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Yang Z, Zhang M, Yan L, Xiao J, Li Y, Li X, Luo Y. Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up. Endocrine 2024; 85:1066-1074. [PMID: 38801598 DOI: 10.1007/s12020-023-03660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. METHODS PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. CONCLUSIONS Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.
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Affiliation(s)
- Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Bourke G, Wade RG, van Alfen N. Updates in diagnostic tools for diagnosing nerve injury and compressions. J Hand Surg Eur Vol 2024; 49:668-680. [PMID: 38534079 DOI: 10.1177/17531934241238736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.
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Affiliation(s)
- Gráinne Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Nens van Alfen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
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Lucey Á, Kennedy S, Hussey A, McInerney N, Kelly JL, Joyce KM. The application of human reliability analysis to carpal tunnel decompression. Ann R Coll Surg Engl 2024; 106:432-438. [PMID: 37381781 PMCID: PMC11060861 DOI: 10.1308/rcsann.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Many surgical procedures are prone to human error, particularly in the learning phase of skills acquisition. Task standardisation has been suggested as an approach to reducing errors, but it fails to account for the human factors associated with learning. Human reliability analysis (HRA) is a structured approach to assess human error during surgery. This study used HRA methodologies to examine skills acquisition associated with carpal tunnel decompression. METHODS The individual steps or subtasks required to complete a carpal tunnel decompression were identified using hierarchical task analysis (HTA). The systematic human error reduction and prediction approach (SHERPA) was carried out by consensus of subject matter experts. This identified the potential human errors at each subgoal, the level of risk associated with each task and how these potential errors could be prevented. RESULTS Carpal tunnel decompression was broken down into 46 subtasks, of which 21 (45%) were medium risk and 25 (55%) were low risk. Of the 46 subtasks, 4 (9%) were assigned high probability and 18 (39%) were assigned medium probability. High probability errors (>1/50 cases) included selecting incorrect tourniquet size, failure to infiltrate local anaesthetic in a proximal-to-distal direction and completion of the World Health Organization (WHO) surgical sign-out. Three (6%) of the subtasks were assigned high criticality, which included failure to aspirate before anaesthetic injection, whereas 21 (45%) were assigned medium criticality. Remedial strategies for each potential error were devised. CONCLUSIONS The use of HRA techniques provides surgeons with a platform to identify critical steps that are prone to error. This approach may improve surgical training and enhance patient safety.
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Affiliation(s)
- Á Lucey
- Galway University Hospital, Ireland
| | | | - A Hussey
- Galway University Hospital, Ireland
| | | | - JL Kelly
- Galway University Hospital, Ireland
| | - KM Joyce
- Galway University Hospital, Ireland
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Douglas S, Sax OC, Dubin J, Remily E, Bains SS, Hameed D, Chen Z, Ingari JV. Comparative analysis of open versus endoscopic carpal tunnel release in a comprehensive national database. HAND SURGERY & REHABILITATION 2024; 43:101615. [PMID: 37939918 DOI: 10.1016/j.hansur.2023.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Carpal tunnel syndrome is the most common compressive neuropathy. There is limited evidence to support endoscopic compared to open carpal tunnel release according to the 2016 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on carpal tunnel syndrome. The purpose of the present study was to assess differences between the two procedures by comparing 30- and 90-day complications and mean hospital costs in a large patient population. METHODS Using the national Mariner15 Database by PearlDiver Technologies, we retrospectively studied 27,192 carpal tunnel syndrome patients who received carpal tunnel release using an endoscopic or open surgical approach from 2010 to 2019. Patients who met the inclusion criteria were grouped and case-matched at a 1:1 ratio through the corresponding International Classification of Diseases codes (n = 13,596) and assessed for 30- and 90-day complications such as median nerve injury, superficial palmar arch injury, and revision carpal tunnel release surgery. Univariate analysis was used to compare outcomes and a multivariate regression was performed to identify risk factors associated with each outcome. RESULTS Endoscopic carpal tunnel release was associated with a higher rate of median nerve injury than open release at 30 days (0.3% vs. 0.1% odds ratio, 2.21; 95% confidence interval, 1.29-3.81; p < 0.05) and 90 days (0.4% vs. 0.3%; odds ratio, 1.77; 95% confidence interval, 1.16-2.70; p < 0.05). Endoscopic release was also associated with a higher rate of superficial palmar arch injury (0.1% vs. 0%; odds ratio, 25.02; 95% confidence interval, 1.48-423.0; p < 0.05). CONCLUSIONS In the present study, risk of median nerve injury and vascular injury was higher after endoscopic than open carpal tunnel release. At 90 days, all-cause revision rates were similar between techniques. Surgeons should understand these differences, to optimize surgical decision-making. LEVEL OF EVIDENCE Therapeutic, IIIa.
