Journal articles: 'Root canal obstruction'

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Байтус, Н. А., and Ю. П. Чернявский. "Modern Clinical Approach in Treatment of Destructive Forms of Chronic Apical Periodontitis." Стоматология. Эстетика. Инновации, no. 2 (September 8, 2020): 153–60. http://dx.doi.org/10.34883/pi.2020.4.2.004.

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Целью исследования было клиническое изучение эффективности использования материала «Биопласт-Дент» пасты при деструктивных процессах в тканях апикального периодонта. Объектами исследования явились 22 пациента с деструктивными процессами в тканях периодонта, которые обратились в Клинику ВГМУ и на кафедру терапевтической стоматологии с курсом ФПК и ПК УО «ВГМУ» в период 2014–2018 гг. Временную обтурацию корневых каналов проводили материалом «Биопласт-Дент» паста. Постоянную обтурацию корневых каналов при сохраненной верхушке корня зуба осуществляли с использованием материала на основе эпоксидной смолы и гуттаперчевых штифтов методом латеральной конденсации. При наличии резорбции корня применяли материал на основе минерального триоксидного агрегата – «Рутсил». Окончательную реставрацию коронки зуба осуществляли после рентген-контроля с момента постоянной обтурации корневых каналов через 3 месяца. Всего динамически R-контроль проводили через 3, 6, 12, 24 месяца. Результаты исследования показали эффективность клинического применения гидроксиапатита в 81,82% случаев (p<0,05). The aim of the study was a clinical study of the effectiveness of the use of "Bioplast-Dent" paste material destructive processes in the tissues of the apical periodontium. The subjects of the study were 22 patients with destructive processes in the periodontal tissues, who applied to the Clinic of the Vitebsk State Medical University and the Department of Therapeutic Dentistry with a course of Faculty of Advanced Training and Retraining Vitebsk State Medical University in the period 2014–2018. Temporary root canal obstruction was performed with "Bioplast-Dent" paste material. Permanent obstruction of the root canals with the preserved apex of the root of the tooth was carried out using a material based on epoxy resin and gutta-percha pins by lateral condensation. In the presence of root resorption, a material based on MTA, "Rооtsil" material was used. The final restoration of the tooth crown was carried out after x-ray control from the moment of constant obstruction of the root canals after 3 months. In total, R-control indicated dynamically after 3, 6, 12,24 months. The results of the study showed the effectiveness of the clinical use of hydroxyapatite in 81.82% of cases (p<0.05).

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Matos, Ivna Maria Melo, Anderson Gamileira Pontes, Yasmin de Sousa Paiva, et al. "ENDODONTIA GUIADA NO MANEJO DE CANAIS CALCIFICADOS: EVIDÊNCIAS ATUAIS E RELATO DE CASO." ARACÊ 7, no. 6 (2025): 32643–58. https://doi.org/10.56238/arev7n6-205.

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INTRODUCTION: Calcified root canals can manifest as pulp nodules or pulp obstruction, resulting in narrow canals that are difficult to access and visualize. Guided endodontics is an approach that represents a minimally invasive alternative for the endodontic treatment of teeth with calcification. Objective: This study aims to conduct an integrative literature review and report a clinical case on the use of guided endodontics as a safe and effective alternative for treating calcified teeth. MATERIALS AND METHODS: The literature search was conducted in the PUBMED database using the descriptors: (Cone-beam computed tomography) AND (dental pulp calcification) AND (root canal therapy) in English, covering the period from 2015 to 2025. Thirty-eight articles were found. Full-text articles were included, and after a critical reading of titles and abstracts, case reports and studies unrelated to the topic were excluded, resulting in 8 selected articles. A 26-year-old patient reported tooth discoloration and a history of trauma over 10 years ago. Radiographs showed total obliteration of the canal in tooth 21 and periapical bone rarefaction. Cone-beam computed tomography (CBCT) was performed for planning, and guided endodontics was chosen. Tomographic images and intraoral scanning enabled the fabrication of a surgical guide. Conservative access was performed without perforations, and the canal was successfully instrumented and filled. After six months, the patient remained asymptomatic. RESULTS: The guided technique showed high accuracy in locating calcified root canals, with a 93% success rate. It was effective for both endodontists and general practitioners, reducing treatment time and tooth substance loss. The technique prevented complications such as perforations and deviations, being safer than the conventional approach. Dynamic navigation allowed for a faster and more predictable procedure, especially for less experienced professionals. However, it requires training and may not be suitable for professionals with visualization or control difficulties. Despite its high accuracy, it requires additional radiographs and careful planning. CONCLUSION: Guided endodontics is an effective technique for treating calcified canals, offering greater precision, less damage to dental structure, and predictability, and can be used regardless of the operator's experience.

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Vivekananda Pai, AR, Shugufta Mir, and Rachit Jain. "Retrieval of a metallic obstruction from the root canal of a premolar using Masserann technique." Contemporary Clinical Dentistry 4, no. 4 (2013): 543. http://dx.doi.org/10.4103/0976-237x.123069.

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Marchese, Manuela, Pontoriero I. K. Denise, Edoardo Ferrari Cagidiaco, Alfredo Iandolo, Simone Grandini, and Marco Ferrari. "Endodontic Irrigants and Their Activation Efficacy on Cleansing Post-Space Root Canal Walls." Prosthesis 3, no. 4 (2021): 406–14. http://dx.doi.org/10.3390/prosthesis3040036.

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The aim of this study was to evaluate the efficacy of activated irrigants (EDTA e NaOCL) during the cleansing of root walls, of the smear layer, of the debris, and gutta-percha after the preparation of the restorative space. Twenty single and multi-rooted (n = 20) have been collected. All samples were prepared by the same operator, using Nickel-titanium rotating instruments (Mtwo) through the Simultaneous Shaping Technique. The continuous-wave of condensation technique of obturation was used. To all specimens, the restorative space has been made, leaving 5 mm of apical gutta-percha, and postoperative periapical X-rays were performed. The samples were randomly divided into two groups: Group (A): cleansing of the root walls with ultrasonic activation of the irrigants (NEWTRON P5 XS; Satelec Acteon); Group (B): radicular walls wash without ultrasonic activation of endodontic irrigants (NaOCl 5.25% and EDTA 17%). Both dental sample groups were cut longitudinally with a low-speed saw (Isomet); the samples were observed by using a scanning electron microscope (Jeol, Jsm-6060LV) in order to evaluate: (1) the amount of debris/smear layer; (2) the mount of obstruction of dentinal tubules found in the two groups; and (3) evaluation of the presence of gutta-percha. Then, the other five samples each group (with and without ultrasonic activation) were prepared following the same protocol. Then, a universal bonding system (G-Praemio Bond, GC) and a layer of a flowable resin composite (Gaenial Flow, GC) were light-cured and used on top of the prepared root canal walls. The samples were cut in two pieces along the long axis of the root. Then, half sample teeth were kept in an acidic solution (37% HCl) for 48 h in order to completely dissolve dental structures and to have a direct view of resin tags formation under SEM. The other half was prepared to observe the adhesive interface under SEM. The amount of debris was not satisfactory in 9 out of 10 cases in Group B, while in Group A, which has been treated with ultrasounds, the result was either good or great in most of the samples. For the sample group treated with ultrasound, the tubules were evaluated as perfectly clean in 9 out of 10 cases, instead, the results are unsatisfactory for 9 out of 10 cases of group B not treated with ultrasound. Differences between Group A and B were statistically significant. With respect to the presence of debris and tubules obstruction treatment with ultrasonic activation, it offers with no doubt better results. When ultrasonic activation is used in combination with endodontic irrigants, a clean dentin substrate is be obtained for the adhesion of restorative materials, but in order to confirm the findings of this study, further in vivo trials are needed.

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Aksel'rov, M. A., V. N. Evdokimov, V. V. Svazyan, T. V. Sergienko, and I. I. Kuzhelivsky. "Gastric and esophageal duplications in children." Voprosy praktičeskoj pediatrii 15, no. 4 (2020): 110–13. http://dx.doi.org/10.20953/1817-7646-2020-4-110-113.

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Considerable attention is currently being paid to the diagnosis and treatment of gastric malformations complicated by its obstruction. This can be attributed to stable incidence of these disorders among other congenital anomalies of the gastrointestinal tract and no clear understanding of the causes and mechanisms underlying the development of this pathology. Gastrointestinal duplications are rare congenital malformations that differ significantly in their appearance, location, size, and clinical manifestations. Their incidence is 1 case per 4,500 autopsies. Duplications can be cystic and diverticular (tubular) and can be located in any part of the gastrointestinal tract from the root of the tongue to the anal canal. The small intestine is affected most frequently, while duplications of the rectum, duodenum, and esophagus are exceedingly rare. In this article, we report two cases of gastrointestinal duplications in children treated using surgery. Key words: neonate, obstruction, developmental malformations, gastric duplication, esophageal duplication, case report

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Damasceno, Ingrid Barros da Costa, João Pedro de Mello Dutra Magalhães, Paulo Henrique dos Santos Belo Júnior, et al. "USE OF GUIDED ENDODONTICS IN TREATING TEETH WITH PULP OBLITERATION DUE TO CALCIFICATION AND THE RELEVANCE OF CLINICAL SCRUTINY IN DECISION MAKING: A CLINICAL CASE REPORT." ARACÊ 7, no. 5 (2025): 22714–25. https://doi.org/10.56238/arev7n5-109.

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Endodontic treatment of teeth with pulp canal obliteration (PCO) represents a procedure of higher complexity, as it requires the professional to have precise control over access direction, considering that essential references are lost. This difficulty becomes even more critical when the PCO extends to the apical third of the tooth. In such cases, a relatively recent alternative emerges as a viable option that facilitates and provides greater control over the procedure: guided endodontics. In this process, surgical guides are designed using scans of the arch and high-resolution tomography scans and then printed to integrate perfectly with high-precision sleeve and drill systems. This allows pulp obliteration to be bypassed up to the portion of the canal with preserved anatomy. However, this procedure cannot be performed without a specialist's parallel supervision, as minor trajectory deviations can result in root perforations. This clinical case report illustrates a scenario in which the guided procedure was interrupted by the specialist's decision. Upon evaluating the depth already cleared and the image of the obstruction, the specialist considered the possibility of a deviation in the trajectory, although this was not observed radiographically. Therefore, he requested a new high-resolution tomography, which confirmed the deviation of the trajectory from the palatine, although it remained parallel to the root canal. Thus, the professional opted for a traditional approach, aided by the operating microscope, and achieved a successful treatment. In conclusion, a situation is demonstrated that, although not frequently reported, shows the vital importance of carefully monitoring the entire clinical step-by-step by the specialist.

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Vivekananda Pai, AR, and Varun Arora. "Using a syringe needle to cut dentin and dislodge and remove a metallic obstruction from the root canal." Journal of Conservative Dentistry 21, no. 2 (2018): 230. http://dx.doi.org/10.4103/jcd.jcd_316_16.

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Shakouei, Sahar, Negin Ghasemi, Parvin Zakeri-Milani, Afsaneh Shahali, and Mahdieh Alipour. "The sealing ability of different endodontic biomaterials as an intra-orifice barrier: evaluation with high-performance liquid chromatography." Biomaterial Investigations in Dentistry 11 (July 24, 2024): 91–96. http://dx.doi.org/10.2340/biid.v11.41069.

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Objective: This study evaluated the sealing ability of different biomaterials as intra-orifice barriers in the internal bleaching of discolored teeth with the walking bleaching technique. The release of hydroxyl ions from the bleaching materials can cause cervical root resorption, making it necessary to use intra-orifice barrier materials to prevent this issue. Materials and methods: In the current study, the high-performance liquid chromatography (HPLC) method was used to measure the released hydroxyl ions. The study included 90 single-rooted and single-canal premolars, which were divided into four groups based on the intra-orifice barrier materials used (mineral trioxide aggregate [MTA], calcium-enriched mixture [CEM], Biodentine, and MTA+PG) and the type of bleaching material (sodium perborate + water or sodium perborate + hydrogen peroxide 30%). Two control groups were also considered in this study: a positive control group, where sodium perborate and hydrogen peroxide were placed inside the pulp chamber without any intra-orifice barriers; and a negative control group, where no bleaching agent or surgical obstruction was used, and the root surface was covered with wax up to the cemento-enamel junction (CEJ) level. Results: The results showed that there was a significant difference in the concentration of hydroxyl ions released among the studied groups. The amount of hydroxyl ion released was highest in the positive control group and lowest in the CEM group. Among the intra-orifice barrier materials used, CEM cement was found to be the most appropriate material for use in the step-by-step internal bleaching method. Conclusions: The study highlights the importance of using appropriate intra-orifice barrier materials to prevent root cervical resorption in internal bleaching procedures.

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Shenoy, Vanitha, and Rithima Sokhi. "Retrieval of Separated Instrument using Ultrasonics in a Permanent Mandibular Second Molar: A Case Report." Journal of Contemporary Dentistry 4, no. 1 (2014): 41–45. http://dx.doi.org/10.5005/jp-journals-10031-1066.

