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PubMed1976

Gingival recession. The condition, process, and treatment.

The condition of gingival recession with its attendant patient complaints and additional professional concerns has been distinguished from the process of recession of the gingiva which has an obscure etiology. It has been suggested that the complaints and concerns regarding gingival recession be treated directly when they occur. Deviation from the expected anatomical form is not considered to be an excuse for therapy. The importance of the anatomical factors of alveolar bone dehiscence (long gingival fiber attachment) and lack of attached gingiva (absence of the fiber barrier) is not known. However, the current modailties of treatment have been examined in light of these hypotheses. Clearly, the effects of these anatomical factors on the process of recession of the gingiva need to be investigated.

Alveolar Process↗
PubMedDate not supplied

The normal width of anterior hip synovial recess in children.

To establish the diagnostic criteria for hip joint effusion, the normal width of the anterior hip synovial recess in children and the difference between both hips of the same child were examined in this study. Eight kindergarten schools were randomly selected for study in Kaohsiung City. The width of anterior hip synovial recess of 1,568 hips in 784 children (421 boys, 363 girls) was measured by ultrasound scanner with 7.5-MHz linear probe. The age of children ranged from 2.5 to 6.6 years old. During measurement, the children were put in supine position with hips and knees in extension and patella facing up. The results revealed that the mean width of the anterior synovial recess was 7.29+/-1.15 mm. Linear correlation of the width of synovial recess to age and height was disclosed and expressed as follows: width (millimeters) equal to 6.52+0.013x age (months), or width (millimeters) equal to 3.97+0.030x height (centimeters). The mean difference between both hips of the same child was 0.611+/-0.523 mm, and the difference was independent from the factors of age, gender, height, or weight (p>0.05). Ninety-five percent of the differences should be < or =1.46 mm, so that if the difference between hips is >1.46 mm, hip joint effusion should be suspected.

Child↗
PubMed2001

Outcome of surgery in 124 cases of Duane's Retraction Syndrome (DRS) treated by intraoperatively graduated recession of the medial rectus for esotropic DRS, and of the lateral rectus for exotropic DRS.

PURPOSE: To determine the outcome and effectiveness of simple horizontal muscle recession surgery in Duane's Retraction Syndrome (DRS). CASES & METHODS: A total of 194 cases of DRS were operated on by us during the past 25 years. Surgery was aimed at improving the binocular alignment and eye position at the primary position as well as any abnormal head posture. Sufficient data were available in 124 cases. Recession of the medial rectus muscle was performed on 76 cases with esotropia and of the lateral rectus on 48 cases with exotropia. Recession dosage was determined during surgery based on three factors: size of the preoperative strabismus in primary position; forced ductions/resistance to traction, and the appearance of the rectus muscle at surgery. RESULTS: Both the primary eye position and the abnormal head posture were satisfactorily improved in 119 cases (89%) after surgery with a result rated "excellent" or "good" by a residual deviation of 7 degrees or less and a definitely improved abnormal head posture, for all types of DRS deviations. CONCLUSION: Recession of the appropriate horizontal rectus muscle is a safe and effective primary procedure for both the primary deviation and abnormal head posture in all types of DRS.

Adolescent↗
PubMedDate not supplied

Safety of steroid injections in the treatment of nasofrontal recess obstruction.

A retrospective review was undertaken to determine if steroid injection is a safe and effective intervention in the management of chronic nasofrontal recess obstruction. Seventy-four patients were identified who had undergone prior endoscopic sinus surgery and subsequently developed nasofrontal recess obstruction that was treated with injection of Kenalog 20 mg/mL (Bristol-Myers Squibb Co., Princeton, NJ) directly into the polyps or fibrosis. The study included 38 men and 36 women with a mean age of 45.4 years. These patients collectively underwent 687 injections, an average of 9.3 injections per patient. The indication was polyposis in 70 patients and fibrosis in 17 patients, with 13 sharing both indications. These patients also required 112 office procedures to maintain nasofrontal recess patency, an average of 1.5 procedures per patient. Three patients eventually required frontal sinus obliteration. The mean follow-up period from the initial injection was 50.1 months, and no complications were reported. Therefore, nasofrontal steroid injection appears to be safe and effective in the treatment of nasofrontal recess obstruction.

