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Introduction Effective pain management in the immediate postoperative period is a crucial first step in the treatment of shoulder arthroplasty patients. Previous studies suggested that local infiltrative analgesia (LIA), specifically with Liposomal Bupivacaine (LB), is equivalent to interscalene nerve block (ISNB) for postoperative pain management. This prospective, randomized, double-blinded study seeks to measure the difference in efficacy between the 3 widely-used LIA cocktail formulations: Bupivacaine, LB, and Ropivacaine. Methods Between 2018 and 2019, 179 consecutive patients underwent reverse total shoulder arthroplasty for end-stage shoulder arthropathy. Patients were enrolled and randomized in a prospective, double-blind clinical trial to receive one of 3 LIA injections before skin incision and after skin closure: 0.25% Bupivacaine ±Epinephrine, 1.3% LB, or 0.5% Ropivacaine cocktail with Ketorolac. There were 67 patients excluded due to preoperative comorbidities or consent refusal. The eligible 112 patients were monitored for 24 hours after surgery. Mean age was 67.9 years (range: 40-90 years). The primary outcome measure was the mean preoperative Visual Analog Scale (VAS) pain score, mean postoperative VAS score during the 24-hour postoperative period, and change in mean VAS score. The secondary outcome measure was total Morphine Milligram Equivalents (MMEs) used, antiemetic use, and laxative use during the same period. Pre-hoc power analysis found a total sample size of 219 (73 per group) was estimated to detect a significant difference at 80% power and 0.05 Type I error rate. Results Use of Bupivacaine, LB, and Ropivacaine resulted in 1.2±2.9, 0.6±3.2, and 0.1±2.8 change in VAS scores, respectively (P=.32). Total postoperative MMEs used were 124.1±115.1, 116±84.5, and 105±96.7 milligrams, respectively (P=.71). There were no statistically significant differences amongst the 3 cocktails for postoperative pain relief or rate of antiemetic/laxatives used.There was a nonsignificant trend toward superior analgesic effect of Ropivacaine compared to Bupivacaine. Ad-hoc power analysis found that the estimated sample sizes required to detect a difference between the Ropivacaine and Bupivacaine treatment for change in VAS score and total MMEs use, were 321 and 1593 patients, respectively. Because of the non-clinically significant differences, continued patient enrollment was terminated. The cost of Bupivacaine was comparable to Ropivacaine ($13.43 and $21.95, respectively), whereas LB cost ($434.96) was 20-30 times higher. Conclusion There were no differences in clinical efficacy amongst Bupivacaine, LB, and Ropivacaine cocktails for perioperative pain management in shoulder arthroplasty. LB was not clinically advantageous compared to the other two medications and did not justify the increase in cost. Level of evidence Level I

Introduction: The jigsaw method is one of the learning methods that has great potential to make students learn a large amount of information in a short period of time. It is a classroom technique where students act as blocks of jigsaw puzzle and learn cooperatively with all the participating students acting as teachers as well as learners. Aim: To assess the effectiveness of jigsaw active learning method in comparison to conventional didactic method in promoting knowledge gain and retention among final year medical students. Materials and Methods: This quasi-experimental crossover pretest post-test study was conducted among final year medical students of a tertiary care teaching hospital in North Kerala from June 2021 to July 2021 during the integrated sessions by Surgery and Pharmacology Departments. Students were randomly divided into two groups A and B of 28 students each. They were taught two topics i.e., hyperthyroidism and hypothyroidism, as two sessions by either a jigsaw (experimental) or didactic (control) method. The first topic was taught by the two methods and then the same groups were later crossed over for the second topic. Knowledge gain and retention were assessed by immediate and delayed post-tests consisting of 20 multiple choice questions with a single correct response. Each correct response was given one mark and incorrect responses were given no negative marks. All data collected was analysed statistically. Statistical significance was considered at p-value

Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular surgery for patients with rotator cuff arthropathy, unreconstructible proximal humeral fracture, and end-stage glenohumeral arthritis. The increased annual volume of RTSAs has resulted in more postoperative complications and revision rates between 3.3% and 10.1%. Postoperative infection is one of the most common complications requiring revision surgery after primary RTSA. This study assesses patient-specific risk factors for development of early infection after primary RTSA in a single high-volume shoulder arthroplasty institution. Methods From 2014 to 2019, 902 consecutive primary RTSAs were performed for surgical treatment of rotator cuff arthropathy, glenohumeral arthritis, inflammatory arthropathy, and/or dislocation. Excluding proximal humeral or scapula fractures, 756 cases met the inclusion criteria and had a minimum of 3-month follow-up. All surgeries were performed using the same surgical technique and received similar antibiotic prophylaxis. Age, patient demographics, medical history, smoking history, and prior ipsilateral shoulder treatment and/or surgery were recorded. Multivariable logistic regression analysis was used to determine risk factors associated with development of postoperative shoulder infection. Results Thirty-five patients did not meet minimum follow-up criteria and were lost to follow-up. Overall, of 721, 22 patients (3%) developed a postoperative ipsilateral shoulder infection. Previous nonarthroplasty surgery and history of rheumatoid arthritis were significantly associated with the development of postoperative shoulder infection. Amongst 196 patients who had previous nonarthroplasty shoulder surgery, there were 12 postoperative shoulder infections (6%) compared with those without previous shoulder surgery (10 of 525, 2%) (P = .003). Among 58 patients with rheumatoid arthritis, there were 5 postoperative shoulder infections (9%) compared with patients without rheumatoid arthritis (17 of 663, 3%) (P = .010). Patient age, gender, smoking status, history of diabetes mellitus, history of cancer/immunosuppression, and prior cortisone injection did not demonstrate significant associations with the development of postoperative infection. Conclusion Prior nonarthroplasty shoulder surgery and/or rheumatoid arthritis are independently associated with the development of postoperative infection after primary RTSA. Patients who demonstrate these risk factors should be appropriately evaluated and preoperatively counseled before undergoing primary RTSA. Strong consideration should be given to avoid minimally invasive nonarthroplasty surgery as a temporizing measure to delay definitive RTSA.

The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public–private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisciplinary approaches to pain management that decrease the over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders. The Task Force specifically called on specialty organizations to work together to develop evidence-based guidelines. In response to this report’s recommendations, a consortium of 14 professional healthcare societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. The modified Delphi process included two rounds of electronic voting and culminated in a live virtual event in February 2021, during which seven common guiding principles were established for acute perioperative pain management. These principles should help to inform local action and future development of clinical practice recommendations.

