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BMC Oral Health Aug 2019A common strategy in the non-extraction treatment of Class II molar relationship is maxillary molar distalization, which could increase lower face height and cause...
BACKGROUND
A common strategy in the non-extraction treatment of Class II molar relationship is maxillary molar distalization, which could increase lower face height and cause clockwise mandibular rotation. The aim of this retrospective study was to analyse the effects on vertical dentoskeletal dimension of young adults treated with sequential distalization with orthodontic aligners.
METHODS
Lateral cephalometric radiographs of 10 subjects (8 females 2 males; mean age 22.7 ± 5.3 years) treated with upper molars sequential distalization with orthodontic aligners (Invisalign, Align Technology, San Josè, California, USA) were analyzed.
RESULTS
No statistically significant difference was observed for the primary outcome SN-GoGn between T0 and T1 and it was recorded a mean variation of 0.1 ± 2.0 degrees. Statistically significant differences were found in the linear position of the upper molars (6-PP, 7-PP) the molar class relationship parameter (MR) and the upper incisive inclination (1^PP) with at least p < 0.01.
CONCLUSIONS
Upper molar distalization with orthodontic aligners guarantee an excellent control of the vertical dimension representing an ideal solution for the treatment of hyperdivergent or openbite subjects. It also allows an excellent control of the incisal torque without loss of anchorage during the orthodontic procedure.
Topics: Adolescent; Adult; California; Cephalometry; Female; Humans; Incisor; Male; Malocclusion, Angle Class II; Maxilla; Molar; Orthodontic Appliance Design; Orthodontic Appliances, Removable; Retrospective Studies; Tooth Movement Techniques; Vertical Dimension; Young Adult
PubMed: 31409348
DOI: 10.1186/s12903-019-0880-8 -
The International Journal of Angiology... Dec 2018The dogma for optimal arteriovenous fistula (AVF) creation is based on starting as distally as possible on the upper limb and progressing proximally. We herein present...
The dogma for optimal arteriovenous fistula (AVF) creation is based on starting as distally as possible on the upper limb and progressing proximally. We herein present our findings of an AVF that is as distal as possible on the hand. To document primary patency rates of the distal-to-snuffbox AVF. A 10-year prospective study (2006-2016) involving 31 patients whose distal cephalic vein diameter was ≥3 mm with a normal Allen's test was conducted. Patients were excluded if the radial artery in the wrist was highly calcified, the cephalic vein did not dilate more than 3 mm with proximal compression, and there was previously failed AVF of the limb or previous trauma to the limb. The procedure was performed under local anesthetic, and the anastomosis performed with a 6.0 polypropylene suture in an end-to-side fashion. Thirty-one patients with end-stage renal disease underwent distal vascular access using the distal-to-snuffbox (Hitchhiker's) AVF (HAVF). During follow-up, eight patients died with an adequately functioning HAVF. The primary patency rates at 12, 24, 48, and 60 months were 90, 87, 85, and 82%, respectively. Failure occurred in six (19%) cases over the follow-up period, two in the first 2 weeks and four over a span of 60 months. The creation of radiocephalic AVFs in the first web space, distal to the tendon of the extensor pollicis longus, serves as a viable option with acceptable success rates. This allows the surgeon more options with proper patient selection for this procedure.
PubMed: 30410295
DOI: 10.1055/s-0038-1660803 -
The Angle Orthodontist Jul 2020To determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II...
OBJECTIVES
To determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II skeletal relationships.
MATERIALS AND METHODS
The sample included 59 adolescents (16 boys and 43 girls) with unilateral or bilateral Class II molar and bilateral Class II canine relationship. They were divided into group 1 with skeletal Class I (N = 27; ANB 2.90° ± 1.40°; 13.30 ± 1.53 years) and group 2 with skeletal Class II (N = 32; ANB 6.06° ± 1.64°; 13.26 ± 1.76 years). Cone beam computed tomography images were traced with Invivo software pretreatment (T1) and post-CMA usage (T2). The treatment changes in 36 measurements were calculated in each group, and the changes in 16 measurements were compared between them.
RESULTS
In group 1 and 2, maxillary first molars underwent significant distal movement (1.92 mm ± 0.80 mm and 1.67 mm ± 1.56 mm, respectively) with distal tipping and rotation, maxillary canines underwent significant distal movement (2.34 mm ± 1.07 mm and 2.24 mm ± 1.91 mm, respectively) with distal tipping and rotation, and mandibular molars underwent significant mesial movement (-1.37 mm ± 1.23 mm and -2.51 mm ± 1.51 mm, respectively) with mesial tipping. Between the groups, there were significant differences in mandibular molar mesial movement and the U1-SN changes (P < .05).