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ABSTRACT Clinicians are frequently challenged by endodontically treated teeth that have obstructions, such as hard impenetrable pastes, separated instruments, silver points or posts in their root canals. Intracanal separation of endodontic instruments may hinder cleaning and shaping procedures within the root canal system, with a potential impact on the outcome of treatment. Broken instruments usually prevent access to the apex and the prognosis of teeth with broken instruments in the canals may be lower than for normal ones. The prognosis of these cases mainly depends on the preoperative condition of the periapical tissues. For these reasons, an attempt to remove broken instruments should be undertaken in every case. Ultrasonics have often been advocated for the removal of broken instruments because the ultrasonic tips or endosonic files may be used deep in the root canal system. Furthermore, the use of an ultrasonic endodontic device is not restricted by the position of the fragment in the root canal or the tooth involved. This case report elaborates on retrieval of broken instrument lodged in the coronal third of the root canal using ultrasonics and dental operating microscope. How to cite this article Sokhi R, Sumanthini MV, Shenoy V. Retrieval of Separated Instrument using Ultrasonics in a Permanent Mandibular Second Molar: A Case Report. J Contemp Dent 2014;4(1):41-45.

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Shenvi, Suresh, and Sonal B. Joshi. "Smear layer removal potential of a naturally occurring antioxidant: An in-vitro scanning electron microscopic study." IP Annals of Prosthodontics and Restorative Dentistry 11, no. 1 (2025): 35–39. https://doi.org/10.18231/j.aprd.2025.008.

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The primary objective of endodontic therapy is to thoroughly disinfect the root canal system. The smear layer formed during instrumentation presents a substantial impediment to optimal root canal disinfection, as it provides a medium for bacterial proliferation, hinders the penetration of disinfecting agents, and creates a physical barrier that undermines the efficacy of root canal sealers by obstructing the interface between the obturating core material and the dentinal tubules. Consequently, the removal of the smear layer is of utmost importance. This in vitro study assessed the efficacy of 20% N-acetyl-cysteine (NAC) and 17% ethylenediaminetetraacetic acid (EDTA) in removing the smear layer from root canal dentine. Ninety-two single-rooted teeth were instrumented and divided into two groups: 20% NAC for 1 minute, and 17% EDTA for 1 minute. Following irrigation, the samples were analyzed using scanning electron microscopy (SEM) to evaluate smear layer removal in the coronal, middle, and apical thirds of the root canals. No statistically significant difference was observed between 20% NAC and 17% EDTA in their ability to remove the smear layer across all sections of the root canal. 20% NAC demonstrates smear layer removal capability comparable to 17% EDTA as a final irrigant.

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Almhimeed, Yasser Ali, Yaser Ali Aloutaibi, Naif Attiah Alharbi, et al. "The role of micro-endodontics in the management of complex root canal anatomy." International Journal Of Community Medicine And Public Health 10, no. 7 (2023): 2609–14. http://dx.doi.org/10.18203/2394-6040.ijcmph20232060.

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Micro-endodontics has emerged as a critical component in endodontics, revolutionizing the management of complex root canal anatomy. It utilizes magnification devices, such as dental operating microscopes or loupes, to enhance visualization and identify intricate anatomical details. Micro-endodontics encompasses advanced techniques and technologies that are utilized alongside the principles of conventional endodontics. While both approaches share common goals of cleaning, disinfection, and obturation of the root canal system, micro-endodontics specifically focuses on managing complex root canal anatomy by utilizing specialized tools and techniques to enhance visualization, instrumentation, disinfection, and obturation. Ultrasonic instruments aid in negotiating challenging canal configurations and removing obstructions. Nickel-titanium rotary instruments offer flexibility and durability for efficient cleaning and shaping. Advanced irrigation techniques, such as ultrasonics and laser-activated irrigation, improve disinfection. Innovative obturation techniques ensure the thorough filling of intricate canals. Despite limitations like cost, learning curve, treatment time, and access limitations, micro-endodontics has a promising future. Technological advancements, minimally invasive approaches, biomaterials, biotechnology, artificial intelligence, robotics, and interdisciplinary collaboration will further enhance micro-endodontics, improving treatment outcomes and expanding its scope in complex root canal anatomy.

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CHENAIL, B., and P. TEPLITSKY. "Orthograde ultrasonic retrieval of root canal obstructions." Journal of Endodontics 13, no. 4 (1987): 186–90. http://dx.doi.org/10.1016/s0099-2399(87)80138-3.

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Singh, Avishek, Nikhil Bhardwaj, Rajnish K. Jain, Ambica Khetarpal, Shally Suri, and Rachita Arora. "Endodontic management of a severely dilacerated mandibular third molar: A case report." IP Indian Journal of Conservative and Endodontics 9, no. 3 (2024): 142–45. http://dx.doi.org/10.18231/j.ijce.2024.031.

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It is crucial to have a thorough grasp of the anatomical changes in the roots and root canals of third molar teeth, as well as the endodontic consequences of these variations, before beginning any endodontic therapy. The key to the success of endodontic therapy is the cleaning and shape of the root canal. While treating curved canals, a few procedural mistakes might occur, such as ledge development, obstructions, and apical transportations and perforations. It was advised utilizing precurve files or flexible NiTi files to minimize procedural errors. Third molars face a variety of anatomical differences, such as merged canals, C-shaped canals, curved roots, and bayonet roots. Curved canals have become more common and been discovered to be comparatively higher in mandibular third molars (3.3 to 30.92%) as opposed to maxillary third molars (1.33 to 8.46%). The following article presents a case report of the endodontic treatment of a mandibular third molar with severely curved canals and highlights the various disciplines and modifications employed for its management.It is essential to give thorough attention to the radiographic assessment, access cavity preparation, and exploration in order to successfully navigate curved canals.

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Hulsmann, Michael. "Methods for removing metal obstructions from the root canal." Dental Traumatology 9, no. 6 (1993): 223–37. http://dx.doi.org/10.1111/j.1600-9657.1993.tb00278.x.

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Johnson, William B., and Richard G. Beatty. "Clinical technique for the removal of root canal obstructions." Journal of the American Dental Association 117, no. 3 (1988): 473–76. http://dx.doi.org/10.1016/s0002-8177(88)73020-2.

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Ebihara, Arata, Masaaki Takashina, Tomoo Anjo, Atsushi Takeda, and Hideaki Suda. "Removal of root canal obstructions using pulsed Nd:YAG laser." International Congress Series 1248 (May 2003): 257–59. http://dx.doi.org/10.1016/s0531-5131(03)00038-4.

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Makarov, S. A., A. G. Aganesov, M. M. Alexanyan, and V. A. Demina. "Prevention of recurrent disc herniation after lumbar microdiscectomy and sequestrectomy." Bulletin of Pirogov National Medical & Surgical Center 19, no. 3 (2024): 136–40. http://dx.doi.org/10.25881/20728255_2024_19_3_136.

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Introduction: degenerative and dystrophic diseases of the lumbar spine in Russia rank 5th among the causes of hospitalization and 3rd among the causes of surgical treatment. Herniated discs are the most common degenerative disease of the lumbar spine causing low back pain and radicular symptoms in the lower extremities. Lumbar microdiscectomy has become one of the most common spinal surgeries. Various worldwide studies cite a postoperative recurrence rate ranging from 1.1% to 27.3%. Recurrences of herniated discs are one of the main reasons for revision surgeries in spinal surgery. Also in a number of cases, radicular pain syndrome persists after microdiscectomy, which may be associated with biochemical changes in the intervertebral disc. Through the annular defect inflammatory mediators (interleukins), cytokines and chemical agents are released from the pulposus nucleus, which cause irritation of the spinal ganglion and nerve root. Purpose of the study: to analyze the frequency and causes of recurrence of herniated discs after microdiscectomy and sequestrectomy according to the literature, which will allow us to develop a device to reduce the number of recurrences. Materials and methods: we searched available literature sources, including PubMed and eLibrary databases, for the following keywords: "recurrence of disc herniation", "annulus fibrosus defect", "annulus fibrosus prosthesis", "lumbar disc reoperation", "annulus fibrosus defects", "annulus fibrosus prosthesis". The depth of the search was more than 20 years (2002-2023). As a result of the search, 108 articles were found and analyzed. Results: in our opinion and according to the literature, the most complete reduction in the number of disease recurrences is possible only with the help of mechanical obstruction of regenerate or intervertebral disc substance exit into the spinal canal by covering the intraoperative defect of the annulus fibrosus. We analyzed the devices, methods that were used earlier or are used now, formulated the requirements that, in our opinion, the implant should possess. Based on this, we came to the conclusion that at present there is no device that meets all the requirements. The time of implant degradation should coincide with the process of fibrous ring regeneration to ensure proper tissue remodeling. The change in the mechanical properties of the implant as a result of degradation must remain compatible with the repair and regeneration process. Finally, the implant should contribute to the restoration of normal spine biomechanics: restoration of IVD height; correct distribution of load on all areas of the IVD; restoration of physiologic volume of movement, lordosis; achievement of sagittal balance. Conclusion: based on the analysis of the world literature data, we started to develop a biocompatible biodegradable device for filling the intervertebral disc cavity and closing the defect in the area of the annulus fibrosus after sequestrum and microdiscectomy to restore the biomechanics of the vertebral-motor segment in the lumbar spine and to eliminate postoperative recurrences. At present, the FGBNU "Petrovsky RRCS" together with SIC "Kurchatov Institute" are conducting laboratory tests of prototypes to study the static properties of materials and select the most suitable one.

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Ghimire, Siddharth, Shweta Dhital, Deepak Kumar Roy, Priyanka Poudel, and Roshan Kumar Roy. "Assessment of Knowledge, Attitude and Practice based Survey on the Use of Ultrasonics in Endodontics among General Practitioners and Endodontists of Nepal." Journal of Nepalese Association of Pediatric Dentistry 5, no. 1 (2024): 14–20. https://doi.org/10.3126/jnapd.v5i1.79222.

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Introduction: Endodontic practice has seen a massive technological leap over the past few decades which have improved the prognosis of the treatment performed. Ultrasonics simplifies complex endodontic procedures like navigating calcified canals and removing obstructions. Ultrasonic endodontic treatment, for both primary and permanent teeth, streamlines procedures, minimizing appointments, patient stress, and expenses. Ultrasonic irrigation enhances root canal cleaning, leading to improved endodontic success. Objective: The study aims to determine the knowledge, practice, and attitude of ultrasonics in endodontics among the general practitioners, endodontics postgraduates and endodontists of Nepal. Methods: A self-administered questionnaire containing questions regarding the knowledge, attitude, and practice of ultrasonics in endodontics was distributed to 151 general practitioners, postgraduates and endodontists working in Nepal. Data was collected and entered in Microsoft Excel sheet and analysis was done using Statistical Package of Social Sciences (SPSS) software version 16. Descriptive statistical analysis was done using mean, proportion and percentage. Results: Although 96% of dentists knew about ultrasonic endodontics, only 25% used it routinely. Common uses included; irrigation 65% and removing blockages 60%. Most of them (68.9%) preferred 3% or less sodium hypochlorite as passive activation of irrigation solution by ultrasonics. High equipment cost (71%) and heat generation (35%) were major usage barriers. Conclusion: In the present study, we found that the majority of the participants were well aware of the use of ultrasonics in endodontics and had adequate knowledge regarding the working principle and the type of ultrasonics used. But they don’t use it routinely in their practice.

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Chitrambalam, Tharun Ganapathy, Pradeep Joshua Christopher, Jeyakumar Sundaraj, and Sundeep Selvamuthukumaran. "Diagnostic difficulties in obturator hernia: a rare case presentation and review of literature." BMJ Case Reports 13, no. 9 (2020): e235644. http://dx.doi.org/10.1136/bcr-2020-235644.

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Hernia arising from obturator canal is rare and it contributes to about less than 1% of incidence of all hernias. Diagnosing an obturator hernia clinically is a challenging one and nearly impossible. These hernias usually present as an intestinal obstruction as more than 50% of obturator hernias goes in for strangulation. Here, we report an unusual presentation of an obturator hernia in a 70-year-old woman who presented to emergency room with acute abdomen and uncomplicated reducible inguinal hernia. Radiological imaging showed obstructed inguinal hernia while on diagnostic laparoscopy, a strangulated and perforated obturator hernia of Richter’s type was seen in addition to an uncomplicated inguinal hernia. Obturator hernia, although very rare, is associated with high morbidity and mortality as it is often underdiagnosed as in our case. Laparoscopy bailed us out from missing out a perforation from an occult obturator hernia.

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Schaffzin, David M., Thomas J. Stahl, and Lee E. Smith. "Perianal Mucinous Adenocarcinoma: Unusual Case Presentations and Review of the Literature." American Surgeon 69, no. 2 (2003): 166–69. http://dx.doi.org/10.1177/000313480306900218.