Adolescent↗
PubMedDate not supplied

The surgical treatment of undercorrected esotropia: an evaluation of the effect of recession of the medial rectus muscle 13.5 mm from the limbus.

Nineteen patients with residual esotropia following conventional maximum horizontal recess-resect surgery were treated by further recession of the medial rectus muscle to a point 13.5 mm from the limbus. Six of these patients also underwent an 8-mm resection of the ipsilateral lateral rectus in addition to the medial recession. Eighteen of the patients achieved a good to excellent cosmetic result in the primary position. One patient was markedly overcorrected probably secondary to an unwarranted lateral rectus resection. Most of the patients showed some mild limitation of adduction, but this was generally not a significant cosmetic or functional defect. The degree of limitation seen was no greater than that which has been observed in similar patients treated by marginal myotomy. Recession of the medial rectus muscle 13.5 mm from the limbus seems to be a safe and effective method of treating surgically undercorrected esotropia.

Adolescent↗
PubMed2002

[Diagnosis and treatment of congenital recessive cleft palate].

OBJECTIVE: To explore an effective method to diagnose and treat the congenital recessive cleft palate. METHODS: For the treatment of congenital recessive cleft palate, an operation was designed to recover the anatomic length and function mobility of the soft palate. The operation procedure includes incising vertically the midline mucous membrane of the soft palate, creating and pushing back the mucosal flap of the hard palate, making Z-plasty on the nasal mucosa, reconstructing the sling of the levator veli palatini muscle and repairing the palatal defects with the buccinator muscularis mucosae flap. 12 cases of congenital recessive cleft palate have treated with this method. RESULTS: All of the 12 cases obtained good results. Their pronunciation improved obviously. CONCLUSION: The method is effective for diagnosis and treatment of congenital recessive palate, which is worthy of further application.

Adolescent↗
PubMedDate not supplied

Multiplanar reconstructed computed tomography images improves depiction and understanding of the anatomy of the frontal sinus and recess.

AIMS: The use of multiplanar reconstructed computed tomography (CT) images of frontal recess and sinuses was assessed with regard to depiction and understanding of anatomy and effect on surgical approach. MATERIALS AND METHODS: Three otorhinolaryngologists and one radiologist read CT scans of 43 patients referred for routine paranasal sinus scans. Spiral (helical) CT scans were obtained and coronal and parasagittal reconstructions were imaged. Three hundred forty-two readings were analyzed. The scans were assessed in the coronal plane and then in the parasagittal plane. The images were assessed for (i) Bent and Kuhn classification of frontal ethmoidal sinus air cells, (ii) size of frontal sinus ostium (assessed as unsure, normal, small, or large), (iii) use of parasagittal scans regarding additional understanding of the anatomy with particular reference as to how the agger nasi cell and frontal ethmoidal cells were arranged in a three-dimensional space, and (iv) if the parasagittal scan and subsequent three-dimensional picture created altered the surgical approach. The first two criteria were assessed in the coronal plane and then in the parasagittal plane. RESULTS: There was no statistically significant difference between the Bent and Kuhn classification of frontoethmoidal cells on coronal and reconstructed parasagittal images (t-test; p > 0.05). The parasagittal scans were significantly better than the coronal scans for identifying and assessing the size of the frontal sinus ostium (p < 0.001; chi-square test). Assuming an intraobserver change rate (repeat error) of 10% on CT scan observations, an exact binomial test was performed on S-PLUS, which showed that there was a significant (p < 0.001) proportion of observers who changed their rating after looking at the parasagittal scan. There also was significant improvement in observers' abilities to identify and classify the size of the frontal ostium as reflected by the number of observers who changed from being unsure on the coronal scans to sure on the parasagittal scans. Observers felt that the parasagittal scans improved their three-dimensional understanding of the anatomy of the frontal recess by 58% on a 10-point Lickert scale. In 55% of these observations, the surgical plan was altered by a mean of 70.2% on a 10-point Lickert scale based on additional information obtained by viewing the parasagittal scans. CONCLUSIONS: The three-dimensional understanding of the frontal recess is improved greatly by using both coronal and parasagittal reconstructed images as compared with coronal images alone. This had important implications on the planning of the surgery in the frontal recess.

