bluuebunny/crossref_metadata_2025_split huggingface dataset:
Semilunar Flap for Minimizing the Scar Length in Nipple Reconstruction
Authors: Lee Jang Won , Hwang Euna 
Published: December 2018

Summary:
Nipple reconstruction is an essential procedure to change an amorphous breast mound to a distinct breast. Various skin flaps have been proposed for nipple reconstruction. In the C-V flap technique, which is one of the most commonly used flaps for nipple reconstruction, the scar that is developed after closure of the donor site of the V-flap frequently extends beyond a new areola area. To reduce the length of the donor site scar, various modifications of the C-V flap have been proposed. We adopted the semilunar flap instead of the V flap of C-V flap by changing the angle of V flap for nipple reconstruction. The semilunar flap design allowed generation of a donor flap with sufficient width and length of the skin flap for a nipple barrel without increasing the length of the donor site scar. In most cases, the semilunar flaps showed stable outcomes and resulted in angled donor-site scars that were usually located within the boundary of a new areola. We think the semilunar flap represents a good alternative method in nipple reconstruction by changing the angle of the donor-site scar and leaving the scar length within the new areolar area.
Lower Extremity Muscle Strength and Force Variability in Persons With Parkinson Disease
Authors: Skinner Jared W. , Christou Evangelos A. , Hass Chris J. 
Published: December 2018

Background and Purpose:
Adequate lower limb strength and motor control are essential for mobility and quality of life. People with Parkinson disease (PD) experience a significant and progressive decline in motor capabilities as part of this neurodegenerative disease. The primary objective of this study was to examine the effect of PD on (1) muscular strength and (2) force steadiness in muscles that are primarily responsible for locomotion and stability.

Methods:
Thirteen persons with PD and 13 healthy age-matched controls participated. Participants performed maximal and submaximal (5%, 10%, and 20% maximum voluntary contractions) isometric force tasks with the limb stabilized in a customized device. Strength of the hip extensors and flexors, hip abductors and adductors, and ankle plantar flexors and dorsiflexors was quantified based on data obtained from force transducers, with the relevant joint stabilized in standardized positions.

Results:
Individuals with PD were weaker and exhibited higher amounts of force variability than controls across the lower extremity. Reduced strength was greatest in the hip flexors (2.0 N/kg vs 2.6 N/kg) and ankle plantar flexors (1.74 N/kg vs 2.64 N/kg) and dorsiflexors (1.9 N/kg vs 2.3 N/kg). Force steadiness was impaired in the hip flexors, ankle plantar flexors, and dorsiflexors.

Discussion and Conclusions:
Reduced maximal force production was concomitant with impaired force control within the muscles that are critical for effective ambulation (hip flexion, ankle dorsiflexion, and ankle plantar flexion). These features should be evaluated when considering contributors to reduced mobility and quality of life.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A241).
Procalcitonin and Other Common Biomarkers Do Not Reliably Identify Patients at Risk for Bacterial Infection After Congenital Heart Surgery
Authors: D’Souza Shane , Guhadasan Rathi , Jennings Rebecca , Siner Sarah , Paulus Stéphane , Thorburn Kent , Chesters Christine , Downey Colin , Baines Paul , Lane Steven , Carrol Enitan 
Published: December 2018

Objectives:
Following surgery, it is difficult to distinguish a postoperative inflammatory reaction from infection. This study examined the predictive value of the biomarkers; procalcitonin, C-reactive protein, lactate, neutrophils, lymphocytes, platelets, and the biphasic activated partial thromboplastin time waveform in diagnosing bacterial infection following cardiac surgery.

Design:
Prospective, observational study.

Setting:
A regional, PICU in the United Kingdom.

Patients:
Three-hundred sixty-eight children under the age of 16 admitted to the PICU for elective cardiac surgery were enrolled in the study.

Interventions:
All biomarker measurements were determined daily until postoperative day 7. Children were assessed for postoperative infection until day 28 and divided into four groups: bacterial infection, culture-negative sepsis, viral infection, and no infection. We used the Kruskal-Wallis test, chi-square test, analysis of variance, and area under the curve in our analysis.

