Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot with ladies.Omaxe Reviews get lot of hits on omaxe reviews official omaxe reviews introducing omaxe reviews and Mr. Anil Kumar get set go. Omaxe Reviews at next month but all over get hot. oma
Correlation of pericoronitis and the status of eruption of mandibular third m...marcos alexandre
This study analyzed the relationship between the status of eruption of mandibular third molars and pericoronitis by examining 50 patients clinically and radiographically. The results found that 86% of cases had partially erupted third molars while 14% were impacted. Using the Pell and Gregory classification, position IA was most prevalent at 42% followed by IIB at 34% and IIA at 20%. Vertical and distoangular impactions were slightly more common based on Winter's classification. The study concluded that partially erupted mandibular third molars, especially those in position IA, vertical, and distoangular orientations, have a higher risk of developing pericoronitis and its complications.
Corseting: A new technique for the management of diffuse venous malformations...Dibya Falgoon Sarkar
1) The study introduces the "corset suturing" technique for treating large diffuse venous malformations in the head and neck region. Corset suturing involves continuous suturing that incorporates the lesion and strangulates the vessels to induce occlusion.
2) The technique was performed on 90 patients with non-cutaneous venous malformations. Most lesions resolved within 4-8 weeks with minimal complications and good cosmetic outcomes.
3) While corset suturing provides an effective and low-cost alternative treatment, the study had limitations as a retrospective study without controls to fully evaluate the technique.
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
This study analyzed 252 knee replacement surgeries performed between 2008-2013 to determine surgical site infection rates. 10 patients (4%) developed superficial infections treated with antibiotics or debridement. 4 patients (1.6%) developed deep infections, with 1 acute infection treated with debridement and antibiotics. 3 patients developed delayed deep infections between 4 weeks to 2 years post-op, with 2 requiring revision surgery. Increased body mass index was the only risk factor significantly associated with higher superficial infection rates. Overall infection rates were comparable to literature reports for primary knee replacements.
Foreign Body Reaction to a Plastic Pin-like Object in the Chin – A Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Relationships between onchocerca volvulus microfilaraemia and the clinical ma...Alexander Decker
This study examined the relationship between Onchocerca volvulus microfilariae and clinical manifestations of onchocerciasis in two communities in southeastern Nigeria. Skin snips and clinical exams were performed on residents and microfilarial prevalence and intensity were analyzed in relation to skin changes, nodules, and visual problems. Microfilarial prevalence and intensity were higher in those with chronic skin damage, leopard skin, subcutaneous nodules, and visual issues. The differences were statistically significant, indicating O. volvulus microfilariae were closely associated with clinical manifestations, especially in older age groups, in this meso-endemic area.
Journal Club on A novel approach to the management of a central giant cell gr...Dr Bhavik Miyani
This journal club presentation summarizes a case report on the use of denosumab to treat central giant cell granuloma (CGCG) of the mandible. CGCG is an aggressive bone lesion with high recurrence rates following surgical treatment. The case report describes a patient who did not respond to intralesional steroids or calcitonin, but did experience resolution of symptoms and ossification of the lesion within 6 months of treatment with denosumab. A biopsy 18 months later found no residual CGCG. The presentation reviews current treatments for CGCG and the mechanism of action of denosumab, and concludes denosumab may be an effective alternative or adjunct to surgery.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
Correlation of pericoronitis and the status of eruption of mandibular third m...marcos alexandre
This study analyzed the relationship between the status of eruption of mandibular third molars and pericoronitis by examining 50 patients clinically and radiographically. The results found that 86% of cases had partially erupted third molars while 14% were impacted. Using the Pell and Gregory classification, position IA was most prevalent at 42% followed by IIB at 34% and IIA at 20%. Vertical and distoangular impactions were slightly more common based on Winter's classification. The study concluded that partially erupted mandibular third molars, especially those in position IA, vertical, and distoangular orientations, have a higher risk of developing pericoronitis and its complications.
Corseting: A new technique for the management of diffuse venous malformations...Dibya Falgoon Sarkar
1) The study introduces the "corset suturing" technique for treating large diffuse venous malformations in the head and neck region. Corset suturing involves continuous suturing that incorporates the lesion and strangulates the vessels to induce occlusion.
2) The technique was performed on 90 patients with non-cutaneous venous malformations. Most lesions resolved within 4-8 weeks with minimal complications and good cosmetic outcomes.
3) While corset suturing provides an effective and low-cost alternative treatment, the study had limitations as a retrospective study without controls to fully evaluate the technique.
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
This study analyzed 252 knee replacement surgeries performed between 2008-2013 to determine surgical site infection rates. 10 patients (4%) developed superficial infections treated with antibiotics or debridement. 4 patients (1.6%) developed deep infections, with 1 acute infection treated with debridement and antibiotics. 3 patients developed delayed deep infections between 4 weeks to 2 years post-op, with 2 requiring revision surgery. Increased body mass index was the only risk factor significantly associated with higher superficial infection rates. Overall infection rates were comparable to literature reports for primary knee replacements.
Foreign Body Reaction to a Plastic Pin-like Object in the Chin – A Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Relationships between onchocerca volvulus microfilaraemia and the clinical ma...Alexander Decker
This study examined the relationship between Onchocerca volvulus microfilariae and clinical manifestations of onchocerciasis in two communities in southeastern Nigeria. Skin snips and clinical exams were performed on residents and microfilarial prevalence and intensity were analyzed in relation to skin changes, nodules, and visual problems. Microfilarial prevalence and intensity were higher in those with chronic skin damage, leopard skin, subcutaneous nodules, and visual issues. The differences were statistically significant, indicating O. volvulus microfilariae were closely associated with clinical manifestations, especially in older age groups, in this meso-endemic area.
