Search

To compare the effects of using motorized diamond burr polisher in pterygium excision versus manual polishing of the corneoscleral bed in reducing the recurrent rate. A prospective, comparative and interventional study of 90 consecutive patients with different grads of primary pterygium, who underwent pterygium excision at Shahid Aso teaching eye hospital in Sulaimani city, between August 2018 till September 2019, which was performed by single surgeon. In group A (45) eyes polishing of the corneoscleral bed done using motorized diamond polishing burr, and in group B (45) eyes using manual crescent blade for polishing. Recurrent rate was evaluated after about (8±2) months postoperatively. Ethical consideration of the risks and the benefits of the procedure was observed for each individual patient. A 90 patients with the mean age of group A (48.84±12.7) years and group B (49.67±12.3) years, complained of different grads of primary pterygium, group A had 31(68.9%) male and 14(31.1%) female, while group B had 22(48.9%) male and 23(51.1%) female. Each individual factors like age, gender, visual acuity, BCVA pre and postoperatively, IOP measurement, dryness of the eye and risk factors like smoking and UV exposure affecting the recurrence were assessed. In both groups the main indication for surgery was sign of irritation. The mean surgical time was calculated and the difference between two groups were significant. After follow-up of average six months the outcomes and recurrent rate were checked, recurrent rate was in group A 1(2.2%) while in group B was 6(13.3%) patients. it significantly decreased. Corneal scar happens in only 1(2.2%) case of group A while in 11(24.4%) cases in group B, Corneal scar was statistically significant. In both groups the change of BCVA was significant but the visual change was more significant in group A in compare to group B. Motorized diamond burr is a safe instrument for polishing the cornea during pterygium excision, it is easy to handle, low price, need lesser operative time, its effect on recurrence postoperatively is significant and beside it leaves lesser corneal scar and early visual recovery postoperatively.

Objective The objective of the study was to evaluate the relation between occlusal loading and peri-implant crevicular fluid cytokine expression in patients with implant-supported complete fixed prostheses in both arches. Material and methods A prospective longitudinal clinical study was performed at a university clinic. Fifteen patients were selected and 11 were included. All patients had bimaxillary implant-supported complete fixed ceramo-metallic prostheses loaded at least 12 months before the beginning of the study. Allocation was established for each patient using a computerized occlusal analysis system. The test implant was the maxillary implant closest to the point of highest occlusal loading. The maxillary implant with least loading was the control implant. Occlusal adjustment was performed using a round diamond burr. This occlusal distribution was verified with the occlusal analysis system. Expression of cytokines from peri-implant crevicular fluid (TNF-α, IL-10, IL-6, IL-1β, IL-8) were recorded and analyzed in both test and control implants before (baseline: T0) and 2 (T1) and 12 months (T2) after occlusal adjustment. The Brunner-Langer non-parametric test was performed. Results At T0, the expression of IL-10 was significantly higher in the test group implants (p = 0.018). Between T0 and T1, the expression of all the cytokines decreased in the implants of both groups with statistically significant differences, except for TNF (p = 0.271). When comparing both groups at T1, there was no statistically significant difference in any of the analyzed cytokines. At T2, TNF-α suffered when compared with baseline, a statistical decrease in both study and control implants (p Conclusions Implants with higher occlusal load presented higher expression of IL-10 in peri-implant crevicular fluid. Occlusal adjustment produced a decrease in the expression of all the analyzed cytokines, both in test and control implants.

Purpose: To present a patient with giant cell tumor (GCT) of the orbit by changing behavior from an intraorbital mass to an intraosseous tumor. Methods: A 16-year-old boy presented with pain, swelling, erythematous of the left upper and lower eyelids, proptosis, and diplopia. Ophthalmic examination revealed chemosis, conjunctival injection, limited elevation, depression as well as abduction in the left eye. Results: Multislice computed tomography scan (CT scan) of the orbit and paranasal sinuses showed a hyperdense, oval, extraconal mass with bone erosion. Magnetic resonance imaging of the orbit showed an inferior lateral isointense, oval, extraconal mass that had indented the globe. The patient underwent superior lateral orbitotomy, and the orbital mass was excised. Two months later, the patient developed proptosis, severe chemosis, and eyelid erythema in the same eye. CT scan showed an intraosseous mass in the lateral wall of the orbit that had pushed the globe anteromedially. Intraosseous tumor was resected, and the lateral orbital wall was drilled during the second surgery. GCT was diagnosed based on pathological survey. Conclusion: Following the resection of the orbital GCT, the tumor behavior may change to an intraosseous lesion.