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Perianal mucinous adenocarcinoma is a rare cancer constituting 3 to 11 per cent of all anal carcinomas. It may arise de novo or from a fistula or abscess cavity. We present two cases of this disease process. Case One is a 52-year-old man with a chronic history of perianal abscesses who presented to the emergency room with a large bowel obstruction. He required diversion and wide local excision with lateral internal sphincterotomy for relief of the obstruction. Pathology from the excised material revealed the unexpected diagnosis of invasive mucinous adenocarcinoma of the anus. Case Two is a 59-year-old man with a chronic history of complex fistulas and abscesses who presented to our office with a horseshoe fistula and deep postanal space abscess. Because of the nonhealing nature of the wound, biopsies from the abscess crater, fistulous tract, and the perianal skin opening were taken. The pathology department identified the specimens as invasive mucinous adenocarcinoma of the anal canal. This is an aggressive cancer often misdiagnosed clinically as benign pathology. A high index of suspicion and biopsy of fistulous tracts and abscesses are the keys to early diagnosis and treatment. With combination chemotherapy and radiation therapy in conjunction with aggressive surgical resection long-term survival might be obtained.

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Stanimirov, Pavel, and Greta Yordanova. "TEETH EXTRACTION WITH ROOT DELACERATION ON THE ORTHODONTIC INDICATIONS." Teacher of the future 31, no. 4 (2019): 853–57. http://dx.doi.org/10.35120/kij3104853s.

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Dilaceration of root is a phenomenon that changes the axial axis of the tooth at an angle, at the crown or root’s level. The actual mechanical obstructions in the way of dental eruption can be: root canal infections in the neighborhood tissues, development of the ectopically located dental germs and lack of space for them, anatomically dense structures, ankylosis temporary tooth, and so on. The purpose of our study is to analyze the causes of dental root dilaceration in patients, the first with the upper central incisor affected, and the second with the lower first premolar affected, as well as the approaches to their orthodontic treatment. In the first clinical case, the root dilaceration of the lower right first premolar is due to the development of a large cystic formation from a devialized lower right first temporary molar. In the second clinical case a rectangular upper left central incisor with a delacerated apex and a reversed direction of a crown-root was found, with the crown near the nasal cavity. The most accurate morphology of the affected teeth may be performed by a CBCT study. The treatment approach in both patients is extraction of the tooth with root dilaceration. In the first clinical case, the mechanical force that compresses and changes the direction of tooth formation is the cystic collection. In the second clinical case, the real cause of the delaceration and inverted direction of the germ of an upper left central incisor is not clear. A trauma of temporary teeth is often overlooked by parents. An early and timely intervention can save patients from the consequences of this trauma. Clinicians, who treat such as cases should use pre-diagnostic means such as CBCT to plan the treatment. Parents and dentists should devote particular attention to the deviated temporary teeth which shift is delayed. It is necessary to carry check-ups out at the age of tooth replacement, obligatory with X-ray followed by the consultation with an orthodontist.

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Fernández Gómez-Cruzado, Laura, Teresa Marquina Tobalina, Eva Alonso Calderón, Leire Agirre Etxabe, Jasone Larrea Oleaga, and Arkaitz Perfecto Valero. "Prolapso rectal incarcerado secundario a adenoma velloso gigante." Revista Argentina de Cirugía 111, no. 3 (2019): 180–83. http://dx.doi.org/10.25132/raac.v111.n3.1414.es.

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Villous adenomas may present with bleeding, diarrhea, electrolyte imbalance (Mackittrick-Weelock syndrome), obstruction, being a very rare cause of rectal prolapse. Rectal prolapse is a full thickness protrusion of the rectum through the anal canal and its presentation as an incarcerated rectal prolapse is very infrequent. If manual reduction is deemed impossible, perineal recto-sigmoidectomy, or Altemeier’s procedure, is one of the best surgical options, as an alternative transanal excision of the polyp could be performed with subsequent manual reduction of the rectal prolapse. We report the case of a female patient, admitted to the emergency room presenting an incarcerated rectal prolapse with a friable ulcerated mass of 10 × 8 × 5 cm, compatible with a villous polyp in the back side of the rectum. Since manual reduction was considered not feasible, surgery was decided and a transanal excision of the polyp was performed, following a successful manual reduction of the rectal prolapse. This case is of particular interest for its unusual association of incarcerated rectal prolapse due to a giant villous adenoma, having only 4 cases been reported in the literature.

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Almoznino, Galit, Ortal Kessler Baruch, Ron Kedem, et al. "SOS Teeth: First Priority Teeth with Advanced Caries and Its Associations with Metabolic Syndrome among a National Representative Sample of Young and Middle-Aged Adults." Journal of Clinical Medicine 9, no. 10 (2020): 3170. http://dx.doi.org/10.3390/jcm9103170.

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“SOS teeth” are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present. These are teeth with severe morbidity, that may require pulp capping, root canal treatment, or extraction, and therefore should be treated first. The study aims to explore whether or not a metabolic syndrome (MetS) is associated with SOS teeth. To that end, we performed across-sectional records-based study of a nationally representative sample of 132,529 military personnel aged 18–50 years, who attended the military dental clinics for one year. The mean number of SOS had no statistically significant association with: smoking (p = 0.858), alcohol consumption (p = 0.878), hypertension (p = 0.429), diabetes mellitus (p = 0.866), impaired glucose tolerance (p = 0.909), hyperlipidemia (p = 0.246), ischemic heart disease (p = 0.694), S/P myocardial infarction (p = 0.957), obstructive sleep apnea (p = 0.395), fatty liver (p = 0.074), S/P stroke (p = 0.589), and S/P transient ischemic attack (p = 0.095) and with parental history of: diabetes (p = 0.396)], cardiovascular disease (p = 0.360), stroke (p = 0.368), and sudden death (p = 0.063) as well as with any of the medical auxiliary examinations (p > 0.05). Cariogenic diet was positively associated with SOS teeth (p < 0.001). We conclude that SOS teeth had no statistically significant association with MetS components or with conditions that are consequences or associated with MetS. The only statistically significant parameter was a cariogenic diet, a well-known risk factor for caries and MetS.

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Uddin, Mohammed Kamal, and Sayed Morshed Moula. "The Prevalence of Pulp Stones in Bangladeshi Adults." Journal of Chittagong Medical College Teachers' Association 26, no. 2 (2016): 62–66. http://dx.doi.org/10.3329/jcmcta.v26i2.62252.

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Pulp Stones (PS) are discrete calcified masses found in the dental pulp. The purposes of this study were to calculate the prevalence of pulp stones in Bangladeshi adult’s undergone endodontic treatment and to report any observed associations between occurrence of pulp stones and sex, tooth type, dental arch, side and dental status. From 131 Bangladeshi adult patients, comprising 58 males and 73 females aged between 12-60 years, 148 teeth were examined under 2x magnifications on periapical radiographs pre-operatively, carefully removed roof of the pulp chamber, examined with magnified intraoral camera, and tried for orifices patency with narrow instrument. Directly observed stones, or any obstruction to negotiation to canal orifice, color change & any tactile sense of having stone like material in the pulp chamber treated as positive sign. Loose stones are then removed with curve probe like instruments; tight stones are loosen using narrow long fissure bur peripheral to stones. Pulp stones thus collected were scored as found or not found, and associations with sex, tooth type, dental arch, side and dental status noted. Pulp stones were found in 31 (23.66 percent) of the subjects and 31 (20.95 per cent) of the teeth treated. Occurrences were rare in premolars and cuspid (Almost zero percent) but significantly higher in molars (24.80 percent). If third molars were left out of analysis, pulp stones were more common in first molars than in second molars and in maxillary first molars than in mandibular first molars. Unrestored and intact molars displayed higher prevalence of pulp stones than carious and or restored molars. This study result will provide the readers significant clues about the pulp stones during canal negotiation. Pulp stones may also provide useful forensic information when examining dental records to identify deceased persons.  JCMCTA 2015 ; 26 (2) : 62 - 66

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Seaman, Scott C., Luyuan Li, Arnold H. Menezes, and Brian J. Dlouhy. "Fourth ventricle roof angle as a measure of fourth ventricle bowing and a radiographic predictor of brainstem dysfunction in Chiari malformation type I." Journal of Neurosurgery: Pediatrics 28, no. 3 (2021): 260–67. http://dx.doi.org/10.3171/2021.1.peds20756.

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OBJECTIVE Chiari malformation type I (CM-I) is a congenital and developmental abnormality that results in tonsillar descent 5 mm below the foramen magnum. However, this cutoff value has poor specificity as a predictor of clinical severity. Therefore, the authors sought to identify a novel radiographic marker predictive of clinical severity to assist in the management of patients with CM-I. METHODS The authors retrospectively reviewed 102 symptomatic CM-I (sCM-I) patients and compared them to 60 age-matched normal healthy controls and 30 asymptomatic CM-I (aCM-I) patients. The authors used the fourth ventricle roof angle (FVRA) to identify fourth ventricle “bowing,” a configuration change suggestive of fourth ventricle outlet obstruction, and compared these results across all three cohorts. A receiver operating characteristic (ROC) curve was used to identify a predictive cutoff for brainstem dysfunction. Binary logistic regression was used to determine whether bowing of the fourth ventricle was more predictive of brainstem dysfunction than tonsillar descent, clival canal angle, or obex position in aCM-I and sCM-I patients. RESULTS The FVRA had excellent interrater reliability (intraclass correlation 0.930, 95% CI 0.905–0.949, Spearman r2 = 0.766, p < 0.0001). The FVRA was significantly greater in the sCM-I group than the aCM-I and healthy control groups (59.3° vs 41.8° vs 45.2°, p < 0.0001). No difference was observed between aCM-I patients and healthy controls (p = 0.347). ROC analysis indicated that an FVRA of 65° had a specificity of 93% and a sensitivity of 50%, with a positive predictive value of 76% for brainstem dysfunction. FVRA > 65° was more predictive of brainstem dysfunction (OR 5.058, 95% CI 1.845–13.865, p = 0.002) than tonsillar herniation > 10 mm (OR 2.564, 95% CI 1.050–6.258, p = 0.039), although increasing age was also associated with brainstem dysfunction (OR 1.045, 95% CI 1.011–1.080, p = 0.009). A clival canal angle < 140° (p = 0.793) and obex below the foramen magnum (p = 0.563) had no association with brainstem dysfunction. CONCLUSIONS The authors identified a novel radiographic measure, the FVRA, that can be used to assess fourth ventricular bowing in CM-I and is more predictive of brainstem dysfunction than tonsillar herniation. The FVRA is easy to measure, has excellent interrater variability, and can be a reliable universal radiographic measure. The FVRA will be useful in further describing CM-I radiographically and clinically by identifying patients more likely to be symptomatic as a result of brainstem dysfunction.

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Salceanu, Mihaela, Alexandru Andrei Iliescu, Andrei Iliescu, Aureliana Caraiane, Mihaela Monica Scutariu, and Anca Melian. "Chemical Processes in Endodontic Failure Due to Incidents and Accidents." Revista de Chimie 69, no. 7 (2018): 1770–73. http://dx.doi.org/10.37358/rc.18.7.6414.

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The fundamental principle that must guide the activity of each dentist is the conservative, hence the task of preserving, as much as possible, the teeth in the arches, knowing what important injury brings extractions to the individual. An essential concern of endodontic therapy is the thorny problem of infected canals. At present, it is essential for any practitioner to recognize the relationship between microbial oral and pulpal and periapical tissue, the notions of endodontic microbiology being the key to understanding the basic methods of debriding, modeling and obstructing canals. Among the pathological conditions that overrun the clinical picture of pulp sickness, not only at the local and general level, the simple or complicated pulp gangrene has a well-established role. The endodontic treatment has three basic stages: diagnosis, preparation of the channel that follows the debridement, its modeling and sterilization, and the root filling. The rationale behind the treatment of this disease is that the devital pulp does not have defense mechanisms, the endocannicular microbial flora finding under these conditions a favorable environment of development. Regardless of the degree of expertize, the accumulated experience, the responsibility and the correctness of medical care, certainly no dental practitioner has been circumvented by failures in endodontic therapy. The relatively high percentage of failures has led to countless attempts to improve the tools and materials made available to the dentist. Currently, he faces a new problem, that of choosing the most correct method of endodontic treatment. Material and Method: The structure of the study material was 240 cases taken into account, from 2012-2017. Results and Discussion:Because endodontic therapy requires very precise working techniques, it implies rigorous records, both in terms of the sequence of treatment phases, but also in relation to some technical aspects - such as - data on root canals, the chronology of the radiological examinations, the instruments and the substances used - the neglect of the correct records resulting in unnecessary time losses and traumatisations of the periodontal-apical area.Conclusions: Starting from the assumption that the radiological examination is the only objective way of initial assessment of dental morphology, the certification of the existing pathology and the establishment of a diagnosis, the orientation of the treatment plan and the verification of the correctness of the therapeutic variant chosen through a monitoring of the results over time, we sought to clarify the actual role and the actual value of the radiological examination in endodontic therapy.