Journal Club on A novel approach to the management of a central giant cell gr...Dr Bhavik Miyani
This journal club presentation summarizes a case report on the use of denosumab to treat central giant cell granuloma (CGCG) of the mandible. CGCG is an aggressive bone lesion with high recurrence rates following surgical treatment. The case report describes a patient who did not respond to intralesional steroids or calcitonin, but did experience resolution of symptoms and ossification of the lesion within 6 months of treatment with denosumab. A biopsy 18 months later found no residual CGCG. The presentation reviews current treatments for CGCG and the mechanism of action of denosumab, and concludes denosumab may be an effective alternative or adjunct to surgery.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
Background: Cerebellopontine Angle (CPA) meningiomas comprise 10% of all intracranial meningiomas and due to their location, are producing different surgical challenges. This study is evaluating surgical management and clinical outcome of CPA meningiomas operated during 15 years.
Key hole surgery - Intertrochanetric femur fracture DeepakTyagi110
This study evaluated outcomes of using a keyhole surgery technique called minimum invasive dynamic hip screw (MIDHS) to treat intertrochanteric femur fractures in elderly patients. 16 patients underwent MIDHS surgery. The mean duration of surgery was 39 minutes, mean blood loss was 31.5 ml, and mean drop in hemoglobin was 0.2g/dl. Keyhole surgery resulted in smaller incisions, less blood loss, and shorter operating times compared to conventional techniques, without any patients requiring blood transfusions. The study concluded that MIDHS is a good option for treating intertrochanteric fractures in elderly patients or those with comorbidities, due to its minimal invasiveness and soft tissue disruption.
COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...KETAN VAGHOLKAR
Background: Skin approximation is a very important step in a surgical operation. The quality of skin
approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications.
Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare
traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound
complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients
are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation).
The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation)
had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction.
Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.
An open fracture is a serious bone fracture where broken bone fragments pierce the skin. Open fractures are caused by high-energy trauma and can lead to infection. They are classified based on wound size and soft tissue damage. Diagnosis involves clinical exam, imaging, and assessing neurovascular status. Management includes wound cleaning, temporary stabilization, antibiotics, and definitive fixation once the wound is healthy. Complications can include infection, neurovascular injury, and compartment syndrome.
31 title pagewithauthordetails-724-1-10-20210129buatdownload6
This document discusses the use of a pins and rubber traction frame technique to treat comminuted fractures of the proximal interphalangeal (PIP) joint in 8 patients. The technique involves inserting K-wires above and below the fracture site and connecting them with rubber bands to provide traction. All patients achieved bone union without complications. Postoperative range of motion of the PIP joint averaged 4.88-86.25 degrees and of the DIP joint averaged 4.38-86.25 degrees. The pins and rubber traction frame provides a simple, effective method for stabilizing complex PIP fractures to allow early motion and prevent joint stiffness.
This study analyzed 112 patients with rotator cuff disease to understand its characteristics and implications based on the stage of lesion evolution. Most patients were women around 51 years of age, with the right side being more injured and highly incapable of upper limb movement. The most common pathology was partial rupture of the supraspinatus tendon. While most patients underwent physiotherapy, 19% required surgery. The study showed that rotator cuff disease causes significant functional impairment, affecting social and work life, with high incapacity even after treatment.
Objectives: To describe the pattern of clavicle fractures and to evaluate the results of surgical treatment for clavicle fractures. Patients and methods: This retrospective study included 38 cases of clavicle fractures who were treated by open reduction internal fi xation at Hanoi Medical University Hospital between January 2008 and June 2013.
Results: The ratio of male to female was 1.5/1. Average age was 42.0 years. Simple fractures (no intermediate fragments) are most common with 65.8% of patients. Middle third fractures accounted for
92.1% of patients. Bone union rate was 100%. The surgical results were excellent in 94.7% and good in 5.3% of cases according to Constant Score.
- The document classifies open fractures using the Gustilo-Anderson classification system based on wound size, soft tissue injury, and degree of contamination. Grade I fractures have a clean wound less than 1 cm, while Grade III fractures have extensive soft tissue damage or injury over 8 hours old.
- Management of open fractures aims to prevent infection through prompt debridement, antibiotics, splinting, and wound coverage. Early debridement within 5 hours can significantly reduce infection rates compared to later debridement.
- Risk of infection increases with higher fracture grade, from 0-12% for Grade I up to 9-55% for Grade III fractures. Prompt antibiotics, debridement, and wound management seek
Journal Club on Tooth in the line of fracture its prognosis and its effects o...Dr Bhavik Miyani
This study compared outcomes of mandibular angle fracture cases where the third molar in the fracture line was either preserved or extracted. 54 patients were divided into two groups. Results showed infection was higher when the tooth was preserved, while occlusion discrepancy was higher when the tooth was extracted. Most preserved teeth showed recovery within 6-12 months, with only mild root resorption and no ankylosis. The conclusion was that despite higher complication risks, the tooth in the fracture line should generally be preserved for its benefits.
This study compared the efficacy of treating dorsal wrist ganglions with aspiration and triamcinolone injection versus surgical excision. 60 patients were randomly assigned to either treatment. Successful resolution was achieved in both groups. The aspiration/injection group reported mild pain in 23.3% of patients and a 6.66% recurrence rate over 2 years. The surgical excision group reported moderate postoperative pain requiring analgesics for 5 days and a 16.66% recurrence rate. The study concluded aspiration/injection is superior due to lower recurrence and morbidity rates.
The document describes a clinical trial that assessed the effects of using a Connecticut intrusion arch (CIA) with or without a distal bend on maxillary incisor and molar positions. 44 patients were randomly divided into two groups: one treated with a CIA without a distal bend, and one treated with a CIA with a distal bend. Cephalometric analysis found that the group without a distal bend experienced labial flaring and proclination of maxillary incisors, while the group with a distal bend experienced palatal inclination and retroclination of maxillary incisors. No significant differences were found between the groups for maxillary molar positions. The presence or absence of a distal bend in the CIA affects incis
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
Call for case report,review and research article for journals
1.International journal of medical and applied sciences.
Volume 6 issue2,2018
2.IRO International journal of medical and applied sciences.