Introduction Reverse total shoulder arthroplasty (RTSA) is reportedly an effective option in the treatment of glenohumeral arthritis and severe comminuted proximal humeral fractures. To date, RTSA failures and their subsequent revisions are significant issues that have not been well studied. In revision RTSA cases with severe proximal humeral bone loss (PHBL), there is increased risk of early failure [ 4 , 10 , 28 , 30 ]. In this series, the authors evaluate the short-term results of a novel custom-made, patient-specific Deltoid Lateralization Sleeve (DLS) with an adjustable humeral RTSA component for revision of failed arthroplasty with severe bone loss. Methods Patients treated with a custom, adjustable DLS system for revision RTSA between 2012 and 2019 at one institution were identified using medical health records and included in the study. Each patient had undergone multiple previously failed surgeries before the current salvage procedure was performed. Revision RTSAs with less than 5 centimeters (cm) of bone loss, precluding DLS use, were excluded. Data was retrospectively collected and included demographics, surgical history, amount of bone loss in centimeters, preoperative and postoperative range of motion (ROM), patient-reported outcome scores, and postoperative complications. Results From 2012 to 2019, fifteen patients with a mean PHBL of 8.3 cm (range 5-12.5cm) underwent revision RTSA with DLS. Median age was 66.0 years (range 25-81 years). Median clinical and radiographic follow-up was 30 months (range: 23-77 months). Median preoperative active anterior elevation (AE), active external rotation (ER), and active internal rotation (IR) improved from 10° to 120°, 0° to 35°, and 0° to 40°, respectively. Median Visual Analog Scale (VAS) pain score improved from 5 to 0, American Shoulder and Elbow Surgeons (ASES) score improved from 25 to 65, Simple Shoulder Test (SST) score improved from 0 to 46, and Single Assessment Numeric Evaluation (SANE) score improved from 20% to 68%. There were 9 (60%) complications, including 5 major complications requiring revision surgery (33.3%). One patient (6.7%) was lost to follow-up. Discussion/Conclusion Revision RTSA for excessive PHBL with severe tuberosity deficiency can be surgically challenging. Irrespective of the high complication rate, DLS use in patients with severe PHBL and severe tuberosity deficiency may provide favorable long-term glenohumeral reconstruction viability. Level of evidence Level IV

Introduction: Diabetes affects 88 million people in south-east Asia with a regional prevalence of8.8%, and of them, 77 million live in India. Diabetic Foot Disease is an important complication thataccounts for significant morbidity and mortality in a diabetic individual. Aim: This study wasconducted to study the presentation stage of diabetic foot disease during the pandemic period asseen at a tertiary care hospital in North Kerala. Methods: This was a retrospective cohort studycarried out on patients diagnosed with diabetic foot and admitted to the Department of Surgery of atertiary care hospital in North Kerala during the study period of 6months from July 2020 toDecember 2020. A sample size of 63 was calculated. Data were collected from the case records ofthe patients, and the stages of presentation, relevant blood investigations, culture reports,radiological imaging and arterial doppler ultrasound findings were noted. Results: In this study, atotal of 63 patients were included. Of the 63 patients, 51(80.9%) were males, and 12 (19.0%) werefemales with a male to female ratio of 4.25:1. The mean age of the patients was 57.74 years. In thisstudy, as per the Wagner-Meggitt Classification of diabetic foot, the most common stage ofpresentation of diabetic foot encountered was Grade III (42.9%) followed by Grade IV (28.6%),Grade II (19.0%) and Grade V (9.5%).Conclusion: This is in part may be due to financialconstraints of the patient's families due to lack of job, transportation difficulties, shortage ofmedicines, shutting down of small scale health care facilities and pharmacies, prolonged neglect ofwounds, discontinuing of regular medications and poor home wound care which in turn are due tothe frequent regional lockdowns as a result of the covid pandemic.

Introduction Operating room (OR) efficiency is a crucial component in the delivery of high quality, cost-efficient healthcare in orthopedic shoulder arthroplasty, and generally in surgery. Utilizing a dedicated OR team may lead to higher clinical efficiency by potentially reducing total OR time and cost while avoiding operational redundancies or errors. The purpose of this study is to identify specific parameters influencing OR efficiency with a 2-roomed system with dedicated OR staff and evaluate its influence on operational cost of the OR per min. Methods From 2017 to 2018, 348 patients underwent primary shoulder arthroplasty at one institution, that had 2 established OR systems: A traditional “1-room” system (TS) with general OR staff, and a “2-room” shoulder service (SS) with a dedicated OR team. Medical health records were accessed to obtain pertinent study data, which included demographics, surgical indication, and time-points per surgical case. Anesthesia preparatory time (APT) was time from patient OR entry to skin incision; surgery time (ST) – from skin incision to skin closure; conclusion time (CT) – from skin closure to patient exiting OR; and turnover time (TT) – time from 1 patient's exiting to the next patient's admittance into the OR. Nonoperative time was a summation of APT, CT, and TT, while Total OR time comprised of nonoperative time and ST. Cost equivalent per minute OR operation was then used to calculate differences between the 2 interest groups. Results The SS treated 270 patients (77.6%) and TS treated 78 patients (22.4%). The SS demonstrated a 74 minutes decrease in total OR time (116 vs. 190 minutes) when compared to the TS (P Conclusion A dedicated OR team using 2 ORs improves both clinical efficiency (decreases total OR time) and reduces cost (decreases total OR cost) - despite having more staff members and associated staffing costs - compared to a traditional 1-room system. When surgeon-specific factors were removed, the largest reduction in OR cost was associated with decrease in turnover time. Level of Evidence Level III.

The aim of present work is to prepare the orally dissolving tablets of poorly soluble Ondransetron Hydrochloride as its soluble form by adopting complexation method using different superdisintegrants alone and in combination. The growing importance of orally dissolving tablet was underlined recently when European Pharmacopoeia adopted the term “Oro dispersible tablet” as a tablet that to be placed in the mouth where it disperses rapidly before swallowing. Their characteristic advantages such as administration without water anywhere, anytime lead to their suitability to geriatric and paediatric patients. The complex prepared was showed better solubility in simulated salivary PH of 6.8. The pre compression characteristics of drug, drug with Beta cyclodextrin and final blend were evaluated with respect to standards. Results of the study showed that the optimized tablet with combination of superdisintegrants (2.5% crosspovidone, 3.5% sodium starch glycolate) showed hardness of 3.5Kg/Cm2, thickness 2.10mm, wetting time 18 sec, drug content 99.15%, disintegration time 20sec, in-vitro dispersion time 25sec, in-vitro drug release of 89.59% (in 3min) and percentage of drug permeation as 89.45% (in 5 min) and it is comparable with higher percentage of superdisintegrants used for tablet preparation. So this method was a promising approach for developing cost effective dosage form with high efficacy in treatment.