Frontal Sinus↗
PubMed2003

V-pattern esotropia: a review; and a study of the outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 78 consecutive patients.

BACKGROUND: A V-pattern esotropia with bilateral overaction of the inferior oblique (IO) is a common finding. The clinical characteristics of this condition in a large series are not available. Also, data is lacking about the surgical outcome of graded bilateral inferior oblique recessions. Lastly, it is not known whether patients with a V pattern below 15 prism diopters (pd) should have IO weakening when horizontal eye muscle surgery is to be performed. SUBJECTS AND METHODS: Seventy-eight consecutive patients without complicating factors were fully evaluated and submitted to bilateral graded recessions of the IO. In Group 1, 59 patients had a V pattern of 15 pd or more; 55 were also operated for a horizontal imbalance. In Group 2, 19 patients in whom a horizontal surgery was required and who also had a V pattern of less than 15 pd, also had a bilateral graded recession of the IO performed. RESULTS: Preoperative findings: In Group 1, the distribution of V patterns showed 88.1% in the range 15 to 35 pd. A bilateral overaction of the IO, a bilateral underaction of the superior oblique (SO), and elevation in adduction OU were present in 62.7% of the patients. A vertical imbalance was observed in 20.3%. In Group 2, a bilateral overaction of the IO, a bilateral underaction of the SO, and elevation in adduction OU were noticed in 42.1% of the patients. A vertical deviation was seen in 26.3%. After surgery, in Group 1, 83% had less than 15 pd of V pattern or less than 10 pd of A pattern. Surgery reduced a presurgical vertical imbalance, but created a vertical deviation in some cases devoid of hypertropia before surgery. After surgery in Group 2, a full correction or undercorrection was obtained in 63.1% of the patients and an overcorrection to an A pattern in 21.0% Surgery was also prone to induce a vertical deviation. Binocularity: There was an improvement of the fusional status with surgery, (ascertained with the Worth Four Dot Test and major amblyoscope measurement), in patients of both Groups 1 and 2. CONCLUSION: In V-pattern esotropia cases of 15 pd or more the vast majority were in the range 15-35 pd. Overaction of both IO, underaction of both SO, and elevation in adduction OU constituted a triad of co-occurrent signs present in a significant number of patients. A vertical imbalance was detected in 1/5 of the cases. A good outcome (collapse of the V pattern) was obtained with bilateral graded recession of the IO, but this surgery can create a vertical imbalance. In cases of V pattern less than 15 pd, and requiring horizontal surgery, weakening of both IO's can be advised.

Child↗
PubMed1992

[Synovial recesses and bursae of the lumbosacral joint].

There are four types of cavities of the lumbosacral joints. Type A: The synovial membrane is all around attached to the margin of the articular facet of the superior articular process of the sacrum. Type B: The synovial membrane extends to the posterior surface of the sacrum forming a recess at the root of the superior articular process; this recess communicates widely with the cavity of the joint. Type C: The synovial membrane also forms a recess similar to that of type B, but the gap of communication is narrowed by a fibro-adipose meniscoid. Type D: The synovial membrane is attached in the same way as described in type A; besides a synovial bursa non communicating with the cavity is found at the root of the superior articular process. We have found 43% showing type A, 33% type B, 16% type C and 8% type D. The recesses and bursae described above enable the inferior articular process of the fifth lumbar vertebra to slide at the posterior surface of the sacrum, thus avoiding a painful rubbing during dorsiflexion of the lumbar spine. The existence of these sliding facilities does not depend on the range of the lumbosacral angle nor on the quality of the lumbosacral intervertebral disc.

Adult↗
PubMed2005

Everybody else is: Networks, power laws and peer contagion in the aggressive recess behavior of elementary school boys.

