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Hyun-joon Sohn - One of the best experts on this subject based on the ideXlab platform.
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Variant Origin of Obturator Artery: A Branch of Inferior Epigastric Artery from External Iliac Artery
Korean Journal of Physical Anthropology, 2013Co-Authors: Hyun-joon SohnAbstract:The Obturator artery normally originates from the internal iliac artery. However, variation in the origin of Obturator artery has been reported in many countries. Since no such case has been reported in Korea, we examined variations in the origin of Obturator artery in cadavers donated to the medical school at the Chungbuk National University. Thirty-six pelvic halves from 18 cadaveric subjects (13 males and 5 females) were studied in this study. Normal origin of the Obturator artery from the internal iliac artery was observed in 88.9% (16/18) of cadavers or in 91.7% (33/36) of pelvic halves. A variation in the origin of Obturator artery was observed in 11.1% (2/18) of cadavers or in 8.3% (3/36) of pelvic halves. All of the variant Obturator arteries originated from external iliac arteries as branches of inferior epigastric arteries. Bilateral presence of variant Obturator arteries was observed in 5.6%(1/18) of cadavers. The Obturator artery arose from inferior epigastric artery at a distance of 1 to 2.4 cm from origin point of inferior epigastric artery, and then the Obturator artery ran inferiorly and medially with the inferior epigastric artery running superiorly and laterally. Presence of variant Obturator artery would be important to clinical fields with interest to pelvic anatomy, such as radiology and surgery.
Ziv Williams - One of the best experts on this subject based on the ideXlab platform.
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femoral branch to Obturator nerve transfer for restoration of thigh adduction following iatrogenic injury
Journal of Neurosurgery, 2011Co-Authors: Konstantinos Spiliopoulos, Ziv WilliamsAbstract:Obturator nerve injury is a rare complication of pelvic surgery. A variety of management strategies have been reported, with conservative measures being the preferred treatment in most cases. While nerve transfer has become more commonly used for restoring brachial plexus injuries, it has rarely been applied to the lower extremities. To the authors' knowledge, this is the first report of an Obturator nerve neurotization. A patient presented 7 months after an iatrogenic right Obturator nerve palsy due to pelvic surgery for gynecological malignancy. She underwent a femoral branch to Obturator nerve transfer to restore right thigh adduction. Ten months after the neurotization procedure, there was electromyographic evidence of almost complete Obturator nerve reinnervation. At 1 year postoperatively, the patient had regained full muscle strength on thigh adduction and a normal gait. Nerve transfer could therefore be a good option in patients with Obturator nerve injury whose symptoms fail to respond to conservative medical therapy.
Jian Sun - One of the best experts on this subject based on the ideXlab platform.
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functional outcome and quality of life after a maxillectomy a comparison between an implant supported Obturator and implant supported fixed prostheses in a free vascularized flap
Clinical Oral Implants Research, 2017Co-Authors: Feng Wang, Wei Huang, Chenping Zhang, Jian SunAbstract:Objective Defects of the maxilla caused by tumor resection create high levels of psychological and physical trauma for patients. The application of osseointegrated dental implants using either an Obturator prosthesis or a free vascularized flap has tremendously changed the retention and stability of the superstructure. However, no study has been performed to compare the function of the aforementioned two approaches and the quality of life using the subjective assessments of patients. Materials and methods Eligible patients who were treated with maxillary resection and rehabilitated with implant supported Obturator prostheses (group 1) or those who received free vascularized flap transfers with implant supported fixed prostheses (group 2) were enrolled between March 2006 and May 2014. A questionnaire that included the indices of the Obturator Functioning Scale (OFS), EORTC Head and Neck 35 assessment and the Mental Health Inventory (MHI) was used to evaluate the functional rehabilitation and QOL of patients in the study. Results A total of 42 dental implants, including 25 zygomatic implants, were used in 18 patients (mean age: 56.2 ± 12.3 years) in the Obturator prostheses in group 1. Twenty patients (mean age: 45.6 ± 14.1 years) who were treated with a vascularized free flap including the fibula (n = 15) and ilium (n = 5) combined with a total of 71 regular implants for fixed prostheses comprised group 2. No statistically significant median differences in the OFS, EORTC Head and Neck assessment and MHI global scale were observed between the groups. On the MHI subscales item-levels, higher median subscale scores exhibited by group 1 than group 2 and had statistically significant difference between the groups (P = 0.024). Conclusion Within the limitations of this study, it demonstrated no difference in oral function between patients with implant supported Obturators and implant supported fixed prostheses in free vascularized flaps after a maxillectomy. However, patients who received Obturator therapy seemed to have poorer mental health than did patients with fixed prostheses, but it should be interpreted prudently with the study's limitation.
Hiroshi Baba - One of the best experts on this subject based on the ideXlab platform.
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a new ultrasound guided pubic approach for proximal Obturator nerve block clinical study and cadaver evaluation
Anaesthesia, 2016Co-Authors: Takayuki Yoshida, T Onishi, Kenta Furutani, Hiroshi BabaAbstract:We evaluated an alternative technique for ultrasound-guided proximal level Obturator nerve block that might facilitate needle visualisation using in-plane ultrasound guidance. Twenty patients undergoing transurethral bladder tumour resection requiring an Obturator nerve block were enrolled into a prospective observational study. With the patient in the lithotomy position, the transducer was placed on the medial thigh along the extended line of the inguinal crease, and aimed cephalad to view a thick fascia between the pectineus and Obturator externus muscles that contains the Obturator nerve. A stimulating nerve block needle was inserted at the pubic region and advanced in-plane with the transducer in an anterior-to-posterior direction. Eight ml levobupivacaine 0.75% was injected within the fascia. The median (IQR [range]) duration for ultrasound identification of the target and injection were 8.5 (7-12 [5-24]) s and 62 (44.5-78.25 [39-383]) s, respectively. All blocks were successful. A cadaver evaluation demonstrated that the dye injected into the target fascia using our technique travelled retrogradely through the Obturator canal, and surrounded the anterior and posterior branches of the Obturator nerve both proximally and distally to the Obturator canal. We believe that this is a promising new technique for ultrasound-guided proximal level Obturator nerve block.
Matthew M Hanasono - One of the best experts on this subject based on the ideXlab platform.
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microvascular free flap reconstruction versus palatal obturation for maxillectomy defects
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Mauricio A Moreno, Roman J Skoracki, Ehab Y Hanna, Matthew M HanasonoAbstract:Background. Palatal Obturators and microvascular free flaps are both used to treat patients with maxillectomy defects, however, the optimal technique remains controversial. Methods. A retrospective analysis of 113 patients undergoing maxillectomy for cancer was performed. Seventy-three patients received an Obturator and 40 patients were reconstructed with a free flap. Results. Speech intelligibility and postoperative diet were comparable between the Obturator and free flap groups, except in cases of extensive (>50%) palatal defects, where free flap reconstruction was superior in both aspects (p = .019 and p = .043, respectively). The average time for presenting with a local recurrence in advanced cancer involving the palate was comparable in both groups (p = .33). Conclusion. Moderate-sized maxillectomy defects involving the palate can be successfully treated with either an Obturator or free flap reconstruction. Extensive defects have a better functional outcome with free flaps. Evidence does not suggest that free flap reconstructions delay diagnosis of local recurrences. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
