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Liu K, Hu H, Lu Y, Yu Z. A Novel Five-Step Reduction Technique of Arytenoid Dislocation. Laryngoscope 2024; 134:1744-1748. [PMID: 37632726 DOI: 10.1002/lary.30999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/30/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Abstract
The article reported a novel reduction device and standardized reduction technique for patients with arytenoid dislocation. The results showed that this reduction technique has been excellent in helping patients with arytenoid dislocation. Laryngoscope, 134:1744-1748, 2024.
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Affiliation(s)
- Kai Liu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Huiying Hu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Lu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenkun Yu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
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Yan W, Chen Z, Dong W, Qian Y. High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study. Medicine (Baltimore) 2023; 102:e34771. [PMID: 37653787 PMCID: PMC10470738 DOI: 10.1097/md.0000000000034771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.
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Affiliation(s)
- Wenqing Yan
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Weihua Dong
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yihong Qian
- Department of Anesthesiology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Kong X, Song Y, Wang L, He G, Ma C, Zhao R, Wang M, Shi L, Cui W. Risk factors of arytenoid dislocation after endotracheal intubation: A propensity-matched analysis. Laryngoscope Investig Otolaryngol 2022; 7:1979-1986. [PMID: 36544918 PMCID: PMC9764803 DOI: 10.1002/lio2.977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Arytenoid dislocation (AD) after general anesthesia with endotracheal intubation (EI) is an iatrogenic injury that impairs patient function and requires reduction. We aimed to investigate the risk factors of AD following EI. Methods This retrospective case-control study involved surgical adults who received EI for general anesthesia at a single institution from June 2010 to June 2020. Cases included all the patients who had AD. We used a ratio of 1:5 to identify patients in the propensity-matched control group. Results Multivariate analysis of 49 cases with AD and 245 controls without AD demonstrated that the use of a nasogastric (NG) tube (odds ratio [OR], 23.9; 95% confidence interval [CI], 6.8-84.1), undergoing abdominal surgery (OR, 3.7; 95% CI, 1.2-11.9), and an operative time longer than 3 h (OR, 5.2; 95% CI, 2.1-12.9) were risk factors for AD. We did not find significant independent associations between AD and 40 years or older age, gender, body mass index, whether a laryngeal mask airway was used, endotracheal tube size, and EI performers' experience. Conclusion The use of an NG tube, abdominal surgery, and longer operative time were risk factors for AD. Among these, the NG tube application showed a strong association with AD. Preventive measures of informing the patients of the increased risk and providing high-level patient monitoring can reduce the incidence of AD. Level of Evidence III.
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Affiliation(s)
- Xiangyu Kong
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina,Department of OtorhinolaryngologyCentral Hospital of Yingkou Development ZoneYingkouChina
| | - Yang Song
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Lijun Wang
- Department of RadiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Guili He
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Changhong Ma
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Rui Zhao
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Minjun Wang
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Lin Shi
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Wanming Cui
- Department of OtorhinolaryngologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
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Abstract
Arytenoid dislocation and subluxations commonly are reduced surgically using Holinger and straight Miller-3 laryngoscopes. We present a case of arytenoid cartilage subluxation returned to good position using a 28-Jackson dilator. A 66-year-old man was diagnosed previously with right vocal fold paresis and left vocal fold paralysis following a motor vehicle accident that required a 14-day intubation and tracheotomy maintained for 3 weeks. Evaluation by strobovideolaryngoscopy 3 months following the accident showed severe left vocal fold hypomotility and arytenoid height disparity; laryngeal electromyography showed only mild-to-moderate decreased recruitment in laryngeal muscles. No abnormalities were appreciated on neck computed tomography. Upon palpation of both arytenoid cartilages in the operating room, the left joint was found to be subluxed anteriorly and immobile. A 28-Jackson dilator was used to mobilize and reduce the left arytenoid cartilage, and steroid was injected into the cricothyroid joint. Increased mobility was obtained in the operating room and the patient reported significant improvement in his voice. Six months later, we saw improvement in arytenoid height disparity and left vocal fold movement, better glottic closure, and voice handicap index was improved. A 28-Jackson dilator can be used to manipulate the cricoarytenoid joint without trauma to the vocal process.