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Affiliation(s)
- Scott Douglas
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Ethan Remily
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - John V Ingari
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Oyem PC, Burke ZD, Mesko NW, Nystrom LM. Custom three-dimensional printed implants for reconstruction of oncologic pelvic defects. J Surg Oncol 2024; 129:424-435. [PMID: 37754672 DOI: 10.1002/jso.27465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
The use of three-dimensional printed implants in the field of orthopedic surgery has become increasingly popular and has potentiated hip reconstruction in the setting of oncologic resections of the pelvis and acetabulum. In this review, we examine and discuss the indications and technical considerations for custom implant reconstruction of pelvic defects.
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Affiliation(s)
- Precious C Oyem
- Cleveland Clinic, Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary D Burke
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nathan W Mesko
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lukas M Nystrom
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Kannari L, Marttila E, Oksa M, Furuholm J, Snäll J. Non-Surgical Site-Related Complications in Mandibular Fracture Surgery - A Problem of Elderly Patients? J Oral Maxillofac Surg 2024; 82:47-55. [PMID: 38164998 DOI: 10.1016/j.joms.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/29/2023] [Accepted: 10/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Scientific evidence of nonsurgical site-related complications in mandibular fracture patients is limited. PURPOSE The purpose was to measure the frequency of nonsurgical site complications in patients with mandible fractures, describe the types of complications, and identify the risk factors associated with these complications. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was conducted at the Helsinki University hospital between 2018 and 2021. Patients undergoing surgery with open reduction and internal fixation of mandibular fracture(s) were evaluated. Patients under 16 years of age were excluded. PREDICTOR VARIABLE Primary predictor variable was age. Patient-related predictor variables were sex, long-term disease(s), smoking, and alcohol and/or drug abuse. Injury and fracture-related variables were injury mechanism, type and site of facture, combined craniofacial fracture(s), and associated injury(s). MAIN OUTCOME VARIABLE(S) The primary outcome variable was nonsurgical site-related postoperative complication. The secondary outcome variable was type of complication. COVARIATES Not applicable. ANALYSES The main outcome variable was cross tabulated for pairwise comparisons with predictor variables. Multivariate logistic regression was performed for statistically significant (P < .05) variables. RESULTS The data included 314 patients (age range: 16 to 89 years; mean age: 38 years old; median age: 33 years old); most (78.3%) were men. Nonsurgical site-related postoperative complications occurred in 6.7% of patients. The most common complication type was pulmonary complication (36.0%), followed by urinary complication (20.0%) and general infection (16.0%). Nonsurgical site-related postoperative complications were most likely to occur in patients who were elderly (adjusted odds ratio [aOR] 5.55; 95% CI 1.92 to 16.21; P = .002), had combined craniofacial fractures (aOR 2.92; 95% CI 1.06 to 8.03; P = .038), and abused alcohol or drugs (aOR 4.51; 95% CI 1.70 to 11.96; P = .003). Pulmonary complications occurred more often in elderly patients, whereas urinary complications were more common in younger patients. CONCLUSIONS AND RELEVANCE The types of nonsurgical site complications in mandibular fracture patients increase and vary according to the patient's age. Awareness of possible complications related to different age groups helps anticipate and identify these in clinical work, and to consider the overall treatment of the patient beyond the fracture.
