Surgeries

Background/Objectives: Intraoperative neuromonitoring (IONM) has improved safety in thyroid and parathyroid surgery, yet intermittent IONM (I-IONM) may miss traction injuries developing between stimulations. We evaluated the feasibility and clinical utility of a trend-based intermittent monitoring mode (NIM Vital NerveTrend®) that records closely spaced stimulations and plots amplitude and latency over time. Methods: We conducted a prospective observational study at a high-volume endocrine surgery unit (January–September 2025). Forty-four consecutive patients undergoing thyroidectomy and/or parathyroidectomy with NerveTrend® were enrolled. Electromyography (EMG) responses were categorized as Green (amplitude > 50% of baseline and latency < 110%), Yellow (amplitude < 50% or latency > 110%), Red (amplitude < 50% and latency > 110%), and Loss of Signal (LOS: amplitude <100 µV). Primary outcomes included LOS prevalence and the association between stimulation frequency and the appearance of Yellow trends. Ethical approval: AVEN protocol 486/2024/OSS/AOUPR; informed consent obtained. Results: Of 71 nerves at risk (NAR), 55 had a valid baseline and were analyzed; LOS occurred in 3/55 NAR (5.5%). The mean number of stimulations per NAR was 4.5 (range 1–9). Cases with both Green and Yellow points had a significantly higher mean number of stimulations than cases with only Green points (5.1 vs. 3.8; Student’s t-test p = 0.0059). One Red measurement occurred in a case that progressed to LOS. Conclusions: NerveTrend® provided near real-time functional feedback while maintaining the simplicity of I-IONM. Increased stimulation frequency was associated with early Yellow trend alerts, potentially signaling traction stress and enabling timely surgical adjustments. Larger multicenter studies and protocol standardization are warranted.

Background: Lip aging is a heterogeneous and visually complex process, yet a standardized morphological classification applicable to clinical practice is still lacking. Current approaches mainly focus on volumetric loss or perioral rhytids, while the geometric features of the lips, including borders, projection, and eversion, remain poorly codified. Methods: Fifty anonymized lip images acquired under standardized conditions using digital facial imaging were independently evaluated by five physicians experienced in esthetic medicine. Images were classified according to three predefined morphotypes representing distinct patterns of lip aging. Inter-rater reliability was assessed using Fleiss’s kappa statistic. Results: Three recurrent morphotypes were consistently identified: devolumized lips, central lips, and chapped lips. Overall, 87% of images were assigned to one of the three morphotypes by at least four of five evaluators, while 13% were classified as undefined due to mixed features. Inter-rater agreement was substantial (κ = 0.89; 95% CI 0.79–0.99), confirming high reproducibility of the proposed classification. Conclusions: This study proposes a simple and reproducible image-based morphotypic classification of lip aging that captures recurrent visual patterns within this cohort. The framework may facilitate standardized clinical communication, support personalized rejuvenation strategies, and provide a foundation for future quantitative imaging studies and AI-based phenotype recognition in esthetic and reconstructive practice.

Background: Dupuytren’s disease (DD) is a fibroproliferative disorder of the palmar fascia that results in progressive digital flexion contractures. Various treatment strategies have been developed to restore extension, ranging from minimally invasive collagenase clostridium histolyticum (CCH) injection to more invasive surgical procedures such as open selective aponeurectomy. While CCH has gained widespread adoption due to its limited invasiveness and rapid recovery, questions remain about its long-term durability compared with open surgery (OS). This study aims to compare long-term outcomes of CCH injection and OS in patients with stage 2 or higher single-digit DD, focusing on recurrence, patient satisfaction, complications, and return to work at least 10 years after treatment. Methods: A retrospective cohort study was conducted on patients treated in 2012 with either CCH injection or OS. All patients had at least stage 2 DD and at least 10 years of follow-up. The primary outcome was to compare recurrence rates between the two patient cohorts. Secondary outcomes included visual analogue scale (VAS) satisfaction, Michigan Hand Questionnaire (MHQ) scores, complications, and time to return to work. Results: A total of 97 patients completed 10-year follow-up (60 OS, 37 CCH). Recurrence at 7 years was relatively similar between groups. However, a pronounced divergence emerged between 7 and 10 years. At 10 years, recurrence occurred in 10 patients in the OS group versus 15 in the CCH group, with statistically significant differences overall (p = 0.0175) and particularly in the PIP subgroup (p = 0.0041). VAS satisfaction at 10 years was higher after OS (7.9 ± 1.5) than after CCH (6.4 ± 1.6), and return to work was significantly faster after CCH. MHQ scores were comparable. Conclusion: Both treatments provided acceptable patient satisfaction at 10 years; however, OS yielded better long-term recurrence rates and fewer complications. Although CCH offers rapid recovery, its durability beyond 7 years appears markedly inferior. These findings reinforce the need for careful patient selection and long-term counseling when considering minimally invasive treatment.