Surgical Research and Reviews

  • RECONSTRUCTION OF ANTERIOR FRONTAL WALL AND CONTOURS DEFECTS USING BONE SUBSTITUTE

    Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital…

  • TRANSLATIONAL MEDICINE AND AUTOLOGOUS FAT TRANSFER: FROM BENCH TO BEDSIDE. REGENERATIVE AND PROLIFERATIVE POTENTIAL OF ADIPOSE TISSUE

    Aim: Autologous fat transfer (AFT) for the correction of maxillofacial defects was first reported at the end of the 19th century. AFT was introduced as a way of improving facial esthetics and in the last few years has expanded into applications in craniomaxillofacial reconstructive surgery and regenerative therapy. This protocol is part of translational medicine. The aim of translational medicine, or translational science, is to combine disciplines, resources, expertise, and techniques based on three main pillars: bench, bedside, and community. The primary goals to coalesce assets of various natures to significantly improve the global healthcare system. AFT is thus part of translational medicine in tissue healing, regeneration and augmentation. Methods: Several techniques have been suggested for harvesting and grafting the fat. The Authors follow Coleman’s technique with centrifugation and infiltration using different types and sizes of cannulas. Conclusion: This review provides a fairly comprehensive summary of the many exciting possibilities that exist in the field of facial fat grafting. Five clinical cases are presented and discussed. Translational medicine is the basis of this new reconstructive and regenerative field of science and research.

  • SINGLE STITCH OPEN INTERVAL APPENDECTOMY; WHEN AND WHY

    Appendicitis is a very common cause of acute abdomen. Most of the patient admit in surgical emergency. Diagnosis usually made clinically, sonography sometimes may be helpful. Regarding management there is still controversy exists. Developed country usually performed laparoscopy appendectomy while in developing country surgical management is still in debate. Different surgeons have different opinion either emergency open or laparoscopy appendectomy or interval appendectomy. Even in open appendectomy there is still debate between classical procedure vs small incision. This study favors single stitch surgery rather than classical and laparoscopy appendectomy. this case study supports even better cosmetic and outcome than laparoscopy appendectomy.

  • BLUE ROUND SMALL CELL TUMOR: A SURGICAL UPDATE OF DSRCT WITH REVIEW OF LITERATURE ‘A GRIM AFFAIR’

    Desmoplastic small round cell tumor (DSRCT) is a tumor derived from the Greek desmos referring to knot and plasis to formation an uncommon soft tissue malignant tumor, mesenchymal in origin and aggressive with a prelidiction for males and advanced at presentation. It was first described as a distinct clinical entity by Gerald WL and Rosai J (7). There are fewer than 200 reported to date. Depending on the primary site of location the Clinical manifestations vary. As most arise from the abdomen and pelvis they remain asymptomatic till they attain a huge size. Other reported sites are the skull, thorax, and paratesticular region (10,13). We report the case of a 19 yr old male who had non specific abdominal discomfort with asthenia for a period of six months and was referred to us for evaluation of left supraclavicular nodes. The prognosis of Desmoplastic small round cell tumor (DSRCT) is poor with few surviving less than two years.

  • TREATMENT OF “EN COUPE DE SABRE “ LINEAR SCLERODERMA. SOFT TISSUE AUGMENTATION AND REGENERATION BY AUTOLOGOUS FAT TRANSFER

    Aim: Frontal linear scleroderma, also known as ‘‘en coup de sabre,’’ is a congenital deformity characterized by atrophy and furrowing of the skin of the front parietal area above the level of the eyebrows. In most cases it occurs as a single paramedian line that may be associated with hypoplasia of underlying structures and facial hemiatrophy. In case of a wide lesion many reconstructive strategies have been proposed. The modern approach is aimed at augmentation of the tissue deficiency by using lipostructure and tissue regeneration. Autologous fat transfer (AFT) seems to be an effective strategy to restore the normal volume and contour of the face while providing a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. Methods: In this report, we present a rare case of linear scleroderma en coupe de sabre which was successfully managed with three stages of autologous fat grafting. Conclusion: The proposed uses for ADSCs in tissue repair and regeneration are quite impressive. Recent works on ADSCs would suggest that adult cells may prove to be an equally powerful regenerative tool in treating congenital and acquired maxillofacial disorders. More importantly, physicians, researchers and international associations need to cooperate in informing clinicians about what practices are based on evidence and to encourage support of additional research. There is increasing interest in a possible therapeutic effect of ADSCs from processed lipoaspirate for a wide spectrum of clinical applications in the facial and craniofacial area. AFT can be used in any facial area where soft tissue is lacking or where there is scarring, producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine. However, more definitive studies are needed to answer specific questions regarding the best technique to be used and the role of ADSCs. Autologous fat grafting provides a safe…