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Mahale, Vivek Devidas, Tanushree Saxena, Sonali Sharma, and E. Aparna Mohan. "Quantitative analysis of troughing depth for successful instrument retrieval using the loop technique: A cross-sectional in vivo study." Journal of Conservative Dentistry and Endodontics 28, no. 4 (2025): 360–65. https://doi.org/10.4103/jcde.jcde_844_24.

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Abstract Introduction: Fractured endodontic instruments complicate root canal treatment by obstructing cleaning and shaping. The loop technique is a widely used retrieval method, but the optimal depth of dentin troughing required for successful retrieval remains unclear. Insufficient troughing can lead to failed attempts, wasted materials, and operator fatigue, whereas excessive troughing may increase chair side time, cause dentin loss, and lead to iatrogenic errors. Aim: The aim of the study was to evaluate the depth of dentin troughing required for successful retrieval of fractured endodontic instruments using the loop technique and to analyze secondary outcomes, including retrieval time and success rates. Materials and Methods: This cross-sectional in vivo study included 60 teeth with fractured instruments, comprising 39 rotary and 21 hand instruments. The procedure was performed using high magnification, with a modified Gates Glidden drill and an ISO 25 sonic spreader to create a staging platform and expose the file head. The loop technique, employing a 27-gauge syringe and 0.02 mm Stainless steel wire, was used for retrieval. Troughing depth and retrieval time were recorded. Measurements were taken using a stereo microscope and analyzed with ImageJ software. Statistical Analysis: Data obtained were statistically analyzed using ANOVA, paired samples test. P < 0.05 was considered statistically significant. Results: The mean troughing depth was significantly greater for rotary instruments (0.42 mm ± 0.25 mm) than for hand instruments (0.28 mm ± 0.18 mm). The overall success rate was 98.3%, with no significant difference between rotary (97.4%) and hand instruments (100%). Retrieval time was significantly longer for rotary instruments (46.2 ± 3.2 min) than for hand instruments (32.4 ± 2.4 min, P < 0.05). Conclusion: Rotary instruments require deeper troughing and longer retrieval times compared to hand instruments. This study provides evidence-based guidance for optimizing fractured instrument retrieval while preserving tooth structure and minimizing procedural risks.

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Rashed, Albatol, and Nora Bedaiwi. "1227 Spinal Stenosis as a Rare Cause of Central Sleep Apnea." SLEEP 47, Supplement_1 (2024): A523. http://dx.doi.org/10.1093/sleep/zsae067.01227.

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Abstract Introduction Central sleep apnea is characterized by lack of drive to breathe during sleep, resulting in periods of insufficient ventilation and compromised gas exchange. CSA causes based on the awake Paco2 either hypercapnic and a nonhypercapnic group. Common causes include high-altitude, congestive heart failure, and chronic use of opioids and its very rare to be secondary to spinal stenosis. Report of case(s) 49 years old male patient known to have hypertension and cervical spondylosis causing severe canal stenosis on epidural steroid injection. He was Referred to sleep medicine clinic for the assessment of possible obstructive sleep apnea, as he has interrupted sleep, history of snoring and witnessed apnea. Calculated STOP BANG 6. on examination, BMI 33, neck circumference 44 cm, micrognathia and malapati class 4, Split night sleep study showed severe respiratory events with AHI of 125.4 mainly central apneas with total 177 episodes, Frequent arousals related to events and oxygen desaturation were recorded to 82%. End tidal CO2 reached 57 mmhg during the study. CPAP titration was initiated and pressure gradually increased and ended at 12.0 cmH2O where all respiratory events were controlled with REM sleep supine position. Day time arterial blood gas showed PH 7.437 PaCo2 39mmhg, PaO2 86.9 mmhg and Hco3 26.2 mmol/ liter with base excess +2.1. Investigation for the cause of central sleep apnea were negative except for cervical MRI which showed multilevel degenerative disc disease at the level of C3-C4 ,C4-5, C5-6 and C6-7 causing different severity of neural foramen stenosis and nerve root compression. Based on the investigations the patient was diagnosed with severe central sleep apnea secondary to severe spinal stenosis, he was started on CPAP 12 cmh2o well tolerated and complaint to the PAP and his latest CPAP data showed AHI of 8/hour. For the spinal stenosis he is following with spine surgery and pain management team for pain control. Conclusion To diagnose the cause of central sleep apnea it is mandatory to exclude all other possible causes and consider spinal stenosis when facing a case with isolated central sleep apnea. Support (if any)

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Sagun, Joyce Rodvie M., and Emmanuel Tadeus S. Cruz. "Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology." Philippine Journal of Otolaryngology-Head and Neck Surgery 33, no. 1 (2018): 51–55. http://dx.doi.org/10.32412/pjohns.v33i1.37.

