IFH. Regardless of the location of the IFH and the presence or absence of a periocular component, it is recommended that they receive a full initial ophthalmological assessment.

An esthetic, functional, and low-invasive lower red lip reconstruction using a mucosal perforator flap: A case report.

Key Clinical Message: Lower red lip reconstruction using a mucosal perforator flap is low-invasive and adheres to the concept of "like with like." The location of the mucosal perforator can easily be detected using color Doppler ultrasound. Abstract: Lip reconstructions should provide results of a high degree regarding both functionality and esthetics. We describe a case of lower red lip reconstruction using a mucosal perforator. An 81-year-old man complained of repeated bleeding from a submucosal venous malformation on his lower red lip, and surgery was performed under local anesthesia. The venous malformation was completely resected. A 4 cm × 2 cm triangle-shaped flap containing a mucosal perforator, identified using color Doppler ultrasound preoperatively, was designed in the lower red lip adjacent to the defect. The perforator flap was raised in the submucosal layer, and the defect was covered with the flap in an advancement manner. The flap transfer-related defect was closed, and at the one-year follow-up examination, no recurrence, drooling, or speech impediment was observed. In this case, excellent functional and esthetic results were achieved following the low-invasive reconstruction using a mucosal perforator flap.

Association Between Preoperative Glenoid Bone Loss and Postoperative Outcomes After Coracoid Transfer Combined With Open Bankart Repair: Comparison of the Bristow and Latarjet Techniques.

Background: Whether the extent of glenoid bone loss (GBL) affects clinical outcome after coracoid process transfer (CPT) is still unclear. Purpose: To evaluate postoperative outcomes after CPT combined with open Bankart repair in young rugby players in terms of the extent of GBL and between the Bristow and Latarjet techniques. Study Design: Cohort study; Level of evidence, 3. Methods: The authors investigated 101 shoulders in 91 competitive rugby players who underwent CPT combined with open Bankart repair by the Bristow (group B; 66 shoulders) or Latarjet (group L; 35 shoulders) procedure between 2007 and 2017. The extent of GBL was calculated from the en face view of the glenoid on preoperative 3-dimensional computed tomography scans and was used to categorize shoulders into 4 grades (grade 0, 0%; grade 1, >0% and ≤10%; grade 2, >10% and ≤20%; grade 3, >20%). At the minimum 2-year follow-up, the authors analyzed the relationship between GBL or GBL grade and postoperative outcome scores (American Shoulder and Elbow Surgeons score, Rowe score, Western Ontario Shoulder Instability Index, and patient satisfaction), return-to-play (RTP) times, graft failure (insufficient union or translocation), and recurrence. Results: The mean GBL in all shoulders was 10.9% ± 9.2% and was not significantly different between the 2 groups. There were no significant correlations between GBL and any outcome measure in either group. The mean RTP time was significantly shorter in group L versus group B (4.8 ± 1.1 vs 5.8 ± 1.8 months, respectively; P = .002), but it was not associated with GBL. In group B, the rate of graft failure was not significantly higher in shoulders with grade 0 or 1 GBL versus grade 2 or 3 GBL (8 [25.0%] vs 4 [11.8%], respectively; P = .21). In group B, graft failure was confirmed in 12 shoulders (18.2%), compared with 1 shoulder (2.9%) in group L. Postoperative recurrence occurred in significantly fewer shoulders in group B than in group L (2 [3.0%] vs 5 [14.3%], respectively; P = .047). Conclusion: The extent of GBL did not affect outcome scores after CPT, regardless of operative procedure.

Glenoid defect size increases but the bone fragment rarely resorbs in shoulders with recurrent anterior instability.