Print journal
Volume 1 issue2, 2018
email: earthjournals@gmail.com
www.earthjournals.in
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
This document summarizes a journal presentation on a clinical study assessing lingual nerve injury from mandibular third molar surgery. The study examined 1200 patients undergoing third molar removal and found an overall 5.6% temporary lingual nerve impairment rate and 0.3% permanent rate. Factors associated with higher temporary injury rates included lingual flap retraction, tooth sectioning, and buccal guttering. The presentation reviews the study methodology, results, comparisons to other studies, and discusses techniques to reduce lingual nerve injury risk during third molar surgery.
INFLUENCE OF GENDER ON MUSCLE ACTIVITY PATTERNS DURING NORMAL AND FAST WALKING ijbesjournal
Electromyography (EMG) signals are often described as electrical manifestation of neuromuscular
activation associated with the muscles. These signals are commonly utilized as principal input signals to
control several prosthetic devices such as prosthetic hands, arm, lower limbs, and exoskeleton robots as
well as in designing of rehabilitation and assistive devices. It is well proven that EMG signals vary among
subjects and gender is one of the major factors that play a significant role in this variation. This study
detects the possible gender differences by measuring changes in the EMG activity during different phases
of human walking by acquiring the surface EMG signals from Gluteus Maximus, Hamstrings (biceps
femoris), Quadriceps (rectus femoris) and Soleus muscles of the leg with the healthy subjects walking
barefoot at two paces-normal and fast. The statistical analysis of the results showed no gender differences
at normal speed of walking but when speed of walking changed; it showed clear differences in the
behavior of these muscles. The results from this study would aid in designing closed loop control strategy
for designing a smart functional electrical stimulator (FES) which is the larger goal of this research.
Interactivity in Goodsalls Rule and Fistula in anoijtsrd
Fistula in ano is a tract lined by granulation tissue which opens deeply in the anal canal or rectum and superficially on the skin around the anus. Managing fistula in ano is a challenging task. Because recognizing the internal opening and cause of the fistula tract is difficult. Both external and internal openings of the fistula tract are essential for the complete identification of the tract. The purpose of the present study was to study the relevance between Goodsalls rule and course of the fistula tract. A sample of 106 patients with simple fistula was studied. In this study Hydrogen Peroxide was injected by using syringe through the external opening of the fistula and seenthe appearance of air bubbles which are come out from the internal opening. The site and number of internal and external openings and the course of the tract were recorded. The median age of the participants was 37 years. The majority were male 57.54 . Thirty one point one percent 31.1 showed intersphincteric fistula, 51.8 showed transphincteric fistula and 16.9 had superficial fistula. The overall predictive accuracy of Goodsalls rule in studied group was 68.3 . It is significantly associated with the type of fistula. The high predictive accuracy in superficial fistula 94.4 , intersphincteric fistula 84.4 and transphicteric fistula 69.09 were observed. It was concluded that, Goodsalls rule was not accurate in 31.7 of all fistulae it can be used as a guide in locating the course of the tract and the internal opening. Samaranayake G. V. P | Chandimal K. M "Interactivity in Goodsalls' Rule and Fistula-in-ano" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31383.pdf Paper Url :https://www.ijtsrd.com/medicine/anatomy/31383/interactivity-in-goodsalls-rule-and-fistulainano/samaranayake-g-v-p
Analysis and Management of Tripod Fractures: Our ExperienceSachender Tanwar
Abstract: The present prospective study seeks to evaluate the incidence of tripod fracture, etiology and treatment options. All patients
with faciomaxillary fractures following road traffic accidents admitted in the Deptt. Of otorhinolayngology, silchar medical college &
hospital, Assam during the period of one year from Aug 2011 to Aug 2012, were scrutinized for tripod fracture, both clinically and
radiologically & were managed according to the severity of fracture. Patients presenting with simple zygomaticomaxillary complex
fractures were managed conservatively. While comminuted/malaligned fractures had monofragments fixed using open & closed
reduction methods. Out of which most had early intubation, before edema occurred, to make airway control and provide anaesthesia.in
few patients in whom intubation by oral route was impossible, tracheostomy was performed to secure airway.The adequacy of fracture
reduction & its stability was confirmed by subsequent CT scan measurements, statistical analysis, and clinical follow-up during the
postoperative period, in which patients showed no significant associated complications, facial asymmetry, enophthalmos, or diplopia.
Road traffic accidents came out to be most common cause of facio-maxillary fracture, incidence of zygomaticomaxillary fractures is
second to nasal bone fracture, which in itself most common facial fracture.
Keywords: tripod fracture, zygomaticomaxillary complex fractures, fracture reduction.
This document summarizes a study that examined the length of styloid processes in 46 cadavers from Colombia. The researchers found that the average length was 35.1 mm, with 23 processes (50%) over 30 mm long. They noted this frequency was comparable to other studies. While an elongated styloid process (over 30 mm) has been linked to Eagle's syndrome symptoms, the researchers suggested angulation may be more relevant than length alone in determining clinical significance. Understanding anatomical variations in a population can aid in differential diagnosis of related conditions.
Background: Cerebellopontine Angle (CPA) meningiomas comprise 10% of all intracranial meningiomas and due to their location, are producing different surgical challenges. This study is evaluating surgical management and clinical outcome of CPA meningiomas operated during 15 years.
Key hole surgery - Intertrochanetric femur fracture DeepakTyagi110
This study evaluated outcomes of using a keyhole surgery technique called minimum invasive dynamic hip screw (MIDHS) to treat intertrochanteric femur fractures in elderly patients. 16 patients underwent MIDHS surgery. The mean duration of surgery was 39 minutes, mean blood loss was 31.5 ml, and mean drop in hemoglobin was 0.2g/dl. Keyhole surgery resulted in smaller incisions, less blood loss, and shorter operating times compared to conventional techniques, without any patients requiring blood transfusions. The study concluded that MIDHS is a good option for treating intertrochanteric fractures in elderly patients or those with comorbidities, due to its minimal invasiveness and soft tissue disruption.
COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...KETAN VAGHOLKAR
Background: Skin approximation is a very important step in a surgical operation. The quality of skin
approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications.
Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare
traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound
complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients
are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation).
