Search Results (1,279)

Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and is generally associated with an excellent prognosis. Historically, treatment strategies were uniform and frequently aggressive, including total thyroidectomy and routine radioiodine ablation, even in low-risk cases. Current Perspective: Over the past decade, the management of PTC has shifted toward a de-escalation paradigm. This transition is driven by high evidence showing that the majority of PTCs follow an indolent course, with low recurrence and mortality rates. As a result, there is increasing emphasis on tailoring the extent of surgery and adjuvant therapy to individual patient risk profiles. Active surveillance, hemithyroidectomy, and selective use of radioiodine now represent valid alternatives to traditional radical approaches, particularly for low-risk tumors. Clinical Implications: The goal of this evolution is to balance oncologic safety with quality of life, reducing overtreatment and minimizing long-term complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Personalized treatment decisions are now guided by tumor biology, molecular markers, and refined risk stratification systems. Conclusions: This article will review the current evidence supporting this shift, highlight the challenges of implementation in clinical practice, and discuss future trends in the management of papillary thyroid carcinoma. Full article

Objectives: To retrospectively evaluate the survival rate and complications of immediately loaded implant-supported restorations in atrophic mandibles of patients subjected to inferior alveolar nerve relocation for the placement of dental implants. Methods: Consecutively treated patients having a follow-up of four years after loading of implants immediately placed after inferior alveolar nerve repositioning were included. Outcome measures were implant and prothesis survival rates and any type of complications related to the surgery, in particular related to post-operative neurosensory disturbance. Results: Data from 14 consecutive patients rehabilitated with 51 implants were analyzed. All provisional prosthetic restorations could be immediately placed after implant placement, none failed, and no patient dropped out over the four years after definitive loading. Only one implant failed. One day postoperatively, all patients experienced dysesthesia or paresthesia. At two weeks, nine patients had a total neurological recovery and one had partial recovery, while the remaining four patients did not recover. One mandible fractured three weeks after implant placement. At one-year post-loading, one patient was still affected by neurosensory dysfunction and three partially recovered (one of these had it preoperatively). After three years, two patients still presented partial recovery. After four years, no further changes were recorded, and no patients reported total neurosensory dysfunction. The patient with the fractured mandible recovered completely with no neurosensory disturbances. Conclusions: Implant placement in atrophic mandibles following inferior alveolar nerve transposition or lateralization may represent a viable alternative to vertical ridge augmentation, with the added advantage of allowing immediate fixed provisional prothesis. Although severe complications and neurosensory disturbances are not uncommon, all patients experience gradual recovery within one to three years. Full article

Introduction: Nerve-sparing (NS) during robot-assisted radical prostatectomy (RARP) plays a critical role in postoperative functional recovery, particularly urinary continence and erectile function. Despite the importance of precise neurovascular bundle (NVB) preservation, intraoperative assessment of NS quality remains largely subjective and lacks standardized evaluation tools. The aim of this study was to develop and preliminarily evaluate a structured intraoperative scoring system designed specifically for assessing NS quality during RARP. Methods: A novel 10-point intraoperative NS scoring system (NSQ Score) based on five domains was developed: dissection plane, bleeding control, bundle manipulation, continuity of dissection, and symmetry. Each parameter was rated on a 0–2 scale. Thirty robot-assisted radical prostatectomy (RARP) procedures performed in 2024 were randomly selected from a prospectively maintained institutional surgical video archive. Cases were not pre-filtered based on tumor stage, surgical difficulty, or intraoperative complexity. High-definition video recordings of the nerve-sparing phase were anonymized and independently evaluated by three experienced observers blinded to patient outcomes and to each other’s assessments. Inter-rater agreement was analyzed using weighted Cohen’s kappa statistics with quadratic weights, complemented by exact and near-agreement proportions. Cluster bootstrap resampling was applied to account for bilateral observations. Results: A total of 48 evaluable observations were analyzed. The overall inter-rater agreement demonstrated a weighted kappa of 0.41 (95% CI 0.36–0.48), indicating fair-to-moderate agreement among reviewers. Exact agreement occurred in 43% of observations, while near-agreement (allowing one ordinal level difference) reached 98%. Among individual parameters, symmetry demonstrated the highest reliability with substantial agreement (κ = 0.70; 95% CI 0.58–0.81). Other domains showed fair agreement, including intraoperative bleeding (κ = 0.36), continuity of dissection (κ = 0.39), bundle manipulation (κ = 0.34), and dissection plane (κ = 0.27). Agreement levels were comparable between left- and right-sided dissections. Conclusions: We propose a novel structured intraoperative scoring system for evaluating nerve-sparing quality during RARP. The scale is simple, procedure-specific, and feasible for structured postoperative or video-based assessment. Preliminary results demonstrate fair-to-moderate inter-rater reliability with very high near-agreement, supporting the feasibility of this tool for clinical use. The proposed scoring system may facilitate standardized training, objective performance assessment, and future studies correlating intraoperative NS quality with functional outcomes. Full article