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Affiliation(s)
- Leena Kannari
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Emilia Marttila
- Consultant, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Oksa
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Furuholm
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Associate Professor (tenure-track), Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Koliarakis I, Manatakis DK, Tsitsipanis C, Drakonaki E, Tsamandouras I, Tsiaoussis J. Spinal accessory nerve anatomy in the posterior cervical triangle: A systematic review with meta-analysis. Clin Anat 2024; 37:130-139. [PMID: 37767816 DOI: 10.1002/ca.24119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/10/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
This study aimed to investigate the anatomy of the spinal accessory nerve (SAN) in the posterior cervical triangle, especially in relation to adjacent anatomical landmarks, along with a systematic review of the current literature with a meta-analysis of the data. Overall, 22 cadaveric and three prospective intraoperative studies, with a total of 1346 heminecks, were included in the analysis. The major landmarks relevant to the entry of the SAN at the posterior border of the SCM muscle (PBSCM) were found to be the mastoid apex, the great auricular point (GAP), the nerve point (NP), and the point where the PBSCM meets the upper border of the clavicle. The SAN was reported to enter the posterior cervical triangle above GAP in 100% of cases and above NP in most cases (97.5%). The mean length of the SAN along its course from the entry point to its exit point from the posterior triangle of the neck was 4.07 ± 1.13 cm. The SAN mainly gave off 1 or 2 branches (32.5% and 31%, respectively) and received either no branches or one branch in most cases (58% and 23%, respectively) from the cervical plexus during its course in the posterior cervical triangle. The major landmarks relevant to the entry of the SAN at the anterior border of the TPZ muscle (ABTPZ) were found to be the point where the ABTPZ meets the upper border of the clavicle and the midpoint of the clavicle, along with the mastoid apex, the acromion, and the transverse distance of the SAN exit point to the PBSCM. The results of the present meta-analysis will be helpful to surgeons operating in the posterior cervical triangle, aiding the avoidance of the iatrogenic injury of the SAN.
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Affiliation(s)
- Ioannis Koliarakis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Christos Tsitsipanis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Elena Drakonaki
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioannis Tsamandouras
- Department of Otorhinolaryngology - Head and Neck Surgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - John Tsiaoussis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Sribhasyam V, Maddikunta S, Hanna B, Hanna A. Accessory head of flexor carpi radialis and abnormal course of the median nerve in the forearm. Surg Neurol Int 2023; 14:411. [PMID: 38213422 PMCID: PMC10783689 DOI: 10.25259/sni_822_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
Background The median nerve anatomy and its clinical presentation are crucial for surgeons to consider avoiding iatrogenic injury and performing effective surgical interventions. Case Description An atypical presentation of median nerve anatomy proximal to the carpal tunnel was found during cadaveric dissection. The median nerve was located deep to a uniquely double-headed flexor carpi radialis and curved medially around the tendons of the forearm to enter the carpal tunnel superficially. Conclusion The atypical presentation of median nerve anatomy can assist surgeons in adverse event reduction during surgeries such as carpal tunnel and pronator teres syndrome releases.
