Spinal Accessory to Suprascapular Nerve Transfer in Traumatic Brachial Plexus Injury: A Comparative Study of Shoulder Recovery Outcomes in Anterior versus Posterior Approach and Surgeons' Preference.

PROBLEM STATEMENT: Conventionally, neural transfer of SAN to SSN for shoulder abduction in traumatic brachial plexus injury is done via the anterior approach. But important advantages of the posterior approach like the proximity of neural coaptation to the muscle to be reinnervated and negating the effects of a second injury to the suprascapular nerve have made it an alternative option. METHODOLOGY: Retrospective data was collected for a total of 30 SAN to SSN transfer patients of brachial plexus injury in two groups of 15 patients each of anterior (Group A) and posterior approach (Group B) over four years. Functional outcome at the shoulder was measured as muscle power and active range of motion (ROM) at 18 months and data on patients' satisfaction levels and surgeons' perceptions were also collected. RESULTS: No statistical difference was found in the muscle strength achieved in the two groups (p-value = 0.34) but significant recovery was found in the external rotation achieved by group B (p-value = 0.02). Statistical difference was insignificant in the two groups' active ROM during abduction and external rotation. The satisfaction index of patients was 86.7% in the posterior approach compared to 68% in group A. Surgeons' perspective showed a faster speed of suprascapular nerve exploration as perceived in the posterior approach with better visibility of supraspinatus muscle contraction, and overall surgeons' preference for a posterior approach. CONCLUSION: External rotation at the shoulder is better with the posterior approach but no difference in abduction. Patients with the posterior approach were more satisfied with the recovery, and surgeons preferred the posterior approach.

Impacted Ectopic Maxillary Incisor at the Margins of an Oronasal Palatal Fistula.

An oronasal fistula is one of the most common complications that can occur after cleft palate surgeries. Some of the reasons for the failure of repair are the closure of palatal flaps under tension, vascular compromise, and infection. We present a case of a 10-year-old patient who experienced nasal regurgitation during feeding, four years after undergoing a redo palatoplasty. The reason was identified as an impacted maxillary incisor located at the fistula site. The patient was managed with the closure of the oronasal palatal fistula, with a two-layered repair technique using bilateral mucoperiosteal flaps after the removal of the impacted tooth.

Post-Traumatic Radial Artery Pseudoaneurysm at the Wrist Level: A Case Report.

A pseudoaneurysm is a collection of blood outside the arterial lumen but remains in continuity with the lumen and lined by fibrous tissue. Radial artery pseudoaneurysm is a rare entity mostly occurring due to iatrogenic reasons. Traumatic causes are rare. In this case report, we report a post-traumatic left radial artery pseudoaneurysm at the wrist level in a 20-year-old male patient. The patient was treated with end-to-end repair of excised pseudoaneurysm with a vein graft taken from the radial artery vena comitantes through the same incision.