Background: Severe trismus and post-oncologic maxillary defects often prevent conventional zygomatic implant placement. This study evaluates a novel implant specifically designed for reverse insertion (from the zygoma toward the oral cavity) and assesses its feasibility and accuracy in a cadaveric model. Materials and Methods: A Brown Class II maxillectomy was simulated in a fresh-frozen cadaver. Four custom reverse zygomatic implants were virtually planned and placed using CAD/CAM surgical guides. Superior and inferior orbital approaches were compared. Postoperative CT was superimposed onto the preoperative plan to measure linear and angular deviations, and a 3D-printed verification bar assessed prosthetic alignment. Results: All implants were successfully inserted with primary stability and without compromising critical structures. The superior orbital approach yielded lower deviations and better guide stability, which was reflected in the results: deviation at the zygomatic bone was 1.25 mm in the superior approach vs. 2.32 in the inferior approach, intraorally 4.7 mm vs. 7.3 mm, and angular deviation 1.85° vs. 5.63°. Despite minor distal deflection, intraoral emergence remained within clinically acceptable limits, allowing partial seating of the verification bar. Conclusions: Reverse-insertion zygomatic implants are technically feasible, anatomically safe, and compatible with fixed prosthetic rehabilitation in cases where conventional placement is impossible. Penetrating the orbit, injuring the skin or the infraorbital nerve could be possible but guided surgery seems to prevent them. A forthcoming clinical series of eight additional cases will further validate this protocol. Full article

Background/Objectives: Shoulder arthroscopies are commonly conducted in orthopedic practice. The interscalene brachial plexus block (ISB) is regarded as the “gold standard” for postoperative analgesia in shoulder surgeries. The serratus posterior superior intercostal plane block (SPSIPB) was introduced as an innovative treatment for addressing thoracic and shoulder discomfort. This study aims to examine the effects of SPSIPB and ISB techniques on postoperative pain levels, opioid intake, and respiratory function measures in patients having shoulder arthroscopy. Methods: Patients were divided into two groups. In the ISB group, 15 mL of fluid containing 0.25% bupivacaine was applied between interscalene muscles, while in the SPSIPB group, 30 mL of 0.25% bupivacaine was applied in the fascial plane between the serratus posterior superior muscle and the intercostal muscles. Results: There were no statistically significant differences in demographic characteristics (p > 0.05). VAS scores were statistically lower in the ISB group compared to the SPSIPB group at rest at 1, 2, 4, 8, 12, and 24 h postoperatively in the PACU (p < 0.05). VAS scores were also lower in the ISB group compared to the SPSIPB group during active movement at 1, 2, 4, 8, and 12 h postoperatively in the PACU (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the ISB group compared to the SPSIPB group (407.50 ± 169.32 μg and 767.50 ± 178.00 μg, respectively, p < 0.001). The decrease in FEV₁ and FVC was higher in the ISB group compared to the SPSIPB group (p < 0.001). Conclusions: ISB effectively relieves pain during shoulder arthroscopic procedures; however, while SPSIPB is considered a more advantageous option in terms of respiratory safety, it may not provide adequate analgesia on its own. Full article

