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Dorsal preservation involves eliminating the dorsal hump by performing reduction while preserving the patient's natural dorsal anatomy. This can involve surface manipulation or foundational techniques or a combination of both. When surgeons begin performing dorsal preservation, there are important factors to consider to avoid complications. In an effort to inform surgeons on how to avoid unfavorable outcomes, I will discuss my first 20 cases where I performed dorsal preservation. I review less than ideal outcomes and how these issues can be prevented.

Augmentation of the nasal dorsum is frequently required in the ethnic rhinoplasty patient to create a narrowing effect and to balance the upper two thirds of the nose with the desired increase in tip projection. The subdorsal cantilever graft (SDCG) provides a method to elevate the nasal dorsum to complement the increase in nasal tip projection. SDCG type A is situated below the bony dorsum and acts to raise the dorsum with limited elevation of the radix. The SDCG type B extends through a radix osteotomy site and raises the radix down to the supratip after complete release of the bony dorsum and middle nasal vault. Placement of the SDCG below the dorsum has many advantages, including preserving the features of the natural dorsum (dorsal aesthetic lines), controlled narrowing, and camouflage of the subdorsal graft. This is a complex procedure that requires a good understanding of dorsal preservation techniques. Use of the SDCG to raise the nasal dorsum in ethnic patients combines structure rhinoplasty with the principles of dorsal preservation for augmentation of the profile in patients with a low dorsum.

The supraclavicular exposure represents an alternative approach for thoracic outlet decompression in neurogenic thoracic outlet syndrome with unique access to neurovascular structures. We aimed to evaluate the learning curve for this approach and associated patient outcomes.Patients undergoing first-time, unilateral, supraclavicular thoracic outlet decompression for neurogenic thoracic outlet syndrome were included. Cumulative-sum and linear-spline-regression analyses were used to determine the operative time learning curve. Patients were consecutively organized into early (learning phase) and late (competency) cohorts. Primary endpoints were the operative time learning curve operation number and association of this learning curve on differences in self-reported postoperative symptomatic improvement between early and late cohorts, adjusting for American Society of Anesthesiology classification, body mass index, previous treatment (opioid/neuropathic medication/botulinum-injection), and length of stay.Among 114 patients, learning curve analyses showed decreasing operative times, plateauing at the 51st operation (ß = -1.63, 95% confidence interval [-2.30, -0.95], P.001). No periprocedural differences existed between early (operations 1-50) and late (operations 51-114) cohorts. Self-reported 90-day outcomes were similar in early and late cohorts (odds ratio [OR]: 1.60 [0.65, 3.95], P = .31). Mediators of poor self-reported outcomes included increasing American Society of Anesthesiology classification (OR 0.21 [0.08, 0.54], P = .001), failed preoperative botulinum injection (OR 0.15 [0.03, 0.65], P = .01), and increased length of stay (OR 0.40 [0.22, 0.73], P = .003).The learning curve for supraclavicular thoracic outlet decompression in neurogenic thoracic outlet syndrome occurred after 51 operations with a trend towards improved 90-day self-reported outcomes from the early to late phases. These findings, along with mediators of poorer outcomes, may aid surgeons in adopting a new approach and counseling patients on expected outcomes.

Background: Postoperative infections after rhinoplasties are rare, yet devastating on patient outcomes. The literature reports an overall incidence of

Background/purpose Abdominal lymphatic malformations (LM) are a rare subset of vascular anomaly caused by abnormal development of the lymphatic system. They are classified as macrocystic, microcystic or combination macrocystic and microcystic. Surgical resection, percutaneous sclerotherapy, and medical therapy are all employed to treat these complex and often symptomatic lesions. No standardized treatment algorithm exists currently. The purpose of this study was to establish a multidisciplinary treatment approach to abdominal LMs. Methods A retrospective observational study was conducted from 2013 to 2019 on patients with abdominal LMs at a single tertiary children's hospital vascular anomalies center. Demographics, imaging, and treatment modality were recorded. Clinical and/or radiographic response to the primary treatment modality as well as complications was the outcomes measured. Results Nineteen patients (12 macrocystic, 5 microcystic and 2 combined) were identified, with a median age at diagnosis of 2.2 years (range 0.1–20.8 years). Sclerotherapy was the most common primary treatment, followed by surgical resection and sirolimus. No difference in clinical response (p = 0.58) or complications (p = 0.31) was observed based on primary treatment or subtypes. Conclusions Based on our institutional experience, we propose an LM subtype-based treatment algorithm for abdominal LMs. It employs a multidisciplinary approach, and results in satisfactory patient outcomes with minimal complications. Level of evidence Level III, retrospective comparative study.