CONCLUSIONS
The CMA corrected Class II malocclusion through distal tipping and rotational movement of maxillary canines and molars and corrected mesial tipping of mandibular molars. Significantly more mandibular molar mesial movement and maxillary incisor flaring were observed in patients with skeletal Class II.
Topics: Adolescent; Cephalometry; Female; Humans; Incisor; Male; Malocclusion, Angle Class II; Maxilla; Molar; Orthodontic Appliance Design; Tooth Movement Techniques
PubMed: 33378493
DOI: 10.2319/080919-523.1 -
Annals of Plastic Surgery Jan 2023Soleus muscle flap can be used in different modifications to reconstruct lower limb defects. It can be proximally based, distally based, island or reversed flow flap....
BACKGROUND
Soleus muscle flap can be used in different modifications to reconstruct lower limb defects. It can be proximally based, distally based, island or reversed flow flap. The first description of the soleus muscle as an island flap supplied by one distal perforator was reported by Yajima et al (Plast Reconstr Surg. 1995;96:1162-1168). However, its use as a propeller flap supplied by the distal perforators and rotated for more than 90 degrees was not described yet.
OBEJECTIVES
The aims of the study are to study the detailed vascular anatomy of the distal perforators of the soleus muscle flap and to demonstrate the applicability of using it as a propeller flap.
PATIENTS AND METHODS
A total number of 42 patients were included in this study. These patients had various distal leg and foot defects. All patients were assessed preoperatively by Doppler study and computed tomography angiography to define the vascular status of the leg. The muscle was raised as a reversed flow flap, based on 1 or more distal perforators and its feeding vessel (posterior tibial artery) after being dissected and divided proximally. The muscle was rotated for more than 90 degrees to reach distal leg defects and approximately 180 degrees to reach the foot defects.
RESULTS
All flaps survived completely with good and durable coverage. The vascularity of the limb was not affected in all patients. There was no functional donor site morbidity.
CONCLUSIONS
The reversed flow hemisoleus muscle flap supplied by the distal perforators and the posterior tibial artery has a great arc of rotation that can cover all distal leg, ankle, and foot defects. Therefore, it can be used as alternative to free flap in lower extremity reconstruction. A new nomenclature is suggested for this flap which is the propeller hemisoleus muscle flap.
Topics: Humans; Plastic Surgery Procedures; Foot; Muscle, Skeletal; Tibial Arteries; Free Tissue Flaps; Perforator Flap; Soft Tissue Injuries
PubMed: 36534105
DOI: 10.1097/SAP.0000000000003365 -
International Journal of Sports... Apr 2019Distal biceps rupture is less common than injury to the proximal biceps; however, injury distally has profound functional implications on activities which rely on power...
BACKGROUND AND PURPOSE
Distal biceps rupture is less common than injury to the proximal biceps; however, injury distally has profound functional implications on activities which rely on power during elbow flexion and forearm supination. The majority of distal biceps ruptures can be treated with surgical repair of the distal biceps utilizing either a single or two-incision technique; both of which achieve comparable improved outcomes and reported minimal pain and disability at two years. Safe and effective rehabilitation following distal biceps repair is accomplished through a phased progression, with avoidance of premature stress to the healing soft tissue repair.The purpose of this clinical commentary is to provide a concise review of distal biceps tendon injury, including relevant anatomy, etiology, diagnosis, and operative intervention as well as post-operative factors influencing the pursuit of a criterion based, progressive rehabilitation program after distal biceps tendon repair. This commentary seeks to provide an update on current treatment strategies used in distal biceps rehabilitation with accompanying scientific rationale.
LEVEL OF EVIDENCE
5.
PubMed: 30997282
DOI: No ID Found -
Journal of Wrist Surgery Nov 2017There is a paucity of information on the microstructure of the distal radius, and how this relates to its morphology and function. This study aims to assess the...