Background and Objectives: This study aimed to evaluate postoperative outcomes following transaxillary first rib resection with concomitant anterior scalenotomy (Roos procedure) for Thoracic Outlet Syndrome, using an ambispective design with a standardized two-year multimodal follow-up in a prospectively observed subgroup. Materials and Methods: This ambispective observational cohort study included 32 patients (87.5% women; mean age, 33.8 years) who underwent transaxillary first rib resection with anterior scalenotomy for Thoracic Outlet Syndrome. Of these, seven patients comprised the retrospective cohort, having undergone surgery between 2017 and 2019, while the remaining 25 patients were enrolled prospectively and underwent surgery from 2020 onwards. Patients were classified as having neurogenic, vascular (arterial or venous), or mixed Thoracic Outlet Syndrome. Retrospective data were obtained from medical records, while prospectively treated patients were followed according to a predefined postoperative protocol. Longitudinal changes in clinical outcomes were analyzed using mixed linear and logistic regression models. Results: All analyzed symptoms improved after surgery (p < 0.05), with a significant reduction in upper limb edema over time (OR = 0.44, p = 0.002). The prevalence of positive provocative tests decreased notably across all maneuvers postoperatively. Pathological color duplex ultrasound findings of the upper limb vessels resolved almost completely during follow-up. Patient-reported outcome measures (CBSQ, DASH, and BPI) demonstrated meaningful postoperative improvement with sustained benefits over time. Electrophysiological evaluation revealed notable improvement in median sensory and motor nerve conduction parameters. Conclusions: Transaxillary first rib resection with anterior scalenotomy appears to improve clinical, functional, and objective outcomes in patients with Thoracic Outlet Syndrome; however, findings should be interpreted with caution due to the ambispective design, small sample size, and cohort heterogeneity, and require confirmation in larger prospective studies. Full article

Background: Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies. While surgical decompression is widely considered the definitive treatment, conservative options remain clinically relevant, particularly for symptom relief and functional recovery in the short term. Objectives: To update the evidence comparing surgical versus non-surgical interventions for CTS, assessing pain, function, and clinical recovery. Design: Systematic review of randomised controlled trials (RCTs). Data Sources and Methods: Six databases (CENTRAL, MEDLINE, Embase, Cochrane Neuromuscular Register, ClinicalTrials.gov, and WHO ICTRP) were searched for RCTs published between November 2022 and January 2025. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Due to clinical heterogeneity, a narrative synthesis was performed. Results: Four RCTs (n = 1158) were included. Corticosteroid injection and percutaneous electrical nerve stimulation (PENS) appeared to provide faster symptom relief than surgery at short-term follow-up. However, surgery was associated with a higher probability of sustained recovery at 12–18 months (RR 1.36; 95% CI 1.19–1.56). Evidence for PENS was limited to one female-only trial, which restricts generalisability. Certainty of evidence was moderate for long-term outcomes and low for short-term results and safety. Conclusions: The available evidence suggests that surgery may offer more durable long-term recovery, whereas corticosteroids and PENS may be useful for short-term symptom relief. These findings should be interpreted with caution given the limited number of trials and the risk of bias in most included studies. Treatment choice should align with patient goals and recovery timelines. Registration: PROSPERO (CRD420250650789). Full article

Drug-resistant epilepsy (DRE) has a significant burden on children and their families that extends beyond seizure management. Surgery can be a curative treatment but is sometimes not an option for certain generalized epilepsies or epilepsy in an eloquent region. Neuromodulation therapies (vagus nerve stimulation–VNS, deep brain stimulation–DBS, and responsive neurostimulation–RNS) have emerged as effective palliative treatments to mitigate seizure burden. Only VNS is FDA-approved for use in certain pediatric populations for epilepsy, but all are used off-label to treat pediatric drug-resistant epilepsy. This review provides an overview of these therapies, the perioperative considerations related to their implantation, and the perioperative considerations related to managing a device in situ. Care must be taken to avoid unintentional harm to the device, the leads, and the generator. Procedures must be cognizant of possible physiological changes that can occur intraoperatively and anatomic restrictions due to lead/generator placement. Although there is still a need for more long-term safety data regarding the use of neuromodulation devices in children, the current data demonstrate good efficacy and safety thus far. More children are likely to receive these devices for treatment, and so continued training and education will be needed for health care providers to maintain device longevity and safety. Full article