The saddle nose deformity typically occurs after the loss of underlying septal support with loss of projection of the middle nasal vault. This creates a saddling effect as the upper lateral cartilages contract and forms a dip in the profile. The saddle nose deformity can occur from many different etiologies, including septal hematoma, fracture of the septum after trauma, disruption of the dorsal L-strut support after septoplasty, and metabolic disorders resulting in the loss of septal support. In most cases, the nasal bones remain in their native position creating a discrepancy in dorsal height and deformity. Correction of the saddle nose deformity can be performed using one of the two primary approaches. The most basic option is to simply fill the defect with a cartilage onlay graft (solid graft, diced cartilage and fascia, and so on) to create a normal dorsal line. This approach can be effective in many cases. Over time, the onlay graft may descend and create deformity or become visible. The other approach involves opening the middle nasal vault, placing spreader grafts, and reconstituting the dorsal L-strut, performing septal reconstruction or extracorporeal septoplasty. In this paper, we present our technique of repairing the saddle nose deformity using a “push up” method that preserves the middle vault anatomy and reconstitutes the proper projection of the middle-third of the nose.

IntroductionLimited data exist on brain MRI enhancement in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD) and differences from aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD), and multiple sclerosis (MS).MethodsIn this retrospective observational study, we identified 122 Mayo Clinic MOGAD patients (1 January 1996–1 July 2020) with cerebral attacks. We explored enhancement patterns using a discovery set (n=41). We assessed enhancement frequency and Expanded Disability Status Scale scores at nadir and follow-up in the remainder (n=81). Two raters assessed T1-weighted-postgadolinium MRIs (1.5T/3T) for enhancement patterns in MOGAD, AQP4+NMOSD (n=14) and MS (n=26). Inter-rater agreement was assessed. Leptomeningeal enhancement clinical correlates were analysed.ResultsEnhancement occurred in 59/81 (73%) MOGAD cerebral attacks but did not influence outcome. Enhancement was often patchy/heterogeneous in MOGAD (33/59 (56%)), AQP4+NMOSD (9/14 (64%); p=0.57) and MS (16/26 (62%); p=0.63). Leptomeningeal enhancement favoured MOGAD (27/59 (46%)) over AQP4+NMOSD (1/14 (7%); p=0.01) and MS (1/26 (4%); p3 months) was rare (0%–8%) across all groups. Inter-rater agreement for enhancement patterns was moderate.ConclusionsEnhancement is common with MOGAD cerebral attacks and often has a non-specific patchy appearance and rarely persists beyond 3 months. Leptomeningeal enhancement favours MOGAD over AQP4+NMOSD and MS.