Measurements and Main Results:
In total, 71 of 368 children (19%) developed bacterial infection postoperatively, the majority being surgical site infections. In those with bacterial infection, procalcitonin was elevated on postoperative days 1–3 and the last measurement prior to event compared with those without bacterial infection. The most significant difference was the last measurement prior to event; 0.72 ng/mL in the bacterial infection group versus 0.13 ng/mL in the no infection group (for all groups; p < 0.001). Longitudinal profiles of all biomarkers were indistinct in the bacterial infection and nonbacterial infection groups except in those with culture-negative infections who had distinct procalcitonin kinetics on postoperative days 1–4. Children with culture-negative sepsis required longer ventilatory support and PICU stay and were more likely to develop complications than the other groups.

Conclusions:
None of the biomarkers studied within 3 days of infection distinguished between infection and postoperative inflammatory reaction. However, procalcitonin kinetics peaked on postoperative day 2 and fell more sharply than C-reactive protein kinetics, which peaked at postoperative day 3. The monitoring of procalcitonin kinetics following cardiac surgery may help guide rational antimicrobial use.
Nonsurgical Rhinoplasty: Nasal Grid Analysis and Nasal Injecting Protocol
Authors: Bertossi Dario , Lanaro Luca , Dorelan Simone , Johanssen Kristen , Nocini Pierfrancesco 
Published: December 2018

Background:
Nonsurgical rhinoplasty using injectable fillers improved skin quality and texture, cost-effectiveness, and quick recovery. The aim of this study was to provide a valid and customized protocol for injecting the nose with the aid of a nasal grid.

Methods:
From January of 2015 to October of 2018, 150 consecutive patients entered the trial. The mean patient age was 36 years (range, 16 to 60 years). The patients were divided into two arms: primary nasal defects (no previous surgery, n = 109) and secondary nasal defects (previous surgery, n = 41). The primary defect group included 43 male patients and 66 female patients, and the secondary nasal defect group included 14 male patients and 27 female patients. Within each arm, patients were stratified into three age group tiers: younger than 30 years, 30 to 45 years, and older than 45 years.

Results:
The grid became the reference for quantity and sequence of injection records. The overall complication rate was 1.82 percent, and a visual analogue scale ranging from 1 to 10 was implemented (with 10 being the most accurate correction). Of the patients evaluated, 98.350 percent scored 8 to 10, 0.825 percent scored 6 to 8, and 0.825 percent scored below 6.

Conclusions:
Fillers can be either alternatives or complementary to plastic surgery. Nonsurgical rhinoplasty, with its avoidance of general anesthesia, splints, swelling, and bruising, represents a distinct advantage, allowing the patient to return to work as quickly as the same or the next day.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Wider Suturectomy Before Posterior Distraction for Craniosynostosis
Authors: Kyutoku Shigeo , Iwanaga Masahiro , Okamoto Toyoko , Harada Atsuko , Ueda Koichi 
Published: December 2018

Abstract
The aim of the surgery for craniosynostosis is to release increased intracranial pressure and to normalize cranial shape. The procedure has developed so far in Japan, from a simple strip craniectomy before 1960s through a total calvarial remodeling after 1970s and later methods of 1990s, such as distraction and its modifications applying to the posterior cranium. Since a distracter needs certain hardness and thickness of the bone, the surgery has to be stood by until 5 to 6 months of age. Modified Jimenez procedure, as a latest option, were applied for very early years of 10 patients with several types of craniosynostosis, in our team in the past 3 years. The experience was small with short follow-up; the results are all good in those volume change and shape. The procedure proved to be another alternative especially prior to posterior distraction of syndromic patients in terms of positive and expedited control in an earlier surgical management.
Cone Beam Computed Tomographic Evaluation of Intracranial Physiologic Calcifications
Authors: Bayrak Seval , Göller Bulut Duygu , Kurşun Çakmak Emine Şebnem , Orhan Kaan 
Published: December 2018

Objective:
The aim of the present study was to evaluate the incidence of physiologic intracranial calcifications detected in cone beam computed tomography (CBCT) images of a Turkish subpopulation.

Methods:
The CBCT image of the full head of 573 patients taken between 2015 and 2018 was evaluated retrospectively. The prevalence of habenular calcification, petroclinoid ligament, coroid plexus, interclinoid ligament (ICL), and carotico-clinoid ligament (CCL) calcifications was investigated. The age and gender of the patients were recorded.

