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Objectives: Multiple surgical approaches exist to access the infraorbital region to treat fractures. As with facial approaches, the onus is on good esthetics at the end of the procedure. Access is either through transcutaneous or transconjunctival approaches. In this study, we compared two transcutaneous approaches, the infraorbital and subciliary approaches, to assess functional and esthetic outcomes. Materials and Methods: This was a comparative analytical study of 22 patients over 18 months with zygomaticomaxillary complex (ZMC) fractures, indicated for open reduction and fixation of infraorbital margin. Patients were randomized into subciliary and infraorbital groups, assessed for intraoperative parameters of time, accessibility, and technique sensitivity and evaluated for postoperative esthetic outcomes of edema, scarring, and any complications such as denting ectropion or scleral show at the end of 1 week, 1 month, 3 months, and 6 months. Results: The intraoperative time was three times greater in the subciliary incision group. The accessibility to the fracture site is excellent in the infraorbital approach, although it was also adequate in the subciliary approach. Regarding the esthetic outcomes, denting, scleral show, and ectropion parameters were observed more in the initial postoperative period in the subciliary group and more scar visibility for the same period in the infraorbital group. However, no significant esthetic differences were present between the two approaches at the end of 6 months. Conclusions: The infraorbital approach has low esthetic and functional complications of scleral show and ectropion with relatively good esthetics and ease of performing for infraorbital and orbital floor fractures.

Introduction Perfect reduction and fixation of orbital blowout fractures remain challenging due to difficulty in visualization of herniated orbital contents and intact bony ledge. This often leads to eyeballing during surgery, which results in inadequate soft tissue reduction or improper implant placement. The use of endoscopy greatly overcomes these challenges. Patients and Methods In this paper, the authors have described 3 clinical scenarios where a combined approach of open reduction and transantral endoscopy (through an anterolateral wall defect of the maxillary sinus or Caldwell-Luc procedure) has been used for the reduction and fixation of orbital floor fractures with soft tissue entrapment. This approach has ensured perfect soft tissue reduction and precise implant position, which in turn have alleviated post-operative complications and improved patient symptoms. Discussion Conventional techniques for orbital floor repair include lower lid transcutaneous or transconjunctival approaches. However, it is difficult to visualize the posterior intact bony shelf and difficult to confirm adequate herniated soft tissue reduction. Endoscopic techniques allow superior visualization of these structures. When transantral endoscopy is combined with a traditional open approach, it provides better illumination, visualization, and effective reduction and fixation of large defects with a provision for confirmation post-fixation. In the presence of a concomitant anterolateral wall of maxillary sinus fracture, an endoscope can be easily introduced into the sinus for better visualization and confirmation. The authors have also set down a few guidelines for approaching orbital floor fractures with the combined technique in the form of an algorithm. This algorithm can help surgeons decide which type of approach to adopt based on certain characteristics of the fracture. Conclusion The combination of open reduction and transantral endoscopy is easy, effective, and shows promising results for orbital floor repair.

Background Ultrasound (US) guided transoral biopsy is a novel and safe procedure for obtaining tissue in patients with oral masses. However, this procedure is less commonly used in comparison to US guided transcutaneous biopsy. The aim of this study is to compare the efficacy and safety of US-guided transoral and transcutaneous core needle biopsy (CNB) in patients with oral masses. Methods From November 2019 to March 2021, consecutive patients with oral masses were randomly assigned to undergo US-guided transoral CNB (transoral group) and US-guided transcutaneous CNB from a submental approach (transcutaneous group). During the operation, procedure time, intra‑operative blood loss volume, diagnostic performance, rate of complications and pain level were recorded and compared. Results There were 112 patients (62 in the transoral group and 50 in the transcutaneous group) evaluated in this study. The postprocedural complication rate of the transcutaneous group was significantly higher than the transoral group (24% vs. 0%, P  = 0.000). There was no significant difference in accuracy (95.2% vs. 88%, P  = 0.30), biopsy time (76 ± 12 s vs. 80 ± 13 s, p  = 0.09), blood losses (2.6 ± 0.5 mL vs. 2.7 ± 0.4 mL, p  = 0.17) and visual analogue score ( p  = 0.327 and p  = 0.444 before and after the sampling procedure) between the two groups. Conclusion US-guided transoral CNB results in high rates of technical success and lower rates of postprocedural complications.

Objective Transcutaneous vocal cord injection is a popular treatment choice for patients suffering from unilateral vocal cord paralysis. Transcutaneous transcartilaginous (through the thyroid cartilage) approach abolishes any anatomical constraint to reach the vocal cord. However it is a largely blind procedure as the needle should stay submucosal. Herein we report our experience in employing ultrasound guidance to circumvent this problem. Methods Retrospective review of a series of 8 patients who underwent combined ultrasound/endoscopy-assisted vocal cord injection for unilateral vocal cord paralysis. Results Vocal cord injections were successfully completed in all but one patient. There were no associate complications. Conclusion The use of ultrasound in aiding transcutaneous transcartilaginous vocal cord injection is safe and feasible. Key Points • Vocal cord injection is effective in treating unilateral vocal cord paralysis • A number of transcutaneous approaches with the patient awake have been described • Transcutaneous transcartilaginous approach theoretically has minimal anatomical restraint to reach the vocal cord • Disadvantage of that approach is the difficulty to accurately position the needle • Our experience of using ultrasound to circumvent this problem is positive

The clinical efficacy of functional electrical stimulation (FES) for female detrusor instability (DI) is reviewed. Various types of FES methods (including anogenital long-term stimulation, short-term maximal stimulation, implantable stimulation and transcutaneous stimulation) have been reported. The therapeutic effects of these approaches were similar: the percentage of patients improved has been reported to be in the range 50%-90%. FES for female DI is a non-destructive procedure with a curative effect and very few side effects. This curative effect (re-education) is a major benefit of FES.[PUBLICATION ABSTRACT]