The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation)
had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction.
Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.
An open fracture is a serious bone fracture where broken bone fragments pierce the skin. Open fractures are caused by high-energy trauma and can lead to infection. They are classified based on wound size and soft tissue damage. Diagnosis involves clinical exam, imaging, and assessing neurovascular status. Management includes wound cleaning, temporary stabilization, antibiotics, and definitive fixation once the wound is healthy. Complications can include infection, neurovascular injury, and compartment syndrome.
31 title pagewithauthordetails-724-1-10-20210129buatdownload6
This document discusses the use of a pins and rubber traction frame technique to treat comminuted fractures of the proximal interphalangeal (PIP) joint in 8 patients. The technique involves inserting K-wires above and below the fracture site and connecting them with rubber bands to provide traction. All patients achieved bone union without complications. Postoperative range of motion of the PIP joint averaged 4.88-86.25 degrees and of the DIP joint averaged 4.38-86.25 degrees. The pins and rubber traction frame provides a simple, effective method for stabilizing complex PIP fractures to allow early motion and prevent joint stiffness.
This study analyzed 112 patients with rotator cuff disease to understand its characteristics and implications based on the stage of lesion evolution. Most patients were women around 51 years of age, with the right side being more injured and highly incapable of upper limb movement. The most common pathology was partial rupture of the supraspinatus tendon. While most patients underwent physiotherapy, 19% required surgery. The study showed that rotator cuff disease causes significant functional impairment, affecting social and work life, with high incapacity even after treatment.
Objectives: To describe the pattern of clavicle fractures and to evaluate the results of surgical treatment for clavicle fractures. Patients and methods: This retrospective study included 38 cases of clavicle fractures who were treated by open reduction internal fi xation at Hanoi Medical University Hospital between January 2008 and June 2013.
Results: The ratio of male to female was 1.5/1. Average age was 42.0 years. Simple fractures (no intermediate fragments) are most common with 65.8% of patients. Middle third fractures accounted for
92.1% of patients. Bone union rate was 100%. The surgical results were excellent in 94.7% and good in 5.3% of cases according to Constant Score.
- The document classifies open fractures using the Gustilo-Anderson classification system based on wound size, soft tissue injury, and degree of contamination. Grade I fractures have a clean wound less than 1 cm, while Grade III fractures have extensive soft tissue damage or injury over 8 hours old.
- Management of open fractures aims to prevent infection through prompt debridement, antibiotics, splinting, and wound coverage. Early debridement within 5 hours can significantly reduce infection rates compared to later debridement.
- Risk of infection increases with higher fracture grade, from 0-12% for Grade I up to 9-55% for Grade III fractures. Prompt antibiotics, debridement, and wound management seek
Journal Club on Tooth in the line of fracture its prognosis and its effects o...Dr Bhavik Miyani
This study compared outcomes of mandibular angle fracture cases where the third molar in the fracture line was either preserved or extracted. 54 patients were divided into two groups. Results showed infection was higher when the tooth was preserved, while occlusion discrepancy was higher when the tooth was extracted. Most preserved teeth showed recovery within 6-12 months, with only mild root resorption and no ankylosis. The conclusion was that despite higher complication risks, the tooth in the fracture line should generally be preserved for its benefits.
This study compared the efficacy of treating dorsal wrist ganglions with aspiration and triamcinolone injection versus surgical excision. 60 patients were randomly assigned to either treatment. Successful resolution was achieved in both groups. The aspiration/injection group reported mild pain in 23.3% of patients and a 6.66% recurrence rate over 2 years. The surgical excision group reported moderate postoperative pain requiring analgesics for 5 days and a 16.66% recurrence rate. The study concluded aspiration/injection is superior due to lower recurrence and morbidity rates.
The document describes a clinical trial that assessed the effects of using a Connecticut intrusion arch (CIA) with or without a distal bend on maxillary incisor and molar positions. 44 patients were randomly divided into two groups: one treated with a CIA without a distal bend, and one treated with a CIA with a distal bend. Cephalometric analysis found that the group without a distal bend experienced labial flaring and proclination of maxillary incisors, while the group with a distal bend experienced palatal inclination and retroclination of maxillary incisors. No significant differences were found between the groups for maxillary molar positions. The presence or absence of a distal bend in the CIA affects incis
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
Call for case report,review and research article for journals
1.International journal of medical and applied sciences.
Volume 6 issue2,2018
2.IRO International journal of medical and applied sciences.
Print journal
Volume 1 issue2, 2018
email: earthjournals@gmail.com
www.earthjournals.in
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
This document summarizes a journal presentation on a clinical study assessing lingual nerve injury from mandibular third molar surgery. The study examined 1200 patients undergoing third molar removal and found an overall 5.6% temporary lingual nerve impairment rate and 0.3% permanent rate. Factors associated with higher temporary injury rates included lingual flap retraction, tooth sectioning, and buccal guttering. The presentation reviews the study methodology, results, comparisons to other studies, and discusses techniques to reduce lingual nerve injury risk during third molar surgery.
INFLUENCE OF GENDER ON MUSCLE ACTIVITY PATTERNS DURING NORMAL AND FAST WALKING ijbesjournal
Electromyography (EMG) signals are often described as electrical manifestation of neuromuscular
activation associated with the muscles. These signals are commonly utilized as principal input signals to
control several prosthetic devices such as prosthetic hands, arm, lower limbs, and exoskeleton robots as
well as in designing of rehabilitation and assistive devices. It is well proven that EMG signals vary among
subjects and gender is one of the major factors that play a significant role in this variation. This study
detects the possible gender differences by measuring changes in the EMG activity during different phases
of human walking by acquiring the surface EMG signals from Gluteus Maximus, Hamstrings (biceps
femoris), Quadriceps (rectus femoris) and Soleus muscles of the leg with the healthy subjects walking
barefoot at two paces-normal and fast. The statistical analysis of the results showed no gender differences
at normal speed of walking but when speed of walking changed; it showed clear differences in the
behavior of these muscles. The results from this study would aid in designing closed loop control strategy
for designing a smart functional electrical stimulator (FES) which is the larger goal of this research.