Key points: Chondrolaryngoplasty or “tracheal shaving” is cosmetic surgery to reduce the laryngeal prominence in transgender women. Chondrolaryngoplasty represents a challenge in seeking a balance between aesthetics and function: a very conservative resection of the thyroid cartilage may lead to aesthetic dissatisfaction, while excessive resection may destabilize the anterior commissure tendon, causing permanent vocal damage. This was the first study to assess fundamental frequency and GRBAS scale before and after the surgery and there was no permanent vocal change in any of the patients. The midpoint of the height of the thyroid cartilage was a simple, easy to perform and safe parameter to locate and preserve the anterior commissure. Smoothing the edges and flattening the residual laryngeal prominence with a 4 mm diamond burr enabled major remodeling without a temerarious resection. All 15 patients presented a positive variation in the visual analogue score for aesthetic satisfaction, with a mean improvement of 8.6 ± 1.9 out of 10. Chondrolaryngoplasty led to significant aesthetic satisfaction in transgender women. The surgery caused no vocal change.

The training literature may be perfectly written and illustrated, however, it will never replace the practical courses of temporal bone dissection. In order to reduce surgery and failure risks, the lessons must be practiced over and over again. There is a wise spanish proverb saying „ if you follow the path called Later, you will arrive destination named Never“. Otosurgeon is a man of silence whose work starts when the sound of words dies away. Temporal bone dissection laboratory is the place where otosurgeon either individually or guided by a qualified specialist must learn, „train the hand“, practice with work tools and develop attentiveness in regards with complicated segments of temporal bone anatomy. The experience must be gained every day by overcoming dangers hundreds of times, by performing decompression of facial nerve using diamond burr and through thin bone membrane recognizing its pearl like membrane until one is fully convinced that the „stranger“ – the facial nerve has become one‘s friend. The article in detail analyzes the importance of temporal bone dissection, the patologoanatomic techniques of temporal bone removal, conservation of temporal bone, medical equipment of temporal bone laboratory. The article is the result of close and long-term collaboration between French Institute of Otology, Klaipeda University and Klaipeda University Hospital. The historical aspects of temporal bone dissection are described in detail in monograph called „The History of Otology“by Andre A.Sultan and V.Pivrikas, therefore, these aspects will not be discussed in this article. doi:10.5200/sm-hs.2013.072

Purpose To evaluate immediate effects of diamond burr debridement (DBD) on the cornea of canine patients diagnosed with spontaneous chronic corneal epithelial defects (SCCEDs). Animals studied Eight client owned dogs with SCCEDs. Methods Nine eyes from eight dogs with SCCEDs underwent superficial keratectomy (SK). The ulcerated area was divided into quadrants with a 300-micron restricted depth knife. Two of four quadrants underwent DBD for 40–60 s. A SK followed immediately. One burred section and one nonburred section were fixed with formaldehyde 10% and underwent light microscopy (LM). The remaining quadrants from five eyes were fixed with glutaraldehyde 2.5% and underwent transmission electron microscopy (TEM). Masked pathologists evaluated the samples. A student's paired t-test was used to analyze the data. Results With LM all nonburred samples had a superficial stromal hyaline acellular zone (HAZ), seven of the burred samples had an intermittent HAZ and in two burred samples this zone was absent. The HAZ thickness of burred samples (1.062 ± 0.664 μm) was significantly thinner than that of the nonburred samples (4.309 ± 1.348 μm) (P