Electrical stimulation through surface electrodes is a non-invasive therapeutic technique used to improve voluntary motor control and reduce pain and spasticity in patients with central nervous system injuries. The Exopulse Mollii Suit (EMS) is a non-invasive full-body suit with integrated electrodes designed for self-administered electrical stimulation to reduce spasticity and promote flexibility. The EMS has been evaluated in several clinical trials with positive findings, indicating its potential in rehabilitation. This review investigates the effectiveness of the EMS for rehabilitation and its acceptability by patients. The literature was collected through several databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Positive effects of the garment on improving motor functions and reducing spasticity have been shown to be related to the duration of the administration period and to the dosage of the treatment, which, in turn, depend on the individual’s condition and the treatment goals. Moreover, patients reported wellbeing during stimulation and a muscle-relaxing effect on the affected limb. Although additional research is required to determine the efficacy of this device, the reviewed literature highlights the EMS potential to improve the motor capabilities of neurological patients in clinical practice.

Despite significant medical treatment advancements, interventional treatments for intractable headache disorders are limited. This study's objective is to detail a novel percutaneous approach (the \"Q2 approach\") and its technical considerations for implanting peripheral neuromodulation stimulators (PNS) to the C2 dorsal root ganglion (C2-DRG) at the C2 lamina, a previously unattempted target, as a treatment for intractable headache. In an outpatient setting, under combined ultrasound and fluoroscopic guidance, PNS electrodes were percutaneously implanted at the C2-DRG in patients under moderate sedation. The final electrode position was determined by intraoperative patient feedback to ensure optimal stimulation. Four patients were included to demonstrate technical parameters and feasibility. Follow-ups were conducted on postoperative days 10, 30, 60, and 100-120. The Q2 approach allows safe C2-DRG PNS implantations in an outpatient setting. Average operative duration was <60 minutes. All 4 patients achieved >50% pain relief during the 60-day implant period, and 3 of 4 demonstrated sustained benefit beyond the implant period. No complications (eg, lead migration, infection) were observed. The present technical note demonstrates the feasibility of a novel, safe, minimally invasive approach to access the C2-DRG at the C2 lamina for the treatment of intractable headaches. The use of PNS on the C2-DRG fills an important gap in headache management, as it provides an alternative neuromodulation treatment modality to the existing destruction/denervation-based techniques.

A balance between surgical access and aesthetics, with lesser post-op sequelae, is inevitable in the management of facial fractures. Even though various approaches are widely practised, further modifications and revisions are encouraged for better outcomes. We performed a prospective cross-sectional study on 30 patients with Zygomatico-Maxillary Complex (ZMC) fracture with inferior orbital rim involvement. Surgical management was performed using subtarsal (Group A) or laterocaudal (Group B) approach, during which the time taken to expose fracture and the ease of access was documented. Scar evaluation was performed using SCAR Scale on the 15th day and after one-month and three-month follow-up, and the post-op complications including ectropion, infections, edema, etc., were documented. There was a significant reduction in the time taken ( p  < 0.001) in group B than in group A. The ease of access did not demonstrate any significant difference. The SCAR scale score was significantly reduced at 3rd-month follow-up in group B compared to the other group ( p  = 0.009). Laterocaudal approach demonstrated lesser time-taken and better access to the inferolateral rim, with superior aesthetics and fewer complications. This approach can be employed in clinical practice, especially with inferolateral rim involvement in ZMC fractures.

Purpose of ReviewTo summarize the evidence regarding the distribution of renal nerves and their patterns of anatomic variations in animal and human settings. Moreover, the methodology and results of studies regarding renal nerve stimulation (RNS) in both preclinical and clinical models are presented.Recent FindingsThere are differences regarding the number and the size of renal fibers, as well as their distance from the lumen in the diverse parts of the main renal arteries and the branches. In both animals and humans, RNS is safe and results in an increase of blood pressure (BP) while the effect on heart rate varies. In this context, the ConfidenHT™ system constitutes an integrated solution for effective RNS in humans.SummaryDue to the diversity of renal nerve anatomy in humans, arterial areas for more effective renal denervation cannot be homogenously defined. The concept of mapping of renal nerves can improve completeness of renal denervation therapies by means of integrated RNS solutions such as the ConfidenHT™ system.

AbstractBackground: Vulvodynia has been defined as vulvar discomfort, most often described as burning pain, occurring in the absence of relevant findings or a specific, clinically identifiable, neurologic disorder. Vulvodynia is a genital syndrome of multi-causal origin and requires a team approach. The purpose of the case report of provoked vulvodynia is to show the efficacy of individualized, multifaceted and multidisciplinary therapeutic team approach used by a gynaecologist with special knowledge of sexology and a physiotherapist specialising in treatment of pelvic floor dysfunction. Case report: A 35-year old patient presented with a complaint of genital itching and consequently burning pain which first occurred during sexual intercourse one year previously. Afterwards a gynaecologist with special knowledge of sexology performed a biopsychosocial assessment, broader gynaecological examination and psychoeducation. Diagnosed was provoked vulvodynia. Than she was assessed by the physiotherapist specialising in treatment of pelvic floor dysfunction and treated with TENS. To assess the effectiveness of treatment were used Female Sexual Function Index questionnaire and the visual analogue scale before and after the team approach treatment. Conclusions: In our case individualized, multifaceted and multidisciplinary therapeutic approach proved to be a good choice for treating genital syndrome of provoked vulvodynia of multi-causal origin.