ObjectiveTo investigate relationships between serum neurofilament light chain (sNfL), ubiquitin C-terminal hydrolase L1 (sUCHL1), tau (sTau) and glial fibrillary acidic protein (sGFAP) levels and disease activity/disability in neuromyelitis optica spectrum disorder (NMOSD), and the effects of inebilizumab on these biomarkers in N-MOmentum.MethodsN-MOmentum randomised participants to receive inebilizumab or placebo with a randomised controlled period (RCP) of 28 weeks and an open-label follow-up period of ≥2 years. The sNfL, sUCHL1, sTau and sGFAP were measured using single-molecule arrays in 1260 scheduled and attack-related samples from N-MOmentum participants (immunoglobulin G (IgG) autoantibodies to aquaporin-4-positive, myelin oligodendrocyte glycoprotein-IgG-positive or double autoantibody-negative) and two control groups (healthy donors and patients with relapsing–remitting multiple sclerosis).ResultsThe concentration of all four biomarkers increased during NMOSD attacks. At attack, sNfL had the strongest correlation with disability worsening during attacks (Spearman R2=0.40; p=0.01) and prediction of disability worsening after attacks (sNfL cut-off 32 pg/mL; area under the curve 0.71 (95% CI 0.51 to 0.89); p=0.02), but only sGFAP predicted upcoming attacks. At RCP end, fewer inebilizumab-treated than placebo-treated participants had sNfL>16 pg/mL (22% vs 45%; OR 0.36 (95% CI 0.17 to 0.76); p=0.004).ConclusionsCompared with sGFAP, sTau and sUCHL1, sNfL at attack was the strongest predictor of disability worsening at attack and follow-up, suggesting a role for identifying participants with NMOSD at risk of limited post-relapse recovery. Treatment with inebilizumab was associated with lower levels of sGFAP and sNfL than placebo.Trial registration numberNCT02200770.

PURPOSE OF REVIEW To present the novel technique of subdorsal Z-flap in dorsal preservation rhinoplasty and give an overview on current available dorsal preservation techniques in the literature. RECENT FINDINGS The subdorsal Z-flap combines the advantages of the high and low septal strip techniques in dorsal preservation rhinoplasty and ensures well tolerated treatment of the dorsal hump and structural stability. SUMMARY The technique and concept of Dorsal Preservation Rhinoplasty (DPR) has been used for more than a century but only recently gained significant popularity along with specific technical refinements. The advantage of DPR lies in the preservation of the delicate triangular cartilaginous unity of the septal and upper lateral cartilages with its functional and esthetic implications in contrast to all resecting techniques. A variety of modifications of DPR have been published in recent years, each with advantages and disadvantages. The issue of hump recurrence remains a major concern in DPR. We describe the 'subdorsal Z-flap' and related techniques of DPR in detail, present two clinical case studies and discuss alternative technical modifications. The 'subdorsal Z -flap' combines the advantages of the high septal strip procedure with the advantages of the traditional 'low septal strip' or Cottle technique. By starting the incision at a high level, final septal height can be adjusted precisely. By creating a triangular shape with a vertical cut below the K-Area, which is usually the highest point of the hump, significant leverage can be applied from below the hump and the septal overlap may be sutured securely for a stable correction. In combination with Piezo osteotomy and full open approach, great precision and predictability can be achieved. In a recent publication, we presented more than 100 consecutive cases of subdorsal Z-flap DPR with good functional and esthetic outcomes. The subdorsal Z-flap modification is a combination of two popular DPR techniques, fusing their advantages while minimizing risk profile. A slightly higher degree of technical difficulty and necessary tissue dissection provides the benefits of better predictability and reduction of adverse outcomes.

We describe a 17-year-old boy with capillary malformation-arteriovenous malformation syndrome and a massive vascular malformation of the right chest wall, shoulder, and upper arm. Persistent growth of the malformation caused cutaneous ulcerations and recurrent massive bleeding episodes. We proceeded with a modified shoulder disarticulation preceded by ligation of the subclavian artery and innominate vein by median sternotomy. After a staged debulking resection of the residual chest wall arteriovenous malformation with rotational transverse rectus abdominis myocutaneous flap coverage, the patient was discharged home safely. This report demonstrates that a multidisciplinary approach is critical for management of life-threatening complications in capillary malformation-arteriovenous malformation patients.

Preservation rhinoplasty is making a resurgence as a reliable method of performing primary rhinoplasty. Dorsal preservation is an important part of the approach to preserve favorable nasal contours when performing rhinoplasty. Keys to success require proper patient selection and careful execution. There are potential sequelae, such saddle nose deformity, recurrence of the dorsal convexity, cerebrospinal fluid leak, and radix step-off. This article discusses methods and adjustments in technique to help minimize these potential problems when performing dorsal preservation.