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Affiliation(s)
- Annette Kim
- 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ghiath Alnouri
- Department of Otolaryngology-Head and Neck Surgery, 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, 12312Drexel University College of Medicine, Philadelphia, PA, USA.,Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, PA, USA
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Hung KC, Chen YT, Chen JY, Kuo CY, Wu SC, Chiang MH, Lan KM, Wang LK, Sun CK. Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery: A STROBE-complaint retrospective study. Medicine (Baltimore) 2019; 98:e15318. [PMID: 31027101 PMCID: PMC6831391 DOI: 10.1097/md.0000000000015318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tracheal intubation and the use of a large-bore calibrating orogastric (OG) tube have been reported to increase the incidence of arytenoid dislocation (AD) in patients undergoing bariatric/metabolic surgery. This study aimed at identifying the clinical characteristics of this patient subgroup.We retrospectively examined the clinical characteristics of 14 patients with AD (study group) who received tracheal intubation and OG insertion for bariatric/metabolic surgery between 2011 and 2016. For comparison, another group of 19 patients with postoperative AD collected from published literature and 3 patients from the authors' institute served as controls in whom only tracheal intubation was performed. Information on patient characteristics, anesthetic time, symptoms, time of symptom onset, intervention, and postinterventional impact on vocalization of the 2 groups were collected and compared.Patients in the study group were younger than those in the control group (38 [25-60] vs 54.5 [19-88] years, P = .03). Compared with the control group, anesthetic time (282.5 [155-360] vs 225 [25-480] minutes, P = .041) was longer and symptom onset (1.0 [0-6] vs 1.0 [0-6] days, P = .018) was more delayed in the study group. After closed reduction, the frequency of voice recovery was comparable in both groups in a time interval of 12 weeks (84.6% vs 92.9%, P = .59).Our report demonstrates that the clinical characteristics of patients with AD who received tracheal intubation and OG insertion for bariatric/metabolic surgery were different from those with postoperative AD receiving only tracheal intubation, highlighting the importance of implementing individualized strategies for AD prevention in this patient population.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
| | - Yi-Ting Chen
- Department of Anaesthesiology, Chang Gung Memorial Hospital, Chia-Yi
| | - Jen-Yin Chen
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
- Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan
| | - Chuan-Yi Kuo
- Department of Anaesthesiology, E-Da Hospital, I-Shou University
| | - Shao-Chun Wu
- Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine
| | - Min-Hsien Chiang
- Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine
| | - Kuo-Mao Lan
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
| | - Li-Kai Wang
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
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Yu PC, Gao N, Li XM, Zhao X, Sun GB. [The diagnostic value of laryngeal electromyography in vocal fold paralysis and arytenoid dislocation]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:420-423. [PMID: 29737736 DOI: 10.13201/j.issn.1001-1781.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation. METHODS The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed. RESULTS The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (P<0.01) and turns (P<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns. CONCLUSIONS LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.
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Affiliation(s)
- Peng Cheng Yu
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai
| | - Nan Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai
| | - Xu Mao Li
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai
| | - Xia Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai
| | - Guang Bin Sun
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai
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Ma YL, Zhou L, Wang RQ, Zhuang PY, Xu XL. [The role of acoustic analysis of fundamental frequency in differentiating arytenoid dislocation from vocal fold paralysis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:780-783. [PMID: 29798052 DOI: 10.13201/j.issn.1001-1781.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Indexed: 06/08/2023]
Abstract
Objective:Analysis of the sustained vowels of acoustic parameters in arytenoid dislocation and vocal fold paralysis. To investigate their acoustic characteristics and evaluate the role of this acoustic analysis method in differentiating arytenoid dislocation from vocal fold paralysis. Method:Thirty-three cases with unilateral vocal cord movement disorders were collected.All cases were divided into arytenoid dislocation group and vocal fold paralysis group through the laryngeal electromyography. Each group was further devided into male group and female group. The voice signals of sustained vowel of /a/ were measured using the software MDVP and obtain the acoustic parameters(Jitter, Shimmer, SPI and Fo). The acoustic characteristics between the two groups were observed and compared. Results were analyzed using Rank sum test for group design.Result:There were significant differences in Fo between arytenoid dislocation group and vocal fold paralysis group in both male and female group(P <0.05). And mean rank order of Fo in arytenoid dislocation group was greater than vocal fold paralysis group. There were no significant differences in jitter,shimmer and SPI between arytenoid dislocation group and vocal fold paralysis group(P >0.05).Conclusion:Mean rank order of Fo in arytenoid dislocation group is greater than vocal fold paralysis group in both the male and the female group. Fo is of value in differentiating arytenoid dislocation from vocal fold paralysis. This provides a theoretical basis for the acoustic analysis method to identify these two diseases.