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Affiliation(s)
- Vaishnavi Sribhasyam
- College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Shilpa Maddikunta
- College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Barbara Hanna
- M.D. Program, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States
| | - Amgad Hanna
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, United States
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Dongming G, Yuequan J, Qi Z, Huajie X, Zhiqiang W. A novel technique for lymphadenectomy along the left recurrent laryngeal nerve during minimally invasive esophagectomy: a retrospective cohort study. BMC Surg 2023; 23:355. [PMID: 37990240 PMCID: PMC10662753 DOI: 10.1186/s12893-023-02263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND In the context of esophageal cancers, lymph nodes located along the left recurrent laryngeal nerve (RLN) exhibit significant involvement, posing significant challenges for lymphadenectomy. The objective of this study is to assess the safety and efficacy of a novel technique for lymphadenectomy called "elastic suspension of left RLN" method, comparing it with the conventional approach. METHODS Between January 2016 and June 2020, a total of 393 patients who underwent minimally invasive esophagectomy with gastroplasty and cervical esophagogastric anastomosis were enrolled in the study. Among them, 291 patients underwent the "elastic suspension of left RLN" method, while 102 patients underwent the conventional method. We compared the number of harvested lymph nodes along the left RLN and assessed postoperative complications between these two groups. Additionally, the overall survival (OS) rate was calculated and analyzed for the entire cohort. RESULTS In comparison to the conventional group, the elastic suspension group exhibited a higher yield of harvested lymph nodes along the left RLN (5.36 vs 3.07, P < 0.001). Moreover, the incidence of postoperative hoarseness was lower in the elastic suspension group (10.65% vs 18.63%, P = 0.038). The average duration of lymphadenectomy along the left RLN was 11.85 min in the elastic suspension group and 11.51 min in the conventional group, although this difference was not statistically significant (P = 0.091). Notably, the overall 5-year OS was markedly higher in the elastic suspension group compared to the conventional group (64.1% vs. 50.1%, P = 0.020). CONCLUSIONS The findings suggest that the novel "elastic suspension of left RLN" method for lymphadenectomy along the left RLN in minimally invasive esophagectomy is both safe and effective. This technique holds promise for widespread adoption in esophagectomy procedures.
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Affiliation(s)
- Guo Dongming
- Department of Thoracic Cancer Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Jiang Yuequan
- Department of Thoracic Cancer Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Zhang Qi
- Department of Thoracic Cancer Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Xing Huajie
- Department of Thoracic Cancer Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Wang Zhiqiang
- Department of Thoracic Cancer Center, Chongqing University Cancer Hospital, Chongqing, 400030, China.
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Terkawi AS, Altirkawi OK, Salmasi V, Ottestad E. Clinical Approach to Chronic Pain due to Perioperative Nerve Injury. Anesthesiol Clin 2023; 41:489-502. [PMID: 37245952 DOI: 10.1016/j.anclin.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Perioperative nerve injuries are common and may be prevented. The estimated incidence of perioperative nerve injury is 10% to 50%. However, most of these injuries are minor and self-recovering. Severe injuries account for up to 10%. Potential mechanisms of injury are nerve stretch, compression, hypoperfusion, direct nerve trauma, or injury during vessel cannulation. Nerve injury pain usually presents as neuropathic pain ranging from mild to severe mononeuropathy and extends to the disabling complex regional pain syndrome. This review provides a clinical approach to subacute and chronic pain secondary to perioperative nerve injury, presentation, and management.
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Affiliation(s)
- Abdullah Sulieman Terkawi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Omar Khalid Altirkawi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Vafi Salmasi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Einar Ottestad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Hewson DW, Kurien T, Hardman JG. Postoperative ulnar neuropathy: a systematic review of evidence with narrative synthesis. Br J Anaesth 2023:S0007-0912(23)00185-X. [PMID: 37198029 DOI: 10.1016/j.bja.2023.