Queen Victoria Hospital

Facial nerve palsy (FNP) impacts the ocular and periocular regions. Preganglionic trigeminal nerve palsy (PrGTP) may complicate preganglionic FNP (PrGFP), resulting in neurotrophic keratopathy (NK), risking corneal sequelae. We present a case series where comprehensive eyelid surgery (CES) to manage the eyelid sequelae of PrGFP, complicated by PrGTP, resulted in the recovery of corneal sensation, avoiding corneal neurotisation surgery (CNS). A retrospective case series of three patients with PrGFP and PrGTP in whom eyelid abnormalities were addressed through CES. Outcome measures include markers of trophic function, including ocular surface integrity as determined by fluorescein assessment of cornea staining and corneal sub-basal nerve plexus density (CSND) via in vivo confocal microscopy where available. Corneal scarring was assessed, and corneal sensitivity was determined via Cochet-Bonnet or corneal wisp testing. Three patients with longstanding PrGFP and PrGTP (mean of 28.3 (range 18-49) months) underwent CES to correct the eyelid sequelae of FNP. On presentation, two out of three cases had a complete absence of corneal sensation, while one out of three had reduced sensation. All cases had absent trophic nerve function. Following CES, trophic function and corneal sensation started to improve on average 19 days and 10 months later, respectively, for the three patients. CSPD had nearly doubled at 6 months postoperatively in the patient who had this assessed. In cases of NK due to PrGTP complicated by PrGFP, CES should be attempted before considering CNS since improvement in corneal sensation and trophic function may occur. CES helps to reduce exposure and may improve corneal sensation regardless of aetiology.

The prevalence of incidental intraocular malignancy in eye removal cases due to phthisis bulbi remains poorly understood. This retrospective study evaluates the prevalence of unsuspected intraocular malignancies in eye removal specimens. Retrospective study of 1897 evisceration and enucleation specimens submitted for histopathological examination in the UK between 2014 and 2023 submitted to Department of Eye Pathology (DEP), a laboratory within the National Specialist Ophthalmic Pathology Service (NSOPS). Among 664 cases meeting inclusion criteria, the incidence of unsuspected malignancy was 0.75% (n = 5). All cases involved evisceration, with malignancies including melanoma, squamous cell carcinoma in situ, and undifferentiated spindle cell tumours, involving one case of malignancy of a corneal button. One case changed to suspected malignancy intraoperatively due to the findings noted during evisceration. Preoperative clinical assessments, including B-scan ultrasonography, failed to detect malignancies in these cases, highlighting the importance of comprehensive preoperative evaluation. These findings underscore the need for histological examination in end-stage eyes to identify hidden malignancies and inform treatment decisions. While the overall risk of unsuspected intraocular malignancy remains low, this study reinforces the necessity of considering enucleation when intraocular tumours cannot be reliably excluded preoperatively. This data also emphasises the importance of informed consent and shared decision-making, incorporating the small but material risk of malignancy into pre-operative discussions with patients.

ABSTRACT This research aims to improve distance education in orthopedic surgery by leveraging extended reality (XR) and artificial intelligence (AI). It focuses on skill acquisition, feedback, and behavioral training in clinical settings. The study involved 57 experts and included surveys, interviews, and literature reviews to explore how these technologies can improve medical education, focusing on the Challenge Point Framework (CPF). A cognitive task analysis was performed with six experts to refine the XR and AI system, ensuring it aligns with competency-based educational standards for orthopedic surgery. The findings highlight the importance of XR and AI in higher education, promoting the democratization of XR educational tools. The study also examines CPF algorithms for training in total knee replacement (TKR) surgery within virtual environments, aiming to improve mathematical modeling and explore how humans and AI can collaborate in surgical practices. The research seeks to develop customized XR applications for different educational areas, providing a framework for using XR and AI in TKR training. This initiative aims to change how orthopedic education is delivered, enhancing the training experience for surgical professionals. By applying activity theory, the study plans to create an engaging learning experience that enhances both knowledge and practical skills in the field.

Purpose: This is the second part of the comprehensive review of dacryoscintigraphy (DSG), which evaluates the major factors that hinder the routine utility of DSG and possible future directions to improve the technology. Methods: The authors performed a PubMed/Medline search of all articles published in English and other languages on DSG. The data analyzed included the techniques and indications of DSG, the interpretation of the results, and the clinical utility and limitations of DSG. Results: The present major review suggests that the findings of DSG do not add significantly to a thorough clinical examination. The diagnostic reliability of DSG is limited by the lack of standardization, poor anatomical resolution, poor quality of images, intra and interobserver variability, low specificity, insufficient correlation with clinical findings, the inability to distinguish stenosis from obstructions, and the inability to assess the results of lacrimal surgery. These limitations raise concerns regarding any justification for its use in everyday lacrimal practice. Conclusions: DSG is not routinely used by the vast majority of lacrimal surgeons worldwide given that in most cases, it does not profoundly impact clinical decision-making. The DSG technology needs to be improved. Hybrid camera devices with higher resolution, and new radiotracers that simulate the biological and chemical properties of tears may help pave the way forward.