Interactivity in Goodsalls Rule and Fistula in anoijtsrd
Fistula in ano is a tract lined by granulation tissue which opens deeply in the anal canal or rectum and superficially on the skin around the anus. Managing fistula in ano is a challenging task. Because recognizing the internal opening and cause of the fistula tract is difficult. Both external and internal openings of the fistula tract are essential for the complete identification of the tract. The purpose of the present study was to study the relevance between Goodsalls rule and course of the fistula tract. A sample of 106 patients with simple fistula was studied. In this study Hydrogen Peroxide was injected by using syringe through the external opening of the fistula and seenthe appearance of air bubbles which are come out from the internal opening. The site and number of internal and external openings and the course of the tract were recorded. The median age of the participants was 37 years. The majority were male 57.54 . Thirty one point one percent 31.1 showed intersphincteric fistula, 51.8 showed transphincteric fistula and 16.9 had superficial fistula. The overall predictive accuracy of Goodsalls rule in studied group was 68.3 . It is significantly associated with the type of fistula. The high predictive accuracy in superficial fistula 94.4 , intersphincteric fistula 84.4 and transphicteric fistula 69.09 were observed. It was concluded that, Goodsalls rule was not accurate in 31.7 of all fistulae it can be used as a guide in locating the course of the tract and the internal opening. Samaranayake G. V. P | Chandimal K. M "Interactivity in Goodsalls' Rule and Fistula-in-ano" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31383.pdf Paper Url :https://www.ijtsrd.com/medicine/anatomy/31383/interactivity-in-goodsalls-rule-and-fistulainano/samaranayake-g-v-p
Analysis and Management of Tripod Fractures: Our ExperienceSachender Tanwar
Abstract: The present prospective study seeks to evaluate the incidence of tripod fracture, etiology and treatment options. All patients
with faciomaxillary fractures following road traffic accidents admitted in the Deptt. Of otorhinolayngology, silchar medical college &
hospital, Assam during the period of one year from Aug 2011 to Aug 2012, were scrutinized for tripod fracture, both clinically and
radiologically & were managed according to the severity of fracture. Patients presenting with simple zygomaticomaxillary complex
fractures were managed conservatively. While comminuted/malaligned fractures had monofragments fixed using open & closed
reduction methods. Out of which most had early intubation, before edema occurred, to make airway control and provide anaesthesia.in
few patients in whom intubation by oral route was impossible, tracheostomy was performed to secure airway.The adequacy of fracture
reduction & its stability was confirmed by subsequent CT scan measurements, statistical analysis, and clinical follow-up during the
postoperative period, in which patients showed no significant associated complications, facial asymmetry, enophthalmos, or diplopia.
Road traffic accidents came out to be most common cause of facio-maxillary fracture, incidence of zygomaticomaxillary fractures is
second to nasal bone fracture, which in itself most common facial fracture.
Keywords: tripod fracture, zygomaticomaxillary complex fractures, fracture reduction.
This document summarizes a study that examined the length of styloid processes in 46 cadavers from Colombia. The researchers found that the average length was 35.1 mm, with 23 processes (50%) over 30 mm long. They noted this frequency was comparable to other studies. While an elongated styloid process (over 30 mm) has been linked to Eagle's syndrome symptoms, the researchers suggested angulation may be more relevant than length alone in determining clinical significance. Understanding anatomical variations in a population can aid in differential diagnosis of related conditions.
This case report describes a 52-year-old woman who presented with back pain and weakness in her lower limbs. Imaging showed a cystic lesion compressing her spinal cord. She underwent surgery to remove the cyst, which was determined to be a primary spinal hydatid cyst. Hydatid cysts are caused by the parasite Echinococcus granulosus and rarely involve the spine. Complete surgical removal of the cyst without rupture achieved decompression of the spinal cord in this case.
This case report describes a rare case of synovial chondromatosis in the temporomandibular joint of a 36-year-old male patient who presented with a history of difficulty opening his mouth and pain in the left temporomandibular joint region. Imaging and histopathological examination confirmed the diagnosis of synovial chondromatosis. The lesion was surgically excised and the patient's symptoms were relieved post-operatively. Synovial chondromatosis is a benign tumor-like disorder involving the formation of loose cartilaginous nodules in the synovial membrane of joints.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
This document summarizes developments in direct visual internal urethrotomy (DVIU) for treating urethral strictures. It discusses techniques for DVIU, factors that influence outcomes, and the long-term efficacy of DVIU. While initial studies reported high success rates of around 80%, more recent long-term studies have found much lower success rates of only around 8-30%. Recurrence rates are higher for longer strictures, greater spongiofibrosis, distal strictures, and when DVIU is repeated for recurrent strictures. Overall, DVIU has relatively poor long-term outcomes for treating urethral strictures.
This study examines complications arising from squamosal chronic suppurative otitis media (CSOM) at a tertiary hospital in India. 22 CSOM patients with complications were reviewed. Complications were classified as extracranial (e.g. subperiosteal abscess) or intracranial (e.g. pyogenic meningitis, temporal lobe abscess). Common pathogens included Staph aureus and Pseudomonas. Treatment involved antibiotics and surgery such as mastoidectomy. While complications have declined with new drugs and techniques, life-threatening issues persist, emphasizing the need for standardized management protocols.
Presentations and Challenges in Tuberculosis of Head and.pptxzzaw59900
(1) The document discusses a study of 113 cases of tuberculosis in the head and neck region seen at a hospital in India between 2014-2015. (2) The most common presentation was cervical lymphadenopathy, seen in 92.92% of cases. Erythrocyte sedimentation rate was elevated in most patients and Mantoux test was positive in 93.8% of cases. (3) The study highlights that tuberculosis remains an important health issue in developing countries like India, and that diagnostic tests like ESR and Mantoux can help guide diagnosis when access to other investigations is limited.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
This document summarizes a study on the incidence of mylohyoid bridging in mandibles from the Uttarakhand region of India. The study examined 121 mandibles (69 male, 52 female) and found mylohyoid bridging in 9 mandibles (7.43% incidence). Bilateral bridging occurred in 5 mandibles and unilateral in 4 mandibles. The bridging was classified as distal-partial, proximal-trace, or trace. No significant difference was found between males and females. The incidence in this study is similar to some previous studies on Indian populations but lower than one other study on North Indians.