Results:
Intracranial calcification was found in 190 (33.1%) of 573 cases. The frequency of physiological calcifications is respectively; 19.2% were found as habenular, 4.88% as ICL, 3.83% as CCL, 2.7% as petroclinoid ligament, and 2.4% as choroid plexus. 38.2% of the women and 29.3% of the men had intracranial calcification. In 4 patients, both ICL and CCL ossification were detected. No statistically significant relationship was found between age, gender, and calcifications.

Conclusion:
Cone beam computed tomography is a widely used imaging technique for dental diagnosis and treatment. Intracranial physiological calcifications may be a common incidental finding of CBCT scans.
Supplemental Internal Wire Suspension in Orthognathic Surgery Fixation
Authors: Harikrishnan Pandurangan , Madivanan Ilangovan 
Published: December 2018

Abstract
Internal wire suspensions were previously used in the management of maxillary trauma and orthognathic surgery, but currently the gold standard is rigid internal fixation with bone plates and screws. The authors report a case of bimaxillary osteotomy in a skeletal class III patient where a supplemental circum-zygomatic-mandibular suspension was done to stabilize the maxilla because of the instability after rigid internal fixation due to poor bone thickness.
The Fate of the Mandibular Reconstruction Plate
Authors: Abdulrazaq Saif Saadedeen , Riyadh Safaa 
Published: December 2018

Abstract
To preserve the continuity of the mandible after resection or traumatic bone loss, the defect is usually reconstructed with a bone graft fixed by a reconstruction plate. The fate of these plates is the objective of this study. Twenty-three patients (4 females and 19 males) required a reconstructive procedure to restore the discontinuity defect in the mandible by a mandibular reconstruction plate. Postoperative follow-up was performed to assess the outcomes of these plates. The mean age of the patients was 28.22 years. The most common cause of the discontinuity defect was bullet injury. The mean follow-up period was 3.65 years. The most common postoperative complication was the surgical site infection. The reconstruction plate of the mandible is associated with long-term success and body acceptance in the hands of an experienced surgeon.
Immunoglobulin G4-Related Periorbital Soft-Tissue Destruction
Authors: Ana-Magadia Marian Grace , Takahashi Yasuhiro , Valencia Ma Regina Paula , Ishikawa Eri , Nishimura Kunihiro , Kakizaki Hirohiko 
Published: December 2018

Abstract
A study on immunoglobulin G4-related ophthalmic disease (IgG4-ROD) with destructive changes in periorbital soft tissues was presented. The patient was an 89-year-old-man who developed a left-sided orbital lesion involving the globe, lacrimal gland, and extraocular muscles. A diagnosis of definite IgG4-ROD was made based on clinical and histopathologic findings. The patient was started on oral prednisolone, which afforded good response initially. However, when tapering was initiated, full-thickness destruction developed on the lateral half of the lower eyelid margin. Steroid dose was increased, and the patient underwent a series of surgeries (suspension of the lower eyelid and lateral tarsorrhaphy, subtotal exenteration, and debridement and endonasal sinus surgery) in an attempt to manage the progression and recurrence of the condition. Medical management consisting of antibiotics and anti-fungal was administered to control the disease process. With close follow-up, repeated ancillary testing, and continuous management, the periocular and systemic findings were stable for 3 months after the last surgery.
Assessment of Therapeutic Effect of Intra-Articular Nanofat Injection for Temporomandibular Disorders
Authors: Mahmmood Venus H. , Shihab Saif Mohamed 
Published: December 2018

Introduction:
Temporomandibular disorders (TMD) refer to a group of heterogeneous, pain and dysfunction conditions involving the masticatory system, which influences life quality of the sufferers. Nanofat graft injection in temporomandibular joint (TMJ) is a simple and less invasive surgical procedure for treatment of TMJ problems.
The aim of this study was to evaluate influence and effectiveness of nanofat injection in TMJ for treatment of TMD.

