Journal of Surgical Technique and Case Report

Reduction and fixation of unstable fractures of the zygomatic arch: Report of a series of cases

Josuel Raimundo Cavalcante — 2016-08-22

Background: This study evaluated a series of cases of fracture in the zygomatic arch with displacement of the fractured segment.

Materials and Methods: This prospective cohort study was conducted between May 2008 and February 2009. The study sample which consist of 10 patients of both genders with fractures in the zygomatic arch. The collection instrument included a specific sheet with data concerning the patient’s age, cause, side of the fracture, type of treatment performed, recurrence and presence of lesions in the facial nerve. The radiographic indices of Waters and Hirtz were used. The data were presented by means of descriptive statistics (absolute and percentage distributions).

Results: Most of the patients were male (90.0%), the most frequent etiology was a motorcycle accident (70.0%) and the left side was more affected (60.0%). There was no recurrence in any of the patients examined; however, 1 patient had a lesion in the facial nerve. The treatment performed for all patients was reduction and fixation with titanium miniplates.

Conclusion: Fractures in the zygomatic arch are more frequent in young male individuals and the most common cause is a motorcycle accident, with the use of miniplates constituting an effective treatment without recurrence.

Keywords: Accidents, facial injuries, maxillary fractures, traffic, zygomatic fractures

Acute physiological and chronic health evaluation II score and its correlation with three surgical strategies for management of ileal perforations

Anand Munghate — 2016-08-22

Introduction: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score.

Methods: The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure,
resection‑anastomosis, and ileostomy. The outcome was compared.

Results: Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of
total 57 patients, 6 patients had APACHE II score of 0–9, 48 patients had APACHE II score of 10–19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10–19, 15 patients underwent primary closure, 16 patients underwent resection‑anastomosis, and 17 patients underwent ileostomy.

Discussion and Conclusion: Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10–19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10–19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema.

Keywords: Acute abdomen, Acute Physiological and Chronic Health Evaluation II, ileostomy, intestinal perforation, peritonitis

Elective bowel surgery with or without prophylactic nasogastric decompression: A prospective, randomized trial

H.G. Vinay — 2016-08-22

Introduction: Routinely postoperative nasogastric decompression was done until the nasogastric drainage is minimal, reoccurrence of bowel sounds and passing flatus. But prolonged nasogastric intubation is associated with complications like basal atelectasis due to poor cough reflux, loss of electrolytes and increased patient morbidity.

Aims and Objectives: To study the need for routine use of nasogastric tube post operatively in bowel surgeries with reference to (1) Return of bowel movements (2) Compare the incidence of complications (3) Duration of hospital stay.

Methodology: 100 patients who underwent elective bowel surgery were randomized into two groups: Study group (50): Nasogastric tube was removed immediately after operation or in the recovery room. Control group (50): Underwent nasogastric tube removal postoperatively after the patient passed flatus and audible bowel sounds on auscultation.

Results: Incidence of complications were less in the study group i.e., only three patients had vomiting, and two patients had abdominal distension which lead to postponement of oral feeds. Most of our control group patients complained of discomfort and difficulty in coughing and in bringing out sputum, which was the probable cause for high incidence of pulmonary complications.

Conclusion: Routine use of the nasogastric tube adjunct to patient care following bowel surgery may be safely eliminated.

Keywords: Bowel surgery, decompression, morbidity, nasogastric tube

Anterior palatal island advancement flap for bone graft coverage: technical note

Amin Rahpeyma — 2016-08-22

Background: The most important step in bone graft management is soft tissue coverage. Dehiscence of the wound leads to graft exposure and subsequent problems.

Purpose: This study introduces an axial pattern flap for bone graft coverage in anterior maxilla.

Patients and Methods: Use of Anterior Palatal Island Advancement Flap is presented by the authors. It is a mucoperiosteal flap with axial pattern blood supply, based on nasopalatine artery. It is easy to raise and predictable.

Results: Anterior Palatal Island Advancement Flap was effective in bone graft coverage in premaxillary edentulous area.

Conclusion: It can be used as an aid for bone graft coverage of premaxillary edentulous ridge, where the need for mucosa is small in width but long in length.

Keywords: Anterior maxilla, bone graft, dental implant, palatal advancement flap

Primary squamous cell carcinoma of stomach: A rare entity - case report and brief review of literature

Rashmi Patnayak — 2016-08-22

Very few case reports of pure squamous cell carcinoma (SCC) of stomach are available in the world literature. The exact pathology of this uncommon carcinoma in stomach remains unknown. This is an additional case report of SCC in an elderly female arising in the gastric antrum. She underwent distal gastrectomy, gastrojejunostomy and jejunojejunostomy. The histopathology was reported as SCC of stomach without any adenocarcinomatous component. She had no other source of extra gastric primary SCC. After surgery, the patient was advised adjuvant chemotherapy. This is an additional case of primary SCC of stomach.

Keywords: Primary, squamous cell carcinoma, stomach

Echinococcal cyst of the pancreas with Cystopancreatic duct fistula successfully treated by partial cystectomy and Cystogastrostomy

Ahmed Elaffand — 2016-08-22

The primary pancreatic hydatid (echinococcal) cyst is extremely rare with a reported incidence of <1%. Owing to its rareness and a considerable overlap of imaging features, a preoperative diagnosis is usually difficult. The dilemma in confirming this benign diagnosis has often questioned the extent of radical pancreatic resection. The involvement of pancreatic duct (cystopancreatic duct fistula) further complicates the management of such cystic lesions. In this report, we present a case of isolated hydatid cyst of the pancreatic body and tail communicating with the pancreatic duct. Cystogastrostomy preceded by partial cystectomy in the same setting has never been reported to date. The patient had an uneventful postoperative course and follow‑up showed no evidence of cyst recurrence or dissemination. We consider this a safe surgical option in longstanding large cysts, especially if a cystopancreatic fistula is detected beforehand. The success of such a procedure however may rely on the size and thickness of the cyst wall to support this anastomosis.

Keywords: Echinococcal cyst pancreas cystogastrostomy, Hydatid pancreas cystogastrostomy