Thoracic outlet syndrome is a condition of compression involving the brachial plexus and subclavian vessels. Although there are multiple surgical approaches to address thoracic outlet decompression, supraclavicular first rib resection with scalenectomy and brachial plexus neurolysis allow for complete exposure of the first rib, brachial plexus, and vasculature. This technique is described in detail. This approach is safe and can produce excellent outcomes in all variants of thoracic outlet syndrome.

Structural preservation rhinoplasty merges two popular philosophies of rhinoplasty-structure rhinoplasty and preservation rhinoplasty-in an effort to maximize patient outcomes, aesthetics, and function. This allows the surgeon to both preserve the favorable attributes of the nose, and also to structure the nasal tip and dorsum with grafts to maximize contour and support. The concept of dorsal preservation is to preserve favorable dorsal aesthetic lines without the creation of an "open roof." However, the addition of some structure concepts can expand the utility of dorsal preservation in primary rhinoplasty patients. The authors discuss these structure concepts and their applicability to dorsal preservation.

Preservation rhinoplasty in general and dorsal preservation in particular are for sure one of the most attractive topics in modern rhinoplasty and probably the most puzzling concept in this field. Recent major meetings and many other publications have led to an increased interest in these old/new techniques. New strategies for preservation have been developed in recent years, with a broader range of indications than the older push/let down. A simple classification urges to clarify this puzzled semantic concept of "preservation". Is it possible to systematize all new preservation variations in a simple classification? Yes, in this viewpoint, we propose a simple classification that systematizes all kinds of preservation techniques-the old and the new techniques. Classifying preservation will clarify the relative position of all techniques. It will allow comparing procedures from similar families there so to compare outcomes and indications from each technique.

A previously healthy 45-year-old man had development of neck pain and swelling, followed 1 week later by fevers, chills, and night sweats. Cervical computed tomography showed a left-sided cervical soft-tissue abscess. The patient was treated with oral cephalexin for 10 days, without benefit. Fine-needle aspiration biopsy of the mass showed granulomatous inflammation and a heterogeneous lymphocyte population without evidence of malignancy. Meropenem and gentamicin were started. Ten days later, he had development of acute urinary retention, numbness and weakness in the lower extremities, and numbness in the upper extremities. At symptom nadir 2 days later, he required the aid of a walker to ambulate. Lhermitte sign and erectile dysfunction were also present. The patient was admitted to the hospital. Spinal cord magnetic resonance imaging showed a longitudinally extensive, nonenhancing, T2-hyperintense lesion predominantly affecting the ventral and lateral parenchyma of the cervical and thoracic spinal cord. Cerebrospinal fluid examination showed a white blood cell count of 581 cells/µL with 42% neutrophils, 35% lymphocytes, and 22% monocytes, increased protein concentration (109 mg/dL), and normal glucose concentration. A diagnosis of postinfectious idiopathic transverse myelitis was made. The patient was treated with intravenous immunoglobulin, intravenous methylprednisolone, and broad-spectrum antibiotics, with improvement of both the abscess and his neurologic symptoms. After discharge, he was able to walk unassisted. At follow-up evaluation 6 months after the initial evaluation, neurologic examination showed only mild weakness of the left iliopsoas muscle and brisk reflexes in the lower extremities. Acute transverse myelopathies are a heterogeneous group of spinal cord disorders characterized by acute or subacute signs and symptoms of spinal cord dysfunction, typically a combination of sensory, motor, and autonomic manifestations. Underlying causes include vascular, infectious, neoplastic, postirradiation, traumatic, and inherited/metabolic, and inflammatory processes.