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Immobility, fixation, or paralysis of the vocal folds is an ominous sign when encountered in the clinics. This may be due to a variety of diseases, lesions, injuries, or vascular compromise which may affect the integrity and physiologic mechanism of the vocal folds. The common etiologies include infectious processes such as laryngeal or pulmonary tuberculosis (PTB), malignancy or neoplasms, central problems such as cerebrovascular accidents (CVA), stroke and others.1,2,3 The problem should be addressed immediately because this potentially life threatening and imminent narrowing of the glottic opening may lead to respiratory distress. Vocal fold paralysis due to compression of the recurrent laryngeal nerve from PTB and laryngeal cancer are perennially seen in clinical practice, but immobility of the vocal folds due to cricoarytenoid joint fixation or ankylosis is seldom seen and appreciated. Hence, we present a case of bilateral cricoarytenoid joint ankylosis and discuss its etiology, pathophysiology, differential diagnoses, ancillary procedures, and management.  CASE REPORT A 60-year-old man was admitted for the first time because of difficulty of breathing and stridor. One week prior to admission he started to experience difficult breathing associated with productive cough and colds. He consulted in a primary private hospital and was managed as a case of bronchial asthma in exacerbation. Nebulization with salbutamol afforded temporary relief. A few hours prior to admission, difficulty of breathing and productive cough worsened, prompting emergency room consult. He was referred to us for further evaluation of stridor. The patient had no diabetes mellitus, hypertension or allergies to food and drugs. He was diagnosed with refractory bronchial asthma during childhood and had frequent hospitalizations for pulmonary infections. He had no maintenance medication for bronchial asthma and was nebulized with salbutamol during exacerbations. He had PTB and completed six months’ anti-TB medications in 2013. The patient claimed that he had no dyspneic episodes during routine daily activities or upon exertion. No history of hoarseness or joint pain was noted either. A golf caddy, he was a previous 15-pack-year smoker, occasional alcoholic beverage drinker and denied use of illicit drugs. Upon admission, the patient was awake, coherent, not in cardiorespiratory distress. Blood pressure was 110/70 mmHg, pulse rate was 74/minute, respiration was tachypneic at 24 cycles per minute, afebrile. Ear examination showed normal pinnae, no tragal tenderness, patent external auditory canals with no discharge and 80-90% dry central perforations of both tympanic membranes. Anterior rhinoscopy, nasal endoscopy and the oral cavity examination were unremarkable. Head and neck examination showed no cervical lymphadenopathy or palpable mass. Video laryngoscopy showed both vocal folds were immobile and fixed in paramedian position upon inspiration, with a 1–2 mm glottic opening and no mass or lesion appreciated. (Figure 1) The initial impression was impending upper airway obstruction secondary to bilateral vocal fold paralysis. Under general anesthesia, direct laryngoscopy revealed no mass or lesion on both vocal folds and passive mobility test demonstrated resistance and limitation of lateral rotation and movement of the arytenoids on both sides. (Figure 2) The vocal folds did not abduct on lateral retraction of the arytenoids. Tracheostomy was performed and he was discharged after a few days. A subsequent laryngeal electromyography (EMG) study showed no signs of myopathy or acute or chronic denervation changes of the thyroarytenoid muscles, and rheumatoid factor was normal. At this point, bilateral cricoarytenoid fixation or ankylosis was considered and posterior interarytenoid web and bilateral vocal fold paralysis were ruled out.  We recommended a lateralization procedure such as unilateral arytenoidectomy with cordectomy. The patient is currently well while he and his family are still contemplating whether he will undergo the surgical procedure.  DISCUSSION Respiratory stridor is always considered an ominous sign which implies upper airway obstruction. If severe, stridor may compromise breathing and in some instances is life threatening and a telltale sign of imminent danger requiring immediate endotracheal intubation. Stridor is a musical, high-pitched sound which may be elicited in the presence of laryngeal and upper tracheal obstruction while wheezes are defined as high-pitched, continuous, adventitious lung sounds.4,5 Stridor may be due to several reasons such as immaturity of the laryngeal structures seen in laryngomalacia in newborns, laryngeal infection, foreign body in the airway, and chronic obstructive pulmonary disease.3,6 This may be the reason why bronchial asthma was entertained in the clinical course of our patient and initially at the emergency room. It is unfortunate that despite the non-responsiveness of bronchial asthma to medical therapy and persistence of stridor, no ENT referral to evaluate the upper airway was made until recently. It should be emphasized that patients who develop stridor need to be evaluated by otolaryngologists specifically to ascertain the status of the vocal folds, which in this case turned out to be fixed or ankylosed, a condition which is rarely seen and encountered in clinical practice. Among the differential diagnoses considered in this case were laryngeal cancer, vocal fold paralysis, interarytenoid web, and arthritis.7,8,9 Initially, laryngeal cancer was entertained because of his age, however no mass or suspicious lesion was appreciated on video laryngoscopy and this was ruled out. Because the vocal folds were immobile and fixed in paramedian position upon inspiration, bilateral vocal fold paralysis was considered with the etiology to be determined. Vocal fold paralysis occurs when nerve impulses to the laryngeal muscles are disrupted in case of CVA or stroke, recurrent nerve injury after thyroid surgery or compression of the inferior laryngeal nerve due to pulmonary TB or lung cancer.8,11 On the other hand, vocal fold fixation occurs when movement of the cricoarytenoid joint is compromised in cases of rheumatoid arthritis provided that the innervation is intact.10,11 Another common differential diagnosis which may be entertained is laryngeal TB in which nodular lesions may be seen in the vocal folds, granulation tissues are usually present in the posterior commissure and histopathology shows Langhans cells and caseation necrosis.8 Paralysis is oftentimes unilateral due to compression of the recurrent laryngeal nerve from apical PTB. Although the patient has a history of TB, he was asymptomatic and close examination of the vocal folds revealed no lesions except for bilateral fixation, and this was ruled out. Direct laryngoscopy (DL), the gold standard in the evaluation of laryngeal anatomy especially when dealing with the vocal folds,3 showed smooth, normal-looking vocal folds with no lesions. The passive mobility test is done to differentiate vocal fold paralysis from cricoarytenoid ankylosis, by retracting or pushing the arytenoid laterally. If there is limitation of rotation and movement of the arytenoid laterally and the vocal folds do not abduct, then cricoarytenoid ankylosis or fixation is considered. On the contrary, if the arytenoid rotates and abducts laterally when retracted by forceps, then vocal fold paralysis is considered.1,6 Hence, because there was limitation of rotation and movement of the arytenoids, cricoarytenoid joint fixation was entertained and vocal fold paralysis was ruled out. Interarytenoid web was excluded because the vocal folds had no mucosal adhesions, synechiae, or any scarring within the posterior portion of the glottis. In addition, although the patient’s glottic opening was restricted, no difficulty was encountered during endotracheal intubation since a smaller caliber tube was used. To further confirm the diagnosis of cricoarytenoid fixation, laryngeal electromyography (EMG) revealed no paralysis of the thyroarytenoid muscles with no signs of myopathy and acute or chronic denervation, making bilateral vocal fold paralysis unlikely in this case. Laryngeal EMG is indicated to determine the integrity of the laryngeal muscles and innervation especially in cases of vocal fold paralysis.11 In post-thyroidectomy patients, laryngeal EMG is done 6 months after surgery to determine if the laryngeal nerve injury may recover or is irreversible. The 6-month waiting period is to allow swelling or inflammation to subside and to observe whether the injured nerve will recover prior to further intervention.12 The findings on direct laryngoscopy, passive mobility test and laryngeal electromyography clearly favor the diagnosis of cricoarytenoid joint ankylosis. Other ancillary procedures such as a CT scan may show sclerosis of the arytenoids1,11 in elderly patients and videostroboscopy may be useful in determining the relative vertical height and tension of the vocal folds for assessing the cricoarytenoid function.1 A CT scan was not done because there was no palpable neck mass and no other lesion was entertained that would warrant CT imaging. Videostroboscopy may help and may further show and magnify the movement of the vocal folds for observation however, the findings seen on direct laryngoscopy and laryngeal EMG were deemed enough to support and confirm the diagnosis. The patient may be classified under type IV posterior glottic stenosis - congenital or acquired bilateral cricoarytenoid fixation with or without interarytenoid scarring - based on the classification by Bogdasarian and Olson which was later modified by Irving and associates.3 Interarytenoid web and scarring presents as bilateral impaired abduction but adduction is normal and patients affected tend to have a normal voice while the main presenting symptom is airway compromise. In cricoarytenoid joint ankylosis, adduction and abduction of the vocal folds are limited.3 As previously mentioned, to distinguish cricoarytenoid joint ankylosis from vocal fold paralysis, palpation of the cricoarytenoid joint on rigid endoscopy and laryngeal EMG are necessary for definitive diagnosis.6 The patient’s voice was normal because the vocal folds approximate each other with a 1 to 2 mm glottic opening while no history of aspiration was apparent because the vocal folds are fixed in paramedian position which may prevent fluid from entering the larynx during swallowing. Although the patient’s voice is normal, respiration is compromised manifested as stridor and difficulty of breathing requiring tracheostomy.  In contrast, patients with acute or recent unilateral vocal fold paralysis in post-thyroidectomy or post-CVA (stroke) conditions may initially manifest with aspiration. This is because the vocal fold assumes an intermediate position in which the glottic opening is relatively wider compared with the paramedian position. In a few months’ time, the paralyzed fold will compensate, move medially, and assume a paramedian position and aspiration may eventually resolve.13 Cricoarytenoid ankylosis has several etiologies which include arthritides, bacterial infection and trauma. Rheumatoid arthritis may account for numerous clinical diagnoses of cricoarytenoid ankylosis.2 Other causes include gout, Reiter Syndrome, and ankylosing spondylitis. Some anecdotal evidence suggests a mump-associated laryngeal arthritis and fixation secondary to radiation therapy.2, 8 Bacterial involvement of the joint space with infectious microorganisms such as streptococcal species, with resultant ankylosis is also well established.8 External and direct laryngeal trauma may also result in cricoarytenoid joint injury.8 Documented and retrospective studies suggest intubation-related joint injury and posterior or anterior arytenoid displacement secondary to the distal tip of the endotracheal tube engaging the arytenoid during intubation.8 Traumatic obstetric delivery using forceps and postpartum newborn care through vigorous cleansing and suctioning the mouth and pharynx of the newborn are also mentioned in the literature.11 Posterior dislocation resulting from extubation with a partially inflated endotracheal tube cuff is another probable cause.7, 8 Another potential etiology is arytenoid chondritis secondary to prolonged endotracheal intubation, which results in fibrosis.8, 16 Reviewing the patient’s history, however, showed no history of trauma, previous intubation, signs and symptoms of arthritis and serious laryngeal infections. The patient was delivered via normal spontaneous delivery by a traditional birth attendant (“hilot”) and no apparent respiratory distress or postpartum hospitalization was known of by the patient. Cricoarytenoid ankylosis is usually associated with cases of rheumatoid arthritis with 17 to 33% incidence among RA patients.9 House et al. in 2010 described approximately 0.1% incidence of cricoarytenoid joint ankylosis in endotracheal intubations.16 Most cases of vocal fold immobility seen under the service is secondary to vocal fold paralysis due to cerebrovascular accident (stroke), pulmonary problems such as PTB, or laryngeal malignancy and to our knowledge, this is the first reported case of cricoarytenoid joint ankylosis in our institution.  Chronic cricoarytenoid joint ankylosis may be mistaken for asthma or chronic bronchitis, with symptoms of dyspnea, hoarseness, or stridor.3 In rheumatoid arthritis, laryngoscopy may show rough and thick mucosa and narrowed glottic chink which were contrary to the recent endoscopic findings. If the etiology is bacterial, there is direct involvement of the joint space with infectious agents, such as streptococcal species, which leads to scarring and thickening of the cricoarytenoid joints.8 Airway compromise occurs most commonly in patients with long-standing cricoarytenoid ankylosis and laryngeal stridor has been described as the sole presentation of the disease as manifested in this case.8, 14, 17 To rule out RA in this case, rheumatoid factor (RF) was done with negative results.  Finally, when it comes to upper airway obstruction, the glottic opening or opening of the vocal folds should be thoroughly evaluated. The normal glottic opening in newborns opens approximately 4 mm in a lateral direction. Congenital subglottic stenosis is defined as a subglottic diameter of less than 4 mm.13 In retrospect, it may be presumed that the patient’s glottis may not be seriously compromised since birth because he was able to thrive and breathe with no apparent difficulty. It may be conjectured that narrowing of the glottic opening occurred only later in life. Although asymptomatic, rheumatoid factor was negative, and the etiology of the patient’s ankylosis remains perplexing and elusive. The management of cricoarytenoid ankylosis includes tracheostomy to address the upper airway obstruction. Surgical management includes open arytenoidectomy, arytenoidpexy and endoscopic arytenoidectomy or transverse cordectomy and all have their advantages and disadvantages.6, 11, 16 These are lateralization procedures which aim to widen the glottic opening and wean the patient from tracheostomy afterwards. In closing, when bronchial asthma remains refractory to treatment, the physician should not hesitate to refer to otolaryngologists to rule out other probable upper airway pathologies. Although rare, ankyloses of the cricoarytenoid joint should be considered especially when the movement of the vocal folds is compromised. Although direct laryngoscopy, passive mobility tests and laryngeal EMG are indispensable in clinching the diagnosis, the clinical history is important in determining etiology which in this case remains elusive and perplexing.       REFERENCES  Woo Peak M. Laryngeal Trauma in Woo Peak Stroboscopy. 1st California: Plural Publishing Inc. 2010. p. 221-226.. Bryson PC, Buckmire RA. Medscape. Arytenoid Fixation. [Updated 2016 Mar 30; cited 2013 Apr]. Retrieved from: https://emedicine.medscape.com/article/866384-overview#a6. Albert D, Boardman S, Soma M. Evaluation and Management of the Stridulous Child.  In Flint PW, Haughey BH, Lung VJ, Niparko JK, Richardson MA, Robbins T, et al (editors). Cummings Otorhinolarynglogy Head and Neck Surgery. 5th ed. Philadelphia: Mosby Elsevier. 2010. p. 2896-2897.  Lechtzin NM. Stridor. Merck Manual Professional. 2014 [cited 2014 Apr]. Retrieved from Merck Manuals: http://www.merckmanuals.com/professional/pulmonary-disorders/symptoms-of-pulmonary-disorders/stridor Lechtzin NM. Wheezing. Merck Manual Professional. 2014 [cited 2014 Apr]. Retrieved from Merck Manuals: http://www.merckmanuals.com/professional/pulmonary-disorders/symptoms-of-pulmonary-disorders/wheezing Jackson C, Jackson CL. Direct Laryngoscopy in Bronchoesophagology. 5th Philadelphia: W.B. Saunders. 1950. p. 116-117 Cooper R. Extubation and Changing Endotracheal Tubes. In Benumof J, Hagberg CA (editors). Benumof's Airway Management: Principles and Practice. 2nd Philadelphia: Mosby Elsevier. 2007. p. 1160. Heman-Ackah Y, Kelleher K, Sataloff R. Inferior Glottic Ridges That Prevent Vocal Cord Closure. In Sataloff RT, Chowdhury F, Joglekar S, Hawkshaw MJ (editors). Atlas of Endoscopic Laryngeal Surgery. 1st New Delhi: Jaypee Brothers Medical Publishers. 2011. p. 45. Kamanli A, Gok U, Sahin S, Kaygusuz I, Ardicoglu O Yalcin S. Bilateral cricoarytenoid joint involvement in rheumatoid arthritis: a case report. Rheumatology (Oxford). 2001 May; 40 (5): 593-594. PMID: 11371675. Zakaria HM, Al Awad NA, Al Kreedes AS, Al-Mulhim AM, Al-Sharway MA, Hadi MA, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J. 2011 Jan; 26(1): 34–38. DOI: 10.5001/omj.2011.09; PMID: 22043377 PMCID: PMC3191623. Remacle M, Sandhu G. Bilateral Vocal Fold Immobility. In Oswal V, Remacle M, Jovanvic S, Zeitels SM, Krespi JP, Hopper C (editors). Principles and Practice of Lasers in Otorhinolaryngology and Head and Neck Surgery. 2nd Amsterdam: Kugler Publication. 2014. p. 250-251. Chauhan A, Badhwar S, Patel M, Tiwari S. Post - Intubation Bilateral Arytenoid Dislocation with Acute Respiratory Distress. J Anaesth Clin Pharmacol. 2009 Aug; 25(3):361-62. Banovetz J. Benign Laryngeal Disorders. In Adams GL, Boies LR (editors). Boies Fundamentals of Otolaryngology - A Textbook of Ear, Nose, and Throat Diseases. 6th Singapore: W.B. Saunders. 1989. p. 406-408. Stojanovic SP, Zivic L, Stojanovic J, Belic B. Total fixation of cricoarytenoid joint of a patient with rheumatoid arthritis and Hashimoto thyroiditis. Srp Arh Celok Lek. 2010 Mar-Apr; 138(3-4): 230-2. PMID: 20499506. Hamdan AL, Sarieddine D. Laryngeal Manifestations of Rheumatoid Arthritis. Hindawi Autoimmune Diseases. 2013; 2013: 4-6. DOI:10.1155/2013/103081. Polisar IA, Burbank B, Levitt LM, Katz HM, Morrione TG. Bilateral midline fixation of cricoarytenoid joints as a serious medical emergency. JAMA. 1960; 172(9): 901-906. DOI:10.1001/jama.1960.03020090013003 Burkey B, Goudy S, Rohde S. Airway Control and Laryngotracheal Stenosis in Adults. In Snow JB, Ballenger JJ (editors). Ballenger's Manual of Otorhinolaryngology Head and Neck Surgery. 17th Ontario: BC Decker. 2009. p. 911. 