Osteoradionecrosis is a relatively rare but potentially morbid and costly complication of radiation therapy for head and neck cancer. Multidisciplinary diagnosis and treatment are essential. Despite evidence guiding individual aspects of care for osteoradionecrosis, there is a lack of broad consensus on the overall diagnosis and management of this condition. This study comprehensively reviews the literature, with a focus on the past 10 years, to guide evaluation and treatment.

Escherichia coli has been enlisted as a pathogen of antimicrobial resistance (AMR) importance posing a threat to human health. In the wake of the widespread AMR, lytic bacteriophages remain a promising alternative to antibiotics for controlling the multidrug-resistant (MDR) pathogens. However, the major hindrance for phage therapy is the lack of a rapid procedure to harness broad host range phages. Hitherto in vogue, lytic phage isolation methods are based on conventional single host enrichment (M1). Limitation to the available methods includes a higher number of steps, additional instrumentation, cost and time involved in the screening of samples and more recovery of narrow host range phages.To improve the conventional method of isolation, a multiple host enrichment approach (modified method; M2) is developed and validated with a classical approach using 24 MDR extended-spectrum β-lactamase producing (ESBL) E. coli and universal coliphage host E. coli NCIM 2089. A total of 58 phages were isolated using both the methods (27 phages from M1 and 31 phages from M2) and were categorized, based on the DNA restriction digestion pattern, to 25 groups with a maximum host range of 17 in host range analysis. Even though there is no significant difference (P > 0.01) in recovering number of phages between M1 and M2 methods, excepting in one occasion where MFB13 host yielded 3 more morphologically distinct phages in M2 (p ≤ 0.05), the M2 approach was better in terms of reduction in time (4.72%) and cost (23.5%) and same instrumentation requirement. This emphasizes that the proposed method has the potential to yield broad host range lytic phages against localized strain repository of AMR E. coli which can be leading to its application in food, food contact surfaces as well as phage therapy.

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.

Introduction: This case report describes the treatment of a 21-year-old man who presented in an orthodontic office for treatment but lived in a city 100 miles away and wanted the orthognathic surgery in another state in America. The patient presented with an anterior open bite and skeletal Class III relationship. Methods: The treatment plan included: (1) effective and careful communication of the treatment plan with the patient, orthodontist and oral and maxillofacial surgeon; (2) pre-surgical alignment and levelling of the teeth in both arches with Invisalign; (3) a long-distance communication between the orthodontist and the surgeon for surgical plan with virtual surgical planning (VSP Orthognathics; 3D Systems, www.3Dsystem.com ) online; (4) maxillary advancement (LeFort I osteotomy) with mandibular set-back (bilateral sagittal split osteotomy); (5) postsurgical correction of the malocclusion with clear brackets and aligners; and (6) retention and final small tooth movement adjustments with aligners/clear retainers. Results: The anterior open bite was treated, crowding was eliminated in the upper and lower anterior segment, correction of skeletal and dental Class III malocclusion was obtained, mandibular plane angle was reduced and facial profile improved. Conclusions: The results suggest that aesthetic and functional results can be achieved with long-distance communication of two specialties and with the combined use of clear aligners and clear fixed appliances.

There is an increased demand for an ideal biodegradable biomaterial that eradicates infection, while concurrently promoting tissue regeneration in osteomyelitic bone, which eliminates the need for revision surgery. In this study, our objective was to evaluate the efficacy of a nanocomposite fibrous scaffold (silica coated nanohydroxyapatite-gelatin reinforced with poly-l-lactic acid yarns) containing vancomycin for treating methicillin-resistant Staphylococcus aureus (MRSA) induced osteomyelitis in rat models. The antibiotic was either incorporated during scaffold synthesis (SE-V) or loaded directly after the development of the scaffold (SA-V) at 5 wt% and 15 wt%. There was a sustained release of vancomycin from both the groups of scaffolds for 30 days and the released drug demonstrated antibacterial activity against MRSA. Furthermore, implantation of the composite scaffold into osteomyelitic rat femur resulted in significant bacterial reduction, mainly with 15 wt% drug and its efficacy was comparable to that of commercial graft Stimulan. Both drug entrapped and absorbed composite scaffolds promoted bone regeneration in 3 months, with no distinguishable difference between them. However, Stimulan resorbed fast and there were bone voids at the defect site after 3 months. Hence, the nanocomposite fibrous scaffold containing vancomycin can be proposed as a bi-functional graft that can reduce bacterial infection, while subsequently engineer new bone in osteomyelitis.

The Latarjet surgical technique is one of the most effective and well-known techniques in the treatment of anterior shoulder instability(1). The modified Latarjet technique is a history book of surgical details demonstrated by renowned masters of shoulder surgery. The procedure includes soft-tissue repair and osseous reconstruction to stabilize the glenohumeral joint in recurrent anterior instability. The procedure has been shown to have reliable success in reducing recurrent instability and minimizing risk of dislocation arthropathy(2-4). DESCRIPTION: The Latarjet technique can be performed via a cosmetic axillary-based approach. The subscapularis is split horizontally without detachment as described by Neer(5). The capsule is released like in a medially based T-plasty as described by Altchek et al.(6). The coracoid osteotomy is performed with a 90° oscillating saw and prepared for en-face implantation as described by Edwards and Walch(7). The inferior surface of the coracoid is decorticated and prepared per Molé(8). Coracoid fixation is performed with two 3.5-mm cortical screws. The soft-tissue reconstruction is selectively tensioned per Warner et al.(9). The capsular shift is augmented with a pants-over-vest repair per Kim et al.(10). ALTERNATIVES: Nonoperative treatment in young patients with glenohumeral instability and bone loss can lead to recurrence rates as high as 87%(11). Arthroscopic management with anterior capsulolabral repair and a remplissage procedure can be beneficial for patients with instability. In the setting of bone loss, arthroscopic repair is associated with failure rates as high as 75%(12). RATIONALE: In the setting of glenoid and/or humeral bone loss, there is a loss of native osseous anatomy, leading to a higher risk of instability. Gerber and Nyffeler reported a >30% loss of compressive force when the vertical edge of the glenoid defect is greater than one-half of the glenoid diameter(13). The Latarjet procedure is a reliable procedure that reconstructs the anterior osseous anatomy as well as the capsular laxity, restoring glenohumeral stability. When compared with arthroscopic labral repair, the Latarjet procedure is superior with more consistent improvements in functional outcomes with low risk of recurrence, even in high-risk populations of young, active athletes in contact sports(2,3). EXPECTED OUTCOMES: At our institution, a total of 34 patients underwent Latarjet reconstruction as described in the present article and videos from 2013 to 2018, with a minimum follow-up of 1 year. Among these patients, the mean Single Assessment Numeric Evaluation score was 90.7 (range, 70 to 100). There were 4 cases of recurrent instability with graft fracture or resorption (11.8%). Zimmermann et al. presented a series of Latarjet reconstructions with similar functional outcomes and a recurrence rate of 11%(4). Meta-analysis of long-term Latarjet studies show high rates of return to sports and successful outcomes in 86% of cases, with an 8.5% recurrence rate(2). IMPORTANT TIPS: The Latarjet procedure can be consistently performed with a subscapularis-sparing approach, which minimizes adverse comorbidities. Splitting the subscapularis at the inferior one-third junction will position the surgical window directly over the bottom half of the glenoid, which optimizes coracoid implantation. A medially based T-plasty will maximize the glenoid exposure for direct coracoid implantation. Subsequently, the capsule may be shifted for capsular imbrication. Low-profile, non-bulky retractors will help to improve visualization. Adjusting the arm is a key technique in performing this surgical procedure. This adjustment will help to shift the surgical window, expose key anatomic structures, and allow a capsular shift without overtensioning. This cannot be overstated.