Purpose: To evaluate the surgical responses and outcomes of bilateral medial rectus (BMR) recession in esotropic patients with spinocerebellar ataxia (SCA) and to compare the results with normal controls. Methods: The medical records of patients with SCA who underwent strabismus surgery for esotropia between 2006 and 2015 were reviewed retrospectively. Five esotropic patients with SCA (SCA group) and 10 esotropic patients without neurologic disorders (control group) who underwent BMR recession were included. Success rates, surgical responses, and the amount of preoperative and postoperative distance-near disparity were evaluated and compared between the groups. Results: The mean preoperative esodeviation was not different between the SCA and control groups (20 vs 17.3 prism diopters [PD], P = .214). However, patients with SCA showed significant undercorrection compared with controls 1 week postoperatively (4.8 vs 1.0 PD, P = .048) and at the final follow-up (6.8 vs 1.8 PD, P = .032). The surgical success rates for the SCA and control groups were 40% and 80%, respectively ( P = .095). Patients with SCA demonstrated a significantly reduced surgical response compared with controls (3.15 vs 3.87 PD/mm, P = .004), and a greater amount of postoperative distance-near disparity than controls (8.0 vs 1.1 PD, P = .001). Conclusions: A significant undercorrection was observed following BMR recession in esotropic patients with SCA. Accordingly, the authors recommend a slight overcorrection of 5 to 10 PD or adding a slanting procedure when planning strabismus surgery for this distinct group of patients. [ J Pediatr Ophthalmol Strabismus . 2019;56(4):266–270.]

Neurogenic thoracic outlet syndrome (NTOS) results from the compression or irritation of the brachial plexus within the thoracic outlet. The associated symptoms result in significant disability and negative effects on patient health-related quality of life. The diagnosis of NTOS, despite being the most common type of TOS, remains challenging for surgeons, in part due to the nonspecific symptoms and lack of definitive diagnostic testing. In this article, we present the essential components of the evaluation of patients with NTOS including a thorough history and physical examination, stress maneuvers, diagnostic and therapeutic imaging, and assessment of disability using standardized patient-centered instruments.

Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is classically a RASA1 mutation with small CMs and either central nervous system or musculoskeletal AVMs. However, CM-AVM2 has recently been discovered, and is characterized by an EPHB4 mutation to the EPHB4-RAS-ERK pathway. The skin findings favor those of hereditary hemorrhagic telangiectasia with Bier spots and telangiectasias, and the presence of central nervous system and musculoskeletal AVMs mirror classic CM-AVM. To our knowledge, this is the first report of a visceral AVM in CM-AVM2 in the literature. The patient presented with recurrent gastrointestinal bleeds, and after an extensive workup culminating in diagnostic visceral angiography, was found to have a CM-AVM2 with a jejunal AVM.

Objective Following paediatric burn injury, dressings are initially changed in outpatient clinics, necessitating regular visits with substantial burden for parents, children and services. This can potentially be lessened if some parents go on to administer dressing changes for their child at home. However, there is a lack of data regarding support for parent-administered dressing changes. The aim of this study was to describe current practice and views regarding at-home parent-administered dressing changes (PAD) in the UK. Methods An online survey was distributed to 20 paediatric burns services in England and Wales. The survey used fixed and free-text responses to collect data on whether PAD is offered and the reasons for this; patient and parent eligibility criteria; training and support; and respondents’ views on the advantages and disadvantages of PAD. Analysis comprised simple descriptive statistics and simple content analysis of free-text responses. Results Thirteen responses were received (response rate = 65%). Eleven respondents indicated their service offers PAD. Two respondents reported their service does not offer PAD due to alternative nurse outreach appointments (n = 1), and service resource limitations (n = 1), though another respondent indicated service cost savings. Twelve respondents regard PAD positively (n = 8) or very positively (n = 4). Most respondents reported that 10% or fewer parents refuse PAD when offered (n = 7). Perceived advantages of PAD included reduced travel burden (n = 9), patient better able to cope with dressing changes (n = 8), better school and work attendance for child and parent respectively (n = 6), and reduced financial impact on families (n = 4). There are no formal eligibility criteria for PAD, though 5 respondents described informal criteria in place in their service, predominantly involving dressing frequency (n = 5), and size or complexity of wound (n = 4). Conclusion The survey indicates that most paediatric burns services support PAD. However, the absence of formal eligibility criteria, and informal criteria open to interpretation, risks inequity of support received by children and their families. Further research should evaluate whether this inequity extends to variable clinical outcomes to determine what works for who and under what circumstances when supporting parents in paediatric burns aftercare.