Abstract Aim Plastic surgery has historically been underrepresented within medical school curricula. A national student-led conference, organised by the Plastic, Reconstructive, and Aesthetic Surgery Student Association (PRASSA), sought to address this gap. This study aims to assess the conference's educational value in expanding medical students’ knowledge of plastic surgery and developing relevant surgical skills. Method 106 out of 120 (88.3%) delegates completed pre and post conference surveys (1–5-point Likert scale). Assessing interest in pursuing plastic surgery as a career, familiarity with organisations, understanding of various subspecialties, and confidence in performing key plastic surgical techniques: suturing, tendon repair, and microsurgical nerve repair. Data was analysed using Wilcoxon signed-rank test. Results Familiarity with BAPRAS (2.74 ± 1.41 to 3.98 ± 0.93; p<0.01) and PLASTA (2.38 ± 1.27 to 4.12 ± 0.89; p<0.01) increased significantly. Knowledge of plastic surgery in global reconstructive surgery (2.26 ± 1.15 to 4.09 ± 0.76), innovations (2.17 ± 1.06 to 3.89 ± 0.90) and military trauma (2.11 ± 1.18 to 4.17 ± 0.72) all increased significantly (p<0.01). Familiarity of career options within plastic surgery increased significantly (2.62 ± 1.16 to 4.14 ± 0.73; p<0.01). Confidence in practical skills also improved significantly: suturing (2.88 ± 1.20 to 4.34 ± 0.73; p<0.01), tendon repair (1.53 ± 0.94 to 3.76 ± 0.90; p<0.01), and microsurgical nerve repair (1.31 ± 0.70 to 3.69 ± 1.25; p<0.01). Overall, 80.2% (85) were more interested in plastic surgery as a career after attending the conference. Conclusions The conference significantly enhanced delegates' knowledge, practical skills, and interest in plastic surgery, highlighting the educational value of undergraduate initiatives in addressing gaps within undergraduate curricula and fostering early career development.

This article underscores the need for comprehensive interpretation of dental panoramic tomograms (DPTs), emphasising the significance of dental anatomy and broader head and neck structures. While general dental practitioners (GDPs) commonly use DPTs for diagnosing dental pathology, there is a tendency to focus solely on the dentition, overlooking information related to head and neck anatomy. The potential medico-legal consequences associated with incomplete reporting make a thorough assessment imperative. The article introduces 'the Heath-MacLeod technique' for reporting, outlining a systematic approach to ensure all aspects are considered. This stresses the importance of a holistic approach to DPT interpretation using a 'radiological sieve', improving patient care and reducing the risk of misdiagnoses and legal consequences.This article is for GDPs on the wealth of anatomy of the maxillofacial region as seen on a DPT and discusses technical errors and examples of pathology. This in turn will provide a foundation of knowledge, allowing for a robust reporting technique, ensuring no clinical information is missed. This not a comprehensive analysis of pathology seen on a DPT but introduces concepts which will allow safe reporting. The reader should be able to analyse the key anatomy seen on a DPT, its presence or absence and how this applies to the holistic management of the patient.

The scarring that occurs following a burn injury can have devastating physical and emotional consequences for the patient. Scar revision surgery can be very effective, but when surgical options are exhausted or the patient declines, camouflage is an alternative. A 43-year-old woman with mid-deep dermal flame burns sustained in a house fire in August 2020, comprising 6% total body surface area, underwent chemical debridement followed by allograft application. One month later, the patient underwent surgical debridement with a split-thickness skin graft to an unhealed area on her left posterior shoulder. This procedure was successful, with 100% graft take. During her follow-up visits, she developed hypertrophic scarring in this region, which shifted the focus of her care to scar management. We developed a custom-made silicone gel prosthesis to camouflage the scar, help the patient regain confidence, and also provide therapeutic benefit by sealing in hydration. The prosthesis was matched to the patient's normal skin tone and texture, featuring a soft and flexible outer surface with a smooth inner surface for adherence. The patient found the prosthesis easy to apply and inconspicuous, yet effective at concealing the scarred area. The prosthesis also offered protection from external sources of irritation. Both the Patient and Observer Scar Assessment Scale and the Modified Vancouver Scar Scale showed marked improvement when the prosthesis was used.