  • THE VALIDITY OF PROTEIN S 100B IN MILD PEDIATRIC HEAD TRAUMA

    Background; S100B has been shown to be beneficial as a biomarker in the treatment of adults with mild traumatic brain injury (mTBI). The efficacy of S100B as a biomarker in children, on the other hand, has been a subject of debate. Aim and objectives; was to assess the validity of Protein S 100B in Mild Pediatric Head trauma. Subjects and methods; this was a prospective study, included 160 pediatric patients with mild head trauma presented to Emergency Department. Result; A highly significant correlation between Positive S100B protein and traumatic brain injury with S100B protein value 1554.1±84.0 ng/L. A100 had cutoff value for positive CT Brain finding above 987.5 ng/L, The sensitivity was 81.0%, the specificity was 75%%, the NPV was 86%, the PPV was 68%, and overall accuracy 77%. There was none statistical significant difference regarding severity of brain injury and S100 B (P = 0.225), Conclusion; Serum S100B levels cannot be used to substitute clinical examinations or CT scans in identifying pediatric patients with mild head injuries, but they can be used to identify low-risk kids to avoid excessive radiation exposure.

  • SMAS-FLAP TRANSPOSITION IN LOWER FACE-LIFT

    The superficial musculoaponeurotic system is of fundamental importance in facial anatomy. One of its primary functions is to harmoniously integrate the facial mimic muscles by coordinating their movements with each other. The continuity of the superficial musculoaponeurotic system with the platysma also creates an effective unitary connection with the mandibular and cervical areas. For these areas, where the signs of aging are first shown with soft tissue ptosis and cervical bands, we propose our lower face-lift technique with SMAS-flap transposition. This technique is not characterized by the section of the aponeurosis at the earlobe or lower level and by its rotation, but it is characterized by an higher SMAS section at tragus level with transposition of the mobilized pre-parotid and platysma aponeurosis to the high mastoid area. This manoeuvrer allows us for an effective platysma extension-lift and for his secure fixation to the upper mastoid area, resulting in greater stability and duration of the treatment.

  • MODERN DIAGNOSIS AND SURGICAL MANAGEMENT OF THORACIC OUTLET SYNDROME: A COMPREHENSIVE REVIEW

    Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction….

  • IMPACT OF TUMOR SIZE ON DEPTH OF INVASION AND NUMBER OF LYMPH NODES INFILTRATION IN ESOPHAGEAL CANCER

    Introduction: Esophageal cancer (EC) is one of the deadliest malignancies worldwide and is often diagnosed in advanced stages. It is the 8th most common cancer in the world and is the 6th most common cause of cancer related deaths, having a 5-year survival rate of less than 20% despite advances in treatment. It has a poor prognosis due to the late diagnosis and the lack of early presenting symptoms. In the United States, stage IV is the most common stage at the time of diagnosis. Methods: Eighty-seven fit patients were recruited for this multi-institutional clinical prospective study in the period from the start of January 2014 to the end of December 2020, diagnosed as cancer esophagus in by endoscopic biopsy and underwent surgical treatment according to stage at the centers participating in this study. Results: In pre-operative biopsy, Adenocarcinoma was diagnosed in 39/87 cases (44.8%) distributed as (5 in GEJ and 34 diagnosed in lower esophagus) while squamous cell carcinoma (SCC) diagnosed in 48/87 cases (55.2%) distributed as (28 in lower part, 10 in middle part and 9 in upper esophagus respectively) and only one case out of 87 cases diagnosed as undifferentiated carcinoma of lower esophagus. We found significant association between the increased tumor size and the increase depth of invasion and thenumber of harvested lymph nodes. Conclusion: As the tumor size increased (cutoff point 3cm), the depth of invasion through the layers of esophagus and the number of the infiltrated lymph nodes will increase, and this is associated with poor prognosis and increase in mortality rate from the esophageal cancer.

  • KYRLE’S DISEASE (KD): “AN UPDATE WITH REVIEW OF LITERATURE” A SPONGEBOB SKIN PORES SIMULATION

    Kyrle’s disease (KD) is a Chronic skin condition first described by Austrian pathologist Josef Kyrle in 1916. Kyrle referred to this condition as hyperkeratosis follicularis & parafollicularis in cutem penetrans. These diseases are characterized by the phenomenon of transepidermal elimination of denatured dermis an acquired form of perforating dermatosis [14]. It is characterized by keratotic crater plugs that develop in hair follicles penetrating the epidermis and extending into the dermis [4]. This trans epithelial migration and elimination of proteinaceous components is associated with systemic disorders like renal, liver diseases, chronic heart failure and diabetes mellitus. We present two case scenarios of a young Males with multiple chronic papular eruptions along with a review of literature for Kyrle’s disease (KD).