Background: With recurrent anterior instability the bone fragment of a bony Bankart lesion is often small compared to the glenoid defect. The purpose of the present study was to clarify the changes to both the bone fragment and glenoid defect over time in a single subject. Methods: Participants were patients who underwent computed tomography (CT) at least twice after an instability event between 2004 and 2021 and had a fragment-type glenoid at first CT. The glenoid rim width (A), glenoid defect width (B), and bone fragment width (C) were measured in millimeters. If B or C increased by 1 mm or more from the first to final CT, the change was judged as "enlarged," and if B or C decreased by 1 mm or more, it was judged as "reduced"; all other cases were judged as "similar." Then, glenoid defect size and bone fragment size were calculated as B/A×100% and C/A×100%, respectively, and the changes from the first to final CT were compared. Results: From the first to final CT, the glenoid defect was enlarged in 30 shoulders, similar in 13 shoulders, and reduced in 4 shoulders, and the bone fragment was enlarged in 18 shoulders, similar in 24 shoulders, and reduced in 5 shoulders. The mean glenoid defect size significantly increased from 10.9% to 15.3% (P < .001), and the mean bone fragment size increased from 6.4% to 7.8%, respectively (P = .005). At the final CT, in 6 shoulders a new glenoid fracture was observed at a different site from the original fracture. When they were excluded from the analyses, the mean glenoid defect size still significantly increased (from 11.2% to 15.2%; P < .001), but the mean bone fragment size did not (6.5% vs. 7.3%, respectively; P = .088). Conclusions: In shoulders with recurrent anterior instability, glenoid defect size appears to increase significantly over time, whereas the bone fragment size remains unchanged or increases only slightly. Bone fragment resorption is quite rare, and a bone fragment appears to be small because of an enlarged glenoid defect.

[A Case of Reconstruction of the Osteoradionecrosis of the Jaw Using the Patient-Specific Custom-Made Cutting Guide and Mandibular Reconstruction Plate].

Multidisciplinary treatment, combining ablative surgery and reconstruction, radiotherapy, and chemotherapy, is used to treat advanced oral cancers. In this study, we report a case of extensive osteoradionecrosis of the mandible following multidisciplinary treatment for tongue cancer, in which a computer-assisted, patient-specific custom-made cutting guide and reconstruction plate(TruMatch® )were used to improve the patient's facial morphology and oral-maxillofacial functioning. A 70-year-old man received multidisciplinary treatment for squamous cell carcinoma of the left side of the tongue (cT3N2bM0, cStage ⅣA)at a previous hospital. Seven years postoperatively, bilateral osteoradionecrosis of the mandible developed, and the patient was referred to our department for further treatment. Since the lesions were extensive, we planned reconstructive surgery using the TruMatch® system in collaboration with the plastic surgery department of our hospital. Surgery was performed precisely and accurately according to the preoperative simulation. Postoperatively, the patient's recovery was uneventful. The TruMatch® system enables us to achieve good morphological and comprehensive functional oral-maxillofacial reconstruction.

Perfect intrinsic squeezing at the superradiant phase transition critical point.

Some of the most exotic properties of the quantum vacuum are predicted in ultrastrongly coupled photon-atom systems; one such property is quantum squeezing leading to suppressed quantum fluctuations of photons and atoms. This squeezing is unique because (1) it is realized in the ground state of the system and does not require external driving, and (2) the squeezing can be perfect in the sense that quantum fluctuations of certain observables are completely suppressed. Specifically, we investigate the ground state of the Dicke model, which describes atoms collectively coupled to a single photonic mode, and we found that the photon-atom fluctuation vanishes at the onset of the superradiant phase transition in the thermodynamic limit of an infinite number of atoms. Moreover, when a finite number of atoms is considered, the variance of the fluctuation around the critical point asymptotically converges to zero, as the number of atoms is increased. In contrast to the squeezed states of flying photons obtained using standard generation protocols with external driving, the squeezing obtained in the ground state of the ultrastrongly coupled photon-atom systems is resilient against unpredictable noise.

A new lower eyelid reconstruction using transverse facial artery perforator flap based on an anatomical study.

With the ageing of the global society, the demand for lower eyelid reconstruction following malignant skin tumour resection is increasing. For decades, flaps that require excessive dissection have been used to reconstruct relatively large lower eyelid defects. A new, less invasive option is needed for elderly patients. We present a new surgical technique using a transverse facial artery perforator flap. Records of 11 patients who underwent lower eyelid reconstruction with transverse facial artery perforator flaps after malignant skin tumour resection were reviewed. The mean age of the patients was 85.7 ± 6.7 years. Six patients underwent surgery under local anaesthesia and five under general anaesthesia. Malignant skin tumours were resected with 4-10 mm of the surrounding skin, depending on the tumour type. An ipsilateral transverse facial artery perforator flap was raised to cover the defect. Primary reconstructions were achieved in all cases. The median follow-up period was 13 (range, 9-33) months. Two minor complications occurred during the follow-up period: pyogenic granuloma (n = 1) and temporary ocular pain and conjunctivitis (n = 1). The incidence of complications and the results of the functional and aesthetic evaluation based on the modified patient-reported outcome measure showed no significant differences between the two different anaesthesia groups. To the best of our knowledge, this is the first report to describe the use of a transverse facial artery perforator flap for lower eyelid reconstruction. The flap may be an effective option for lower eyelid reconstruction in elderly patients to achieve good functional and aesthetic outcomes with low risk and minimal invasion.

