Luis Domitrovic

Three-piece orbitozygomatic approach.

OBJECTIVE To describe the technical details of a 3-piece orbitozygomatic approach. INTRODUCTION In a 3-piece orbitozygomatic approach, soft tissue exposure is mostly comparable to the classic frontopterional approach. Osseous resection is a 3-piece operation that consists of first performing anterior and posterior cuts along the zygomatic arch, reflecting it down, attached to the masseter. This is followed by a classic frontotemporosphenoidal craniotomy, and finally, an osteotomy of the orbital rim, roof, and lateral wall of the orbit. RESULTS When compared with its 1- and 2-piece counterparts, 3-piece orbitozygomatic craniotomy, as described here, is a relatively simple operation and is thus advisable when considering an anterior or middle fossa approach. Brain exposure is wide, whereas cerebral retraction is minimal. We recommend avoiding orbit sectioning as deep as the superior orbital fissure. CONCLUSION The modifications described herein show the technical features of the 3-piece orbitozygomatic approach, which provides excellent brain exposure with less retraction and a good cosmetic result.

Effects of eliminating tension by means of epineural stitches: a comparative electrophysiological and histomorphometrical study using different suture techniques in an animal model

UNLABELLED Epineural stitches are a means to avoid tension in a nerve suture. We evaluate this technique, relative to interposed grafts and simple neurorraphy, in a rat model. METHOD Twenty rats were allocated to four groups. For Group 1, sectioning of the sciatic nerve was performed, a segment 4 mm long discarded, and epineural suture with distal anchoring stitches were placed resulting in slight tension neurorraphy. For Group 2, a simple neurorraphy was performed. For Group 3, a 4 mm long graft was employed and Group 4 served as control. Ninety days after, reoperation, latency of motor action potentials recording and axonal counts were performed. Inter-group comparison was done by means of ANOVA and the non-parametric Kruskal-Wallis test. RESULTS The mean motor latency for the simple suture (2.27±0.77 ms) was lower than for the other two surgical groups, but lower than among controls (1.69±0.56 ms). Similar values were founding in both group 1 (2.66±0.71 ms) and group 3 (2.64±0.6 ms). When fibers diameters were compared a significant difference was identified between groups 2 and 3 (p=0.048). CONCLUSION Good results can be obtained when suturing a nerve employ with epineural anchoring stitches. However, more studies are needed before extrapolating results to human nerve sutures.