Use of Autologous Costal Cartilage Combined with Expanded Polytetrafluoroethylene in Asian Rhinoplasty

BackgroundThe corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene (ePTFE) in Asian rhinoplasty were presented in this study.ObjectivesThe purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.MethodsSeventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed. Graft types, complications associated with the graft itself or graft harvesting, surgical outcomes, and patient satisfaction were assessed.ResultsThe mean follow-up time post-operation was 13.5 months. A total of 42/75 patients underwent revision surgeries. Graft-related complications were found in 8% of cases, including two warped graft and four infection cases. Three individuals with infections had mild graft resorption. One patient with an infection removed the implant. Graft exposure, mobility, and substantial resorption were not recorded. A total of two cases underwent revision procedures for infection and perforation, respectively. Chest incision lengths for graft harvesting averaged 2.1 cm. No pneumothorax or significant donor-site pain was found. Donor-site scars were negligible, although two cases had hypertrophic chest scars. In general, functional and esthetic outcomes were mostly satisfactory among the assessed patients.ConclusionsRhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring. Meanwhile, ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes. Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent, long-lasting results with minimal risk; however, the potential for infection should be considered following revision surgery.     

Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

BackgroundPosterior-stabilized antibiotic cement articulating spacers (PS spacers) reduce spacer mechanical complications in prosthetic knee infections (PKIs); however, joint dislocation after femoral cam fracture has been reported. We hypothesized that the rate of post-cam mechanical complications is lower in PS spacers with an endoskeleton-reinforced cam.MethodA retrospective study of PKIs using PS spacers with or without a Kirschner wire–reinforced cam (K-PS or nK-PS spacers, respectively) was conducted between 2015 and 2019. The rates of post-cam mechanical complications and reoperation, as well as risk factors for post or cam failure, were analyzed.ResultsThe cohort included 118 nK-PS and 49 K-PS spacers. All patients were followed up for 2 years. The rate of joint subluxation/dislocation after femoral cam fracture was lower in K-PS (0%) than in nK-PS spacers (17.8%; P = .002). The reoperation rate for spacer mechanical complications was lower in K-PS (0%) than in nK-PS spacers (11.9%; P = .008). The identified risk factors for femoral cam fractures were body mass index ≥25 kg/m², femoral spacer size ≤2, and surgical volume ≤12 resection arthroplasties per year.ConclusionThis preliminary study highlights that K-PS spacers have a lower rate of post-cam mechanical complications than nK-PS spacers. We recommend the use of PS spacers with endoskeleton-reinforced cam when treating PKIs performed by surgeons with lower surgical volumes, especially in patients with higher body mass index and smaller femoral spacer sizes.     

Breast reconstruction after therapeutic or prophylactic mastectomy for breast cancer: A comparison of guideline recommendations

BackgroundThe purpose of this article is to illuminate differences in published clinical practice guideline recommendations for breast reconstruction after prophylactic and therapeutic mastectomy.MethodsTen guidelines were identified through a systematic search of websites and databases of reputable oncology guideline developers, and key differences and gaps in recommendations were noted. Quality assessment of the guidelines was conducted by three reviewers using the AGREE II tool, focusing on breast reconstruction specific documents rather than the general breast cancer guidelines.ResultsThe most comprehensive guidelines were published by Alberta Health Services, Cancer Care Ontario, the American Society of Plastic Surgeons, and the Association of Breast Surgery/British Association of Plastic Reconstructive and Aesthetic Surgeons. AGREE II scores in the domains of “Scope and Purpose” and “Clarity and Presentation” were ranked relatively high for all four guidelines while “Applicability” and “Editorial Independence” were ranked relatively low. The Alberta and Ontario guidelines were the overall highest ranked guidelines across all domains.ConclusionOverall, these guidelines provide consistent recommendations on who should receive breast reconstruction education, who is a candidate for postmastectomy breast reconstruction, and the appropriate timing of reconstruction and extent of mastectomy. Future updates from all should focus on expanding to include alloplastic and autologous forms of reconstruction and should include a broad scope of relevant questions.     