This document summarizes a study on the incidence and types of mylohyoid bridging found in mandibles from the Uttarakhand region of India. The study examined 121 mandibles (69 male, 52 female) and found mylohyoid bridging in 9 mandibles (7.43% incidence). Only distal-partial, proximal-trace, and trace types of bridging were present. Bilateral bridging occurred in 5 mandibles and unilateral bridging in 4 mandibles. There was no significant difference in bridging between males and females. The incidence was similar to other studies on North Indian populations.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document presents a case report of a 65-year-old man with classical rheumatoid arthritis. He presented with progressive breathlessness and left-sided chest pain. He also had joint swelling and pain in his hands, feet, and knees for 12 years, along with deformities in his hands and toes. Examination found pleural effusion on the left side, which diagnostic aspiration determined was caused by rheumatoid arthritis. Hand x-rays showed classical deformities. The document then discusses rheumatoid arthritis as the most common inflammatory arthritis worldwide, affecting the joints and having extra-articular manifestations. It describes typical rheumatoid arthritis presentations and complications affecting multiple organ systems.
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
1) The document discusses a study of 75 multiple myeloma patients who underwent surgical treatment for skeletal complications between 1980-2005.
2) The study found that survival after surgery was favorable, with 37% surviving at 5 years and a median survival of 4.7 years.
3) Factors associated with better survival included having a single bone lesion, negative bone marrow biopsy, no paraproteinemia, and lower Salmon-Durie stage (a staging system for multiple myeloma).
This study evaluated the results of a hemorrhoidal laser procedure (HeLP) in 120 patients with grade 2-4 hemorrhoids over a 1-year period. Patients underwent HeLP and were divided into groups based on their hemorrhoid grade. Results found that while operation times were under 20 minutes for all groups, grade 4 hemorrhoids had higher rates of postoperative complications and recurrence compared to lower grades. The study concluded that HeLP is an effective treatment, though more large-scale studies are needed to further evaluate outcomes.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Comparison of postoperative complications in benign thyroid disorders: subtot...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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Omaxe reviews - omaxe ltd. vs. roma international pvt. ltd.omaxe-reviews
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Omaxe reviews - list of review of training under caft by expert deputed by i...omaxe-reviews
The document lists 21 training programs proposed by various CAFT centers for capacity building of scientists and teachers in 2014-15. It provides details of each program such as the CAFT center organizing it, training title, dates, contact information for the CAFT director, and name and contact of the expert delivering the training. The training programs cover various agriculture related topics and will be delivered at different CAFT centers across India.
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1. Pasricha et al. Anatomical Perspective of Eagle's Syndrome
Asian Journal of Oral Health &Allied Sciences 2012, Volume2, Issue 1 35
CASE REPORT
1
Department of Anatomy, Era’s Lucknow Medical College,
Lucknow, 2
Department of Oral & Maxillofacial Surgery, Saraswati
Dental College & Hospital, Lucknow, 3
Department of Anatomy,
IIMSR, Integral University, Lucknow
Address for Correspondence:
Dr Navbir Pasricha, Flat No. 502, Millennium Tower, Omaxe
Heights, Vibhuti Khand, Gomti Nagar, Lucknow (UP), India.
Contact: +91 8953671222, E-mail: nivibedi@yahoo.com
Date of Submission : 22-11-2011
Reviews Completed : 18-12-2011
Date of Acceptance : 30-12-2011
Dr. Navbir Pasricha completed her graduation
(MBBS) from GGS Medical College, Faridkot in
year 1995, and postgraduation ( MD) in Anatomy
from Himalayan Institute of Medical Sciences, Jolly
Grant, Dehradun in year 2005, India. Currently she
is working as Assistant Professor in the Department
of Anatomy, Era’s Lucknow Medical College, Lucknow, India.
Anatomical Perspective of Eagle’s Syndrome:
Review and a Case Report
Navbir Pasricha1
, Alka Nagar1
, R S Bedi2
, Antima Gupta3
and Karan Punn2
ABSTRACT
Aim: To discuss the anatomical perspective of Eagle’s
syndrome.
Summary: Eagle’s Syndrome is a rare entity which is not
commonly suspected in clinical practice, and only a small
percentage ofthe populationbelieved to have an elongated
styloid processand a calcified stylohyoidligament manifest
the symptoms. It may develop inflammatory changes or
impinge on the adjacent arteries or sensory nerve endings.
A large spectrum of signs and symptoms have been
mentioned in various reports for Eagle’s syndrome.
Diagnosiscanbe made with carefulclinical evaluation and
confirmed with radiographs showing an elongated styloid
process or mineralization of the stylohyoid complex.
Keywords: Eagle’s syndrome, Orofacial pain, Stylohyoid
ligament, Styloid process
INTRODUCTION
Eagle’s syndrome is a rare condition characterized by an
elongated temporal styloid process (greater than 30 mm) or
calcified stylohyoid ligamentirritating the adjacent anatomical
structures. The condition was first described by the
American otorhinolaryngologist Watt Weems Eagle in 1937.1
Although the exact etiology is not known, dystrophic and
degenerative changes in the hyoid complex of the styloid
process is the cause of Eagle’s syndrome. Purulent facial and
cervical inflammations, tumors, tonsillectomies and trauma
play a major role.2,3
The present paper intends to review and
discuss the anatomical perspective of a case of Eagle’s
syndrome.
LITERATURE REVIEW
Eagle’s syndrome comprises a constellation of symptoms
which may include facial pain, otalgia, dysphagia, voice
changes, and a foreign body sensation in the throat that
prompts frequent swallowing which occurs secondary to an
elongation of the styloid process. This elongation was first
described in 1652 by Italian surgeon Pietro Marchetti, who
attributed it to an ossifying process. In 1937, Watt W.