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Huynh, C., E. Clement, D. DeGirolamo, et al. "Canadian Surgery Forum 201901. The future of general surgery training: a Canadian resident nationwide Delphi consensus statement02. Traumatized: Can mindfulness lead to improved mental health outcomes after multisystem trauma?03. Operating room availability for general surgery in 2007 versus 2017 at a regional hospital in BC04. Perceptions and barriers to Gastrografin protocol implementation05. Resident opinions and educational experience of a mixed night-float system for general surgery resident call06. A scoping review of best management for hepato-pancreatobiliary trauma07. Simultaneous versus staged resection for synchronous colorectal liver metastases: a population-based cohort study08. Weight loss following hepatopancreatobiliary surgery. How much is too much?09. Uptake and patient outcomes of laparoscopic liver resection for colon cancer liver metastases: a population-based analysis10. Simultaneous resection of colorectal cancer with synchronous liver metastases: a survey-based analysis11. When is it safe to start VTE prophylaxis after blunt solid organ injury? A prospective study from a level I trauma centre12. Undertriaged trauma patients: Who are we missing?13. Trauma team activation at a level I trauma centre: time of day matters14. The diagnostic dilemma of shotgun injuries15. Evaluating the efficacy of self-study videos for the surgery clerkship rotation: an innovative project in undergraduate surgical education16. Systematic review and meta-analysis: preoperative anti-TNF therapy does not increase the risk of postoperative complications in patients with inflammatory bowel disease undergoing elective surgery17. Simulation platforms to assess laparoscopic suturing skills: a scoping review18. Cost analysis of simultaneous versus staged resection of colorectal cancer liver metastases: a population-based study19. Complementary and alternative medicine use among general surgery patients in Nova Scotia20. General surgery in Canada: current scope of practice and future needs21. Impact of dedicated operating time on access to surgical care in an acute care surgery model22. Adolescent appendicitis management and outcomes: comparison study between adult and pediatric institutions23. A systematic review of behavioural interventions to improve opioid prescribing after surgery24. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma: a gap analysis of the Edmonton Zone Trauma Registry25. Learning by holographic anatomic models for surgical education26. The nature of learning from trauma team simulation27. Comparing reversing half-hitch alternating postsurgical knots and square knots for closure of enterotomy in a simulated deep body cavity: a randomized controlled trial28. Propagating the “SEAD”: exploring the value of an overnight call shift in the Surgical Exploration and Discovery Program29. Comparing 2 approaches to residency application file review30. A Canadian experience with posterior retroperitoneoscopic adrenalectomy31. A cost-efficient, realistic breast phantom for oncoplastic breast surgery training32. Impact of patient frailty on morbidity and mortality after common emergency general surgery operations33. Preventing opioid prescription after major surgery: a scoping review of the literature on opioid-free analgesia34. Correct usage of propensity score methodology in contemporary high-impact surgical literature35. Responsible blood compatibility testing for appendectomy: practice assessment at a single Canadian academic centre36. What patient factors are associated with participation in a provincial colorectal cancer screening program?37. Missed appendix tumours owing to nonoperative management for appendicitis38. Operative delay increases morbidity and mortality in emergency general surgery patients: a study of multiple EGS services within a single city39. Withdrawn40. Improved disease-free survival after prehabilitation for colorectal cancer surgery41. Development of a conceptual framework of recovery after abdominal surgery42. Comparison of Dor and Nissen fundoplication following laparoscopic paraesophageal hernia repair43. A systematic review and summary of clinical practice guidelines on the periprocedural management of patients on antithrombotic medications undergoing gastroenterological endoscopy44. Impact of socioeconomic status on postoperative complications following Whipple procedure for pancreatic ductal adenocarcinoma45. Clinical outcomes of high-risk breast lesions and breast cancer patients treated with total mastectomy and immediate reconstruction46. My On Call (MOC) Pager App: practising and assessing safe clinical decision-making47. Comprehensive complication index for major abdominal surgeries: an external validation using the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP)48. The impact of surgeon experience on script concordance test scoring49. Decay of competence with extended research absences during postgraduate residency training: a scoping review50. Long-term outcomes of elderly patients managed nonoperatively for choledocholithiasis51. Predictors of mortality and cost among surgical patients admitted to hospital and requiring rapid response team activation52. Sex-based disparities in the hourly earnings of surgeons in Ontario’s fee-for-service system53. Outcomes of intestinal ischemia among patients undergoing cardiac surgery54. Factors influencing resident teaching evaluations: the relationship between resident interest in teaching, career plan, training level and their performance in teaching junior learners55. Validating a uniform system for measuring disease severity in acute colonic diverticulitis56. Active negative pressure peritoneal therapy and C-reactive protein (CRP) levels after abbreviated laparotomy for abdominal trauma or intraabdominal sepsis: the validity of serum and peritoneal CRP in measuring outcomes in critically ill patients57. Intraoperative use of indocyanine green fluorescence in emergency general surgery: a systematic review58. Is it safe? Nonoperaive management of blunt splenic injuries in geriatric trauma patients59. Bladder injury from laparoscopic appendicectomy: a multicentre experience over 5 years60. Perioperative cardiac investigations for chest pain after parathyroidectomy rarely yield a cardiac diagnosis61. Entero-hepatic axis injury following hemorrhagic shock: a role for uric acid62. Loss of functional independence after emergency abdominal surgery in older patients: a prospective cohort study63. Association between use of nonsteroidal antiinflammatory drugs, diuretics or angiotensin converting enzyme inhibitor/receptor blockers after major surgery and acute kidney injury: a nested, population-based case–control study64. Timing of CT for adhesive small bowel obstructions (SBO)65. The ABDO (Acute Biliary Disease Optimization) Study: improving the management of biliary diseases in emergency general surgery66. Rates and predictors of advanced biliary imaging and interventions in acute care surgery: a quality improvement study67. The use of early warning scores in patients undergoing emergency general surgery: a systematic review68. Does primary closure versus resection and anastomosis in patients with hollow viscus injury affect 30-day mortality?69. Impact of sarcopenia on morbidity and mortality after Whipple procedure for pancreatic ductal adenocarcinoma70. Mind the speaker gap: a cross-specialty analysis of the representation of women at surgical meetings in 5 different geographic regions71. Immediate breast reconstruction in locally advanced breast cancer: Is it safe?72. An administrative review of the incidence of adverse events involving electrocautery73. If you don’t document it, did it really happen? A review of the documentation of informed consent in laparoscopic cholecystectomy74. Can an online module help medical students gain confidence and proficiency in writing orders?75. The influence of undergraduate medical education anatomy exposure on choice of surgical specialty: a national survey76. Association between patient engagement and surgical outcomes: a pilot study77. Guidelines on the intraoperative transfusion of red blood cells: a systematic review78. Cancer is common in missed appendicitis: a retrospective cohort study79. Everyone is awesome: analyzing letters of reference in a general surgery residency selection process80. Evaluating the true additional costs of general surgery complications using a propensity score weighted model81. Deriving literature-based benchmarks for surgical complications from national databases in high-income countries: a systematic review on pancreatectomy outcomes82. The impact of distance on postoperative follow-up in pediatric general surgery patients: a retrospective review83. Water-soluble contrast in adhesive small bowel obstruction management: a Canadian centre’s experience84. Recognizing predatory journals in general surgery and their common violations85. Prophylactic negative pressure wound therapy for closed laparotomy incisions: a meta-analysis of randomized controlled trials86. Choosing Wisely Canada: 2019 general surgery recommendations87. Content-specific resident teaching can improve medical student learning outcomes on certifying examinations88. Transition to practice: preparedness for independent practice in general surgery graduates89. CAGS Exam 2.0: maximizing the potential for teaching and learning90. Resident attitudes toward the introduction of synoptic operative reporting for appendectomy and cholecystectomy91. Determining the individual, hospital and environmental cost of unnecessary laboratory investigations for patients admitted to general surgery services at an academic centre92. Gender-based compensation disparity among general surgeons in British Columbia93. Transgastric robotic resection for gastrointestinal stromal tumours of the stomach94. Recurrent gallstone ileus after laparoscopic-assisted enterolithotomy treated with totally laparoscopic enterolithotomy01. Predictors and outcomes among patients requiring salvage APR for the treatment of squamous cell carcinoma of the anus: a population-based study02. Short-course radiotherapy with perioperative systemic chemotherapy for patients with rectal cancer and synchronous resectable liver metastases: a single-centre Canadian experience03. Compliance with preoperative elements of the American Society of Colon and Rectal Surgeons rectal cancer surgery checklist improves pathologic and postoperative outcomes04. Clinical predictors of pathologic complete response following neoadjuvant chemoradiation therapy for rectal cancer: a systematic review and meta-analysis05. Rejected06. The impact of laparoscopic technique on the rate of perineal hernia after abdominoperineal resection of the rectum07. An assessment of the current perioperative practice, barriers and predictors for utilization of enhanced recovery after surgery protocols: a provincial survey08. Regional variation in the utilization of laparoscopy for the treatment of rectal cancer: the importance of fellowship training sites09. Local versus radical surgery for early rectal cancer with or without neoadjuvant or adjuvant therapy: a systematic review and meta-analysis10. The relation between the gut microbiota and anastomotic leak in patients with colorectal cancer: a preliminary feasibility study11. Optimizing discharge decision-making in colorectal surgery: an audit of discharge practices in a newly implemented enhanced recovery pathway12. Trends in colectomy for colorectal neoplasms in ulcerative colitis (UC) patients over 2 decades: a National Inpatient Sample database analysis13. Spin in minimally invasive transanal total mesorectal excision articles (TaTME): an assessment of the current literature14. Venous thromboembolism (VTE) in colon cancer: a population-based cohort study of VTE rates following surgery and during adjuvant chemotherapy15. Robotic-assisted lateral lymph node dissection for rectal neuroendocrine tumor16. Loop ileostomy and colonic lavage as an alternative to colectomy for fulminant Clostridium difficile colitis17. Recurrent diverticulitis: Is it all in the family?18. Le traitement des fistules entérocutanées complexes : expérience du Centre hospitalier de l’Université de Montréal (CHUM)19. A North American single-blinded pilot randomized controlled trial for outpatient nonantibiotic management of acute uncomplicated diverticulitis (MUD TRIAL): feasibility and lessons learned20. Treatment failure after conservative management of acute diverticulitis: a nationwide readmission database analysis21. Impact of immunosuppression on mortality and major morbidity following sigmoid colectomy for diverticulitis: a propensity-score weighted analysis of the National Inpatient Sample22. Presentation and survival in colorectal cancer under 50 years of age: a systematic review and meta-analysis23. Genetics of postoperative recurrence of Crohn’s disease: a systematic review and meta-analysis24. Improving the identification and treatment of preoperative anemia in patients undergoing elective bowel resection25. Impact of postoperative complications on quality of life after colorectal surgery26. Colon cancer survival by subsite: a retrospective analysis of the National Cancer Database27. A second opinion for T1 colorectal cancer pathology reports results in frequent changes to clinical management28. Effects of the quadratus lumborum block regional anesthesia on postoperative pain after colorectal resection: a double-blind randomized clinical trial29. Safety of a short-stay postoperative unit for the early discharge of patients undergoing a laparosocpic right hemicolectomy30. What is the optimal bowel preparation to reduce surgical site infection in Crohn disease?31. TaTME surgery and the learning curve: our early experience32. Watch-and-wait experience in patients with rectal cancer: results in selected patients at a high-volume centre01. Automatic referral of suspicious findings detected on thoracic CT scan decreases delays in care without compromising referral quality02. Variation in receipt of therapy and survival with provider volume in noncurative esophagogastric cancer: a population-based analysis03. What makes patients high risk for lobectomy in the era of minimally invasive lobectomy?04. The value proposition of minimally invasive esophagectomy: a community hospital perspective05. Deviation from treatment plan in patients with potentially curable esophageal carcinoma06. Implementation of a standardized minimal opioid prescription for post-thoracic surgery patients is feasible and provides adequate pain control07. Sentinel node navigation surgery using indocyanine green in lung cancer: a systematic review and meta-analysis08. Surgical outcomes with trimodality neoadjuvant versus adjuvant therapy for esophageal cancer: results of the QUINTETT randomized trial09. Enhanced invasive mediastinal staging in an academic thoracic surgical unit by employing a shared accountability model for quality improvement10. Evaluation and harmonization of international database elements for adverse events monitoring following thoracic surgery: the pursuit of a common language11. Endobronchial ultrasound staging of operable non–small cell lung carcinoma: triple-negative lymph nodes may not require routine biopsy12. Wait times in the management of non-small cell lung cancer before, during and after regionalization of lung cancer care: a high-resolution analysis13. Wearable technology for preconditioning before thoracic surgery: a feasibility study14. Impact of carbohydrate-loading enhanced recovery after surgery protocol on adverse cardiopulmonary events in a thoracic surgery population15. Heat production during pulmonary artery sealing with energy vessel-sealing devices in a porcine model16. Who can afford to wait? The effect of wait times on survival in lung cancer patients: clinical predictors of poor outcomes17. Impact of the Integrated Comprehensive Care Program after thoracic surgery: a propensity score matched study18. Incidence, severity and risk of postoperative pulmonary complications in patients undergoing pulmonary resection for cancer19. Evaluation of the limits of use of a thoracoscopic lung palpation device to identify artificial tumour nodules in ex-vivo tissue20. Personalized surgical management of esophagogastric junction cancers21. Validity of a model to predict the risk of atrial fibrillation after thoracic surgery22. Severe symptoms persist for up to 1 year after diagnosis of stage I–III lung cancer: an analysis of province-wide patient-reported outcomes23. Do postoperative infectious adverse events influence cancer recurrence and survival after surgical resection of esophagogastric cancers? Experience from a Canadian university centre24. Utilization, safety and efficacy of hybrid esophagectomy on a population level25. Endoscopic submucosal dissection for upper gastrointestinal neoplasia: lessons learned from a high-volume North American centre26. Long-term quality of life after esophagectomy27. Early and late outcomes after surgery for pT4 NSCLC reclassified by AJCC 8th edition criteria28. Early results on the learning curve for subxiphoid video-assisted thoracoscopic lobectomy29. Should adjuvant therapy be offered for patients undergoing esophagectomy after neoadjuvant CROSS protocol for esophageal cancer? A multicentre cohort study30. Outcomes of patients discharged home with a chest tube following anatomic lung resection: a multicentre cohort study01. Management of cancer-associated intestinal obstruction in the final year of life02. Evaluating the prognostic significance of lymphovascular invasion in stage II and III colon cancer03. A matched case–control study on real-time electromagnetic navigation for breast-conserving surgery using NaviKnife04. Gaps in the management of depression symptom screening following cancer diagnosis: a population-based analysis of prospective symptom screening05. Patterns of symptom burden in neuroendocrine tumours: a population-based analysis of patient-reported outcomes06. Outcomes of salvage surgery for anal canal squamous cell carcinoma: a systematic review and meta-analysis07. Expression of the Plk4 inhibitor FAM46C predicts better survival following resection of gastric adenocarcinoma08. Current treatment strategies and patterns of recurrence in locally advanced colon cancer09. A 5-year retrospective review of outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in a provincial peritoneal malignancy program10. Withdrawn11. Geographic disparities in care and outcomes for noncurative pancreatic adenocarcinoma: a population-based study12. How often is implant-based breast reconstruction following postmastectomy radiation unsuccessful?13. Comparison of partial mastectomy specimen volume and tumour volume following neoadjuvant chemotherapy in breast cancer14. Two-year experience with hookwire localized clipped node and sentinel node as alternative to targeted axillary dissection in a regional centre15. Opioid use among cancer patients undergoing surgery and their associated risk of readmissions and emergency department visits in the 1-year postsurgical period16. Preliminary results of a pilot randomized controlled trial comparing axillary reverse mapping with standard axillary surgery in women with operable breast cancer17. Complementary and alternative medicine among general surgery patients in Nova Scotia18. Improving wait times and patient experience through implementation of a provincial expedited diagnostic pathway for BI-RADS 5 breast lesions19. Population-based regional recurrence patterns in Merkel cell carcinoma: a 15-year review20. Survival and health care cost benefits of high-volume care in the noncurative management of pancreatic adenocarcinoma: a population-based analysis21. Trends in the use of sentinel node biopsy after neoadjuvant chemotherapy in the United States22. Predictors of grossly incomplete resection in primary retroperitoneal sarcoma (RPS)23. Mastectomy versus breast conservation therapy: an examination of how individual, clinicopathologic and physician factors influence decision making24. Immunophenotyping postoperative myeloid-derived suppressor cells in cancer surgery patients25. Adherence to sentinel lymph node biopsy guidelines in the management of cutaneous melanoma in the province of British Columbia26. Breast cancer with supraclavicular and internal mammary node metastases: therapeutic options27. Textbook outcomes and survival in patients with gastric cancer: an analysis of the population registry of esophageal and stomach tumours of Ontario (PRESTO)28. Withdrawn29. Symptomatic bowel complications in patients with metastatic cancer: comparison of surgical versus medical outcomes and development of a prediction model for successful surgical palliation30. Rejected31. Gastric cancer biopsies show distinct biomarker profiles compared with normal gastric mucosa in Canadian patients32. Withdrawn01. Management of high patient-reported pain scores in noncurative pancreatic adenocarcinoma: a population-based analysis02. Outcomes of liver donors with a future liver remnant less than or equal to 30%: a matched-cohort study03. The applicability of intraoperative fluorescent imaging with indocyanine green in hepatic resection for malignancy: a systematic review and meta-analysis04. Impact of adjuvant chemotherapy completion on outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma05. Primary hepatic acinar cell carcinoma06. Laparoscopic distal pancreatectomy provides equivalent oncologic outcomes for pancreatic ductal adenocarcinoma07. Passive versus active intraabdominal drainage following pancreatic resection: Does a superior drainage system exist? A systematic review and meta-analysis08. Low yield of preoperative MRCP and ERCP in the management of low-intermediate suspicion choledocholithiasis09. Pancreatic cancer resection rates and survival in the United States and Canada10. Prognostic value of immune heterogeneity in colorectal cancer liver metastases11. Impact of intraoperative hypovolemic phlebotomy on blood loss and perioperative transfusion in patients undergoing hepatectomy for cancer12. Prediction of postoperative pancreatic fistula following pancreatectomy: a systematic review of clinical tools13. The impact of preoperative frailty in liver resection: an analysis of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP)14. Topical agents as adjuncts in pancreatic surgery for prevention of postoperative pancreatic fistula: a systematic review and meta-analysis15. Phlebotomy resulting in controlled hypovolemia to prevent blood loss in major hepatic resections (PRICE-1): a feasibility randomized controlled trial16. Pylorus-preserving versus classic pancreaticoduodenectomy: a single-centre retrospective review of total lymph node yield17. An audit and evaluation of appropriateness of intraoperative allogenic red blood cell transfusion in liver surgery: application of 3 decision rules18. A comparison of lymph node ratio with AJCC lymph node status for survival after Whipple resection for pancreatic adenocarcinoma19. Duodenopancréatectomie céphalique (intervention de Whipple) par voie laparoscopique pure20. Use of the Molecular Adsorbent Recirculating System (MARS) in acute liver failure: a multicentre experience21. Barriers to adjuvant chemotherapy after resection for pancreatic cancer22. Comparison of primary and metastatic pancreatic cancer by clinical and genomic features23. Factors associated with invasion and postoperative overall survival in resected IPMN01. Incisional hernia repair surgery improves patient-reported outcomes02. Prospective study of single-stage repair of contaminated hernias with the novel use of calcium sulfate antibiotic beads in conjunction with biologic porcine submucosa tissue matrix03. e-TEP transversus abdominus release04. Umbilical hernias05. Review of 1061 femoral hernias done at the Shouldice Hospital over a period of 6 years01. Metabolic outcomes after bariatric surgery for a provincial Indigenous population02. Outcomes of sleeve gastrectomy performed in a regional hospital03. A longitudinal analysis of wait times in a publicly funded, regionalized bariatric care system04. Concurrent laparoscopic ventral hernia repair with bariatric surgery: a propensity-matched analysis05. Outcomes from explantation of laparoscopic adjustable gastric band: experience from a Canadian bariatric centre of excellence06. Development of consensus-derived quality indicators for laparoscopic sleeve gastrectomy07. Conversion of sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass in intestinal nonrotation08. The utility of routine preoperative upper gastrointestinal series for laparoscopic sleeve gastrectomy09. Body image concerns, depression, suicidality and psychopharmacological changes in postoperative bariatric surgery patients: a mixed-methods study10. Technical factors associated with early sleeve stenosis after sleeve gastrectomy: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database11. Analysis of complication and readmission rates after laparoscopic sleeve gastrectomy at a single bariatric surgery centre: a retrospective NSQIP study12. Management of common bile duct stones in patients after Roux-en-Y gastric bypass: a systematic review13. Improvement and resolution of urinary incontinence after bariatric surgery: a systematic review and meta-analysis14. Bridging interventions for weight loss prior to bariatric surgery in patients with superobesity: a systematic review and meta-analysis15. Secondary and tertiary learning curves in bariatric surgery16. Achalasia following laparoscopic sleeve gastrectomy: a case report17. Multidisciplinary approach to halving length of stay after bariatric surgery18. Prospective analysis of staple line haemostatic materials in stapled bariatric surgery19. Barriers and facilitators to managing patients with class II and III obesity in primary care: a qualitative study20. The Edmonton Obesity Staging System predicts risk of postoperative complications and mortality following bariatric surgery21. The impact of attention-deficit/hyperactivity disorder on bariatric surgery outcomes: systematic review and meta-analysis22. The effect of bariatric surgery on migraines: a systematic review and meta-analysis23. A population-based matched cohort study of mortality after bariatric surgery24. Safety and outcomes of bariatric surgery performed at an ambulatory site associated with a tertiary care hospital in Canada25. Race and sex predict adverse outcomes following bariatric surgery: a propensity-matched MBSAQIP analysis26. A survey of primary care physician referral to bariatric surgery: access, perceptions and barriers." Canadian Journal of Surgery 62, no. 4 Suppl 2 (2019): S89—S169. http://dx.doi.org/10.1503/cjs.011719.