Case A 21-year-old woman with a history of multiple failed surgical and conservative management for recurrent involuntary shoulder instability presented with 1-year history of shoulder pain. Physical examination demonstrated intractable static anterior glenohumeral instability, deficient capsular tissue, with reducible scapular winging secondary to long thoracic nerve palsy. Allograft capsular reconstruction and open split pectoralis major tendon transfer were performed to salvage shoulder motion and stabilize her shoulder girdle. Conclusion This report presents a novel repair option for intractable shoulder instability and scapular winging. Surgeons should recognize potential causes of shoulder instability and familiarize themselves with multiple stabilization techniques as potential salvage options before glenohumeral fusion.

PURPOSE The purpose of the study was to examine the impact of residency training institutions on the pursuit of a career in academic oral and maxillofacial surgery and assess variables associated with academic productivity. MATERIALS AND METHODS This was a cross-sectional study of full-time academic oral and maxillofacial surgeons (OMSs) in the United States. The primary predictor variable was program of residency training. Secondary predictors included gender, fellowship training, advanced degrees, and private practice affiliation. The primary outcome variable was the number of graduates in a ful-time academic position. Academic productivity (h-index, publication number) was a secondary outcome. Descriptive, logistic and linear regression analyses were computed. RESULTS The study sample consisted of 294 full-time academic OMSs in 82 training programs. The top 10 high-output residency programs were identified and graduates from these programs were more likely to have a medical degree (OR = 1.99, 9% CI: 1.17 - 3.36, p=0.0108), higher h-indices (11.03 vs 7.96, p = 0.0032) and higher number of publications (40.3 vs 25.6, p = 0.003). Faculty characteristics associated with higher h-indices included a medical degree (10.33 vs 7.66, p = 0.0067), PhD (15.23 vs 8.38, p = 0.0002), MPH (17.47 vs 8.66, p = 0.0040) and fellowship training (11.15 vs 7.76, p = 0.0012). There were no significant differences between genders in having a medical degree, completing a subspecialty fellowship, or academic productivity. Female surgeons represented 16.33% of academic OMSs and were more likely to have entered academia more recently based on duration in years of academic appointment (12.48 versus 21.08; p < 0.001). CONCLUSIONS Ten programs have trained 29.6% (n = 87) of all full-time academic OMSs. These programs' graduates were more likely to have a medical degree, higher h-indices, and greater number of publications.

Tuning of porosity and surface properties of nanoparticles especially on carbon-based nanomaterials, adopting a ‘greener’ or self-activation synthesis technique for electrical charge storage, is progressing. Herein, we report the self-activation of Teak wood sawdust in a nitrogen atmosphere at different activation temperatures to synthesize carbon nanoparticles. The activated carbon nanoparticles synthesized at 900 °C exhibits a maximum ~ 360 m2 g−1 surface area with ~ 2 nm average pore size diameter. Five electrolytes viz. KOH, KCl, Na2SO4, NaCl, and H3PO4 are used for studying the supercapacitance nature of the activated carbon nanoparticles in a 3-electrode configuration. A maximum specific capacitance of ~ 208 F g−1 @ 0.25 A g−1 is obtained in 1 M KOH as the electrolyte. Two symmetric supercapacitors, aqueous (1 M KOH) and solid-state (PVA/KOH), are fabricated, and their performance difference is compiled. The solid-state symmetric supercapacitor performs in a wider voltage window (1.7 V) with a superior energy density of 27.1 Wh kg−1 at a power density of 178 W kg−1.

PURPOSE A growing concern in the community of oral and maxillofacial surgeons (OMSs) is the progressive hearing loss that has become more evident in older surgeons. Very few studies have focused on the effects on a surgeon's hearing based on his or her environment. The purpose of this study was to investigate whether the noise produced by suction, compared with federal guidelines, could have a damaging effect on the hearing of OMSs. MATERIALS AND METHODS A CEM DT-8851 industrial high-accuracy digital sound noise level meter data logger (CEM Instruments, Bengal, India) was used to capture the sound intensities in various procedures. The sound meter was used to record the intensities of sound produced, in decibels, in clinics and operating rooms. The analysis was divided into different variables: non-drilling/suction (in which neither a drill nor suction was used but suction was on), suction, drilling, suction and drilling, suction and irrigation, and Yankauer suction. RESULTS A total of 50 clinic and 50 operating room procedures were recorded, focusing on suction. The noise intensities captured were analyzed based on federal workplace standards. Compared with non-drilling/suction, all other noise exposures on average were greater in intensity and statistically significant with P