Eagle1, 4-7
coinedtheterm stylalgiato describethepainassociated
with this abnormality. In studies conducted over a period of
twentyyears, he reported that the length of the normal styloid
process isapproximately25 mm to 30 mm.Other authorsalso
acknowledge the elongation of the styloid process to be an
etiologic cause of Eagle’s syndrome.8-10
Eaglepostulated that
there are two types of the syndrome : the classic type and the
carotid artery type which was also described in the studies
of Breault11
and Lorman12
. The classic type is characterized
by pain secondary to the stimulation of branches of any of
the following cranial nerves V (trigeminal), VII (facial), IX
(glossopharyngeal), and X (vagus),13
and it is often seen in
patients following tonsillectomy. Eagle theorized that these
patients develop scarring near the styloid apex that
subsequently compresses or stretches nerve structures in
the space surrounding the styloid process. The carotid artery
type occurs when the styloid process becomes involved with
the carotid nerve plexus and causes a foreign body sensation
in the pharynx and neck pain on rotation of the head.
Study done by Sokler et al.14
have shown that the average
length ofthe styloid process isless than 3 cm,withthe normal
length ranging from 1.52 to 4.77 cm. Massey15
reported that
only11 of2,000 cranial dissections detecteda styloidprocess
longer than 4 cm. Harma16
reported that the incidence of
elongated styloid process is 4 to 7%. According to Murtagh
et al.,17
only4 to 10.3% of patients with an elongated styloid
2. Anatomical Perspective of Eagle's Syndrome Pasricha et al.
36 Asian Journal of Oral Health &Allied Sciences 2012, Volume2, Issue 1
process experience pain. The length of the styloid process
has not been found to be correlated to the severity of pain.18
Continuing with the variability of the length of the styloid
process, Kaufman et al.19
reported that 30 mm is the upper
limit for normal styloid processes.Moffat et al.20
performed a
cadaveric study on the styloid process and reported that the
normal length is between 1.52 cm and 4.77 cm. Monsour and
Young21
concluded that the diagnosis of an elongated styloid
process could be made whenever the styloid process was
longer than 40 mm. In a radiological study by Montalbetti22
,
the length of the styloid process was reported to be no longer
than 25 mm. Others like Wang23
, Basekim24
, Savranlar25
and
Jung26
have also studied the length from radiographs and
three dimensional CT. According to Montalbetti22
andPrasad
et al.27
prevalence of Eagle’s syndrome in the population is
reported to be 4% and is more frequent among women.
However, other authors have reported the epidemiological
incidence to be between 1.4-30%.4,28
In their studies they
found that most patients with Eagle’s syndrome were more
than 50 years old.22,27
Rizzati29
found a greater tendency in
patients between 60-79 years of age. Conversely it was
reported in an 11 years old patient by Quereshy et al.30
Ilguy et al.31
reviewed 850 panoramic radiographs (PRs) and
reported the incidence of elongated styloid process as 3.7%,
and a 1: 3 male/ female ratio was noticed in their study. They
stated that elongated styloid processes were mostly bilateral.
It was found to be bilateral in 75% of cases byCawich etal.32
Bozkir etal.33
claimedthat 63% of patientsshowing elongated
process were male and 75% of the cases were bilateral. The
incidence of elongated styloidprocess was estimated at 3.3%
for the total sample in the study of Balcioglu et al.34
who
detected 6 (55%) bilateral cases in PRs, and the male/female
ratio as 1:9. Woolery35
in his study also found a female
preponderance.
Langlais et al.36
classified elongated styloid process and
mineralised styloid complexes based on the radiographic
appearance and structures as follows: Type I: The elongated
type pattern represents an interrupted process; Type II:
Characterized by a single pseudo articulation that seems to
be an articulated elongated styloid process; Type III:
Represents an interrupted process that gives the appearance
of multiple pseudo- articulations within the ligament. This
type can benodular or completelycalcified.He also observed
that Eagle’s syndrome occurs mainly in 30-50-year-old
patients, because regional ligaments and the soft tissues of
the styloid process become less elastic with age and offer
more resistance to surrounding hard tissue structures.27
CASEREPORT
A 49 years old male reported with pain on the left side of the
throat and tongue for the last four years. He also complained
oftinnituswith intermittent otalgia. Onexaminationtherewas
no odontogenic reason of the pain. A thorough clinical and
physical examination revealed that the pain exaggerated with
neck movements and swallowing. Intraoral palpation on the
left side revealed that there was extreme tenderness in the
tonsillar area. The tip of the styloid process was palpable in
the tonsillar bed. On radiographic examination, bilateral
elongated styloid processes were noted and a diagnosis of
Eagle’s syndrome wasmade(Fig. 1). Thepatientwas operated
intraorallyunder generalanaesthesia and antibiotic coverage.
After tonsillectomy the left styloid process was identified
through the bed, all the muscles and other structures attached
to it were stripped off and the styloid process with length
42 mmwasexcised (Fig.2).Sincethe patient hadno complaints
on the right side, the styloid process on right side was not
excised. Postsurgical healing was uneventful and the patient
was relieved of his symptoms.
Figure 1: OPG showing bilateral elongated styloid process
Figure 2: Excised styloid process
DISCUSSION
The stylohyoid complex is composed of the styloid process,
stylohyoid ligaments and the stylomandibular ligament.37
The
styloid process develops from the second branchial arch,
specifically from the Reichert cartilage. Its muscular
attachments include the stylohyoid, styloglossus, and
stylopharyngeus muscles. The stylohyoid muscle connects
the base of the styloid process to the hyoid bone near its
greater horn;it is innervated bycranial nerve VII(Facial).It is
3. Pasricha et al. Anatomical Perspective of Eagle's Syndrome
Asian Journal of Oral Health &Allied Sciences 2012, Volume2, Issue 1 37
perforated near its insertion by the intermediate tendon of
digastric. The muscle may be absent or double. It may lie
medial to the externalcarotid artery. The styloglossus muscle
arises from the anterior and lateral surface of the styloid
process near the apex and descends forward between the
branches of the internal and external carotid arteries. It then
divides upon the lateral side of the tongue to blend with the
fibers of the longitudinalis inferior linguae muscle and
obliquely with the hyoglossus muscle. It is innervated by the
hypoglossal nerve. The stylopharyngeus muscle traverses
the medial aspect of the styloid process to the lateral wall of
the pharynx; it is innervated by the glossopharyngeal nerve.