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Postoperative ulnar neuropathy (PUN) is an injury manifesting in the sensory or motor distribution of the ulnar nerve after anaesthesia or surgery. The condition frequently features in cases of alleged clinical negligence by anaesthetists. We performed a systematic review and applied narrative synthesis with the aim of summarising current understanding of the condition and deriving implications for practice and research. METHODS Electronic databases were searched up to October 2022 for primary research, secondary research, or opinion pieces defining PUN and describing its incidence, predisposing factors, mechanism of injury, clinical presentation, diagnosis, management, and prevention. RESULTS We included 83 articles in the thematic analysis. PUN occurs after approximately 1 in 14 733 anaesthetics. Men aged 50-75 yr with pre-existing ulnar neuropathy are at highest risk. Preventative measures, based on consensus and expert opinion, are summarised, and an algorithm of suspected PUN management is proposed, based upon the identified literature. CONCLUSIONS Postoperative ulnar neuropathy is rare and the incidence is probably decreasing over time with general improvements in perioperative care. Recommendations to reduce the risk of postoperative ulnar neuropathy are based on low-quality evidence but include anatomically neutral arm positioning and padding intraoperatively. In selected high-risk patients, further documentation of repositioning, intermittent checks, and neurological examination in the recovery room can be helpful.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Thomas Kurien
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Trauma and Orthopaedic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jonathan G Hardman
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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Marrone M, Angeletti C, Leonardelli M, Duma S, Cazzato G, Gorini E, Dell’Erba A, Pomara C. Healthcare Liability and Thyroidectomy: When Is the Surgeon Wrong? Healthcare (Basel) 2023; 11:577. [PMID: 36833111 PMCID: PMC9956906 DOI: 10.3390/healthcare11040577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Thyroid surgeries can often lead to operative complications, sometimes with consequences on the patient's health. This often leads to claims for compensation but the assessments of consultants and judges are not always objective. Based on these considerations, the authors analyzed forty-seven sentences issued between 2013 and 2022 regarding claims of alleged medical malpractice. This analysis aims to examine the cases presented in the sentences and the evaluations proposed by the judges to offer ideas for objective evaluation by the legislation in force in Italy.
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Affiliation(s)
- Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, 70124 Bari, Italy
| | - Carlo Angeletti
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, 70124 Bari, Italy
| | - Mirko Leonardelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, 70124 Bari, Italy
| | - Stefano Duma
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Ettore Gorini
- Department of Economics and Finance, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Alessandro Dell’Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, 70124 Bari, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
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Experience of endoscopic transcapsular axillary nerve decompression: series of clinical cases. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract114767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction. Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often is seen after shoulder joint trauma. It can be also occurred as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. Endoscopic surgical technique of decompression is an effective less traumatic alternative to open procedures. Goal. Improve the results of treatment of patients with axillary nerve neuropathy. Material and methods. The results of endoscopic transcapsular axillary nerve decompression in 5 patients, which were operated from 2018 to 2021 year, with the clinics of axillary nerve neuropathy. The mean age of the patients was 44.414.9. Patients were performed endoscopic axillary nerve decompression. Statistical analysis was made according to Mann-Whitney U test. Results. According to VAS-scale the severity of pain syndrome before the surgery was 64.6 points, 6 months after decreased to 1.4 0.5 points (p0.05). According to DASH scale the function of the of shoulder joint before the surgery was 77,6 6,9 points, 6 months after decreased to 12 5,2 points (p0.05). According to BMRC scale (M0-M5) strength of the deltoid muscle was 2 0,4 points, after increased to 4,4 0,5 points (p0.05). Range of motion in a shoulder was: flexion 107 45,6, extension 102 49, external rotation 22 13,6; 6 months after: flexion 154 25,6, extension 156 22,4, external rotation 50 8 (p0,05). The thickness of deltoid muscle according to US before the surgery was 7.21.04 mm., after 6 months - 11.81.44 mm (p0.05). Conclusion. The results characterize the method of endoscopic transcapsular axillary nerve decompression as a reproducible, minimally invasive and effective technique for pain relief, can treat neurological and intraarticular pathology, promotes early restoration of the function of upper limb.
