Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

ObjectiveTo determine the appropriate amount of indocyanine green for bronchial insufflation.MethodsWe enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope.ResultsThe targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume.ConclusionsThe setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.     

Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.     

Primary undifferentiated high-grade pleomorphic sarcoma/malignant fibrous histiocytoma arising from the mandible

A patient who had a primary undifferentiated high-grade pleomorphic sarcoma/malignant fibrous histiocytoma that apparently arose in the mandible, but showed uncertain differentiation on histopathological examination, is described. Our regimen, a combination of pre- and postoperative chemotherapy and surgical resection, produced a good outcome.     

游离腹直肌皮瓣在口腔颌面大型缺损Ⅰ期修复中的应用

目的：探讨应用游离腹直肌皮瓣修复口腔颌面部癌术后大型缺损的可行性。方法：对18例口腔颌面部肿瘤切除术后大型缺损即刻游离移植腹直肌皮瓣修复，对临床资料进行分析和总结。结果：随访3～24个月，18例皮瓣完全成活，成活率100％。结论：腹直肌皮瓣游离移植是修复口腔颌面部大型缺损可靠和理想的方法。     

Orientation of craniofacial planes and temporomandibular disorder in young adults with normal occlusion

The aim of this study was to investigate the relationship between orientation of craniofacial planes relative to the true horizontal and temporomandibular disorder (TMD), in normal occlusion. Fourteen university dental students, with full natural dentition and bilateral Angle Class I occlusion, who exhibited signs and symptoms of TMD, were compared with 14 age- and sex-matched healthy controls. Frontal and lateral photographs were taken in natural head position with the subject standing up, clenching a Fox plane and having a facial arch positioned. Photographs were examined by a standardized image analysis. Inter-pupillary axis, Frankfurt, occlusal and Camper planes were evaluated. In frontal view, the Frankfurt plane was right rotated relative to the true horizontal both in TMD subjects (P < 0.01) and controls (P < 0.05), but rotation was larger in TMD subjects (mean difference between groups, 1.1 degrees, 95% confidence interval, 95% CI, 0.2-2.0 degrees ). No significant deviation from the horizontal or difference between groups was observed for the interpupillary axis and occlusal plane. In lateral view, the Frankfurt plane was upward-orientated relative to the true horizontal in TMD group (mean angular deviation 2.8 degrees, 95% CI, 1.0-4.6 degrees ). The occlusal and Camper planes were downward-orientated in both groups (P < 0.0001), but inclination of occlusal plane tended to be smaller in TMD subjects (mean difference between groups, -3.8 degrees, 95% CI, -7.6-0.1 degrees ). Angles between any craniofacial planes did not significantly differ between groups. The findings show that in young adults with normal occlusion, a weak association exists between the orientation of craniofacial planes in natural head position and signs and symptoms of TMD. Furthermore, they suggest that, within this population, TMD might be mainly associated with head posture rather than with craniofacial morphology.     

总义齿咬合平面定位对最大咬合力的影响

为观察总义齿咬合平面定位设计与患者咀嚼功能的关系，选择１０名无牙颌患者，分别为每个患者各作４副总义齿，其中有一副义齿（标准义齿）的咬合平面以上中切牙近中切角为基准或向后上、或向后下、或向左右方向倾斜５°。测定患者戴各义齿用单侧尽最大力咬合时的力值，发现患者戴标准义齿时平均最大咬合力值显著高于其它义齿。该结果提示：总义齿的咬合平面平分颌间距离且与耳屏鼻翼线平行最有利于无牙颌患者咀嚼功能的发挥     

A direct in vivo measurement of the three‐dimensional orientation of the occlusal plane and of the sagittal discrepancy of the jaws

The aim of the present investigation was to three dimensionally assess craniofacial relationships in vivo. Specifically, by using a non‐invasive direct technique, the following measurements were made: 1) natural head position relative to the ground; 2) orientation of the occlusal plane relative to the subject's intrinsic facial planes; and 3) anteroposterior discrepancy of the dental bases, taking into consideration all the facial hard‐ and soft‐tissue structures. Several dental and soft‐tissue facial landmarks were directly digitized from 24 adult healthy volunteers with Angle Class I occlusions by means of an electromagnetic three‐dimensional computerized digitizer. In natural head position, the three‐dimensional orientation of Camper's, occlusal, and mandibular planes were measured along with the anteroposterior maxillo‐mandibular discrepancies. In the frontal plane projection, all the measured planes appeared about horizontal. In the lateral plane projection, on average, Camper's plane deviated from the true horizontal by approximately 18° (in a ‘head flexed’ direction). The occlusal plane deviated from the same horizontal by about 14°, while the mandibular plane had a steeper inclination (about 30°); both planes were significantly correlated to Camper's plane. The measurements of anteroposterior jaw discrepancy revealed a wide range of sagittal relationships in the analyzed subjects. The method was found to be repeatable and fast. This direct three‐dimensional in vivo assessment of the orientation of occlusal plane relative to the other facial planes could allow for a more comprehensive analysis of maxillo‐mandibular sagittal discrepancies.     

正常汉族成年人前牙区牙槽宽度及根尖位置的研究

目的研究正常[牙合]成人前牙根尖与周围骨皮质的位置关系，为正畸矫治设计、筛选根吸收高危人群和预防医源性并发症等提供指导。方法选择正常拾青年98人，男女各半，年龄范围17～25岁，平均年龄20．29岁。拍摄头颅侧位定位片，测量并计算反映上下颌切牙根尖到周围骨皮质位置关系的12项指标及下颌平面角。建立上述测量指标的均值范围；相关分析研究下颌平面角对其影响。结果（1）建立正常[牙合]男女根尖位置及牙槽宽度的均值。（2）男性组中SN／MP与UH、UH／UW正相关，与UP负相关；女性组中SN／MP与LW负相关。结论（1）正常汉族成年人上下颌前牙牙槽骨宽度及根尖相对皮质骨位置比较稳定。（2）下颌平面角对根尖位置及牙槽宽度有一定影响。