Effect of two fascial incision options for access to the temporomandibular joint on facial nerve function: objective investigation.

This study was performed to compare the effects on facial nerve (FN) function of the deep supra-temporalis muscle subfascial approach (DSFA) and traditional fascial approach (TFA) for access to the temporomandibular joint (TMJ), via qualitative and quantitative evaluations. Thirty patients requiring open TMJ surgery were randomly allocated to one of two groups: group A patients underwent the DSFA approach, while group B patients underwent the TFA approach. The TMJ was accessed via modified endaural incision with temporal extension. Clinical examinations, FN conduction tests, and electromyography (EMG) of the frontalis and orbicularis oculi muscles were used to assess FN function. A FN function deficit was noted in 50% of the whole sample population immediately after surgery, with no statistically significant difference between the groups (P = 0.082). Overall, 37.5% of the total study population experienced temporary loss of frontalis muscle activity, while zygomatic nerve injury was seen only in 25% of group A. Within 2-6 months, normal function returned in both groups. Nerve conduction studies showed no statistically significant difference between the groups in terms of nerve amplitude or latency after surgery. However, EMG of orbicularis oculi activity showed a significant difference between the groups after 6 months (P = 0.010). The results suggest that the traditional dissection approach is more protective of the FN, especially the zygomatic branch, than the deeper dissection technique.

Comparison of polypropylene and silicone Ahmed valve survival 2 years following implantation in the first 2 years of life.

AIM: To compare the 2-year survival rates of polypropylene and silicone Ahmed glaucoma valves (AGVs) implanted during the first 2 years of life. METHODS: Retrospective analysis of polypropylene and silicone AGV implantation during the first 2 years of life in children with 2 years' postoperative follow-up. Patients with prior aqueous drainage device implantation were excluded. RESULTS: Forty-two eyes of 36 children were reviewed. Thirty-one eyes received a polypropylene AGV (six S1, 25 S2), and 11 eyes received a silicone AGV (11 FP7). The average survival time (maintenance of intraocular pressure < or =22 mm Hg with (or without) medications and without significant complications) was significantly longer (p = 0.001 by the logrank test) for the silicone group (23.36 months, standard error (SE) 1.64, 95% confidence interval (CI) 20.16 to 24.00 months) than for the polypropylene group (19.10 months, SE 1.53, 95% CI 16.1 to 22.12 months). Cumulative probabilities of survival at 2 years by Kaplan to Meier analysis were 90.9% (SE 8.7, 95% CI 70 to 100%) and 54.8% (SE 8.9, 95% CI 23 to 87%), respectively (p = 0.001 by the logrank test). All eyes implanted with silicone AGVs had the diagnosis of congenital glaucoma, which was independently associated with 2-year survival. CONCLUSIONS: Two years after surgery, silicone AGVs survived longer than polypropylene AGVs. However, all eyes that received silicone AGVs in our cohort had congenital glaucoma, which had a better survival than other paediatric glaucoma diagnoses. A study of silicone AGV implantation in other paediatric glaucoma diagnoses is needed to determine whether or not silicone AGVs independently have a better survival after implantation in the first 2 years of life.

Complications and 2-year valve survival following Ahmed valve implantation during the first 2 years of life.

AIM: To report complications and 2-year valve survival following Ahmed valve implantation during the first 2 years of life. METHODS: Retrospective institutional case series. RESULTS: Forty-two eyes of 36 patients with Ahmed valve implantation (without prior drainage device surgery) during the first 2 years of life and 2 years' postsurgical follow-up were identified. Most eyes had primary congenital glaucoma (28/42, 66.7%), aphakic glaucoma (5/42, 11.9%) or Peters anomaly (5/42, 11.9%). All but three eyes had prior ocular surgery. Surgery was at a mean age of 11.83 months (m) (SD 5.63). The most common significant postoperative complications were tube malpositioning requiring intervention (11/42, 26.2%), endophthalmitis (3/42, 7.1%; one with tube exposure) and retinal detachment (3/42, 7.1%). Thirty-six eyes (85.8%) required resumption of antiglaucoma medications to maintain intraocular pressure (IOP) < or =22 mm Hg a mean of 7.2 m (SD 6.8) postoperatively. Cumulative probabilities of valve survival (IOP< or =22 mm Hg with or without medication) by Kaplan-Meier analysis were 73.8% and 63.3% at 12 months and 24 months, respectively. CONCLUSIONS: Postoperative tube malpositioning that required surgical revision was common in this age group. Infectious endophthalmitis and retinal detachment are known potential complications following any incisional surgery for advanced buphthalmos; however, tube exposure is a unique potential problem following aqueous shunt implantation that can lead to intraocular infection. Cumulative valve survival 2 years following implantation was 63.3%.