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15
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Ein L, Xiao R, Zhou AS, Hadlock TA. Facial Nerve Exploration for Known or Suspected Transection: The Massachusetts Eye and Ear Experience. Facial Plast Surg Aesthet Med 2022. [PMID: 36516072 DOI: 10.1089/fpsam.2022.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: There is no ideal test to determine likelihood of spontaneous recovery after post-traumatic and postsurgical facial palsy (FP). Objective: Among patients with unexpected FP undergoing facial nerve (FN) exploration for suspected discontinuity, we endeavored to discern whether intraoperative findings, repair type, and time to exploration impact FN recovery, as measured by electronic Facial Clinimetric Evaluation (eFACE) and FaCE scales. Methods: Retrospective cohort study of 42 adult patients who underwent FN exploration. Results: FN injury resulted from either surgery (n = 29) or trauma (n = 13). Average time to repair was 68.4 (standard deviation 79.6) days. Postoperative improvements were observed in total eFACE (73.3-86.5; p < 0.0001) and FaCE (21.5-38.1; p = 0.0214) scores. Distal FN injuries were most common (n = 29) and had best recovery (percentage change in eFACE 57.2% vs. 34.3% main trunk, p = 0.0306). Discontinuity injuries (n = 33) repaired with primary coaptation (n = 18) had noninferior outcomes compared with cable graft repair (n = 16; percentage change in eFACE 49.6% vs. 39.2%, p = 0.3470). Denervation times <3 months yielded better recovery using percentage change in eFACE score (56.9% vs. 33.1%, p = 0.0270). Conclusions: Surgical exploration for unexpected FP allows for direct visualization of anatomical nerve status and timely repair.
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Affiliation(s)
- Liliana Ein
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roy Xiao
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen S Zhou
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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16
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Thalji SZ, Cortina CS, Guo MS, Kong AL. Postoperative Complications from Breast and Axillary Surgery. Surg Clin North Am 2022; 103:121-139. [DOI: 10.1016/j.suc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Risk Factors for Venous Thrombosis after Spinal Surgery: A Systematic Review and Meta-analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1621106. [PMID: 35387225 PMCID: PMC8977314 DOI: 10.1155/2022/1621106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Background. Venous thrombosis, comprising DVT and PE, is an orthopedic condition that may be fatal after surgery. This study’s purpose was to analyze risk factors for venous thrombosis following spine surgery to help guide treatment prophylaxis. Methods. A computer searched English databases such as PubMed, Web of Science, Embase, Cochrane Library, and Google Academic for relevant publications after spinal surgery. Preoperative walking difficulties, hypertension, diabetes, heart disease, preoperative bleeding volume, etc., were all examined using the NOS scale. Data were analyzed using Review Manager 5.3 software. An analysis was done. Due to the study’s differences, the data was compiled using fixed effects or random effects models. Results. A total of 25 studies were considered, with a total of 1,927,781 individuals after spine surgery, including 7843 patients with venous thrombosis. The included literatures had NOS scores ranging from 5 to 8. According to the findings of the meta-analysis, the age of patients with venous thrombosis after spinal surgery (
, 95% CI (6.73, 8.33)), blood loss (
, 95% CI (-154.68, -128.9),
), and operation time (
, 95% CI (73.17, 80.86),
) were higher than those without; diabetes mellitus (OR =1.23, 95% CI (1.12, 1.34),
) and walking disability history (
, 95% CL (1.77, 4.98),
) increased the incidence of postoperative venous thrombosis. Conclusion. High age, female, spinal fusion, big volume blood loss patients, operation time, and hypertension, diabetes, and walking issue are all risk factors for venous thrombosis following surgery.
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Soares-Aquino C, Vasconcelos-Castro S, Campos JM, Soares-Oliveira M. Response to letter to the Editor re' 15-year varicocelectomy outcomes in pediatric age: Beware of genitofemoral nerve injury'. J Pediatr Urol 2021; 17:876-877. [PMID: 34600854 DOI: 10.1016/j.jpurol.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carolina Soares-Aquino
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal.
| | | | - José Miguel Campos
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
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19
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Weyand B, Spies M. [Functional reconstruction in traumatic paralysis]. Unfallchirurg 2021; 124:823-831. [PMID: 34542653 DOI: 10.1007/s00113-021-01078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Traumatic nerve injuries are associated with a high morbidity and long rehabilitation times. The extent of a nerve lesion and the related regeneration potential can often only be estimated during the course, whereby the time window for successful surgical interventions is limited. OBJECTIVE The incidence and distribution of traumatic nerve lesions are reported. Algorithms for treatment decisions are presented. MATERIAL AND METHODS Statistics from the German TraumaRegister DGU® as well as international registers were evaluated. The results of basic research and expert recommendations for diagnostics and treatment are discussed. RESULTS AND CONCLUSION A strategic approach to conservative and surgical treatment of traumatic nerve injuries depending on the extent of injury and resulting regeneration potential is recommended. In conjunction with the clinical course, electrophysiology and imaging diagnostics, e.g. nerve sonography, can help to differentiate between neurapraxia, axonotmesis and neurotmesis.