Full-mouth extractions (FMEs) are common procedures that are classically performed electively due to caries and periodontal disease. Up to 17% of adults over the age of 65 and 2% of adults aged 20-64 in the United States are edentulous. At the University of Cincinnati Medical Center, approximately 250 FMEs are performed annually with nearly half performed on adults over the age of 50. There is currently an absence of data on this patient population and their overall outcomes. The authors hypothesize that FMEs are often performed on socioeconomically and medically vulnerable populations, thereby further compromising their conditions and potentially contributing to their demise. The authors aim to describe patient-related characteristics and document post-FME time to death. The authors performed a single-center retrospective chart review from July 1, 2012, to January 1, 2020. Inclusion criteria included all patients who underwent FME at the institution due to caries, periodontal disease, and non-restorable dentition. Patients were excluded if there were insufficient data or identifiers. Recorded data included demographics, medical insurance, medical history, and social history. The primary outcome variable was post-FME time to death. Patient mortality was identified through chart review and inquiry of the National Death Index, a database of the National Center for Health Statistics. Statistical analysis was performed with SASv9.4 and included simple descriptive statistics and multivariate survival analysis. A total of 1829 patients were included in the study; 976 were female. Median age was 49 (IQR 38-58); 65% identified as Caucasian and the remaining African-American. Insurance coverage included Medicaid (59%), Medicare (30%), and private insurance (10%). In total, 1709 patients were diagnosed with more than 1 comorbidity at the time of FME. The most prevalent were psychiatric illness (50%), diabetes mellitus (20%), coronary artery disease or congestive heart failure (16%), and chronic obstructive pulmonary disease or emphysema (14%). Overall, 1072 patients (59%) were identified as current smokers, 690 (38%) as alcohol users, and 394 (22%) had a history of illicit drug use; 85 (5%) patients were nursing home residents. As of December 31, 2019, a total of 170 patients (9.3%) were identified as dead; 51% of deaths occurred within the first 2 years of the procedure, and 87% occurred within 5 years. Median time to death was 2.0 years (IQR 0.9-3.8) at a median age of 56 (IQR 46-63). Mortality rate was higher in nursing home residents at 29%. Post-FME predictors of mortality included male gender (P-value 3 (P-value FME patients are typically medically disadvantaged and likely to be on Medicaid or Medicare. Approximately 1 in 10 FME patients died within 5 years of the procedure at the center. This may suggest that FME exposure can lead to serious deterioration, comorbidities or death. Further studies are currently underway at the institution to assess FME-related complication rates and quality of life improvement. The authors recommend thoughtful consideration to the overall implications of such a procedure on the well-being of patients rather than strict adherence to traditional indications.

Mental illness is highly prevalent among adults in the United States, with almost 1 in 5 adults living with some degree of mental illness. Given most of oral and maxillofacial surgery (OMS) procedures are inherently anxiety-generating, the authors sought to determine the burden of psychiatric illness in the population seeking care at an outpatient OMS unit of the University of Cincinnati. The authors hypothesized that psychiatric diagnoses would be common in this population. This is an ongoing retrospective cohort study. Study subjects were identified by searching CPT codes through electronic health records to identify all patients older than 15 years of age who underwent any oral and maxillofacial surgery outpatient procedure in 2018 (January 1 to December 21). Data on demographics, ASA status, presence of psychiatric diagnosis according to DSM-5, type of procedure, and complications were collected by performing a retrospective chart review. A total of 4616 patients were identified for the chosen timeframe. All the duplicates (387 patients) were removed; 252 patients were further removed as they did not meet the inclusion criteria (no procedure performed, Descriptive analysis was conducted and prevalence rates were calculated. Out of total of 1300 patients who were reviewed, 60.9% (792) were females and 39.1% (508) were males. Age range was from 15 to 98 years with a mean age of 34.2 years; 45.2% (588) were Caucasian, 39% (507) were African-American, 0.7% (9) were Asian, 3.1% (40) were Hispanic, 3.3% (43) were other races, and 8.7% (113) were of unknown race; 32.1% (418) of patients were classified as ASA I, 55.6% (723) were ASA II, 11.2% (145) were ASA 3, and 1.1% (14) were ASA IV. Among the total reviewed population through OMS vision, 305 patients were found to have reported psychiatric diagnosis. Further review of medical history of the remaining patients was performed through Epic, and 26 more patients were found to have reported psychiatric diagnosis. A total of 25.5% (331) of patients were found to have a pre-existing psychiatric diagnosis. Out of these patients, 62 had neurogenic disorders, 29 had schizophrenia spectrum disorders, 56 had bipolar disorders, 218 had anxiety and depressive disorders, 82 had substance use and addictive disorders, 5 had personality disorders, and 7 had other disorders. A total of 102 patients had multiple psychiatric diagnosis. Among the 1300 procedures completed, 11.8% (153) of patients experienced postoperative complications and, among these, 24.9% (38) had psychiatric diagnoses. The review shows that psychiatric illnesses are common among the oral and maxillofacial surgery population. This population is also likely to have more complications. The ongoing record review would shed more light in this arena when complete. Prognostic implications of preoperative psychiatric disorders on surgical outcome should be demonstrated prospectively in intervention studies.

CASE A 68-year-old male, status post revision right reverse total shoulder arthroplasty (RTSA) for periprosthetic fracture, suffered a periprosthetic joint infection necessitating 2-stage revision. Imaging revealed 8.6 cm of ipsilateral proximal humeral bone loss (PHBL) including loss of the greater and lesser tuberosities. A 2-stage revision was performed using an antibiotic spacer, followed by a custom long-stem RTSA for definitive reconstruction. Two years postoperatively, the patient had significantly improved pain and functional range of motion. CONCLUSION Custom long-stem RTSA could serve as a potentially viable reconstructive option in patients with severe PHBL.

Case A 30-year-old male weightlifter presented after suffering a myotendinous rupture of his latissimus dorsi from heavy weightlifting. Latissimus dorsi injuries are rare, with little to no documented technique in the literature on management, particularly of ruptures through the myotendinous junction of the anatomical muscle. This case report describes the surgical technique, approach, and postoperative management of an acutely avulsed latissimus dorsi using an allograft hamstring tendon to repair the myotendinous junction. Conclusion Allograft hamstring tendon graft augmentation is a viable repair option for patients with latissimus dorsi myotendinous rupture.

Anxiety and pain control has been an inherent part of the oral and maxillofacial surgeon’s (OMS’s) armamentarium. In the United States, achieving competency in anesthesia is an integral part of oral and maxillofacial surgery (OMS) training curriculum. Further, OMS’s maintain the highest of standards in their practice of anesthesia outside the operating theaters. OMS-anesthesia-team model emphasizes patient safety. This requires rigorous training and meticulous standards of practice, not only by the surgeons but by the entire supporting team of office personnel. The American Association of Oral Maxillofacial Surgeons (AAOMS) endorses several critical steps in promoting the safety of this model in OMS offices. Periodic review of parameters of care, mandated training for office team and a peer review for office anesthesia evaluation of fellow OMSs are some of the critical components. AAOMS has a simulation based training to train teams in the provision of safe anesthesia in a low risk environment. Emphasis on appropriate patient selection, impeccable advanced anesthesia monitoring, and periodic strong didactic and skills based training supports the OMS-anesthesia-team in being a valid, safe practice model of anxiety and pain control in an outpatient setting.

