Failure in the eruption of the maxillary incisor necessitates a precise diagnosis and treatment regimen. Impaction can have a number of causes such as physical obstacles in the eruption path, discrepancy in the length of the dental arch, and tooth anomaly. Delayed eruption of anterior teeth can result in a number of issues such as malocclusion and psychological discomfort. In many cases, if the intervention is not done at an early stage, complex orthodontic intervention is required after surgical exposure to enable appropriate eruption. This case report is of a nine-year-old child with unerupted maxillary central incisors. The child was treated surgically for incisor exposure under general anesthesia (GA). Both functional and aesthetic considerations made this surgical procedure necessary. GA was administered due to the negative behavior of the child in a dental setting. Hence, it ensured patient comfort and cooperation. Follow-up examinations showed satisfactory progress in the eruption of the teeth with no complications.

As the thumb is pronated, primary repair of complex injuries may be more difficult than the repair of other digits. We describe a simple technique that facilitates thumb repair. We insert a Kirschner wire perpendicular to the bone axis in the middle of the proximal phalanx, which ensures adequate exposure of the palmar aspect without the need for thumb position adjustment by an assistant. This technique is particularly useful when inexperienced surgeons perform thumb replantation and primary flexor tendon repair using a multistrand suture technique.

UNASSIGNED: Impaction of permanent second molar (PM2) is found occasionally. This study tried to explore the risk factors associated with the impacted PM2 teeth and show how to use different treatment modalities to correct the impaction of PM2 teeth.
UNASSIGNED: This study used three cases of PM2 impaction to show how to identify the risk factors of PM2 impaction and how to remove these risk factors to facilitate the eruption of impacted PM2 teeth to the correct occlusal positions.
UNASSIGNED: The first and second cases both showed delayed eruptions of two maxillary PM2 teeth. After resection of the dense fibrotic gingival tissues on the tooth eruption pathway, these two impacted maxillary PM2 teeth finally erupted to the normal occlusal positions by their inherent tooth eruption potential. The second case also had mesioangular impaction of two mandibular PM2 teeth. After odontectomy of teeth 38 and 48, the two impacted mandibular PM2 teeth also erupted to the normal occlusal positions by their inherent tooth eruption potential. The third case had impaction of teeth 17, 27 and 47. After extraction of four third molars and four selected premolars, orthodontic mesialization of four permanent first molars, and orthodontic traction using a mini-screw, the three impacted teeth finally erupted to the normal occlusal positions.
UNASSIGNED: We conclude that after removing the obstacles on the tooth eruption pathway, the impacted PM2 teeth usually can erupt to their normal occlusal positions by their inherent tooth eruption potential with or without the assistance of orthodontic traction.

OBJECTIVE: The lateral aspect of the cerebellomesencephalic fissure frequently harbors vascular pathology and is a common surgical corridor used to access the pons tegmentum, as well as the cerebellum and its superior and middle peduncles. The quadrangular lobule of the cerebellum (QLC) represents an obstacle to reach these structures. The authors sought to analyze and compare exposure of the cerebellar interpeduncular region (CIPR) before and after QLC resection and provide a case series to evaluate its clinical applicability.
METHODS: Forty-two sides of human brainstems were prepared with Klingler\'s method and dissected. The exposure area before and after resection of the QLC was measured and statistically studied. A case series of 59 patients who underwent QLC resection for the treatment of CIPR lesions was presented and clinical outcomes were evaluated at 1-year follow-up.
RESULTS: The anteroposterior surgical corridor of the CIPR increased by 10.3 mm after resection of the QLC. The mean exposure areas were 42 mm2 before resection of the QLC and 159.6 mm2 after resection. In this series, ataxia, extrapyramidal syndrome, and akinetic mutism were found after surgery. However, all these cases resolved within 1 year of follow-up. Modified Rankin Scale score improved by 1 grade, on average.
CONCLUSIONS: QLC resection significantly increased the exposure area, mainly in the anteroposterior axis. This surgical strategy appears to be safe and may help the neurosurgeon when operating on the lateral aspect of the cerebellomesencephalic fissure.

