Double Pseudoaneurysm of the Superficial Palmar Arch: A Unique Case.

We present the case of a 22-year-old male patient who developed "double" pseudoaneurysm of the superficial palmar arch of the left hand after trivial trauma with a kitchen knife. Following an unsuccessful embolization attempt, surgical excision of the pseudoaneurysm was performed during which the pseudoaneurysm was found to arise from the anterior wall of the palmar arch. Intraoperatively, a second pseudoaneurysm arising from the deeper surface of the superficial palmar arch was found and excised. This is probably the only reported case of double pseudoaneurysm of the palmar arch in literature. The possible mechanism of arterial injury, diagnosis, and management is discussed.

Outcome of Precontoured Titanium Mesh in the Reconstruction of Orbital Blowout Fractures.

Background Orbital blowout fractures are peculiar injuries causing disruption of both ocular function and symmetry. We present our experience with the use of a precontoured titanium mesh in orbital blowout fractures. Methods A retrospective study of patients undergoing correction of orbital blowout fractures with a precontoured titanium mesh was done at a tertiary care center in Mumbai. Data regarding demographics and pre- and postoperative clinical and radiological attributes were retrieved and compared. Results A total of 21 patients (19 males and 2 females) underwent correction of blowout fractures with a precontoured titanium mesh. The follow-up period ranged from 6 to 10 months. Road traffic accident (76%) was the most common etiology. Twenty (95%) patients had impure blowout fractures and 1 (5%) patient had a pure blowout. The orbital floor was most commonly fractured (16 [76%]). Associated fractures of the zygomaticomaxillary complex were found in 71% of patients. All patients were operated on within 3 weeks of trauma. A comparison of the operated and uninjured sides on coronal views of computed tomography (CT) scan in nine patients by Photopea application revealed a correction of the increased cross-sectional area in all cases. Enophthalmos was completely corrected in 94% patients, while 92% patients had complete correction of diplopia. One patient with a comminuted zygomatic fracture had persistent diplopia and mild enophthalmos. Infraorbital paresthesia persisted in 58% patients at 6 months of follow-up. No significant postoperative complications were noted. Conclusion The precontoured titanium mesh restores orbital wall anatomy and is safe, quick, fairly easy, and reproducible with a shorter learning curve. With proper patient selection and execution, prefabricated titanium mesh can serve as an excellent reconstructive option in blowout fractures of the orbit.

Congenital Bilateral Multiple Trigger Fingers in A 5-Year-Old Child.

Paediatric bilateral multiple trigger fingers are extremely rare. The underlying etiopathogenesis and hence the surgical principles of management of trigger finger in children are different from those of pediatric trigger thumb and adult trigger finger. In this paper, we report the case of a 5 year old girl with congenital trigger digits involving the middle, ring and little fingers of both hands. She did not have any episode of trauma, viral or bacterial infections or any metabolic disorder. Following lack of any improvement with a physiotherapy and a splintage regime for 6 weeks, we offered surgical management for the affected digits. Release was done in step-wise pattern. We present the intraoperative findings and surgical management of congenital trigger finger.

Unfavourable results in temporomandibular joint ankylosis surgery.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition usually afflicting children and young adults. Treatment is surgical, i.e., release of the ankylosed joint/s with or without interposition arthroplasty and correction of secondary deformities (mandibular retrusion and asymmetry) This article deals with identifying potential setbacks in TMJ ankylosis surgery and preventing them.

Osseous genioplasty: A case series.

INTRODUCTION: The chin (mentum) is vital to the human facial morphology as it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile. AIM AND STUDY DESIGN: A case series was designed to study the long-term results of osseous genioplasty in Indian patients with regard to patient satisfaction, complications, and long-term stability. MATERIALS AND METHODS: All subjects who underwent osseous genioplasty either alone or as a component of orthognathic surgery between January 1992 and December 2010, with a minimum follow-up of 2 years, were included. The genioplasty was performed using standard protocols of assessment and execution. Post-operative evaluation included patient satisfaction, complications and radiological evidence of long-term stability. A comprehensive score was formulated for the purpose of the study. RESULTS: Thirty-seven subjects underwent osseous genioplasty with at least 2 years of follow-up in the study period. This included 17 male and 20 female subjects, with a mean age of 22.8 years (15-52 years) and a mean follow-up of 3 years 4 months (2 years to 4 years and 11 months). Nineteen subjects underwent isolated genioplasty while 18 underwent genioplasty as a part of orthognathic surgery. The procedures included advancement (22), pushback (9), side-to-side (4) and vertical reduction (2) genioplasty. Thirty-six subjects (97.3%) were extremely pleased with the results with only one subject expressing reservations, without, however, demanding any further procedure. There were no significant complications. The osteotomised segment was well maintained in its new position with good bony union and minimal resorption. Overall, 35 (94.6%) cases had excellent results and 2 (4.4%) cases had good results, according to the comprehensive score. CONCLUSIONS: Osseous genioplasty is a safe and effective means of creating a beautiful and balanced facial profile by producing alterations in the chin morphology with minimal complications and excellent and stable long-term results.

Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective.

CONTEXT: With the increasing emphasis on well-sculpted facial features, today there is a growing need for tools to augment the facial skeleton; either for cosmetic reasons or to re-contour deformities-congenital, post-traumatic and post-ablative. The limitations of autogenous materials has lead to evolution of numerous 'alloplasts', of which, high-density porous polyethylene (HDPE) seems to be a promising alternative. AIMS: To evaluate the long term results of HDPE in facial skeletal augmentation in terms of achieving desired facial contour, patient satisfaction and complications. SETTINGS: A tertiary care referral centre in a metropolitan set-up. DESIGN: Case Series MATERIALS AND METHODS: All patients undergoing HDPE implant insertion for facial skeletal augmentation between July 2001 and November 2009 were included in the study. A total of 70 HDPE implants were inserted in 44 patients. All procedures were performed by a single surgeon following standardized pre, intra and post-operative protocols. The results were evaluated with respect to improvement in facial contour desired and achieved, overall patient satisfaction and complications encountered. RESULTS: The study included 44 patients with a male:female ratio of 1:1, a mean age of 25.09 years (14 to 58 years) and a mean follow-up of 45.34 months (0.5 to 100 months). HDPE implants were used to augment the nasal dorsum, maxilla, malar eminence, chin, mandibular body and angle, orbital rim and frontal region. The overall recontouring afforded by the HDPE implants was good, with most patients reporting satisfactory results. There were seven complications (10%), including three cases of deviation (4.29%), three cases of exposure (4.29%) and one case of sub-clinical infection (1.43%). None however necessitated implant removal. Nasal dorsal HDPE implants, especially those involving secondary surgery, suffered a much higher complication rate compared to other implants. CONCLUSIONS: HDPE is an alternative to autogenous grafts for facial skeletal augmentation with good long-term results and a low incidence of complications, provided there is adequate vascular soft tissue cover.