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Affiliation(s)
- Birgit Weyand
- Klinik für Plastische, Ästhetische, Hand und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, OE 6260, Carl-Neubergstr. 1, 30625, Hannover, Deutschland.
| | - Marcus Spies
- Klinik für Plastische, Hand und wiederherstellende Chirurgie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
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20
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'EngNT' - Engineering live neural tissue for nerve replacement. Emerg Top Life Sci 2021; 5:699-703. [PMID: 34297065 PMCID: PMC8726050 DOI: 10.1042/etls20210085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
Peripheral nerve injury can result in severe long-term disability and current clinical approaches for repairing large gaps rely on the nerve autograft. Engineered Neural Tissue (EngNT) has been developed to provide living aligned therapeutic cells in a stabilised collagen hydrogel, mimicking the key features of the autograft. This Perspective article will introduce the field and discuss the current stage of translation, highlighting the key opportunities for commercial and clinical development.
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21
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van Tonder DJ, Lorke DE, Nyirenda T, Keough N. An uncommon, unilateral motor variation of the intercostobrachial nerve. Morphologie 2021; 106:209-213. [PMID: 34183262 DOI: 10.1016/j.morpho.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
The intercostobrachial nerve (ICBN) is commonly defined as a purely sensory nerve supplying the skin of the lateral chest wall, axilla, and medial arm. However, numerous branching patterns and distributions, including motor, have been reported. This report describes an uncommon variant of the right ICBN observed in both an 86-year-old white female cadaver and a 77-year-old white male cadaver. In both cases the ICBN presented with an additional muscular branch, termed the "medial pectoral branch", piercing and therefore innervating the pectoralis major and minor muscles. Clinically, the ICBN is relevant during surgical access to the axilla and can result in sensory deficits (persistent pain/loss of sensory function) to this region following injury. However, damage to the variation observed in these cadavers may result in additional partial motor loss to pectoralis major and minor.
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Affiliation(s)
- D J van Tonder
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates.
| | - D E Lorke
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - T Nyirenda
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - N Keough
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates; Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
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22
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Fan CJ, Cosetti MK, Levitin GM, Ulkatan S. Intermittent and Continuous Monitoring of the Facial Nerve: From the Ear to the Neck. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00352-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nerve Ultrasound in Traumatic and Iatrogenic Peripheral Nerve Injury. Diagnostics (Basel) 2020; 11:diagnostics11010030. [PMID: 33375348 PMCID: PMC7823340 DOI: 10.3390/diagnostics11010030] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 01/04/2023] Open
Abstract
Peripheral nerve injury is a potentially debilitating disorder that occurs in an estimated 2–3% of all patients with major trauma, in a similar percentage of medical procedures. The workup of these injuries has traditionally been clinical, combined with electrodiagnostic testing. However, this has limitations, especially in the acute phase of the trauma or lack of any recovery, when it is very important to determine nerve continuity and perform surgical exploration and repair in the case of the complete transection or intraneural fibrosis. Ultrasound can help in those situations. It is a versatile imaging technique with a high sensitivity of 93% for detecting focal nerve lesions. Ultrasound can assess the structural integrity of the nerve, neuroma formation and other surrounding abnormalities of bone or foreign bodies impeding the nerve. In addition, this can help to prevent iatrogenic nerve injury by marking the nerve before the procedure. This narrative review gives an overview of why and how nerve ultrasound can play a role in the detection, management and prevention of peripheral nerve injury.
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