Genetic testing has the potential to impact hearing preservation following cochlear implantation

Abstract

Background: Recent advances in less-invasive surgery and electrode design allow for a high degree of hearing preservation (HP) after cochlear implantation (CI), although residual hearing still deteriorates in some patients. To date, the factors predictive of preserving residual hearing remain a controversial topic.

Objective: The aim of this study was to investigate the predictive factors, including the etiology of hearing loss (HL) as a patient-related factor, influencing residual HP after CI.

Methods: Forty-four patients (50 ears, 41 families) with residual acoustic hearing who underwent CI were included. Auditory thresholds before and at 6 months after initial activation were measured. Genetic testing was performed to identify the responsible genes for HL.

Results: We identified the cause of HL in 21 families (51.2%). HP was marginally correlated with age at implantation, while it was independent of pre-operative low-frequency hearing thresholds, cochlear duct length, and electrode length. We found that patients who had pathogenic variants in the CDH23, MYO7A, or MYO15A gene showed statistically better HP scores compared with patients with HL due to other causes (p?=?.002).

Conclusions: Identification of the etiology of HL using genetic testing is likely to facilitate the prediction of HP after implant surgery.     

Nobel clinician软件引导上颌窦内提升术在磨牙缺失修复中的应用研究

目的:研究Nobelclinician软件引导上颌窦内提升术在磨牙缺失的应用效果,为临床应用提供指导。方法:选择2016年10月-2018年10月在笔者医院进行手术的86例上颌磨牙缺失患者为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组:采用常规上颔窦内提升术;观察组:在Nobelclinician软件引导下进行上颌窦内提升术,两组均使用nobelreplace种植体种植。比较两组患者的种植体存留率及种植体周围组织情况[包括术前上颌窦底距牙槽嵴骨高度(Bone height of the maxillary sinus floor from the alveolar ridge,RBH)、术后6个月新骨获得量、术后1年垂直骨丧失、牙周探诊深度(Periodontal probing depth,PPD)];比较两组患者治疗后的X片检查结果及治疗满意度。结果:观察组的RBH、PPD及术后1年垂直骨丧失均显著小于对照组,术后6个月新骨获得量显著大于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后随访6个月,观察组的种植体存留率(100.00%)与对照组(94.55%)相比,差异不具有统计学意义(P>0.05),X片检查结果显示,两组患者的种植体及周围骨组织均结合良好,术后1年均已生成新的上颌窦底壁。观察组患者的满意度(100.00%)显著高于对照组(90.70%),差异具有统计学意义(P<0.05)。结论:Nobelclinician软件引导上颌窦内提升术能够降低垂直骨丧失量,增加新骨获得量,有助于提高磨牙缺失修复的美学效果,提高患者满意度。     

感音神经性聋患儿伴分泌性中耳炎同期人工耳蜗植入效果分析

目的探讨伴分泌性中耳炎的感音神经性聋患儿同期植入人工耳蜗术后的听觉言语康复效果。方法回顾性分析安徽医科大学第一附属医院2015年1月到2017年12月期间伴分泌性中耳炎同期植入人工耳蜗的感音神经性聋患儿30例(A组)的临床资料,并与同期不伴分泌性中耳炎的感音神经性聋患儿30例(B组)比较。所有患儿均采用面隐窝入路植入人工耳蜗,术后随访24个月,采用听觉行为分级(categories of auditory performauce-Ⅱ,CAP-Ⅱ)和言语可懂度分级(speech intelligibility rating,SIR)评估并比较两组患儿的听觉言语康复效果。结果 A组患儿同期植入人工耳蜗后均未出现术后并发症,术前A组CAP-II评分为0.87±1.07分,SIR评分为1.07±0.37分,术后分别为5.07±0.91和3.73±0.87分,术后较术前明显提高(P<0.01)。B组术前CAP-II评分为0.93±1.17分,SIR评分为1.10±0.40分,术后分别为5.23±0.77和3.77±0.73分,术后较术前明显提高(P<0.01)。A组与B组之间术前、术后CAP-II和SIR评分差异均无统计学意义(P>0.05)。结论感音神经聋患儿伴分泌性中耳炎患儿同期人工耳蜗植入安全可行,且分泌性中耳炎对术后听觉言语康复效果无明显影响。