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Affiliation(s)
- Y L Ma
- Department of Otorhinolaryngology, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China
| | - L Zhou
- Department of Otorhinolaryngology, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China
| | - R Q Wang
- Medical College of Xiamen University
| | - P Y Zhuang
- Department of Otorhinolaryngology, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China
| | - X L Xu
- Department of Otorhinolaryngology, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China
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Zhuang P, Nemcek S, Surender K, Hoffman MR, Zhang F, Chapin WJ, Jiang JJ. Differentiating arytenoid dislocation and recurrent laryngeal nerve paralysis by arytenoid movement in laryngoscopic video. Otolaryngol Head Neck Surg 2013; 149:451-6. [PMID: 23719396 PMCID: PMC3770460 DOI: 10.1177/0194599813491222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/02/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a new method of quantifying arytenoid movement during inspiration and determine if it can be used to distinguish arytenoid dislocation from vocal fold paralysis. STUDY DESIGN Case series with chart review. SETTING Retrospective study conducted in a university laboratory based on university hospital data. SUBJECTS AND METHODS Endoscopic videos from 8 patients with dislocation and 5 patients with vocal fold paralysis diagnosed by electromyography were included. Vector analysis measured cuneiform movement, an indirect measurement of arytenoid movement, during 1 inspiration. Measurements normalized and not normalized to vocal fold length were evaluated. Interrater reliability (2 raters) and intrarater reliability (1 rater performing the analysis twice) were evaluated using intraclass correlation coefficient (ICC) analysis. Raters were blinded to subject group during analysis. RESULTS Pixel-valued cuneiform movement was 81.16 ± 25.62 for dislocation and 30.22 ± 23.60 for paralysis (P = .019). Unitless cuneiform movement was 0.58 ± 0.17 for dislocation and 0.24 ± 0.18 for paralysis (P = .030). Interrater ICC was 0.942 for pixel-valued measurements and 0.962 for unitless measurements. Intrarater ICC was 0.909 for pixel-valued measurements and 0.881 for unitless measurements. CONCLUSIONS Both pixel-valued and unitless measures of arytenoid movement were significantly greater in arytenoid dislocation than vocal fold paralysis. Pixel-valued measurements were included to demonstrate the ability to make quantitative comparisons across subjects without precise knowledge of camera precision, provided position is approximately stable, as each measurement is inherently normalized by vocal tract length. Future studies will apply this new method of evaluating vocal fold immobility disorders on a larger scale and incorporate a more diverse group of etiologies.
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Affiliation(s)
- Peiyun Zhuang
- Xiamen University Zhongshan Hospital, ENT Department, Xiamen, Fujian, China
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Goz V, Qureshi S, Hecht AC. Arytenoid dislocation as a cause of prolonged hoarseness after cervical discectomy and fusion. Global Spine J 2013; 3:47-50. [PMID: 24436851 PMCID: PMC3854589 DOI: 10.1055/s-0032-1329890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/08/2012] [Indexed: 11/06/2022] Open
Abstract
Study Design Case series of two arytenoid dislocations after anterior cervical discectomy. Objective To recognize arytenoid dislocation as a possible cause of prolonged hoarseness in patients after anterior cervical discectomies. Summary of Background Data Prolonged hoarseness is a common postoperative complication after anterior cervical spine surgery. The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve. However, other causes of postoperative hoarseness may be overlooked in this clinical scenario. Other possible etiologies include pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, as well as arytenoid cartilage dislocation. Arytenoid dislocation is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury. Methods We report two cases of arytenoid dislocation and review the literature on this pathology. Results Two patients treated with anterior cervical discectomy and fusion experienced prolonged postoperative hoarseness. Arytenoid dislocation was confirmed by flexible fiber-optic laryngoscopy in both cases. The dislocations experienced spontaneous reduction at 6 weeks and 3 months postsurgery. Conclusions Arytenoid dislocation must be considered in the differential diagnosis of prolonged postoperative hoarseness and evaluated for using direct laryngoscopy, computed tomography, or a laryngeal electromyography. Upon diagnosis, treatment must be considered immediately. Slight dislocations can reduce spontaneously without surgical intervention; however, operative intervention may be required at times.
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Affiliation(s)
- Vadim Goz
- Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York
| | - Andrew C. Hecht
- Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York,Address for correspondence Andrew C. Hecht, M.D. Leni and Peter W. May Department of Orthopaedic SurgeryMount Sinai Medical Center, 5 East 98 Street, 9th FloorNew York, NY 10029
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