Defining the Safe Entry Point in Deep Plane Facelifting with Novel Landmark for the Buccal Branch of the Facial Nerve.

Background: In deep facial surgery, accurate preoperative landmarking of branches of the facial nerve is helpful in avoiding inadvertent facial nerve injury. The objective of our study was to determine the accuracy at which the intersection point of two bisecting lines that join facial surface landmarks can be used to accurately locate the buccal branch(es) of the facial nerve, specifically at the deep plane entry point (ie, intercept landmark). Methods: Thirty-three cadavers were dissected to determine the position of the buccal rami relative to the intercept. Results: Buccal rami crossed the intercept in 12.12% of specimens (0 mm from intercept, n = 4). Buccal rami passed superiorly in 66.67% of specimens (3.71 ±â€…3.28 mm from intercept, n = 7) and inferiorly in 21.21% of specimens (2.44 ±â€…0.92 mm from intercept, n = 7). Noteworthy, buccal rami were located within 1 cm of the intercept landmark with 96.97% accuracy (32/33 cadavers). Conclusions: These data suggest that this novel intercept (1) reliably locates the buccal branch of the facial nerve as it courses distal to the parotid gland, and (2) helps define a "safe zone" for entry into the deep plane where the likelihood of encountering the facial nerve is extremely low.

Greater glycemic control following low-load, high-repetition resistance exercise compared with moderate-intensity continuous exercise in males and females: a randomized control trial.

Exercise has long been known for its beneficial effects on insulin sensitivity (IS) and glucose handling with both moderate-intensity continuous (MIC) exercise and resistance exercise (RE) inducing beneficial effects. In recent years, low-load, high-repetition (LLHR) RE has emerged as a strategy to increase muscle mass and strength to levels similar to traditional RE; however, the effects of LLHR RE on glucose handling has yet to be investigated. The purpose of this trial was to compare the acute effects of LLHR RE to MIC exercise on post-exercise glycemic control and insulin sensitivity in males and females. Twenty-four (n = 12/sex) participants completed acute bouts of MIC exercise (30 min at 65% V̇O2peak) and LLHR (3 circuits, 6 exercises/circuit, 25-35 repetitions/exercise/circuit) matched for time with muscle biopsies immediately pre and post exercise and an oral glucose tolerance test (OGTT) 90 min following exercise. Blood glucose concentrations (p = 0.002, ηp 2 = 0.37), glucose AUC (p = 0.002, ηp 2 = 0.35) and max glucose concentration (p = 0.003, ηp 2 = 0.34) were lower during the post exercise OGTT following LLHR RE compared to MIC exercise. There was a main effect of trial on TBC1D1 Ser237 phosphorylation (p = 0.04, ηp 2 = 0.19) such that it was greater following MIC exercise compared to LLHR RE. Furthermore, phosphorylated ACC Ser79 increased following MIC exercise with no change following LLHR RE (p < 0.001, ηp 2 = 0.50). Phosphorylation of PTEN Ser380 was greater in males than females during LLHR RE (p = 0.01, ηp 2 = 0.27). These findings suggest that LLHR RE is a feasible exercise modality to improve post-exercise glycemic control in both males and females. Trial registration number: NCT06217679.

Approach to burn treatment in the rural emergency department.

OBJECTIVE: To outline an approach to the assessment and initial management of patients with burns in the rural emergency department setting. Three mnemonics are presented that can be used for both the assessment and the initial management of patients with burns in rural settings. QUALITY OF EVIDENCE: Current and local guidelines compiled by a plastic surgeon were reviewed to develop a systematic approach to the treatment of patients with burns. PubMed and other databases were also searched for current literature on emergency care of patients with burns. MAIN MESSAGE: Burn injuries are a common reason for presentation to the emergency department. However, the care of patients with these injuries can vary substantially depending on geographic location, provider training, and hospital resources. Classification of burns, fluid resuscitation guidelines, dressings and wound care, indications for referral, and pain management are discussed. CONCLUSION: Using a systematic approach may help improve burn injury outcomes for patients and provide practitioners with a step-by-step framework for the management of patients with burns in rural settings.

Treatment of acquired partial oculomotor nerve palsy with dexamethasone - A case report.

INTRODUCTION/IMPORTANCE: Oculomotor nerve palsy is an acquired condition caused by injury to the third cranial nerve. Patients present classically with their eye in a "down and out" positioning, ptosis and abnormalities in most extraocular movements causing diplopia. Ocular dysfunction may be due to a variety of different etiologies, such as aneurysm, microvascular disease, trauma, and viral infections. Clinical prognosis is usually quite good and is often self-limiting. CASE REPRESENTATION: We present a case of an otherwise healthy 40-year-old male who awoke one morning with moderate diplopia, unable to focus with binocular vision and developed eyelid ptosis two days later. He was previously infected with the Omicron variant of COVID-19; however, a rapid test could not confirm it. No intracranial or vascular pathology were identified on CT head, CT angiogram, or MRI. Repeat COVID-19 PCR test was negative. He was assessed by a neuro-ophthalmologist and was diagnosed with left partial oculomotor nerve palsy presumed secondary to viral microvascular injury. COVID-19 infection seemed likely given the history but could not be confirmed. The specialist recommended monitoring the patient without any treatment, with no recommendation of corticosteroid use. CLINICAL DISCUSSION: Cranial neuropathy guidelines for viral palsies involving the 7th or 8th cranial nerve are treated with corticosteroids. After considering the risks, the patient elected treatment with a left eye patch and a dexamethasone taper. Full return of function in all extremes of gaze was restored less than 2 months after onset. CONCLUSION: Given the complete and timely recovery, it may be reasonable to consider corticosteroids for all cranial neuropathies.

Non-Hodgkins lymphoma of the nasal cavity: A case report.

We present a rare case of an 81-year-old woman presenting with acute left nasal blockage caused by a large nasal mass of unknown origin. The mass was subsequently diagnosed as diffuse large B-cell non-Hodgkin lymphoma (NHL). Nasal/paranasal space involvement in NHL is uncommon, representing only 0.2%-2% of cases. In this case, the nasal NHL mass exhibited a favorable prognosis, in contrast to previously reported sinonasal lymphomas with poor outcomes. The patient underwent excisional biopsy and was treated with 3 cycles of R-CHOP chemotherapy, resulting in complete resolution of the mass confirmed by a follow-up CT scan and no signs of disease after 1 year. Differentiating sinonasal lymphomas from other neoplasms can be challenging due to their variable morphology and location. Diffuse presentations of sinonasal lymphoma can aid in distinguishing them from discrete lesions associated with other sinonasal neoplasms. However, differentiation from acute invasive sinonasal infection remains difficult. MRI can help identify lymphomas through the characteristic hypointense T2 signal and diffusion restriction, with the combined use of CT to aid in differentiating masses of unknown morphology. Nonetheless, squamous cell carcinoma, which mimics lymphoma features on MRI, poses additional challenges to accurate identification. This case highlights the rarity of nasal NHLs, their potential for excellent prognosis, and the importance of diverse imaging techniques in their diagnosis and differentiation from other sinonasal pathologies.