Background/Objectives: To evaluate whether mandibular third molar germectomy is associated with differences in neurosensory injury, postoperative complications, and patient-centred outcomes compared with delayed extraction. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, Cochrane Library, LILACS, and Google Scholar. Comparative studies including pediatric or adolescent patients undergoing mandibular third molar germectomy were included. Primary outcomes were inferior alveolar nerve (IAN) injury and overall postoperative complications; secondary outcomes included postoperative morbidity and patient-reported outcome measures (PROMs). Random-effects models were used for quantitative synthesis. Results: Ten studies met the inclusion criteria, including two randomized controlled trials and eight observational studies. Comparative evidence suggested that early removal at an immature developmental stage was associated with a lower risk of IAN injury (pooled RR = 0.05, 95% CI 0.01–0.37) and fewer overall postoperative complications (pooled RR = 0.29, 95% CI 0.20–0.42) compared with delayed extraction. However, certainty of evidence was limited due to heterogeneity, risk of bias, and potential confounding. PROMs consistently showed a short-term increase in pain and temporary quality-of-life impairment after germectomy, while delayed-onset infections were reported several weeks after surgery. Conclusions: Germectomy may reduce neurosensory risk and overall postoperative morbidity in selected developmental-age patients but entails a measurable short-term symptom burden. Decisions should therefore rely on individualized risk assessment and shared decision-making rather than routine preventive removal. Further prospective comparative studies with standardized outcome reporting are required to support definitive clinical recommendations. Full article

Background: Zenker’s diverticulum arises from the posterior hypopharyngeal wall through Killian’s dehiscence and predominantly affects older adults. Surgical and endoscopic treatments may be complicated by adverse events, including recurrent laryngeal nerve injury, cervical emphysema, mediastinitis, and pharyngoesophageal fistula formation. Methods: We report the case of a 69-year-old male who underwent open surgical treatment for Zenker’s diverticulum and subsequently developed an upper esophageal fistula complicated by a retroesophageal abscess. Results: The patient was treated using an externally adapted endoluminal vacuum-assisted closure system (EndoVAC), which enabled continuous drainage, local lavage, and progressive closure of the esophageal defect. Conclusions: Endo-VAC therapy represents a safe and minimally invasive therapeutic option for the management of postoperative esophageal fistulas following Zenker’s diverticulum surgery and may reduce the need for extensive esophageal reconstruction. Full article

This study investigated whether tongue motor loss induced by bilateral transection of the hypoglossal nerves (Hx) alters anxiety- and/or depression-like behaviors in rats and examined the associated neuroendocrine changes. Male Sprague–Dawley rats underwent Hx or sham surgery and were evaluated in the ambulatory activity, elevated plus maze, forced swim, and sucrose preference tests at different postoperative time points. Neuroendocrine parameters were assessed by plasma corticosterone assay, quantitative real-time PCR, Western blot analysis, and adrenal histology. At two weeks after surgery, Hx rats exhibited anxiety-like behavioral changes in the elevated plus maze and increased immobility with reduced struggling in the forced swim test, consistent with a depression-like behavior. Reduced sucrose intake was observed at earlier postoperative stages, suggesting early anhedonia-like behavior. Hx rats also showed chronically increased plasma corticosterone levels, adrenocortical hypertrophy, and decreased hippocampal glucocorticoid receptor expression. These findings highlight a potential oral–systemic interaction in which loss of oral motor function alters neuroendocrine homeostasis and emotional regulation. Full article

Background/Objectives: Unilateral condylar hyperplasia is an idiopathic condition that causes facial asymmetry and occlusal problems. Currently, traditional treatment protocol is the combination of orthognathic and extra-oral condylectomy surgery via pre-auricular incision, which can create aesthetic problems with additional risks of facial nerve damage. The purpose of this study was to report management of condylar hyperplasia patients through minimally invasive condylectomy that was planned via virtual methods. Methods: The custom-made cutting guides were produced, and unilateral condylectomy operations were performed via intra-oral approach. Orthognathic surgery with/without genioplasty operations were either done with condylectomy in one session or in an additional session. Results: Custom-made cutting guides produced by virtual methods provided easy operations without any need for additional extra-oral incisions. Planned osteotomies were transferred successfully from the virtual surgical plan and resections of the excess bone tissues were performed using novel piezo surgery devices. The bones were fixed to their pre-planned position using 3D-printed titanium plates. The patients healed without any complications. Results of this innovative virtually guided protocol tested showed functional and esthetic results without any extra-oral scars with no facial nerve damage. Conclusions: Combination of intra-oral condylectomy with orthognathic surgery using 3D-printed titanium cutting guides seems to be an advantageous approach with successful results in terms of aesthetics and function for management of mandibular condylar hyperplasia patients; however, there is an urgent need in the scientific literature for further clinical research with a larger number of subjects. Full article