PURPOSE To study surgical debridement in the management of fungal keratitis in 44 patients. DESIGN A prospective randomized study. METHODS Patients with presumed fungal keratitis were randomized into 2 groups. The first group had diagnostic corneal scraping with a Kimura spatula while the second group underwent surgical debridement utilizing a motorized drill with attached diamond burr. Material obtained from both methods was plated on Sabaurauds medium, blood agar and stained for bacteria and fungi. Topical and systemic antifungal therapy was instituted, and patients were examined until resolution. RESULTS Pathogens were identified to a greater degree in the aggressive debridement group than in the Kimura spatula group. Patients who had aggressive debridement had a significant reduction in time to re-epithelialization and keratitis resolution (9.4 days) compared with the scraping group (17.1 days, P < 0.001). Mean uncorrected visual acuity (UCVA) in the surgical group was 1.02 logarithm of the minimal angle of resolution (logMAR) preoperatively and 0.43 logMAR postoperatively (P < 0.001). Mean UCVA in the Kimura spatula group was 1.20 logMAR before and 0.58 logMAR after scraping (P = 0.03). A single incidence of perforation occurred in the scraping group with the diagnosis of Fusarium made from the corneal button. CONCLUSIONS Aggressive debridement and debulking of fungal keratitis provides a faster clinical resolution with no reduction in visual potential. The acquisition of pathogens is more accurate with surgical debridement as compared with conventional scraping. Aggressive surgical debridement of keratitis not only aids in diagnosis but may also be therapeutic.

When alveolar ridges lack the appropriate bone volume for implant placement, additional surgicalprocedures are necessary. In the posterior maxilla, the pneumatization of the maxillary sinus reduces theresidual crestal height, and to perform implant placement, several sinus floor elevation techniques have beendeveloped. These techniques involve specific instruments that require some experience, especially whenperforming sinus membrane lifting because of its importance for surgery success. A minimally invasivetransalveolar sinus floor elevation technique is presented, in which a diamond burr used in cranial base surgeryis employed. Surgery was performed on 10 patients. Panoramic radiographs and computerized tomography(CT) scans were taken before surgery and 1 month and 2 years after surgery, and they were used to measurebone height. The achieved augmentation heights were between 2.18 and 5.93 mm. All of the surgical procedureswere conducted without complications. No Schneiderian membrane was perforated, and a verticalaugmentation for allowing implant placement was achieved. It represent a good technique for minimallyinvasive sinus floor elevation. Fil: Decco, Oscar Alfredo. Universidad Nacional de Entre Rios. Facultad de Ingeniería. Departamento de Bioingeniería; Argentina Fil: Zuchuat, Jésica Itatí. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Entre Rios. Facultad de Ingeniería. Departamento de Bioingeniería; Argentina Fil: Maldonado, Ysai. Sanatorio Adventista del Plata; Argentina

Aim of the study: The authors present a prospective histomorphological study of middle ear ossicles, harvested from cholesteatomous ears, to evaluate for presence of residual cholesteatoma after mechanical treatment and short-time autoclaving. Materials and methods: Sixty ossicles were used as specimens in this study. The ossicles were grouped as follows: Group A - ossicles stripped and burred using a fine diamond burr under microscopic control. Group B - ossicles autoclaved for 4 min at 134°C after mechanical burring under microscopic control. Results: In group A, 30 ossicles were histologicaly examined after mechanical treatment. The residual disease was found in one badly eroded ossicle. In group B, 30 ossicles were histologicaly examined after mechanical treatment and autoclaving. That treatment eliminated cholesteatoma in all cases. The difference of results in these two treatment methods was not statistically significant. Conclusion: Authors recommend using mechanical cleaning in cases of mildly eroded ossicles. In cases of badly eroded ossicles authors recommend to either apply a combination of mechanical and autoclaving treatment. The study proved that 4 minutes of autoclaving at 134°C after mechanical cleaning provides safe bone autografts.

Prominent ears are relatively common, with an incidence in whites of about five percent¹. It is inherited as an autosomal dominant trait and is commonly caused by a combination of two defects: (1) underdevelopment of antihelical folding and (2) overdevelopment of the conchal wall. Many techniques have been described to correct the antihelical fold. In 1958 after Gibson and Davis2 showed the ability of injured cartilage to bend away from the side of injury, Stenstrom described scoring of the anterior auricular cartilage to create an antihelical fold, Chongchet’s technique used sharp scoring of the lateral scaphal cartilage to form an antihelix with a scalpel.2-4 Stenstrom, in contrast, used a rasp to blindly score the antihelix.3 Many different instruments have been used for scoring, including scalpels, rasps, abraders, diamond burr drills, Adson-Brown forceps, hypodermic needles and bipolar cautery.5 We present in this paper, a new instrument which can be used for scoring,a fine skin hook.