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Bhasin, Prashant, Vrinda Vats, Sachin Chauhan, Monika Tandon, Hemanshi Kumar, and Rajiv Chugh. "MAGNIFICATION, ULTRASONICS AND BIOCERAMICS - THE IDEAL TRIO FOR FILE RETRIEVAL: A CASE REPORT." BULLETIN OF STOMATOLOGY AND MAXILLOFACIAL SURGERY, January 2023, 9–13. http://dx.doi.org/10.58240/1829006x-2023.19.1-9.

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During routine endodontic therapy, a clinician may encounter many procedural errors which alter the course and outcome of the treatment. Instrument separation is one of the most common types of procedural error, resulting in metallic obstruction in the canal and impeding efficient cleaning and shaping of the root canal. The clinician has to evaluate the options of attempting retrieval, bypassing or leaving the fragment as it is. When an attempt such a fragment becomes difficult, it should be retrieved with the help of ultrasonics under magnification and the canals should with bioceramic sealer to improve the tooths prognosis.

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Li, Mingming, Guosong Wang, Fangzhi Zhu, et al. "Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases." BMC Oral Health 24, no. 1 (2024). http://dx.doi.org/10.1186/s12903-024-04377-5.

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Abstract Background Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. Case presentation Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. Conclusions The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.

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Garrocho-Rangel, Arturo, Aránzazu Sánchez-Reynoso, Miguel Ángel Rosales-Berber, Socorro Ruiz-Rodríguez, and Amaury de Jesús Pozos-Guillén. "Clinical Management of Intra-Pulp Canal Broken Endodontic Files in Primary Teeth: Literature Review." Odovtos - International Journal of Dental Sciences, September 15, 2020, 16–20. http://dx.doi.org/10.15517/ijds.2021.43859.

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Fracture of an endodontic file inside a primary root canal is a rare but critical complication during the pulpectomy treatment, because the mechanical obstruction impedes the optimal cleaning and obturation of the pulp canal, compromising seriously the clinical outcome. This accidental event is mainly associated with over-use and excessive torque of intracanal files. Most clinicians opt to proceed with the extraction of the affected tooth followed by a space maintainer placement. Other practitioners attempt the non-surgical retrieval of the separated fragment through available proven techniques in permanent teeth; however, these methods may involve significant damage to the tooth and surround tissues. On the other hand, preservation of the metallic fragment might affect the treatment prognosis and interfere with the physiological root resorption.

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Marchese, Manuela, Pontoriero I. K. Denise, Cagidiaco Edoardo Ferrari, Alfredo Iandolo, Simone Grandini, and Marco Ferrari. "Endodontic Irrigants and Their Activation Efficacy on Cleansing Post-Space Root Canal Walls." December 1, 2021. https://doi.org/10.3390/prosthesis3040036.

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The aim of this study was to evaluate the efficacy of activated irrigants (EDTA e NaOCL) during the cleansing of root walls, of the smear layer, of the debris, and gutta-percha after the preparation of the restorative space. Twenty single and multi-rooted (n = 20) have been collected. All samples were prepared by the same operator, using Nickel-titanium rotating instruments (Mtwo) through the Simultaneous Shaping Technique. The continuous-wave of condensation technique of obturation was used. To all specimens, the restorative space has been made, leaving 5 mm of apical gutta-percha, and postoperative periapical X-rays were performed. The samples were randomly divided into two groups: Group (A): cleansing of the root walls with ultrasonic activation of the irrigants (NEWTRON P5 XS; Satelec Acteon); Group (B): radicular walls wash without ultrasonic activation of endodontic irrigants (NaOCl 5.25% and EDTA 17%). Both dental sample groups were cut longitudinally with a low-speed saw (Isomet); the samples were observed by using a scanning electron microscope (Jeol, Jsm-6060LV) in order to evaluate: (1) the amount of debris/smear layer; (2) the mount of obstruction of dentinal tubules found in the two groups; and (3) evaluation of the presence of gutta-percha. Then, the other five samples each group (with and without ultrasonic activation) were prepared following the same protocol. Then, a universal bonding system (G-Praemio Bond, GC) and a layer of a flowable resin composite (Gaenial Flow, GC) were light-cured and used on top of the prepared root canal walls. The samples were cut in two pieces along the long axis of the root. Then, half sample teeth were kept in an acidic solution (37% HCl) for 48 h in order to completely dissolve dental structures and to have a direct view of resin tags formation under SEM. The other half was prepared to observe the adhesive interface under SEM. The amount of debris was not satisfactory in 9 out of 10 cases in Group B, while in Group A, which has been treated with ultrasounds, the result was either good or great in most of the samples. For the sample group treated with ultrasound, the tubules were evaluated as perfectly clean in 9 out of 10 cases, instead, the results are unsatisfactory for 9 out of 10 cases of group B not treated with ultrasound. Differences between Group A and B were statistically significant. With respect to the presence of debris and tubules obstruction treatment with ultrasonic activation, it offers with no doubt better results. When ultrasonic activation is used in combination with endodontic irrigants, a clean dentin substrate is be obtained for the adhesion of restorative materials, but in order to confirm the findings of this study, further in vivo trials are needed.

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Al-Sebaei, Maisa, Omar Halabi, and Ibrahim El-Hakim. "Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report." Clinical, Cosmetic and Investigational Dentistry, March 2015, 41. http://dx.doi.org/10.2147/ccide.s79436.

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Martini, Marcelo Zillo, Shajadi Carlos Pardo-Kaba, Juliana Seo, et al. "Windshield glass fragment mimicking a nasal fracture." ARCHIVES OF HEALTH INVESTIGATION 7, no. 11 (2019). http://dx.doi.org/10.21270/archi.v7i11.3050.

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A male patient with facial trauma by road traffic accident arrived in the emergency room and he was assisted by the Trauma and Neurosurgery team. After clinical evaluation a frontal sinus anterior wall fracture plus a nasal fracture were diagnosed. On the primary OMS examination was checked multiple facial lacerations and gross nasal dorsum deviation with pain, nasal airway obstruction and crepitus with clinical diagnosis of a nasal fracture. After radiologic exam a piece of windshield glass that was superimposed on the nasal bones simulating a nasal fracture was visualized. This paper presents clinical data and literature review of foreign body mimicking facial fractures.Descriptors: Road Traffic Accident; Facial Fractures; Windshield Glass.ReferênciasMazinis E, Lambrianidis T, Margelos J. Detection of a residual foreign body during root canal treatment. J Endod. 2005;31(9):691-93. Gray ST. Windshield safety glass foreign body masquerading as a root fragment. Dentomaxillofac Radiol. 1994;23(1):49-51.Goldstein E, Gottlieb MA. Foreign bodies in the nasal fossae of children. Oral Surg Oral Med Oral Pathol. 1973;36(3):446-47 .Madhere S, Barba CA, Painter RL, Morgan AS. Aspiration of shattered windshield glass after blind nasotracheal intubation in a motor vehicle crash. J Trauma. 1997;43:353-56.

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Zadfatah, Firouz, Saeedeh Galledar, Shahram Pourasgar, and Alireza Fathiazar. "Effect of Cryotherapy on Fracture Resistance of Neoniti Rotary Instruments." Frontiers in Dentistry, August 11, 2023. http://dx.doi.org/10.18502/fid.v20i28.13346.

