The effect of soft palate reconstruction with the da Vinci robot on middle ear function in children: an observational study

Cleft palate is associated with a high prevalence of middle ear dysfunction, even after palatal repair. The aim of this study was to evaluate the effects of robot-enhanced soft palate closure on middle ear functioning. This retrospective study compared two patient groups after soft palate closure with a modified Furlow double-opposing Z-palatoplasty technique. Dissection of the palatal musculature was performed using a da Vinci robot in one group and manually in the other. Outcome parameters were otitis media with effusion (OME), tympanostomy tube use, and hearing loss during 2 years of follow-up. At 2 years post-surgery, the percentage of children with OME had reduced significantly to 30% in the manual group and 10% in the robot group. The need for ventilation tubes (VTs) decreased significantly over time, with fewer children in the robot group (41%) than those in the manual group (91%) needing new VTs during postoperative follow-up (P = 0.026). The number of children presenting without OME and VTs increased significantly over time, with a faster increase in the robot group at 1 year post-surgery (P = 0.009). Regarding hearing loss, significantly lower hearing thresholds were recorded in the robot group from 7 to 18 months postoperatively. To conclude, beneficial effects of robot-enhanced surgery were recorded, suggesting a faster recovery when the soft palate was reconstructed using the da Vinci robot.

The effect of subspinal Le Fort 1 corticotomy on nasal morphology in surgically assisted rapid palatal expansion

The purpose of this retrospective study was to evaluate the influence of subspinal Le Fort 1 corticotomy (SLF1C) on nasal morphology in patients treated with surgically assisted rapid palatal expansion (SARPE) using three-dimensional (3D) stereophotogrammetry images. A total of 64 patients were enrolled in the study and divided into two groups according to the surgical approach that was used: in group 1 (n = 32) SARPE was performed using a conventional Le Fort 1 corticotomy (CLF1C), and in group 2 (n = 32) SARPE was performed using a subspinal Le Fort 1 corticotomy (SLF1C). Measurements of alar and columellar width, and nasolabial angle were taken on 3D stereophotogrammetry images before and after SARPE using Vectra 3D camera system. Both surgical groups showed a statistically significant increase in alar and columellar width, and nasolabial angle postoperatively (p<0.05). SLF1C resulted in significantly smaller changes of the columellar base postoperatively (p=0.0456). The datasuggests that SARPE with an osteotomy of the anterior nasal spine as an additional step to the conventional Le Fort 1 corticotomy results in a smaller increase of the columellar base.

A novel instrument for the prevention of condylar torque in bilateral sagittal ramus osteotomy when using bicortical screw fixation

When using the bilateral sagittal split osteotomy (BSSO) technique, rigid internal fixation (RIF) remains the standard method to accurately fix the distal and proximal osteotomy fragments. A concern with the use of RIF, especially with bicortical screws, is the increased risk of condylar torque and its functional consequences. This technical note introduces a new method for preventing torque of the mandibular condyles after BSSO, using a sagittal split space maintainer.

An energy-based beam hardening model in tomography

As a consequence of the polychromatic x-ray source, used in micro-computer tomography (microCT) and in medical CT, the attenuation is no longer a linear function of absorber thickness. If this nonlinear beam hardening effect is not compensated, the reconstructed images will be corrupted by cupping artefacts. In this paper, a bimodal energy model for the detected energy spectrum is presented, which can be used for reduction of artefacts caused by beam hardening in well-specified conditions. Based on the combination of the spectrum of the source and the detector efficiency, the assumption is made that there are two dominant energies which can describe the system. The validity of the proposed model is examined by fitting the model to the experimental datapoints obtained on a microtomograph for different materials and source voltages.