Patients and Methods:
This study was performed in Al-Shaheed Ghazi Al-Hariri Hospital, Department of Oral and Maxillofacial Surgery, Baghdad Medical City from October 2016 and December 2017.
A total of 11 patients (3 males) and (8 females) with range of age 18 to 34 years old.
Every patient was assessed for the following parameters preoperatively: Pain level, maximum mouth opening (MMO), joint clicking, and deviation.

Results:
The present study revealed marked female predilection with female ratio about 72.7% (8 patients) and male ratio 27.3% (3 patients), range between 18 and 34 years old. Three patients were presented with single joint (15.8%) and 16 patients were presented with both joints (84.2%).
In general, all patients tolerated treatment procedures without any serious complications during the procedure or after the procedure.
The results of parameters were pain, clicking, and deviation (P < 0.001 HS) and MMO (P < 0.032–0.041 S).

Conclusion:
Nanofat injection in TMJ showed therapeutic benefits, simplicity, safety, lack of significant side effects, and complication.
Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques
Authors: Tian Jimmy H. , Neiva Rodrigo , Coelho Paulo G. , Witek Lukasz , Tovar Nick M. , Lo Ivan C. , Gil Luiz F. , Torroni Andrea 
Published: December 2018

Objective:
The aim of this in vivo study is to compare the osseointegration of endosteal implants placed in atrophic mandibular alveolar ridges with alveolar ridge expansion surgical protocol via an experimental osseodensification drilling versus conventional osteotome technique.

Methods:
Twelve endosteal implants, 4 mm × 13 mm, were placed in porcine models in horizontally atrophic mandibular ridges subsequent to prior extraction of premolars. Implants were placed with osseodensification drilling technique as the experimental group (n = 6) and osteotome site preparation as the control group (n = 6). After 4 weeks of healing, samples were retrieved and stained with Stevenel's Blue and Van Gieson's Picro Fuschin for histologic evaluation. Quantitative analysis via bone-to-implant contact (BIC%) and bone area fraction occupancy (BAFO%) were obtained as mean values with corresponding 95% confidence interval. A significant omnibus test, post-hoc comparison of the 2 drilling techniques’ mean values was accomplished using a pooled estimate of the standard error with P-value set at 0.05.

Results:
The mean BIC% value was approximately 62.5% in the osseodensification group, and 31.4% in the regular instrumentation group. Statistical analysis showed a significant effect of the drilling technique (P = 0.018). There was no statistical difference in BAFO as a function of drilling technique (P = 0.198).

Conclusion:
The combined osseodensification drilling-alveolar ridge expansion technique showed increased evidence of osseointegration and implant primary stability from a histologic and biomechanical standpoint, respectively. Future studies will focus on expanding the sample size as well as the timeline of the study to allow investigation of long-term prognosis of this novel technique.
New Technique for Closure of Alveolar Cleft With Umbilical Cord Stem Cells
Authors: Garcia Botero Alejandra , Prada Madrid Rolando , Ávila-Portillo Luz Mabel , Rojas Holguin Nancy , Gómez-Ortega Viviana , Menze Erica 
Published: December 2018

Abstract
This article presents the case of a newly born female patient with a cleft of the primary palate (alveolar cleft), with an in utero diagnosis of the described cleft, from whom umbilical cord stem cells are obtained and cryopreserved. The patient is managed with nasoalveolar molding, and at 5 months of age, she is taken to surgery for cheiloplasty and gingivoperiostioplasty with umbilical cord stem cells. A radiographic and CT follow-up is carried out on the described cleft.
Intraparotid Facial Nerve Schwannoma in a Nine-Year-Old Patient: Diagnosis, Classification, and Surgical Approach Stages
Authors: Gumussoy Murat , Ekmekci Sumeyye 
Published: December 2018