Although keyhole transorbital approaches are gaining traction, their indications have not been adequately studied comparatively. In this study the authors have defined them also as transwing approaches-meaning that they use the different facies of the sphenoid wing for cranial entry-and sought to compare the four major ones: 1) lateral orbitocraniotomy through a lateral canthal incision (LatOrb); 2) modified orbitozygomatic approach through a palpebral incision (ModOzPalp); 3) modified orbitozygomatic approach through an eyebrow incision (ModOzEyB); and 4) supraorbital craniotomy through an eyebrow incision (SupraOrb), coupled with its expanded version (SupraTransOrb).
Cadaveric dissections were performed at the neuroanatomy lab. To delineate the skull base exposure, four formalin-fixed heads were used, with two sides dedicated to each approach. The outer limits were assessed via image guidance and were mapped and illustrated accordingly. A fifth head was dissected purely endoscopically, just to facilitate an overview of the transwing concept. Qualitative features were also rigorously examined.
The LatOrb proves to be more versatile in the middle cranial fossa (MCF), whereas the anterior cranial fossa (ACF) exposure is limited to a small area above the sphenoid ridge. An anterior clinoidectomy is possible; however, the exposure of the roof of the optic canal is suboptimal. The ModOzPalp adequately exposes both the ACF and MCF. Its lateral trajectory allows the inferior to superior view, yet there is restricted access to the medial anterior skull base (olfactory groove). The ModOzEyB also provides extensive exposure of the ACF and MCF, but has a more superior to inferior trajectory compared to the ModOzPalp, making it more appropriate for pathology reaching the medial anterior skull base or even the contralateral side. The anterior clinoidectomy is performed with improved visualization of the optic canal. The SupraOrb provides mainly anterior cranial base exposure, with minimal middle fossa. An anterior clinoidectomy can be performed, but without any direct observation of the superior orbital fissure. Some MCF access can be accomplished if the lateral sphenoid wing is drilled inferiorly, leading to its highly versatile variant, the SupraTransOrb.
All the aforementioned approaches use the sphenoid wing as skull base corridor from a specific orientation point; hence these are designated as transwing approaches. Their peculiarities mandate careful case selection for the effective and safe completion of the surgical goals.

Although impaction of the maxillary permanent central incisor is uncommon in dentistry due to its significance to facial aesthetics which are challenging to treat. To abstain from the consequences related to aesthetic and functional occlusion, early detection of an impacted central incisor is imperative. This case report describes a male patient, aged 22 years, who had an impacted central incisor tooth in the maxillary anterior region. A surgery was performed to remove the impacted supernumerary tooth that was preventing the eruption of the central incisor. Using a combination of surgical exposure and orthodontic force, the impacted right maxillary central incisor was relocated to its proper occlusion in the dental arch.

This case study offers a rare and difficult condition involving the impaction of teeth 11, 12, and 13, providing a severe dental challenge. A thorough examination was performed on the patient, which included clinical evaluations and radiographic examinations. Because the impacted teeth were causing discomfort and functional impairment, a multidisciplinary approach was required, which included surgical exposure followed by traction forces to level and align the impacted teeth. The abstract emphasizes the case\'s complexity, digging into the diagnosis process and the establishment of a personalized treatment strategy. The complexities of handling many impacted teeth are explored in length, including surgical intervention, orthodontic considerations, and postoperative care.

Developing adequate exposure when performing a revision total knee arthroplasty is critical to an efficient and safe intraoperative course. Proper planning and knowledge of the relevant anatomy are important when dissecting scar tissue associated with previous trauma or surgery and navigating bone loss. We present a review of the different total knee arthroplasty extensile exposure techniques that have been described in the literature. Specific exposures discussed include the femoral peel, banana peel, medial epicondylar osteotomy, quadriceps snip, tibial tubercle osteotomy, wandering resident, and the V-Y quadricepsplasty with patella turndown. Furthermore, we review the histological healing potential, biomechanical principles that drive post-operative expectations, post-operative rehabilitation protocols, and reported functional outcomes of each technique.

BACKGROUND: Our study examined if there were any limitations when using various measurement techniques in the literature to quantify osseous exposure. Additionally, we also examined if surface contour had any influence on obtained measurements, which no previous study has attempted.
METHODS: Three methods used to quantify osseous exposure area were identified, one in which involves manually applying mesh over exposure area. The other two use digital image capture software (ImageJ, Bethesda, MD). We simulated flat, convex, and mixed surface types using synthetic bone analogs. We assessed the degree of variability between mean values using an ANOVA or Kruskal-Wallis equality of populations rank test. Cronbach\'s alpha test of internal reliability was used to assess the internal reliability of measurement technique.
RESULTS: ANOVA test for difference in measurement techniques on all three surface types was statistically significant (p < 0.05). Cronbach\'s alpha test of internal reliability for each technique on the convex surface did not obtain adequate significance (alpha >0.70). Only the mesh method obtained adequate alpha value for significance when applied to the flat and mixed surface types.
CONCLUSIONS: Each of the three measurement techniques tested demonstrated poor internal reliability. We suggest taking care when comparing studies that use different quantification techniques when calculating osseous exposure for different surgical approaches. Future studies should explore alternative methods of osseous exposure quantification.

Our purpose was to evaluate the efficacy of lateral canthotomy, sub-tenon anesthesia injection, and the use of modified speculum for gaining adequate surgical exposure during surgery for retinopathy of prematurity (ROP). Fourteen eyes of 10 consecutive patients undergoing microincisional vitrectomy surgery (MIVS) for stage 4 and stage 5 ROP were included. There was a significant widening of the palpebral fissure height and length using this technique. No patient developed a lens injury during the surgery. All the canthotomy incisions completely healed at a four-week follow-up visit. This is a safe and effective technique for increasing surgical exposure in cases of ROP requiring vitrectomy.