This paper develops a simple random network model of peer contagion in aggressive behavior among inner-city elementary school boys during recess periods. The model predicts a distribution of aggressive behaviors per recess period with a power law tail beginning at two aggressive behaviors and having a slope of approximately -1.5. Comparison of these values with values derived from observations of aggressive behaviors during recess at an inner-city elementary school provides empirical support for the model. These results suggest that fluctuations in aggressive behaviors during recess arise from the interactions between students, rather than from variations in the behavior of individual students. The results therefore support those interventions that aim to change the pattern of interaction between students.

Child↗
PubMed2005

[Autosomal recessive forms of Charcot-Marie-Tooth disease].

In some countries with a high prevalence of consanguineous mariage, autosomal recessive inheritance probably accounts for the vast majority of all forms of CMT. Like dominant forms, autosomal recessive forms are generally subdivided into demyelinating forms (autosomal recessive CMT1: AR-CMT1 or CMT4) and axonal forms (AR-CMT2). Genetic analysis of large families with recessive transmission has identified several novel CMT-related genes (GDAP1, MTMR2, MTMR13, KIAA1985, NDGR1, periaxin and lamin). Given the clinical, electrophysiological and histological heterogeneity of this disease, numerous culprit genes probably remain to be discovered, leading to an even more complex classification. Clinical and histological features often point to the involvement of a particular gene. Nerve biopsy and molecular studies can contribute to the diagnosis, but this approach is highly time-consuming and can only be performed in specialized laboratories.

Charcot-Marie-Tooth Disease↗
PubMed2005

Distinct phenotypes within autosomal recessive ataxias not linked to already known loci.

Autosomal recessive ataxias represent a large group of neurodegenerative disorders characterized by progressive degeneration of central and peripheral nervous systems and a genetic heterogeneity. To analyse clinical, neurophysiological and nerve biopsy findings in 14 Tunisian unrelated families showing linkage exclusion to the known autosomal recessive ataxia loci, 20 Tunisian families with a total of 73 affected subjects were selected on the presence of a clinical phenotype associating a cerebellar ataxia with retained tendon reflexes on at least the index patient. A genetic linkage study was performed with markers spanning the Friedreich ataxia, Spastic ataxia of the Charlevoix-Saguenay, Autosomal recessive ataxia associated with isolated vitamin E deficiency, Ataxia with oculomotor apraxia, Infantile onset spinocerebellar ataxia, Ataxia with Hearing Loss and Optic Atrophy, AT, ATLD, Spinocerebellar ataxia with axonal neuropathy, Cayman ataxia, Cerebellar ataxia with mental retardation optic atrophy and skin abnormalities, Salla syndrome, Marinesco-Sjögren and the Childhood Spinocerebellar Ataxia loci. Out of the 20 families, 4 showed linkage to the spastic ataxia of the Charlevoix-Saguenay locus, one to the Friedreich ataxia locus and one to the Ataxia with oculomotor apraxia locus. Linkage to all tested loci has been excluded in the 14 remaining families. These families were divided into 3 groups according to tendon reflex status in lower limbs which appear as the most obvious distinguishing clinical sign between patients and families: Group A was characterized by brisk tendon reflexes in lower limbs, group B by a homogeneous feature of tendon reflexes with the absence of ankle reflexes and brisk knee reflexes and group C by variable features of tendon reflexes in lower limbs within the same family. Haplotype analysis and Lod score calculation did not show any evidence of linkage to the 16 known loci of cerebellar ataxias. Aim of this study was to reveal the vast clinical phenotypic variability in patients with autosomal recessive ataxia not linked to known loci. Data obtained indicate that detailed clinical and neurophysiological nerve investigations will be essential in order to pool patients within homogeneous subgroups for gene mapping.

Cerebellar Ataxia↗
PubMed2006

[The measurement of pneumatized mastoid and facial recess in cochlear implant recipients younger than three years old].