Current statistics suggest that the abuse of prescribed opioids is a major problem that is resulting in significant morbidity and mortality. It behooves the oral and maxillofacial surgeon to mitigate this risk by reducing the number of opioid prescriptions. Furthermore, it is important to recognize patients with opioid use disorder (OUD) to ensure that they receive appropriate referral. Several modalities are available to reduce the need for postoperative opioids including multimodal therapy and long-acting local anesthesia.

The provision of sedation and general anesthesia will inevitably result in situations when an emergent airway is required. Positive pressure ventilation (PPV), chin lift/jaw thrust, and adjunct airways will often suffice. On occasion, there will be a need to place an advanced airway. Familiarity with supraglottic airways, intubation, indirect video laryngoscopy, and direct laryngoscopy are critical. The anesthesia provider should also be familiar with a surgical airway such as cricothyroidotomy.

We report a case of left inferior alveolar nerve dysfunction following management of left inferior alveolar artery pseudoaneurysm in a 32-year old female following third molar extractions. After failing to manage the bleeding with conservative methods, embolization of the left inferior alveolar artery and the anastomosing branches of the facial artery was performed by interventional neuroradiology utilizing a fibered coil and N-butyl cyanoacrylate. Immediate hemostasis was achieved without major complications. The patient suffered transient anesthesia of left inferior alveolar nerve but recovered fully after two months.

Preprosthetic surgery remains a work horse of dentoalveolar surgery. Advances in rehabilitation of the edentulous mouth with the use of endosseous osseointegrating dental implants and dermal matrix substitutes have changed the narrative of traditional preprosthetic surgery while maintaining some fundamental principles. An outline of the basic techniques in preprosthetic dentoalveolar surgery is discussed in the setting of these technological and tissue engineering advances.

Background Mirikizumab (miri), an anti-IL-23p19 monoclonal antibody, demonstrated efficacy and was well-tolerated in a phase 2 randomised clinical trial in patients with moderate-to-severe ulcerative colitis (UC; NCT02589665). After 12 weeks (W) of treatment, miri was shown to down-regulate several transcripts correlated with increased UC disease activity as well as anti-TNF resistance. Here we show W52 gene expression analysis from the induction responder cohort at W12 for both miri and PBO treated patient biopsy samples to identify sustained changes in gene expression. Methods Miri-treated patients who achieved clinical response (decrease in 9-point Mayo subscore [rectal bleeding, stool frequency, endoscopy] of ≥2 points and ≥35% from baseline [BL] with either a decrease of RB subscore of ≥1 or an RB subscore of 0 or 1) or better at W12 were re-randomised to miri 200 mg administered subcutaneously (SQ) every 4 weeks or every 12 weeks through W52. Patients given placebo (PBO) in induction who achieved clinical response continued on PBO in the maintenance period. Colonic biopsies were obtained at W0, 12, and 52 from the most affected area at least 30 cm from the anal verge (miri N=31, PBO N=7). Transcript changes at W12 from BL in the PBO and miri arms were clustered into differentially expressed genes (DEGs) using the Bayesian Limma R-package. Among these DEGs, similarly expressed genes (SEGs) were identified as those which maintained their W12 expression level through W52. Results Analysis of transcript changes in W12 responders who continued to maintenance identified a profile of DEG-SEGs in responders (Fig 1A). Of these genes, 63 (70.8%) were present only in miri responders, 5 (5.6%) were present only in PBO responders, and 21 (23.6%) were present in both groups (Fig 1B, C). The magnitude of transcript changes was greater at W12, and more consistent through W52, in the group of miri responders compared to PBO responders (Fig 2). A separate cluster of DEG-SEGs correlated with to disease activity indeces (Robarts Histopathology Index [RHI], modified Mayo; both r>0.5) were shown to be sustained in the miri treated patients but not in the placebo patients. Conclusion In this limited sample of W12 PBO and miri responders, miri responders showed broader, larger, and more sustained magnitude of changes at W52 compared to PBO responders. The qualitative description of transcripts suggests a distinct molecular healing pathway associated with miri treatment, as compared to the spontaneous healing that occurred in PBO responders. A cluster of transcripts that correlated with disease activity indices was identified, demonstrating consistency across molecular, endoscopic and clinical indices of healing in UC.

Background Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion. Objective To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers. Methods A total of 51 patients with complete or near-complete brachial plexus injuries were treated with a combination of nerve reconstruction strategies. The phrenic nerve (PN) was used as axon donor in 40 patients and the spinal accessory nerve was used in 11 patients. The recipient nerves were the anterior division of the upper trunk (AD), the musculocutaneous nerve (MC), or the biceps branches of the MC (BBs). An index comparing the strength of elbow flexion between the affected and the healthy arms was correlated with the choice of target nerve recipient and the length of nerve grafts, among other parameters. The mean follow-up was 4 yr. Results Neither the choice of MC or BB as a recipient nor the length of the nerve graft showed a strong correlation with the strength of elbow flexion. The choice of very proximal recipient nerve (AD) led to axonal misrouting in 25% of the patients in whom no graft was employed. Conclusion The length of the nerve graft is not a negative factor for obtaining good muscle recovery for elbow flexion when using PN or spinal accessory nerve as axon donors in traumatic brachial plexus injuries.

Reverse total shoulder arthroplasty (RTSA) has demonstrated successful outcomes in the treatment of both acute and chronic proximal humeral fractures (PHFs). The traditional RTSA surgical technique uses a methyl methacrylate cemented humeral component to restore and maintain both humeral height and retroversion. However, use of humeral bone cement has been associated intraoperatively with cardiopulmonary risk, increased operative cost, and postoperatively with difficulty if revision arthroplasty is required. We report the clinical and radiographic outcomes of a completely cementless RTSA technique for PHF surgery.Between 2013 and 2018, 60 consecutive patients underwent surgical management of a PHF with cementless RTSA. All surgical procedures were performed by a single senior shoulder surgeon using a modified deltopectoral approach and a completely uncemented RTSA technique. Fractures were defined as either acute or chronic based on a 4-week injury-to-surgery benchmark. The mean age was 67 years (range, 47-85 years). There were 18 acute and 42 chronic fractures. The mean time from injury to surgery was 2 weeks (range, 0.4-4 weeks) for acute fractures and 60 months (range, 1-482 months) for chronic fractures. We excluded 17 cases from postoperative evaluation because of revision and/or loss to follow-up. The remaining 43 cases underwent clinical and radiographic evaluation by 2 independent fellowship-trained shoulder surgeons at a mean of 21 months (range, 10-46 months) postoperatively. Independent statistical analysis was performed using the paired t test and Wilcoxon signed rank test.At final review, mean active anterior elevation was 157° (range, 100°-170°); active external rotation, 52° (range, 6°-80°); and active internal rotation, 66° (range, 0°-80°). Improvements were seen in the visual analog scale pain score (from 6 to 0.2, P.001), Simple Shoulder Test score (from 9 to 93, P.001), American Shoulder and Elbow Surgeons score (from 19 to 91, P.001), and Single Assessment Numeric Evaluation score (from 21% to 89%, P.001). Overall, 39 of 43 greater tuberosities (91%) demonstrated osseous healing to the humeral shaft. No significant differences in clinical and radiographic outcomes were found in acute vs. chronic cases, as well as cases with minimum follow-up of 1 year vs. 2 years. Overall, there were 4 major complications necessitating surgical revision (6.7%) and no cases of aseptic humeral stem loosening.Cementless RTSA for acute and chronic PHFs demonstrates clinical and radiographic outcomes similar to those after traditional cemented RTSA. The successful greater tuberosity healing and absence of humeral stem loosening in this short-term cohort are encouraging for the continued long-term success of this technique. By avoiding cemented humeral implants, surgeons may minimize intraoperative complications, operative cost, and postoperative revision difficulty.