Background/Objectives: Urinary continence recovery after robot-assisted radical prostatectomy (RARP) follows a progressive trajectory that is often simplified into binary outcomes. Modeling continence recovery as an ordered process may better reflect post-operative functional patterns and identify clinically relevant predictors. Methods: We retrospectively analyzed 180 patients undergoing extraperitoneal single-port RARP. At 6 months, continence recovery was classified into three ordered categories: early continence, late continence, and persistent incontinence. Multivariable ordinal logistic regression was used to identify independent predictors of continence recovery. The primary model included nerve-sparing (NS) status, postoperative complications, age, and prostate volume. Sensitivity analyses were performed by sequentially replacing prostate volume with body mass index, surgical case number, or preoperative prostate-specific antigen (PSA). An interaction between NS and age group was also tested. Results: NS surgery was the factor most strongly associated with favorable continence recovery (p < 0.001), followed by absence of post-operative complications (p = 0.003). Younger age and larger prostate volume were also independently associated with improved continence recovery. Sensitivity analyses confirmed the robustness of the primary model, as replacement of prostate volume with body mass index, surgical case number, or PSA did not improve model performance and did not alter the effect of NS surgery. No significant interaction between NS and age group was observed. Conclusions: Continence recovery after extraperitoneal RARP is primarily associated with NS surgery and an uncomplicated post-operative course, with age and prostate volume providing additional refinement. Modeling continence as an ordinal outcome offers a clinically meaningful framework for evaluating functional recovery after prostatectomy. Full article

Background and Clinical Significance: Burkitt lymphoma is an aggressive form of non-Hodgkin lymphoma of B-cell origin, caused by a MYC gene translocation on chromosome 8. There are three clinical subtypes, of which the sporadic subtype is most prevalent in the United States. Sporadic Burkitt lymphoma is diagnosed at a median age of 30 years and commonly manifests as bulky abdominal lesions, most often involving the ileocecal region. Pancreatic involvement is uncommon, and presentation as acute pancreatitis secondary to Burkitt lymphoma is exceedingly rare. Case Presentation: We present a case of a young male who presented with epigastric pain, nausea, and vomiting. He had a diffusely tender abdomen and elevated lipase levels. On imaging, he was found to have large retroperitoneal and intraperitoneal masses, contiguous with an enlarged pancreas. Burkitt lymphoma was confirmed upon biopsy of duodenal and gastric masses via endoscopic ultrasound. MRI brain and testicular ultrasound revealed unilateral fifth cranial nerve and bilateral testicular involvement, respectively. His course was complicated by bowel perforation requiring urgent surgery. However, he achieved complete remission with dose-dense systemic and intrathecal chemotherapy. Conclusions: This case highlights the diverse presentations of Burkitt’s lymphoma and a favorable prognosis with treatment. Clinicians should maintain a high index of suspicion for a malignant etiology of acute pancreatitis in patients without classic risk factors. Full article

The demand for refined anaesthetic protocols in ovine experimental surgery has increased due to ethical considerations and the need to improve perioperative stability. This study evaluated the analgesic efficacy of ultrasound-guided combined sciatic and saphenous nerve blocks using two different local anaesthetics in Hair Canarian Sheep undergoing invasive orthopaedic hindlimb surgery. Fifteen clinically healthy sheep were randomly assigned to one of three groups: lidocaine (2%), bupivacaine (0.5%), or control (general anaesthesia alone). Intraoperative physiological parameters, including heart rate, respiratory rate, and arterial blood pressure, were recorded, and postoperative pain was assessed using a modified Melbourne Pain Scale. Sheep receiving locoregional anaesthesia showed significantly lower postoperative pain scores compared with control animals. Intraoperatively, a significant difference between groups was observed only for respiratory rate, with lower values in the bupivacaine group. The bupivacaine group exhibited lower and more stable respiratory rates, with a trend towards lower heart rates during surgery, as well as consistently lower pain scores during the early postoperative period. Lidocaine provided limited intraoperative and postoperative effects compared with the control group. Respiratory rate appeared to be more closely associated with pain scores than other physiological parameters. In conclusion, ultrasound-guided sciatic and saphenous nerve blocks were associated with improved perioperative analgesia in sheep undergoing orthopaedic surgery. The use of bupivacaine was associated with lower respiratory rates intraoperatively and reduced postoperative pain scores, suggesting a potential benefit in perioperative analgesia. Full article