A técnica de indução de úlceras de córnea superficiais pelo debridamento com Diamond Burr foi avaliada quanto à padronização e segurança para a espécie equina. Após a validação, esta técnica foi empregada na indução experimental da lesão nos olhos de dezoito cavalos. Tratamentos com PRP autólogo e heterólogo foram avaliados e comparados aos grupos controle positivo (olhos debridados tratados apenas com solução fisiológica) e negativo (os olhos esquerdos não-debridados, mas tratados da mesma forma do olho contralateral). Adicionalmente, a termografia ocular infravermelha foi avaliada como recurso diagnóstico da ceratite ulcerativa em equinos. A concordância entre avaliadores na identificação de sinais clínicos oculares foi comparada, indicando o nível de dificuldade na identificação dos mesmos. O Diamond Burr gera lesões que não ultrapassam o estroma anterior, sendo seguro para a indução experimental de úlceras corneanas superficiais em equinos. Os resultados clínicos foram semelhantes (p>0,05) entre os grupos PRP autólogo e heterólogo. O uso do PRP reduziu em 1,92 vezes o tempo de reparação da lesão. Os efeitos benéficos foram similares para o PRP autólogo e o heterólogo, não ocorrendo maior inflamação ocular nesse segundo grupo. A termografia ocular foi eficiente ao identificar 8,67 entre 10 olhos ulcerados e validada como um exame eficaz para a triagem das lesões ulcerativas superficiais de córnea em equinos. A transparência corneana, avaliada 90 dias após a resolução da lesão, foi melhor preservada nos animais tratados com PRP autólogo. Diamond Burr debridement technique was evaluated for inducing superficial corneal ulcers, assessing its safety and standardization for the equine species. After validation, it was employed in the corneal ulcers experimental induction on eighteen horses eyes. Treatments with autologous and heterologous PRP were evaluated and compared to the positive (debrided eyes treated only with saline solution) and negative control groups (the left and non-debrided eye, receiving the same treatment applied in positive contralateral eye). Additionally, infrared ocular thermography was evaluated as a diagnostic feature of ulcerative keratitis in horses. The concordance rate among examiners when identifying ocular clinical signs was compared, pointing the difficulty in interpreting each of them. Diamond Burr debridement does not exceed the anterior stroma, being safe for superficial corneal ulcers experimental induction in horses. Clinical results were similar (p>0,05) among autologous and heterologous PRP groups. PRP use reduced 1,92 times the wound reparation period. Beneficial effects were similar in autologous and heterologous PRP groups and did not increase differently ocular inflammation. Ocular thermography was efficient in identifying 8,67 of 10 ulcerated eyes, being validated as effective screening feature for superficial ulcerative corneal wounds in horses. Corneal transparency, assessed 90 days after wound repair, was better preserved in animals treated with autologous PRP.

Existing surgical simulators provide a physical simulation that can help a trainee develop the hand-eye coordination and motor skills necessary for specific tasks, such as cutting or suturing. However, it is equally important for a surgeon to gain experience in the cognitive processes involved in performing an entire procedure. The surgeon must be able to perform the correct tasks in the correct sequence, and must be able to quickly and appropriately respond to any unexpected events or mistakes. It would be beneficial for a surgical procedure simulation to expose the training surgeon to difficult situations only rarely encountered in actual patients. We present here a framework for a full-procedure surgical simulator that incorporates an ability to detect discrete events, and that uses these events to track the logical flow of the procedure as performed by the trainee. In addition, we are developing a scripting language that allows an experienced surgeon to precisely specify the logical flow of a procedure without the need for programming. The utility of the framework is illustrated through its application to a mastoidectomy.