Biological method of nanocomposite synthesis using plant extracts is suggested as possible ecofriendly choice to physical and chemical methods. Co precipitation followed by Calcination was used for the synthesis of CuO/MgO functional nanocomposite. EDTA and Momordica Charantia leaf extracts were used as the capping agents. The structures of the nanocomposites were analyzed using X-ray diffraction. Diffraction peaks of the nanocomposites reveals the well- crystalline characteristics indicating the mixture phase of CuO and MgO. The antioxidant behavior of synthesized CuO/MgO nanocomposites were evaluated by 2,2-diphenyl-1-picrylhydrazyl hydrate (DPPH) assay. Green synthesized CuO/MgO nanocomposite showed efficient antioxidant activity. Optical activity of the samples were studied by analyzing UV-VIS spectra.

A poly (riboflavin) modified pencil graphite electrode was fabricated by electropolymerization process. The fabricated electrode was characterized morphologically and electrochemically. Dopamine and serotonin was found to undergo irreversible electroxidation at potentials 0.103 V and 0.292 V respectively on the modified electrode surface in phosphate buffer saline pH 7.4. Also the potential of the developed electrode as a tool to determine the concentrations of serotonin and dopamine was also described. The sensor possesses a linear range of 1 µM – 320 µM. The efficiency of the sensor to be used in practical samples was tested using human serum samples.

Purpose A common concern among oral and maxillofacial surgeons (OMSs) is progressive hearing loss throughout their careers. Although this has not been critically studied, there could be several factors that contribute to this detriment, including drills, saws, suction, music, and other sounds within the closed operating environment. This study observed the intensity of noise in operating rooms (ORs) and clinical settings during the use of drills, saws, surgical handpieces, and other tools. Materials and Methods In this cross-sectional study, sound intensities were measured in decibels using a CEM DT-8851 industrial high-accuracy digital sound noise level meter data logger in clinics and ORs. The device measured sound intensities during the entire duration of the procedures. The recorded drilling periods were extracted from the data and t tests were run to determine whether a statistically relevant difference existed between the non-drilling and drilling periods. In addition, the duration during which intensity was greater than or equal to 85 dB was measured. Results Fifty procedures were recorded in the clinical setting and 50 were recorded in the OR. The results of this study proved that OMSs were indeed exposed to sound intensities in decibels that exceeded Occupational Safety and Health Administration (OSHA) guidelines, but these exposures occurred less than 1% of the time. The maximum recorded intensities in the clinic and OR were during a non-drilling period and these were attributed to suction. Conclusion OSHA guidelines were exceeded in clinical and OR settings, but the results were not relevant. The authors believe this is a very promising study for future endeavors. They found that the threshold set by OSHA was exceeded at points during surgical procedures in the clinic and OR. This will prompt future studies focusing on recordings when suction is used and longitudinal studies of individual OMSs.

With increasing awareness for minimally invasive approaches, endoscopic techniques for peripheral nerve decompression are becoming increasingly popular. The first endoscopic approach to release a pinched nerve was for carpal tunnel release through a single entry port, whereby the compressed canal was dilated with bougies and an endoscope introduced into this canal to transect the transverse carpal ligament. Since most of the manipulations with the blunt bougie in this technique were done in a blind fashion, there was a lurking potential for iatrogenic nerve injury using the bougie technique. Thus the retractor-integrated endoscopic technique was developed. In this technique, the retractor bearing the endoscope is introduced into a plane above the compressing ligaments and the nerve proper and a bird’s eye perspective of the anatomical site is gained. Owing to the simplicity of the technique, the retractor-endoscope was used to decompress any nerve at any site in the body: furthermore it was employed for harvesting nerves, vessels and tendons for transplantation. In this paper, we describe the various endoscopic techniques used for decompression in peripheral nerve entrapment syndromes and provide a comprehensive and comparative metaanalysis of the techniques.

Pediatric patients present to the oral and maxillofacial surgeon for surgical services that can be performed safely and efficiently. Children and parents tend to be anxious; achieving cooperation is paramount for successful procedures. Several techniques can be used to alleviate anxiety and provide analgesia and anesthesia. This article outlines the anatomy and physiology of children and the preoperative anesthetic preparation and techniques unique to pediatric anesthesia. It discusses standards in training in pediatric anesthesia and current recommendations for monitoring. Management of children with autism spectrum disorders and attention deficit hyperactivity disorders highlights special considerations in the management of these children.

Oat is among the food crops and ancient grains cultivated and consumed worldwide. It is gaining in popularity owing to its nutritional composition and multifunctional benefits of select bioactive compounds. Beta-glucan is an important component of dietary fiber found in oat grains. It is the major active compound in oats with proven cholesterol-lowering and antidiabetic effects. Oats also provide substantial levels of other bioactive compounds such as phenolic acids, tocols, sterols, avenacosides, and avenanthramides. The consumption of oats has been determined to be beneficial for human health by promoting immunomodulation and improving gut microbiota. In addition, oat consumption assists in preventing diseases such as atherosclerosis, dermatitis, and some forms of cancer. While much has been published in relation to oat nutrients and oat fibers and their impact on major diseases, the oat industries and consumers may benefit from greater knowledge and understanding of clinical effects, range of occurrence, distribution, therapeutic doses and food functional attributes of other oat bioactives such as avenanthramides and saponins as well as other anti-inflammatory agents found in the cereal. This review focuses on the various studies relevant to the contribution of the consumption of oats and oat-based products in preventing human diseases and promoting human health.