Objective Paediatric burn injuries present physical and psychosocial effects for children and their parents, including disruption to family life. Some burns services in the UK enable parents to administer dressing changes at home to reduce the number of hospital visits. To date, there is no research on parents’ experiences of administering dressing changes. The aim of this study was to describe parents’ experiences of administering dressing changes in paediatric burns aftercare. Methods Semi-structured research interviews were conducted with a purposive sample of parents recruited from a paediatric burns centre in the UK. The interview addressed the initial offer of at-home dressing changes by clinicians; parental decision-making in relation to dressing changes; training and support received; and the experience of administering dressing changes, including practical and emotional considerations. Thematic analysis of the data was informed by the framework approach, including associative analysis using demographic and clinical characteristics. Results Seventeen participants were interviewed. Three themes of parents’ experiences of administering dressing changes were identified including (1) Parental Identity concerning the newly undertaken responsibility and the impact on the parental role; (2) Challenges, physical or emotional, confronted or lessened by administering dressing changes; and (3) Reassurance provided by healthcare professionals and others to support parents to adopt and maintain parent-administered dressing changes. Conclusion The qualitative data reported here indicates that parents want to be involved in their child’s care by administering dressing changes at home, provided they receive sufficient reassurance that they are able to manage the severity of their child’s burn. Parents’ concerns about the effectiveness of their dressing changes lacks empirical basis, and this study provides preliminary data to support the development and evaluation of best practice guidance for parent-administered dressing changes in paediatric burns aftercare.

Background/Purpose Cervicofacial lymphatic malformations (CFLM) are rare, potentially life-threatening vascular anomalies, yet reports on multidisciplinary treatment strategies are lacking. We evaluated outcomes for CFLMs following sclerotherapy, surgical resection, and/or medical management. Methods We identified children with a CFLM at a vascular anomalies center from 2004 to 2019. Exclusion criteria: retro-orbital malformations, untreated malformations, patients without follow-up. Primary clinical outcome was contour improvement, with significance defined as LM volume reduction of > 50% by cross-sectional imaging. Results Sixty-three children met inclusion criteria: 35 with macrocystic CFLMs, six with microcystic CFLMs, and 22 with mixed-type malformations. Mean post-intervention follow-up was 27.5 months. Fifty-eight patients underwent sclerotherapy (median: two treatments). Doxycycline and/or bleomycin were used in 95% of patients. After sclerotherapy, 97% of macrocystic CFLMs improved significantly compared to 82% of mixed and 67% of microcystic lesions. Sixteen children underwent surgical resection with 75% significantly improving; two additional patients were successfully treated with sclerotherapy after debulking surgery. Six children received sirolimus for microcystic disease, of which 33% significantly improved. Conclusion Sclerotherapy is very effective for macrocystic components of CFLMs, albeit less so for microcystic disease. Microcystic CFLMs frequently require surgical resection. Sirolimus is a helpful therapeutic adjunct, particularly for microcystic lesions, but more study is needed. Level of Evidence Level II, prognosis study

Nasal valve collapse has multiple causes, including congenital, traumatic, and, unfortunately, iatrogenic. Recognition of the causes of nasal valve collapse and the methodology for treatment is paramount not only for the otolaryngologist but also for any physician managing the nasal airway. This article focuses on the cause and surgical management of internal and external nasal valve collapse.