The stylohyoid ligament connects the apex of the styloid
process and the lesser horn of the hyoid bone, and the
stylomandibular ligament extends fromthe styloid process to
the parotideomasseteric fascia between the mandible and the
mastoid process.
Other structures relevant to the operative management of
Eagle’s syndrome include the external and internal carotid
arteries and the internal jugular vein. The styloid process is
located between the internal and external carotid arteries and
is juxtaposed near cranial nerves VII, IX, X, XI (accessory),
and XII. Mostcases of elongated styloidprocess are acquired,
often as a result of trauma, but some are congenital.
In case of traumatic fracture of the styloid process there is
proliferation of granulation tissue, which places pressure on
the surrounding structures. In addition to trauma, inciting
events for Eagle’s syndrome include infection and early
menopause. The symptom of pain in Eagle’s syndrome may
be multifactorial in origin. As mentioned, pain may arise
secondary to compression of various cranial nerves (cranial
nerves V, VII, IX, and X), irritation of the pharyngeal mucosa
by direct compression or post-tonsillectomy scarring.
Frictional irritation leading to chronic inflammation
progressing to osteitis, periostitis, and tendinitismaylikewise
incitepain.Pain mayalso becaused byirritationofthe superior
and inferior caroticotympanic nerves (leading to otalgia) and
the carotid sympathetic plexus close to an elongated styloid
process. Albinas et al.38
in their exhaustive study observed
patients with spasmodic pain in the tonsils, arches of the
palate, the soft palate, the root of tongue and the pharynx.
The diagnosis of Eagle’s syndrome is frequently entertained
only after a number of other diagnoses have failed to explain
a patient’s complaints. A complete history and physical
examination may elucidate symptoms of a foreign-body
sensation in the throat, otalgia and pain in the neck with a
change of head position, dysphagia, or shoulder pain. The
history may include tonsillectomy or neck trauma, often
remote from the presentation of symptoms. The physical
examination may reveal a palpable styloid process in the
tonsillar fossa. Digital palpation of the styloid process often
reproduces pain or a foreign-body sensation.30
A suspected
diagnosis of Eagle syndrome can be confirmed in the office
setting; the diagnosisis established if aninjection of lidocaine
into the tonsillar fossa provides relief of symptoms within
minutes. Lateral views of the skull base and cervical spine
and orthopantomographic (OPG) x-rays have been used as
adjuncts to diagnose Eagle’s syndrome. Although not
essential, CT of the neck aids in discerning anatomic
relationships and may rule out other conditions that produce
similarsymptoms.
Also, barium swallow studies can show the indentation of
the elongated styloid process as a filling defect.39
Despite the
valuable information about the anatomy, there are some
difficulties in reading the plain radiographs (true lateral, PA
view and lateral oblique views of skull) secondary to
superimposed anatomical structures. Superimposition of the
mandible and the teeth can cause difficulty in viewing the
styloid process, especially if it is not very long. Again,
calcification ofthe stylohyoid ligament isdifficult to evaluate
in plainfilms.Superimposition of severalosseous structures,
and distortion and magnifications secondary to angulations
are the potentialdisadvantages of conventional radiographs.40
In CT imaging, those drawbacks are eliminated.
3D-CT images reformattedfrom the raw dataobtained with a
spiral scanner provide all the information about the styloid
process, including its length, direction, and anatomical
relations.41,42
Another advantage of the 3D-CT images is, of
course, three dimensional length measurements, which are
impossible in2D images such asin coronal or axialplanes. In
cross-sectional imaging, even in coronal plane, most of the
time the images are not parallel to the styloid process, which
leads to underestimation of the actual length of the styloid
process.
Differential diagnosis may include laryngopharyngeal
dysesthesia, facial neuralgia39,43,44
dental malocclusion,
neuralgia of sphenopalatine ganglia, temporomandibular
arthritis, glossopharyngeal45
andtrigeminal neuralgia, chronic
tonsillo-pharyngitis, hyoid bursitis, Sluder’s syndrome,
histamine cephalgia, cluster type headache, esophageal
diverticula, temporal arteritis, cervical vertebral arthritis,
benign or malignant neoplasms and migraine type
headache13,46
or sometimes even as impacted molar teeth.47
The nonsurgical treatment of Eagle syndrome generally
involves pharmacotherapy with anticonvulsants (e.g.,
gabapentin) or antidepressants, but results are short-lived.
Other treatments include steroid injections into the affected
tissueswithvaryingresult48,49
. Long-lastingsymptomaticrelief
requires the surgical removal of the elongated portion of the
styloid process. Two surgical approaches have been
described intraoral and extraoral.Intra oralapproach requires
more surgical skill as the chances to damage the adjacent
vital structures are more owing to limited access and
4. Anatomical Perspective of Eagle's Syndrome Pasricha et al.
38 Asian Journal of Oral Health &Allied Sciences 2012, Volume2, Issue 1
visualization. However, it is less time consuming and more
aesthetic. Conversely the extra oral approach is easier, but
leaves a visible surgical scar50-52
.
CONCLUSION
It is crucial for the dentists, otolaryngologists and
neurologists to be aware of the elongation of the styloid
process and its anatomical basis. If any of the symptoms
exist, digital palpation of the styloid process as a simple
diagnostic procedure should be routine during the
examination. Owing to the fact that styloid process with
normal length is not normallypalpable, the examination may
easily reveal the problem. General dentists also need to be
vigilant when viewing OPGs to ensure that they assess all
the structures that can be seen and not just the teeth, alveolar
bone, and temporomandibular joints.
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