This report describes an extensive surgical journey for a patient with Ehlers-Danlos syndrome (EDS) who underwent a total temporomandibular joint reconstruction and illustrates an ongoing challenge for oral and maxillofacial surgeons treating patients with connective tissue disorders and managing chronic pain symptoms. The surgical team attempted multiple procedures including 2 failed total temporomandibular joint replacements and a myocutaneous vascularized free flap. This case demonstrates the potential for postoperative complications in patients with Ehlers-Danlos syndrome.

Dentoalveolar surgeries are among the more common procedures performed by oral maxillofacial surgeons. It is only natural that there are several controversies associated with many aspects of this type of surgery. Although good scientific evidence is the basis of most oral maxillofacial procedures, some of what is accepted as common wisdom may not meet strict guidelines of evidence-based practice. This article explores some controversies that are relevant to the current practice of dentoalveolar surgery.

Modern shoulder arthroplasty techniques include hemiarthroplasty, total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). Out of all arthroplasty procedures, total shoulder arthroplasty produces more satisfactory outcomes for osteoarthritis and inflammatory arthropathy (Sanchez-Sotelo, 2011 [1]). As shoulder arthroplasty procedures continue to increase in popularity, so do revision surgeries (revision TSAs and revision RSAs). Implants used in shoulder arthroplasty procedures have been transformed substantially from generation to generation, going from 1st to 4th generation implants. We propose 5th generation convertible implants that enable a more patient-specific, anatomic reconstruction with the potential to solve major issues that exist with implants from previous years.

In the past 2 decades, advancements have been made in procedures for preserving and restoring the function of the proximal humerus when treating glenohumeral (GH) osteoarthritis. This review addresses two surgical options for GH osteoarthritis in the young patient, stemless total shoulder arthroplasty and resurfacing arthroplasty. These procedures preserve bone stock, have low complication rates, ease future revision if indicated, and report equal if not superior results compared with stemmed implant options. Comparative studies especially of long-term clinical outcomes of humeral resurfacing and stemless implants are still needed to make an informed treatment decision, especially in the young patient.

Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24–90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24–33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. ASES score increased from a median of 38.2 ± 6.2 preoperative to 92.1 ± 4.7 postoperatively (p ≤ 0.05). The median VAS score improved from 62 mm (range 45–100 mm) preoperatively to 8 mm (range 0–20 mm) at final follow-up (p ≤ 0.05). No patient experienced pain or discomfort with either direct palpation of the AC joint or with cross-body adduction. Final radiographs demonstrated symmetric AC joint contour in 25/32 (78%) patients. Seven patients (22%) radiographically demonstrated superior translation of the distal clavicle relative to the superior margin of the acromion but less than 50% of the clavicular width. 30/32 patients (93%) were able to return to their pre-injury level of work and sports activities. This novel surgical technique using a free graft and braided suture for simultaneous coracoclavicular ligament and AC joint capsular reconstruction successfully controls superior and posterior translations after type V AC joint dislocation and minimizes the incidence of persistent postoperative AC joint subluxation. Retrospective case series, Level IV.

Background The basic necessities for surgical procedures are illumination, exposure, and magnification. These have undergone transformation in par with technology. One of the recent developments is the compact magnifying exoscope system. In this report, we describe the application of this system for surgical operations and discuss its advantages and pitfalls. Methods We used the ViTOM exoscope mounted on the mechanical holding arm. The following surgical procedures were conducted: lumbar and cervical spinal canal decompression (n = 5); laminotomy and removal of lumbar migrated disk herniations (n = 4); anterior cervical diskectomy and fusion (n = 1); removal of intraneural schwannomas (n = 2); removal of an acute cerebellar hemorrhage (n = 1); removal of a parafalcine atypical cerebral hematoma caused by a dural arteriovenous fistula (n = 1); and microsutures and anastomoses of a nerve (n = 1), an artery (n = 1), and veins (n = 2). Results The exoscope offered excellent, magnified, and brilliantly illuminated high-definition images of the surgical field. All surgical operations were successfully completed. The main disadvantage was the adjustment and refocusing using the mechanical holding arm. The time required for the surgical operation under the exoscope was slightly longer than the times required for a similar procedure performed using an operating microscope. Conclusions The magnifying exoscope is an effective and nonbulky tool for surgical procedures. In visualization around the corners, the exoscope has better potential than a microscope. With technical and technologic modifications, the exoscope might become the next generation in illumination, visualization, exposure, and magnification for high-precision surgical procedures.

Purpose Although arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid (HA) or corticosteroid (CS) remains uncertain. The purpose of this study was to assess the efficacy of HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis for changes in quality of life (QoL), jaw function (Jaw Function Limitation Scale [JFLS] score), and maximum incisal opening (MIO). Materials and Methods This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California–Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then instillation of HA, CS, or LR. All patients were evaluated clinically at 1 and 3 months. The outcome variables were QoL, JFLS score, and MIO. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant. Results One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for analysis of data at 1 month. An additional 51 were lost to follow-up at 3 months, leaving 51 patients for data analysis at this time point. There was no difference among groups for QoL Mental Health Composite score at 1 month ( P = .70) or 3 months ( P = .69). There was no difference among groups for JFLS score at 1 month ( P = .71) or 3 months ( P = .98). There was no difference among groups for MIO at 1 month ( P = .47) or 3 months ( P = .31). All groups showed within-group improvements in JFLS score and MIO at 1 and 3 months. Conclusion Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at 1 and 3 months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.

Arthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain, with good success. The additional use of hyaluronic acid (HA) or corticosteroid (CS) remains controversial. The purpose of this study was to compare HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis.This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then the instillation of HA, CS, or LR. Patients were evaluated clinically at 1 and 3 months. The primary outcome variable was pain at 1 month (by visual analog scale). Secondary outcome variables were pain at 3 months and analgesic consumption. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant.One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for the final analysis. The mean age of patients in the HA, CS, and LR groups was 39.6, 44.3, and 51.8 years, respectively (P = .02). There was no difference among groups in time to follow-up at 1 month (P = .11). The mean decrease in pain in the CS group was 19% for right-side procedures (P = .12) and 36% for left-side procedures (P = .02). The mean decrease in pain in the HA group was 31% for right-side procedures (P = .01) and 34% for left-side procedures (P = .01). The mean decrease in pain in the LR group was 43% for right-side procedures (P.01) and 37% for left-side procedures (P.01). There was no difference in pain decrease among groups (P = .55). There was no difference in the use of narcotic (P = .52) or nonsteroidal anti-inflammatory drugs (P = .71) among groups.Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in decreasing TMJ pain.