A new three-dimensional method of assessing facial volumetric changes after orthognathic treatment.

OBJECTIVE: To validate a new method of facial volumetric assessment that is dependent on the use of stereophotogrammetric models and a software-based Facial Analysis Tool. DESIGN: The method was validated in vitro with three-dimensional (3D) models of a lifelike plastic female dummy head and in vivo with a male-subject head. METHODS: Thirty facial silicone explants were added in the nasal and perioral regions of each head, and their volumes were obtained by three different algorithms. These were compared with the actual values obtained by a "water displacement" method. RESULTS: The least mean error was found with the "tetrahedron formation" method followed by the "projection" method and the "back-plane construction" method. The error with the tetrahedron formation method was 0.071 cm(3) (95% confidence interval [CI]: -0.074 to 0.2161 cm3) with the in vitro models and 0.314 cm3 (95% CI: -0.080 to 0.708 cm3) with the in vivo models. The increased volumetric assessment error observed in vivo was attributed to the registration procedure and possible changes in facial expression. CONCLUSIONS: These results encourage the use of this method in the 3D assessment of orthognathic surgical outcome, provided a standardized facial expression is used for image acquisition.     

A minimally invasive novel design for a vascular-pedicled bone segment for experimental studies of reconstruction of mandibular defects

We describe a new minimally invasive vascularised bone segment (VBS) for experimental reconstruction of the mandible. The study was validated and the feasibility was tested on fresh sheep cadavers. The integrity of the arterial blood supply was confirmed using inferior dental artery static arteriography. A pilot investigation was conducted on two adult sheep. Two full thickness bone cuts 35 mm apart were created in the parasymphyseal region. The inferior dental neurovascular bundle was preserved at the posterior bone cut but not anteriorly. A VBS was created, pedicled only on the inferior dental artery. The continuity of the mandible was maintained using fixation plates and the animals were followed up for 12 weeks. There was complete bony union and restoration of approximately 80% of the bony strength. The model is minimally invasive, reduces the operating time, and does not require special equipment and skills in microvascular anastomosis.     

Osteomyelitis of the accessory navicular bone in the foot. A case report

The accessory navicular is one of the most symptomatic bones of the foot. Osteonecrosis and fracture of this bone have been previously described. We report a case of osteomyelitis of an accessory navicular bone in a young girl, to make treating clinicians aware of this rare possibility.     

Sacral neuromodulation for refractory detrusor overactivity in women with an artificial urinary sphincter

PURPOSE: We assessed the efficacy of sacral neuromodulation as an alternative therapeutic option in women with an artificial urinary sphincter (AUS) who had de novo irritative urinary symptoms (urgency/frequency) refractory to conventional treatment. MATERIALS AND METHODS: Between 1984 and 2002 we implanted an AUS in 350 women and detrusor overactivity developed in 14. Six of the 14 patients responding positively to a percutaneous nerve evaluation test (greater than 50% subjective/objective improvement) were implanted with an S3 neuromodulator within 42.8 weeks (range 21 to 106) of AUS implantation. Followup included analysis of the voiding diary, a pad test and urodynamic assessment. RESULTS: After 30.5 months followup (range 14 to 40) 1 patient was dry, 4 were improved and treatment failed in 1. At 12 months mean voiding frequency daily had decreased from 17 (range 12 to 23) to 8 (range 4 to 12) and the mean number of leakages episodes daily had decreased from 14.7 (range 8.5 to 17) to 6 (range 4 to 10). Mean voided volume had increased from 121.7 (range 90 to 170) to 180 ml (range 120 to 225), mean first desire to void volume had increased from 117 (range 88 to 190) to 183 ml (range 130 to 275) and mean functional bladder capacity had increased from 325 (range 200 to 530) to 372 ml (range 250 to 580). Uninhibited bladder contractions had resolved in 4 of 5 patients. CONCLUSIONS: In women who already have an AUS with urge incontinence sacral neuromodulation can help resolve symptoms. Because this therapy does not compromise the potential for future treatment, it appears to be an alternative option in these patients. It can postpone or avoid more mutilating surgery and self-catheterization.     

A case of pulmonary sarcoidosis, not tuberculosis

The case of sarcoidosis of the lungs is described in a 50 years old female who presented with symptoms similar to pulmonary tuberculosis. As she showed no improvement on anti-tubercular therapy, sarcoidosis was suspected and confirmed by endobronchial biopsy and she responded well to treatment.     

Use of pupil size and reaction to detect orbital trauma during and after surgery

We describe how pupillary reactions, used as an index of optic nerve function, can be elicited using only one working pupil. This is to challenge the conclusion of a study that did not appreciate this physiological phenomenon and thus gave rise to erroneous conclusions that might otherwise limit the scope of pupil measurements during and after surgery. For suitable cases, non-opioid anaesthesia and further clinical development of pupillometry are suggested by us as measures to monitor optic nerve function.