Palatal root surgery of a maxillary molar using a piezosurgery transantral approach with simultaneous sinus lift grafting: a case report

Application Effect of External and Internal Elevation of Maxillary Sinus in Implant Restoration of Posterior Maxilla

Objective

To explore and analyze the application effect of external and internal elevation of the maxillary sinus in implant restoration of the posterior maxilla.

Methods

A total of 84 patients undergoing implant restoration of the posterior maxilla in the hospital were enrolled between January 2019 and March 2021. According to the random number table method, they were divided into the observation group (n = 42) and the control group (n = 42). The control group underwent external elevation of the maxillary sinus, while the observation group underwent internal elevation of the maxillary sinus. At 6 h, 12 h, and 24 h after surgery, the pain degree between the two groups was compared. All were followed up at 6 months after surgery. The osseointegration (bone resorption around implants, elevation height of maxillary sinus floor, average healing time) and soft tissues (bleeding index, plaque index, probing depth) in both groups were observed. The occurrence of postoperative complications was recorded.

Results

At 6 h, 12 h, and 24 h after surgery, VAS scores in the observation group were significantly lower than those in the control group (P < 0.05). At 6 months after surgery, bone resorption and elevation height of the maxillary sinus floor in the observation group were significantly higher than those i.0.0n the control group, and the average healing time was significantly shorter than that in the control group (P < 0.05). The bleeding index, plaque index, and probing depth in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the observation group and the control group (9.52% vs. 19.05%) (P > 0.05).

Conclusion

The application effect of internal elevation of the maxillary sinus is good in implant restoration of the posterior maxilla, which can relieve pain and swelling and improve implant effect.

A Novel Approach to First-Rib Resection in Neurogenic Thoracic Outlet Syndrome

Objectives: The treatment for neurogenic thoracic outlet syndrome (NTOS) conventionally involves first-rib resection (FRR) surgery, which is quite challenging to perform, especially for novices, and is often associated with postoperative complications. Herein, we report a new segmental resection approach through piezo surgery that involves using a bone cutter, which can uniquely provide a soft tissue protective effect.

Methods: This retrospective study involved the examination of 26 NTOS patients who underwent piezo surgery and another group of 30 patients who underwent FRR using the conventional technique. In the patient group that underwent piezo surgery, the rib was first resected into two pieces using a piezoelectric device and subsequently removed. In the patient group that underwent conventional surgery, the first rib was removed as one piece using a rib cutter and rongeurs.

Results: The piezo surgery group had significantly shorter operative time (96.85 ± 14.66 vs. 143.33 ± 25.64 min, P < 0.001) and FRR duration (8.73 ± 2.11 vs. 22.23 ± 6.27 min, P < 0.001) than the conventional group. The posterior stump length of the residual rib was shorter in the piezo surgery group than in the conventional group (0.54 ± 0.19 vs. 0.65 ± 0.15 cm, P < 0.05). There were no significant differences in postoperative complications and scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Cervical Brachial Symptom Questionnaire (CBSQ), and the visual analog scale (VAS). Even the TOS index (NTOS Index = [DASH + (0.83 × CBSQ) + (10 × VAS)]/3) and patient self-assessments of both the groups showed no significant differences. Univariate analyses indicated that the type of treatment affected operative time.

Conclusion: Our results suggest that piezo surgery is safe, effective, and simple for segmental FRR in NTOS patients. Piezo surgery provides a more thorough FRR without damaging adjacent soft tissues in a relatively short duration and achieves similar functional recovery as conventional techniques. Therefore, piezo surgery can be a promising alternative for FRR during the surgical treatment of NTOS.