Abstract
Intraparotid facial nerve schwannoma (IFNS) is rarely observed in children compared with adults. Only a few cases have been reported in the literature. After radiological imaging and fine needle aspiration biopsy, an IFNS diagnosis may be skipped and confused with pleomorphic adenoma, which has a high prevalence among patients who have a mass in the parotid gland. The probability of IFNS can be recognized by a close relation between the mass and the facial nerve during the application of parotidectomy and by the frozen biopsy of the mass. The surgeon evaluates the mass and faces with surgical mass excison and facial nerve reconstruction according to the relation between the mass and the facial nerve because there is no diagnostic method for the presurgery diagnosis of IFNS. Therefore, the surgeon should be prepared for the possibility of functional lossin the facial nerve during parotidectomy. This article presents the case of a 9-year-old patient with an IFNS diagnosis who had a surgical operation in our clinic, and the algorithm designed according to the literature for the diagnosis and surgical classification of IFNS, as well as the approaches to facial nerve reconstruction.
Study on the Therapeutic Effects of Trigeminal Neuralgia With Microvascular Decompression and Stereotactic Gamma Knife Surgery in the Elderly
Authors: Yu Rui , Wang Chengwei , Qu Chuncheng , Jiang Jun , Meng Qinghu , Wang Ji , Wei Shengcheng 
Published: December 2018

Objective:
The aim of the study was to evaluate the efficacy of microvascular decompression (MVD) and stereotactic gamma knife surgery (GKS) in the treatment of trigeminal neuralgia (TN) in the elderly.

Patients and Methods:
Retrospective analysis of 137 elderly cases with TN underwent MVD, partial sensory rhizotomy (PR) treatment from August 2007 to March 2017 and 56 cases underwent GKS treatment from May 2014 to February 2017 was made, compared the efficacy of MVD and GKS in different age groups.

Results:
In 125 patients of MVD alone, the responsible vessels included 60 cases of superior cerebellar artery, 55 cases of anterior inferior cerebellar artery, 4 cases of venous vascular compression, 13 cases of mixed arteriovenous compression and 3 cases of vertebral artery, and 2 cases of no responsible vessel. Operation methods: MVD 125 cases, MVD + PR 10 cases, PR 1 cases, simple exploration in 1 case. Results of MVD surgery: Among 125 patients of MVD alone, 95 cases were cured, 15 cases improved, and 15 cases were ineffective. Among 10 cases of MVD + PR, cured in 9 cases and improved in 1 case. PR and simple exploration in 2 cases got pain disappeared. Postoperative complications of MVD: No deaths, CSF leakage in 2 cases, intracranial infection in 3 cases, ipsilateral hearing loss in 1 case, and ipsilateral facial paralysis in 1 case, delayed intracranial hematoma in 2 cases. After GKS treatment, the shortest onset time was from 9 days up to 6 months, an average of 2.2 months. Among 56 patients, 30 cases were cured, accounting for 53.6%, 20 cases improved, accounting for 35.7%, 6 cases were ineffective, accounting for 10.7%. Postoperative complications were facial numbness and dysesthesia, 7 cases, the incidence was 12.5%. In the group of 60 to 70 years old and the group of 70 to 80 years old, the treatment effect of MVD was better than that of GKS (χ2 test, P < 0.05); there was no significant difference between MVD and GKS in >80 years old group (χ2 test, P > 0.05). There was no significant difference in the therapeutic effect of TN underwent GKS among all age groups (χ2 test, P > 0.05).

Conclusion:
Microvascular decompression should be performed more prudently in elderly patients (>80 years old), and the indications for PR should be relatively relaxed. MVD + PR could improve the curative effect in patients with trigeminal neuralgia >80 years. Gamma knife treatment of trigeminal neuralgia had high safety, less complications, and positive curative effect, especially suitable for patients >80 years.
Microsurgical Replantation of Completely Avulsed Nasal Segment
Authors: Akyurek Mustafa , Perry Dylan 
Published: December 2018

Abstract
Complete avulsion of the nose is a devastating injury that may result in permanent disfigurement. Microvascular reattachment is technically difficult due to small size of the injured vessels, associated avulsion or crush injury, and relative inability to achieve venous anastomosis. This report describes a successful case of microsurgical replantation of the distal third of the nose in a 47-year-old patient after a dog bite injury with the use of a superficial temporal vein graft for arterial repair and leeching for venous outflow. The recovery was uneventful with total survival of the replant noted except for marginal skin necrosis, which healed by secondary intention. There was no need for any transfusion. The authors found that use of the superficial temporal vein for arterial revascularization was efficient and convenient as it was in the same surgical field, offering a favorable donor site scar in the preauricular sulcus. Microsurgical replantation should be attempted whenever feasible in cases of complete nose amputation.