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Objectives: Nickel-titanium (NiTi) rotary files were introduced to optimize root canal instrumentation in endodontic treatment. However, despite the numerous advantages of NiTi instruments, they may unexpectedly break during clinical use, resulting in obstruction of the root canal system. The current investigation aimed to assess the effect of cryotherapy on fracture resistance of Neoniti rotary files. Materials and Methods: This in vitro, study was conducted on 20 Neoniti rotary files with #35 tip size and 6% taper in two groups with and without cryogenic treatment (N=10). For cryogenic treatment, the files were immersed in liquid nitrogen at -196°C for 24 hours. Next, the Neoniti files in both groups were subjected to cyclic fatigue testing in a hand-piece operating at 500 rpm with 20 N/cm torque. The files were rotated until fracture and the fracture time as well as the number of cycles to fracture were recorded for each file. The two groups were compared by independent t-test at 0.05 level of significance. Results: The number of cycles to fracture was 235700±50649.22 in the control and 280600±22979.21 in the cryotherapy group. The mean fracture time was 471.40±101.29 and 561.20±45.958 seconds in the control and cryotherapy groups, respectively. Significant differences in both variables were noted between the two groups (P<0.05). Conclusion: Based on our findings, utilizing cryogenic treatment may enhance the fracture resistance of rotary instruments, making it a beneficial practice for dental clinicians to adopt. By using cryogenically treated rotary instruments, clinicians can potentially reduce the risk of file fracture during dental procedures.

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Gupta, Artika, Ankur Pareek, and Himani Kapila. "Ultrasonics in endodontics." International journal of health sciences, July 31, 2021, 264–77. http://dx.doi.org/10.53730/ijhs.v5ns1.5602.

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The piezoelectric ultrasonic device has the potential to become routinely incorporated into almost every component of endodontic treatment, re-treatment, and apical microsurgery. It is already indispensable as a precise tool with which the most challenging clinical situations, such as finding hidden root canals and removing root canal obstructions, can be done with relative ease, predictability, and conservancy. It can be seen by the few innovative studies which take advantage of the energizing ability of ultrasound that a thorough understanding of how ultrasonic tips and files behave with irrigants and tooth structure can produce methods and conditions to truly enhance the beneficial effect of such energy in the confined root canal space.

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Naderian, Ashkun, Hooman Baghaie, and Vysheki Satchithanandha. "Accidental ingestion of an endodontic file: a case report." Journal of Medical Case Reports 16, no. 1 (2022). http://dx.doi.org/10.1186/s13256-022-03363-1.

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Abstract Background Ingestion of dental instruments is rare during dental surgery but can result in serious complications. Here we describe a case in which an endodontic hand file was accidentally misplaced in situ during endodontic (root canal) therapy. Plain radiographs were used to identify its location, and serial imaging was used to monitor passage of the endodontic file through the gastrointestinal tract, and it ultimately passed without intervention. We conclude by describing methods for surveillance and management of ingested dental instruments. Case report A 62-year-old Caucasian male presented to the Emergency Department approximately 2 hours after suspected ingestion or inhalation of an endodontic hand file. He had experienced two episodes of excessive coughing and dyspnea while undergoing endodontic therapy, and was promptly referred by his dentist for further investigation. On admission, plain abdominal radiographs confirmed the position of the file in the duodenum, and serial radiographs were used to monitor its transition and clearance through the gastrointestinal tract. During this time, the patient did not demonstrate any clinical signs of bowel perforation, nor was there any radiographic evidence of pneumoperitonium. The patient was discharged after a final radiograph confirmed the absence of the foreign body. Conclusion Ingestion and inhalation of dental instruments can be life threatening and should be managed cautiously, with early input from general surgeons, gastroenterologists, or respiratory physicians for possible endoscopic retrieval, emergent laparotomy, or surgical intervention. Imaging studies are useful for discerning the position of the foreign body and to determine whether retrieval is possible, and the management will ultimately depend on the position and characteristics of the foreign body, as well as risk factors from the patient which may increase the likelihood of perforation, obstruction, or impaction.

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Lima, Taís da Silva, Lara Biliato Alves, and Fábio Pereira Linhares de Castro. "Methods for Removing Fractured Endodontic Instruments in Root Canal : A Brief Systematic Review." MedNEXT Journal of Medical and Health Sciences, June 10, 2021, 20–25. http://dx.doi.org/10.34256/mdnt2134.

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Introduction: In the scenario of endodontic treatment, fracture of the instrument complicates the endodontic procedure by obstructing debridement, delaying the completion of treatment, and affecting the patient's dental experience. When a file fractures during root canal treatment, several treatment options are available. Fractured endodontic instruments inhibit optimal cleaning and filling of root canals. Objective: To carry out a brief systematic review study to present the main clinical outcomes of different types of techniques for removing fragments of endodontic instruments in root canals. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from November 2020 to January 2021 and developed based on Scopus, PubMed, and SCIENCE DIRECT. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 132 articles were found involving the removal of fragments of endodontic instruments. A total of 80 articles were evaluated in full and 30 were included and evaluated in the present study. It has been found that the probability of successful removal of a fractured instrument is reported to range from 53 to 95%, with more than 80% of fractured instruments being removed by the use of ultrasound. Also, long fragments (0.4 mm) can adsorb ultrasonic energy and hinder its loosening. Nickel-titanium (NiTi) instruments with their pseudo-elasticity, especially the newly developed heat-treated NiTi instruments are more ductile and flexible compared to conventional NiTi2. Conclusion: Fractured instruments can be removed by a variety of methods, such as good ultrasonic tips, microtubule devices, and hemostatic pliers/forceps. Removing a fractured file is associated with considerable risk, and therefore the fragment must be circumvented. A cost-benefit analysis of the treatment should be considered before selecting a definitive treatment for the patient.

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Yamashita, Yuki, Motoi Ugajin, Saki Yanoma, Masakatsu Yamashita, and Hisanori Kani. "A case of surgical treatment for bronchial foreign bodies with obstructive pneumonia." Respirology Case Reports 12, no. 3 (2024). http://dx.doi.org/10.1002/rcr2.1325.

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AbstractChildren and older adults are prone to unintentional foreign body aspiration. A 69‐year‐old man with fever and anorexia presented with obstructive pneumonia resulting from foreign body aspiration. Attempts to remove the foreign body using a bronchoscope failed due to its adhesion to the periphery of the bronchus. Although antibiotic therapy did not improve the obstructive pneumonia caused by the bronchial foreign body, surgery enabled an improvement. The surgical specimen showed similar pathological findings as the fine brown granular material observed in root granulomas occurring as a complication following leakage of root canal filling used in the treatment of dental caries. Therefore, the bronchial foreign body may have been a dental filling. Case reports describing surgical improvement of difficult‐to‐remove bronchial foreign bodies with concurrent infection are rare.

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Favaro, Helena, Halana Boni Condessa Linhares de Castro, and Fábio Pereira Linhares de Castro. "Major observations of root canal instrument fractures and techniques for treatment and removal of endodontic instrument fragments: a systematic review." MedNEXT Journal of Medical and Health Sciences 5, S4 (2024). http://dx.doi.org/10.54448/mdnt24s409.

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Introduction: In the context of root canal endodontic treatments, fracture of instruments in the root canal during canal shaping is reported as one of the most common reasons for a negative prognosis. Nickel-titanium (Ni-Ti) instruments stand out. However, Ni-Ti instruments can fracture, with a prevalence of approximately 1.6% (0.7-7.4%). Special techniques to retrieve obstructing objects, such as ultrasonic instruments, hollow tubes with cyanoacrylate adhesive, trepanation techniques using an ultrasonic tip or a trepan bur, endo-extractors and welding with neodymium: yttrium-aluminum-perovskite (Nd: YAG) laser, and surgical techniques have been proposed. Objective: It was to develop a systematic review of the endodontic literature to externalize and discuss the main observations of fractures of root canal instruments, as well as to show the main techniques for treatment and removal of fragments of endodontic instruments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 93 articles were found, 34 articles were evaluated and 08 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 32 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2 =89.5% >50%. It was concluded that comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. No consensus has been reached on a safe technique with a high success rate for removing broken instruments. Fracture of nickel-titanium (Ni-Ti) instruments during root canal instrumentation leads to compromised results in endodontic treatments. Thus, irradiation for a clinical procedure involving the use of a Neodymium: Yttrium-Aluminum-Perovskite (Nd: YAP) laser has shown good performance for removing fractured nickel-titanium files. Thus, fractured instruments can be removed by a variety of methods, such as good ultrasonic tips, microtubule devices, and hemostatic pliers/forceps. These techniques require qualified use of the operating microscope. Removing a fractured file is associated with considerable risk, and therefore the fragment must be circumvented. Removing fractured instruments can be expensive in terms of time and equipment. Thus, a cost-benefit analysis of the treatment must be considered before selecting a definitive therapy for the patient.

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Raad, Micheal, and Peter Derman. "Endoscopic Posterior Cervical Foraminotomy and Discectomy." JBJS Essential Surgical Techniques 15, no. 2 (2025). https://doi.org/10.2106/jbjs.st.24.00003.

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Background: Open posterior cervical foraminotomy has been shown to be comparable with anterior cervical discectomy and fusion (ACDF) in the treatment of cervical radiculopathy 1,2 . More recently, posterior endoscopic cervical foraminotomy was described as an ultra-minimally invasive technique that allows for neural decompression in cervical radiculopathy. This technique has been shown to have excellent clinical outcomes with a short length of hospital stay and low postoperative pain levels 3 . Description: The procedure is performed with the patient in the prone position under general anesthesia. Fluoroscopy is utilized to mark out the incision and target the medial-most aspect of the facet at the level of foraminal stenosis. Sequential dilators are then inserted to create a working canal, and the endoscope is introduced. Soft tissue is cleared until the classic “V” interlaminar anatomic landmark is visualized. The superior edge of the cephalad lamina and the inferior articular process are resected until the superior articular process is identified. The superior articular process is then thinned out with use of a diamond burr and resected carefully with use of a Kerrison punch, allowing visualization of the nerve beneath. Decompression should be wide, carried out from pedicle to pedicle and as laterally as required. A discectomy may be performed at this stage. Alternatives: Alternatives include open posterior cervical foraminotomy, ACDF, and cervical disc arthroplasty. Rationale: In the case of isolated cervical radiculopathy, the pathology is limited to the foramen. The foramen may be approached either anteriorly or posteriorly. However, in order to successfully address the foramen anteriorly, a complete discectomy should be performed. In such cases, either a fusion or disc arthroplasty should be performed concurrently with the discectomy. Both fusion and disc arthroplasty are associated with complications such as adjacent segment degeneration, implant subsidence, infection, nonunion, and others 4 . Posterior foraminotomy allows for successful neural decompression posteriorly, but when performed in an open fashion it requires substantial soft-tissue dissection for an appropriate exposure, which may result in notable postoperative neck pain. Posterior endoscopic cervical foraminotomy addresses many of these shortcomings because it allows for successful neural decompression through an endoscope, with minimal soft-tissue dissection; maintains range of motion; and preserves most of the disc at that level 4 . Furthermore, this technique does not preclude or complicate the ability to perform a full discectomy anteriorly in the future, if needed. Expected Outcomes: Endoscopic posterior cervical foraminotomy has been shown to have excellent clinical outcomes; however, as with any spinal surgery, it carries a risk of complications. Kim et al. compared outcomes between uniportal endoscopic cervical foraminotomy, biportal endoscopic cervical foraminotomy, and tubular cervical foraminotomy. All 3 techniques demonstrated similar outcomes at 1 month in terms of pain improvement; however, length of hospital stay and overall complication rates were lowest in the uniportal endoscopy group 5 . In a recent meta-analysis, Guo et al. compared endoscopic cervical foraminotomy and ACDF for the treatment of cervical radiculopathy. Postoperative pain, symptom resolution, and complication rates were similar between procedures. The most common complications were cage subsidence and dysphagia for ACDF compared with nerve root palsy for endoscopic foraminotomy 6 . Important Tips: Dropping your hands medially allows for undercutting of the inferior articular process, maximizing foraminal expansion while preserving as much facet joint as possible. At least 50% of the facet joint should be maintained in order to avoid iatrogenic instability.To improve hemostasis, transiently increase fluid pressure by obstructing fluid outflow or advancing the endoscope. Pump pressure settings can also be temporarily increased if needed; however, care must be taken not to compromise intrathecal circulation or elevate intracranial pressure.Pulling disc fragments straight out frequently results in fragmentation. Instead, we recommend maintaining a gentle grasp and utilizing a twisting motion to extract disc herniations in the case of larger fragments.Understand the learning curve for performing posterior endoscopic cervical foraminotomy and plan accordingly for case duration 6 . Acronyms and Abbreviations: PECF = posterior endoscopic cervical foraminotomyLOS = length of stayIAP = inferior articular processSAP = superior articular processNSAID = nonsteroidal anti-Inflammatory drugMRI = magnetic resonance imagingOR = operating roomAP = anteroposteriorVAS = visual analog scaleUPE = uniportal endoscopyBP = biportal endoscopy

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Journal articles on the topic 'Root canal obstruction'

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