[A Case of Recurrent Tongue Cancer in a Patient of AYA Generation Who Underwent Salvage Surgery and Oral-Maxillofacial Reconstruction after Super-Selective Intra-Arterial Chemoradiotherapy].

Radical tumor resection for oral cancer can cause morphological and esthetic disorders and oral and maxillofacial dysfunction and maintaining a social life could become challenging, especially in the adolescents and young adults(AYA)generation. Conversely, chemoradiotherapy for young patients may cause adverse reactions such as impaired fertility and late side effects of radiation. Therefore, treatment should be performed cautiously. We report a case of AYA generation patient who underwent salvage surgery and maxillofacial reconstruction for recurrent tongue cancer after super-selective intra-arterial chemoradiotherapy. The patient was a 30-year-old woman who was 20 weeks pregnant. She was diagnosed with Stage Ⅲ squamous cell carcinoma of the right tongue, cT3N0M0. After abortion, the patient underwent super-selective intra-arterial chemoradiotherapy and achieved a complete response. However, 13 years later, a recurrence of Stage ⅣA tongue cancer, r- cT4aN2bM0, was reported. Additionally, the patient had osteoradionecrosis. We performed radical tumor resection(bilateral neck dissection plus subtotal glossectomy plus segmental mandibulectomy)and maxillofacial reconstruction with a fibula flap. Subsequently, we performed occlusal reconstruction treatment using dental implants. Three years postoperatively, no tumor recurrence was observed, and the patient was satisfied with the restored morpho-aesthetic and maxillo-oral functions.

[Two Cases of Advanced Lower Gingival Carcinoma Treated Surgically Using a Novel Patient-Specific Full Custom- Made Mandibular Reconstruction Plate System].

The treatment of advanced lower gingival carcinoma requires postoperative chemoradiotherapy; therefore, simultaneous hard-tissue reconstruction may not be indicated. In these cases, mandibular reconstruction is performed using a temporal reconstruction plate and various skin flaps. Herein, we reported 2 cases of advanced lower gingival carcinoma treated with a novel computer-assisted patient-specific, fully custom-made mandibular reconstruction plate system(Cosmofix®)in combination with a pedicle/free flap. In case 1, an 80-year-old female patient was diagnosed with right lower gingival carcinoma( cT4aN3bM0, Stage ⅣB). Under general anesthesia, she underwent tracheostomy, bilateral neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with an ulnar forearm free flap. In case 2, an 81-year-old male patient was diagnosed with right lower gingival carcinoma(cT4aN2bM0, Stage ⅣA). The patient underwent maintenance dialysis and required minimally invasive surgery using a pedicle flap. Under general anesthesia, the patient underwent tracheostomy, right modified radical neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with a pectoralis major myocutaneous flap. Postoperative facial morphology, occlusion, eating, swallowing, articulation, and other dysfunctions were minimal in both the cases. Adjuvant chemoradiotherapy was recommended. In conclusion, the utilization of the Cosmofix® system enabled both esthetic and functional reconstruction following segmental mandibulectomy for advanced lower gingival carcinoma.

First Case of Pyogenic Spondylodiscitis Caused by Gemella sanguinis.

A 78-year-old man presented with back pain. Magnetic resonance imaging revealed marrow edema within the L4 and L5 vertebral bodies and a spinal epidural abscess in the spinal canal. The patient was considered to have pyogenic spondylodiscitis at the L4/L5 level. The Gram-positive cocci isolated from blood cultures were subsequently identified as Gemella sanguinis using matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Symptom improvement was achieved and the infection was eradicated with conservative treatment (treatment with ceftriaxone [CTRX] and minocycline [MINO]). We report the first case of G. sanguinis-associated pyogenic spondylodiscitis. MALDI-TOF MS was useful in identifying this uncommon bacterium.

Emerging Anti-Inflammatory Pharmacotherapy and Cell-Based Therapy for Lymphedema.