There is a paucity of information on the microstructure of the distal radius, and how this relates to its morphology and function. This study aims to assess the microanatomical structure of the distal radius, and relate this to its morphology, function, and modes of failure. Six dry adult skeletal distal radii were examined with microcomputed tomography scan and analyzed with specialist computer software. From 3D and 2D images, the subchondral, cortical, and medullary trabecular were assessed and interpreted based on the overall morphology of the radius. The expanded distal radial metaphysis provides a wide articular surface for distributing the articular load. The extrinsic wrist ligaments are positioned around the articular perimeter, except on the dorsal radial corner. The subchondral bone plate is a 2 mm multilaminar lattice structure, which is thicker below the areas of the maximal articular load. There are spherical voids distally, which become ovoid proximally, which assist in absorbing articular impact. It does not have Haversian canals. From the volar aspect of the lunate facet, there are thick trabecular columns that insert into the volar cortex of the radius at the metaphyseal-diaphyseal junction. For the remainder of the subchondral bone plate, there is an intermediate trabecular network, which transmits the load to the intermediate trabeculae and then to the trabecular arches. The arches pass proximally and coalesce with the ridges of the diaphyseal cortex. The distal radius morphology is similar to an arch bridge. The subchondral bone plate resembles the smooth deck of the bridge that interacts with the mobile load. The load is transmitted to the rim, intermediate struts, and arches. The metaphyseal arches allow the joint loading forces to be transmitted proximally and laterally, providing compression at all levels and avoiding tension. The arches have a natural ability to absorb the impact which protects the articular surface. The distal radius absorbs and transmits the articular impact to the medullary cortex and intermediate trabeculae. The medullary arches are positioned to transmit the load from the intermediate trabeculae to the diaphysis. The microstructure of the distal radius is likely to be important for physiological loading of the radius. The subchondral bone plate is a unique structure that is different to the cancellous and cortical bone. All three bone types have different functions. The unique morphology and microstructure of the distal radius allow it to transmit load and protect the articular cartilage.
PubMed: 29085733
DOI: 10.1055/s-0037-1602849 -
JBJS Essential Surgical Techniques 2022Open release of a trigger thumb has been shown to be the most reliable option to restore full interphalangeal (IP) joint extension and thus normal thumb-joint motion in...
UNLABELLED
Open release of a trigger thumb has been shown to be the most reliable option to restore full interphalangeal (IP) joint extension and thus normal thumb-joint motion in children. The aim of this procedure is to restore free gliding of the flexor pollicis longus (FPL) tendon in its canal in children with fixed IP joint flexion contractures or those in whom nonoperative treatment modalities have failed.
DESCRIPTION
The surgical procedure is easy to perform and straightforward; however, attention must be given to several details in order to avoid surgical failure and complications. General anesthesia is required for this procedure. The extremity is prepared and draped in a sterile fashion with the patient in the supine position, and a tourniquet is utilized to facilitate surgical dissection. A transverse incision is gently made just adjacent to the thumb metacarpophalangeal (MP) flexion crease, above the so-called Notta nodule. The ulnar neurovascular bundle is retracted to the side, and the Notta nodule, a local enlargement of the FPL tendon, is visualized at the A1 pulley. The pulley is incised longitudinally to allow for full IP joint extension. After verification of full passive motion, the tendon is inspected for any further abnormalities. Then, the tourniquet is released, and the wound is closed with absorbable sutures. We recommend the use of local anesthetics for postoperative pain control. In cases of a trigger thumb stuck in extension, full tenodesis flexion of the IP joint combined with smooth, full passive extension confirms a complete release.
ALTERNATIVES
Nonoperative treatment modalities mainly include watchful waiting for spontaneous resolution, occupational therapy (i.e., passive exercising), and splinting therapy. However, prolonged stretching and splinting may move the nodule to a point distal to the stenotic pulley, thus resulting in a trigger thumb locked in extension with a loss of IP flexion. Alternative surgical treatment techniques involve percutaneous trigger thumb release or open release with alternative surgical approaches (e.g., an oblique or Brunner incision).
RATIONALE
Several reports have shown that open release of a trigger thumb leads to the most reliable outcomes in terms of achievement of range of motion and complications. The main advantage of this procedure is the perfect visualization of the FPL tendon beneath the stenotic A1 pulley, which allows for a complete A1 release with clear vision. Such visualization cannot be provided with use of percutaneous techniques, which position the neurovascular bundle in potential danger for iatrogenic injury or may lead to incomplete pulley release. Moreover, the use of this procedure allows parents to avoid the prolonged therapy and splinting associated with nonoperative treatment. Formal rehabilitation is usually not necessary postoperatively.