Engin Bilge Ozgurhan,1 Necip Kara,1 Aydin Yildirim,2 Zeynep Alkin,1 Ercument Bozkurt,1 Ahmet Demirok1,31Beyoglu Eye Research and Training Hospital, 2Department of Ophthalmology, Sema Research and Treatment Hospital, Fatih University, 3Department of Ophthalmology, Istanbul Medeniyet University Medical School, Istanbul, TurkeyBackground: The purpose of this paper is to report the successful treatment of corneal scarring and high corneal astigmatism secondary to previous pterygium surgery with diamond burr superficial keratectomy using mitomycin C.Methods: Four patients with corneal scarring and high corneal astigmatism related to previous pterygium surgery underwent diamond burr superficial keratectomy with application of mitomycin C. Anterior segment photography and corneal topographic analysis were obtained preoperatively and postoperatively in all patients.Results: Six months after surgery, corneal astigmatism and corneal aberrations were reduced in all patients. A clear cornea was achieved in all cases. No complications were noted during the follow-up period.Conclusion: Diamond burr superficial keratectomy with application of mitomycin C is a potentially effective and simple procedure for treating patients with corneal scarring and high corneal astigmatism secondary to previous pterygium surgery.Keywords: diamond burr superficial keratectomy, astigmatism, pterygium surgery

Il deterioramento delle frese cilindriche non è determinato solamente dall'uso in terapia conservatrice, ma dipende anche dalle caratteristiche iniziali e dalla qualità dei materiali costruttivi. Anche ripetuti cicli di sterilizzazione in autoclave, oggi sempre più necessari, ne sono responsabili. Tutto ciò ci orienta a guardare sempre più con maggiore interesse allo sviluppo dello strumentario monouso.

Tomakomai Paper mill, vitrified artifical pulpstone was employed for the first time in our country, on May, 1949. On this report, at first, comparative groundwood with usual cement artifical pulpstone, natural stone, and pulpstone, uniformity of stock, sorts of burrs, the time between burrings, hour, power consumption, and life of the stone are described. Ezomatsu Todomatsu (Fir) were used mostly as pulping materials in the studies, was used too in part.In the next part, the best conditinn of manufacturing process and the optimum seasoning temperature of asplit which was used as joints between segments of vitrified artificial pulpstone are pointed out.The abstract are1.It has been proved possible to obtain 20-40% greater production of pulp per hour with the alundum stone than cement stone or natural stone. In fibre analysis, there is a considerable increase in the amount retained on the 20 mesh screen, and decrease of flour. The amount of rejects retained on the 65/1000″ screen plate is much comparatively, and freeness of stock is high in general, and strength of pulp test sheets is superior than cement stone, and inferior than natural stone.2. Uniformity of stock was observed by the variation of the highest and lowest values of freeness for nine days, and the rate of variation was alundum stone 85%, cement stone 90%, and natural stone 104%, therefore the most uniform stock is produced with the alundum stone in comparison with the rest.3. On the alundum stone 10 cut spiral burr, 10 point diamond burr, 14 point diamond burr, 2 cut spiral burr in connection with 12 point diamond burr were used, but the distinct conclusion could not derived, for at present burring is done by the help of sensibility of hand, and so the effect of intensity of burring is great. But it appears that 10 cut spiral burr or 2 cut spiral X 12 point diamond burr is suitable for the stone. The time between burrings are four to five days in the case of Ezomatsu (Spruce) and Todomatsu (Fir), and two days in Akamatsu (Pine).4. As has been previously mentioned, the production of pulp per hour increased, and moreover power consumption per100 pounds pulp production decreased.5. It is presumed that the life of thestone (stone diameter 54″, available dimensions in the radius 2′/2″) will be three years and four months in the case of Ezomatsu (Spruce) and Todomatsu (Fir).6. The combination rate of grit of the stone is 36 mesh-33%, 46 mesh-33%, 60 mesh-34%, hardness of the stone is 0, and structure of the stone is 8. The stoneissuitable for pine, and produces high quality pulp which has not much fibre bundles.7. Asplit was used as joints between segments of the stone, and Be 25-26 phenol resin is suitable for easy work.8. The finer alundum grit or silicate powder is used as the filler of phenol plastic, the stronger the tensile strength is and so fines past 150 mesh are desirable 9. As hardening catalysis, para-toluol sulpho-chloride (5%) which react slowly is suitable.10. In consideration of expansion of drum, segments and resin, it is desirable that temperature of seasoning is not too high, about 100°C.

Summary The writer has designed a diamond burr which has been specially constructed for the use of dermabrasive treatment, and this has given very satisfactory results. This diamond burr is available from Messrs Triefus Industries Ltd., Manor Royoal, Crawley, Sussex, England.