Secondary lymphedema is a common complication of lymph node dissection or radiation therapy for cancer treatment. Conventional therapies such as compression sleeve therapy, complete decongestive physiotherapy, and surgical therapies decrease edema; however, they are not curative because they cannot modulate the pathophysiology of lymphedema. Recent advances reveal that the activation and accumulation of CD4+ T cells are key in the development of lymphedema. Based on this pathophysiology, the efficacy of pharmacotherapy (tacrolimus, anti-IL-4/IL-13 antibody, or fingolimod) and cell-based therapy for lymphedema has been demonstrated in animal models and pilot studies. In addition, mesenchymal stem/stromal cells (MSCs) have attracted attention as candidates for cell-based lymphedema therapy because they improve symptoms and decrease edema volume in the long term with no serious adverse effects in pilot studies. Furthermore, MSC transplantation promotes functional lymphatic regeneration and improves the microenvironment in animal models. In this review, we focus on inflammatory cells involved in the pathogenesis of lymphedema and discuss the efficacy and challenges of pharmacotherapy and cell-based therapies for lymphedema.

Role and Function of Mesenchymal Stem Cells on Fibroblast in Cutaneous Wound Healing.

Skin wounds often repair themselves completely over time; however, this is true only for healthy individuals. Although various studies are being conducted to improve wound-healing therapy outcomes, the mechanisms of wound healing and regeneration are not completely understood yet. In recent years, mesenchymal stem cells (MSCs) have been reported to contribute significantly to wound healing and regeneration. Understanding the function of MSCs will help to elucidate the fundamentals of wound healing. MSCs are multipotent stem cells that are used in regenerative medicine for their ability to self-renew and differentiate into bone, fat, and cartilage, with few ethical problems associated with cell harvesting. Additionally, they have anti-inflammatory and immunomodulatory properties and antifibrotic effects via paracrine signaling, and many studies have been conducted to use them to treat graft-versus-host disease, inflammatory bowel disease, and intractable cutaneous wounds. Many substances derived from MSCs are involved in the wound-healing process, and specific cascades and pathways have been elucidated. This review aims to explain the fundamental role of MSCs in wound healing and the effects of MSCs on fibroblasts.

Open Bristow Versus Open Latarjet for Anterior Shoulder Instability in Rugby Players: Radiological and Clinical Outcomes.

Background: Coracoid transfer is a reliable method for managing anterior shoulder instability in athletes who play contact sports; however, differences between the Bristow and Latarjet procedures are unclear. Purpose: To compare clinical outcomes and rates of bone union and bone resorption of the coracoid process between the open Bristow and open Latarjet procedures in rugby players. Study Design: Cohort study; Level of evidence, 3. Methods: Rugby players who underwent an open Bristow or an open Latarjet procedure were retrospectively reviewed for anterior shoulder instability, and 66 shoulders in the Bristow group and 35 in the Latarjet group were included. Graft union and resorption were evaluated using computed tomography at 3 months to 1 year postoperatively. Patient-reported outcome measures (American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate) were obtained at a mean follow-up of 74 months (range, 45-160 months) for Bristow and 64 months (range, 50-76 months) for Latarjet procedures. Recurrence and the rate of return to play (RTP), frequency of pain after RTP, and retirement rate after RTP were also assessed. Results: In 97.1% of the Latarjet procedure cases, bone union of the coracoid was achieved at 3 months postoperatively; however, bone union was achieved in only 72.7% of the Bristow procedure cases at 6 months postoperatively. Bone resorption of the coracoid process occurred in 6.1% of shoulders after the Bristow procedure, whereas 100% of shoulders showed bone resorption after the Latarjet procedure. No statistical differences were found in outcome scores between the 2 procedures. Subluxation and persistent pain after returning to sports were identified at a significantly higher rate in the Latarjet group (5 shoulders [14%] and 9 shoulders [26%], respectively) than in the Bristow group (2 shoulders [3%] and 2 shoulders [3%]) (P = .0471 and P = .001, respectively). Conclusion: The Latarjet procedure had an advantage in the early and high rate of bone union but was at a disadvantage in bone resorption compared with the Bristow procedure. Subluxation and pain after returning to sports were more frequent in patients who underwent the open Latarjet procedure than in those who underwent the open Bristow procedure.

Accuracy of shoulder joint injections with ultrasound guidance: Confirmed by magnetic resonance arthrography.