EXPECTED OUTCOMES
Open release of a trigger thumb is a safe and reliable option that leads to full range of motion in 95% of children, which is substantially higher than for nonoperative treatment with therapy (55%) and splinting (67%). Even delayed open release may provide satisfactory outcomes. Although spontaneous resolution without surgery has been reported in 63% of cases, patients with a flexion contracture of >30° showed spontaneous resolution in only 2.5% of cases. Furthermore, the open surgical technique has been shown to have a lower rate of complications (around 3.4%) compared with percutaneous techniques, which showed a 3.29 times increased risk of recurrence and relevant injury to the neurovascular bundle. If the A1 is fully divided, recurrence is highly unlikely. Postoperative rehabilitation is very quick following open release of a trigger thumb because closure under local anesthesia provides a painless postoperative course, wounds heal within a few days, and children are allowed to resume play immediately once a bandage is applied.
IMPORTANT TIPS
The use of surgical loupes is of paramount importance to safely perform this procedure.Place the skin incision adjacent but not directly onto the palmar MP flexion crease for better scar formation.Divide the skin very gently because the A1 pulley is located directly under the skin, and the FPL and radial nerve can be harmed easily. Retract the ulnar neurovascular bundle aside so as to allow for safe preparation until A1 division.Divide the A1 pulley until the Notta nodule on the FPL can safely glide distally into full IP extension. In some cases with large, distally-sitting nodules, the pulley incision must be extended distally into the oblique bundle.A sign that the entire A1 pulley is released is seeing the corner formed by the distal edge of the pulley and the longitudinal cut in the pulley. Additionally, the cut halves of the fully released pulley will rest completely in the sagittal plane of the thumb, no longer converging over the FPL tendon.Tight bands can exist proximal and distal to the A1 pulley and should be released as well if present.Check for a tight IP volar plate following A1 division, which may require postoperative splinting.For thumbs stuck in extension, tenodesis can be utilized to verify complete A1 release.Utilize absorbable sutures, local anesthesia, and a bulky dressing to allow a comfortable postoperative course.
ACRONYMS AND ABBREVIATIONS
IP = interphalangealMP = metacarpophalangealFPL = flexor pollicis longusROM = range of motionANOVA = analysis of variance.
PubMed: 36741041
DOI: 10.2106/JBJS.ST.21.00053 -
Cardiovascular Diagnosis and Therapy Jun 2022The frozen elephant trunk technique has become a well-established treatment option for patients presenting all thoracic aortic pathologies including acute and chronic... (Review)
Review
The frozen elephant trunk technique has become a well-established treatment option for patients presenting all thoracic aortic pathologies including acute and chronic dissection, aortic aneurysms and even penetrating aortic ulcers involving the aortic arch and descending aorta. Nevertheless, there is a significant incidence of and risk for distal aortic reinterventions after the frozen elephant trunk. Indications mainly include a planned staged approach, diameter progression of downstream aortic segments and the development of distal stent-graft induced new entries (dSINEs). Endovascular stent-graft extension through conventional thoracic endovascular aortic repair (TEVAR) is a relatively simple and safe method to address any pathologies in the remaining descending thoracic aorta up to the level of the coeliac trunk. In fact, the frozen elephant trunk stent-graft provides an ideal proximal landing zone for any endovascular stent-graft extension. Postoperative outcomes are very promising with very low reported in-hospital mortality and morbidity. In case this 2-staged-approach fails to stabilize the remaining aorta, a 3-step procedure, namely open thoracoabdominal aortic replacement, is simplified because the anastomosis site has moved distally. Follow-up of all patients, following frozen elephant trunk implantation or distal stent-graft extension, is mandatory, ideally in an outpatient clinic dedicated to the aorta in order to identify disease progression or to detect any complications as soon as possible.
PubMed: 35800359
DOI: 10.21037/cdt-22-99 -
Developmental Biology Sep 2017Vertebrate limb development relies on the activity of signaling centers that promote growth and control patterning along three orthogonal axes of the limb bud. The... (Review)
Review
Vertebrate limb development relies on the activity of signaling centers that promote growth and control patterning along three orthogonal axes of the limb bud. The apical ectodermal ridge, at the distal rim of the limb bud ectoderm, produces WNT and FGF signals, which promote limb bud growth and progressive distalization. The zone of polarizing activity, a discrete postero-distal mesenchymal domain, produces SHH, which stimulates growth and organizes patterning along the antero-posterior axis. The dorsal and ventral ectoderms produce, respectively, WNT7A and BMPs, which induce dorso-ventral limb fates. Interestingly, these signaling centers and the mechanisms they instruct interact with each other to coordinate events along the three axes. We review here the main interactions described between the three axial systems of the developing limb and discuss their relevance to proper limb growth and patterning.
Topics: Animals; Body Patterning; Extremities; Models, Biological; Signal Transduction
PubMed: 28283405
DOI: 10.1016/j.ydbio.2017.03.006