Postgraduate medical residency programs are laborious and timeintensive, and can be physically, intellectually and emotionally demanding. These working conditions may lead to the neglect of personal health and well-being. The objective of this study was to compare the anthropometric and fitness characteristics of surgical and nonsurgical medical residents. We hypothesized that there is a difference in physical health between these 2 groups.Medical residents completed a demographic information questionnaire and were assessed by trained staff for height, weight, body fat percentage, muscular strength and endurance, and peak oxygen consumption (V̇ᴏForty-five residents (21 surgical and 24 nonsurgical; 31 men and 14 women) participated in the study. Surgical residents worked more hours per week on average than nonsurgical residents (Surgical residents worked more hours than nonsurgical residents, which may have contributed to their higher BMI and lower aerobic fitness levels. Despite a heavy workload, it is important for all medical residents to find strategies to promote a healthy lifestyle for both themselves and their patients to ensure long-term well-being.En médecine, les programmes de résidence postdoctoraux sont fastidieux et chronovores; et ils peuvent être exigeants physiquement, intellectuellement et émotivement. De telles conditions de travail forcent parfois les résidents à négliger leur santé et leur bien-être personnels. L’objectif de cette étude était de comparer les caractéristiques anthropométriques et la forme physique des résidents de chirurgie et d’autres spécialités médicales. Selon notre hypothèse, ces 2 groupes ne présentent pas le même état de santé physique.Les résidents ont répondu à un questionnaire démographique et des assistants dument formés ont mesuré leur taille, leur poids, leur pourcentage de graisse corporelle, leur force musculaire, leur endurance et leur consommation d'oxygène maximale (V̇ᴏQuarante-cinq résidents (21 de chirurgie et 24 d'autres spécialités; 31 hommes et 14 femmes) ont participé à l'étude. Les résidents en chirurgie travaillaient en moyenne plus d'heures par semaine que les autres résidents (résidents en chirurgie travaillaient plus d’heures que les autres résidents, ce qui peut avoir contribué à leur IMC plus élevé et à leur moins bonne capacité aérobique. Malgré la lourdeur de leur fardeau de travail, il est important que tous les résidents en médecine trouvent des stratégies pour adopter de saines habitudes de vie pour eux-mêmes et leurs patients, et assurer leur mieux-être à long terme.

Purpose To compare the postoperative vertical drift in patients with thyroid eye disease (TED) with hypotropia who underwent vertical rectus recession alone versus vertical rectus recession combined with horizontal rectus recession. Methods The medical records of patients with TED who underwent strabismus surgery for hypotropia between 2006 and 2015 were reviewed retrospectively. Patients were divided into two groups: group 1 underwent vertical rectus recession only; group 2 underwent vertical rectus recession plus horizontal rectus recession. Data collection included pre- and postoperative deviation measurements and amount of surgical recession performed. The amount of postoperative vertical drift between groups was compared. Results Of 67 patients who underwent surgery during the study period, 18 met inclusion criteria, 9 in each group. Mean postoperative hypotropia was 24.2Δ in group 1 and 24.5Δ in group 2 (P = 0.82). Mean vertical deviations were 0.3Δ and −2.2Δ (P = 0.134) on postoperative day 1; −0.9Δ and −8.0Δ (P = 0.043) at final follow-up for groups 1 and 2. Mean postoperative vertical drift toward hypertropia was 1.2Δ in group 1 and 6.8Δ in group 2 (P = 0.048). The surgical success rate for group 1 was superior to that for group 2 (89% vs 67% [P = 0.024]). Conclusions There was a significantly larger postoperative vertical drift in TED patients with hypotropia who had combined vertical rectus and horizontal rectus recessions compared with those who underwent vertical rectus recession alone.

Fetuses with obstructive neck and orofacial lesions have been delivered via an ex utero intrapartum treatment (EXIT) procedure to facilitate securement of the airway while on placental circulation. Pregnancy-related cardiovascular changes and technical issues unique to an EXIT procedure increase fetal and maternal risks relative to a standard cesarean section. In order to circumvent such issues, fetal endoscopic intubation has been proposed. We report a case of a fetus with a large neck mass (mixed solid and multiloculated cystic lesion measuring 9.2 × 5.3 × 8.5 cm, neck hyperextension, protruding tongue, and serial gagging movements) that was successfully intubated in utero and delivered at 36 weeks and 0 days via standard cesarean section, thereby avoiding an EXIT procedure. The risks, benefits, and technical issues of in utero tracheal intubation are reviewed.