BACKGROUND: Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used; however, they pose a risk of radiation exposure and are expensive and time-consuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures. AIM: To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography (MRA). METHODS: The study included 179 shoulders of patients with recurrent anterior instability (150 patients; 103 and 76 right and left shoulders, respectively; 160 males and 19 females; average age = 20.5 years; age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 mL lidocaine (1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation (T2)-weighted images of axial planes and classified the intra-articular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage; minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs; and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen's kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman's rank correlation coefficient. RESULTS: Of the 179 injections, 163 shoulders (91.0%) had no leakage, 10 shoulders (5.6%) had minor leakage, and six shoulders (3.4%) had major leakage. In total, 173 shoulders (96.6%) were intra-articularly injected; thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, indicating consistency in the evaluations by both examiners. Regression analysis of the inaccurate injection rate for assessingtechnical learning showed a logarithmic curve with a downward trend (R2 = 0.887, P < 0.001). Three (50%) of the six inaccurate injections classified into "major leakage" were observed in the first 30 injections, indicating that the accurate injection showed a leaning effect. CONCLUSION: Ultrasound-guided intra-articular glenohumeral injections using a posterior approach had high accuracy; however, injection accuracy depends on clinical experience.

Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty.

INTRODUCTION: In total hip arthroplasty (THA), improper cup orientation can result in dislocation, early excessive polyethylene wear, and pain following THA. The supine position during THA provides a more reproducible functional pelvic position than the lateral decubitus position and may allow freehand cup placement as reliable as that obtained by computer navigation. The purpose of this study was to investigate the accuracy of freehand cup placement through a supine direct anterior approach (DAA) compared with computed tomography (CT)-based navigation. MATERIALS AND METHODS: The same surgeon performed primary cementless THA through the DAA in 144 supine patients. Seventy-two patients underwent freehand cup placement with standard mechanical guidance-oriented radiographic target cup positioning, and 72 underwent placement with CT-based navigation guidance. Using three-dimensional templating software, the study group calculated cup inclination and anteversion on postoperative CT scans. RESULTS: The navigation method resulted in a significantly smaller deviation of inclination from the target (p < 0.05); the difference in anteversion was not significant. In addition, the navigation method resulted in significantly fewer cups placed ± 10° outside the target position (0% for inclination, 0% for anteversion) than did the freehand procedure (26% for inclination, 25% for anteversion) (p < 0.0001). CONCLUSIONS: Freehand cup placement is less reliable even in the supine position. Use of a CT-based navigation system can significantly improve cup positioning in THA through the DAA by reducing the incidence of outliers.

[Oral Function Restoration via Two-Stage Reconstructive Treatment of an Extensive Maxillary Defect Following Maxillectomy].

Recently, the number of survivors that had oral cancer has increased, but deterioration in the quality of life of patients concerning oral function and cosmetic appearance has become problematic. Prosthodontic dentures usefully treat jaw defects after maxillary resection for cancer, but advances in microsurgery have rendered the possibility to reconstruct maxillary defect and oral cavity using a microvascular flap. Here, we describe 2-stage treatment after 35 years postoperatively. We restored the maxillofacial function using microvascular flaps and partial denture. The patient was a 59-year-old woman who underwent left lateral maxillectomy 35 years previously to treat an advanced left maxilla gingival carcinoma. A maxillary prosthesis was applied, requiring repeated adjustments and refabrications. The patient visited to obtain improvements for oral and maxillofacial functions and long-term quality of life. The left maxillary bone defect was 45×50 mm in area. Collaborating with the Department of Plastic and Reconstructive Surgery, the patient underwent reconstructive treatment using a microvascular forearm flap and partial denture. The patient's progress was excellent; eating, swallowing, and articulation improved. For 1 year postoperatively, the patient was satisfied with the results.

[A Case of Tongue Carcinoma with Malignant Transformation Caused by the Pandemic].

In April 2020, a state of emergency was declared because of the pandemic, and the public was instructed to refrain from leaving their homes. Consequently, this stirred up anxiety about visiting medical institutions. Here, we describe a case of tongue carcinoma that developed from an oral precancerous lesion into a malignant transformation owing to the effects of refraining from medical examinations caused by the pandemic. The patient was a 62-year-old woman. In March 2020, the patient became aware of a mass at the tongue's margin and was referred to our department. An excisional biopsy was performed, and a diagnosis of inflammatory change was made. The following month, a white ulcerative lesion was found, and another excisional biopsy was performed; therefore, a diagnosis of left tongue leukoplakia without epithelial dysplasia was made. The patient was scheduled for surgery; however, refused treatment and consultation because of the pandemic. In September 2021, the patient revisited our department on her own volition because an ulcerative lesion with indistinct borders and induration was found at the left lingual margin. Upon close examination, a diagnosis of left tongue squamous cell carcinoma(cT2N2bM0, Stage ⅣA)was made. In October 2021, radical tumor resection and reconstruction were performed. After 8 months postoperatively, the patient is currently well.