OBJECTIVE: To evaluate the postnatal growth of mastoid air cells and facial recess and the implications for cochlear implantation in very young children. METHOD: Thirty-two pediatric cochlear implant recipients younger than three years were enrolled in this study. Before implantation, pneumatized mastoid and facial recess were measured by high resolution computed tomography (HRCT) and compared with direct anatomical measurement in implantation. RESULT: We found the similar result in two measurements. All recipients had facial recess and there was no significant difference of the volume between the recipients in this study and the children in another group who were older than seven years old (P >0.05). The size of pneumatized mastoid was significantly different between recipients younger than 16 months and those older (P <0.05). CONCLUSION: (1) HRCT is very clinically valuable in making accurate diagnosis and surgical plan. (2) The facial recess is already adult size in children younger than three years old. (3) The size of pneumatized mastoid may affect mastoidectomy in cochlear implantation in very young children.

Child, Preschool↗
PubMed1991

Modified levator aponeurosis recession for upper eyelid retraction in Graves' disease.

Recession of the levator aponeurosis has proved to be an excellent operation to correct upper eyelid retraction in Graves' disease. Harvey and Anderson's original description included recession of the levator aponeurosis along its entire width and complete extirpation of Müller's muscle. In a modification of the technique, we recess only the lateral two thirds of the levator/Müller's complex. Also, rather than excising Müller's muscle, we simply recess it en bloc with the levator aponeurosis. The lateral horn of the levator is cut, as previously advocated, to relieve the marked temporal elevation of the eyelid characteristic of Graves' lid retraction. This modified procedure provides good upper lid lengthening, with less surgical manipulation, less bleeding, and avoids medial over-corrections. Of 22 upper lids (12 patients) treated with this procedure, 19 (86.3%) were considered "good" after the operation.

Adult↗
PubMed1990

Recession of the superior oblique tendon in A-pattern strabismus.

We performed 9 to 12 mm of recession of the superior oblique tendon for A-pattern strabismus in 10 patients. The average preoperative A-pattern measured 29.4 prism dioptres (PD), and the average pattern correction was 29.3 PD. All patients had a residual pattern of 6 PD or less (average 2.3 PD). No patient experienced significant underaction of the superior oblique, and other surgical complications, such as ptosis, Brown's syndrome, and laceration of the vortex vein or superior rectus, did not occur. The procedure corrected 14 to 40 PD of A-pattern. The amount of pattern corrected was correlated with the size of the preoperative A-pattern but not with the total amount of recession done. No significant shift in esodeviation in primary position was noted in the patients who underwent only superior oblique recession. The procedure appears to be of particular value in patients with moderate superior oblique overaction. The advantages of recession of the superior oblique tendon include the potential for reversibility and reoperation, low risk of induced superior oblique palsy, allowance for asymmetric surgery and potential for adjustable suture technique.

Accommodation, Ocular↗
PubMedDate not supplied

Percutaneous quadriceps recession: a technique for management of congenital hyperextension deformities of the knee in the neonate.

Percutaneous quadriceps recession was compared with open quadricepsplasty in the Finder's type 5 category of congenital hyperextension deformities. Six open quadricepsplasties and six percutaneous recessions were performed between the ages of 5 and 58 days. Follow-up averaged 2 years 3 months. All knees remained reduced and maintained an improved range of motion (ROM). Percutaneous recession avoids a long incision, requires less dissection and surgical time, and has a shorter healing time. When performed in the neonate, percutaneous recession eases management of the child and treatment of coexistent deformities.

Follow-Up Studies↗
PubMed1989

Bimedial rectus recession measured from the limbus for congenital esotropia.

We reviewed the surgical results of bimedial rectus muscle recession measured from the limbus in 34 patients with congenital esotropia less than 1 year of age. The mean amount of recession was 10.8 mm. The procedure was successful (10 delta or less of horizontal deviation at 6 months) in 23 patients (68%). In all but one case failure was due to undercorrection. The success rate was 81% in the small-angle deviation group, compared with 29% in the large-angle deviation group (p less than 0.01). The average amount of deviation before surgery was 54.4 delta in the surgical success group and 65.0 delta in the undercorrection group (p less than 0.02). More surgery should be done in patients with larger deviations. Prospective randomized studies are needed to evaluate the efficacy of recession from the limbus versus recession from the insertion site.

Esotropia↗
PubMed1988

Urethral recess in two male llamas.

Contrast radiography revealed a urethral recess in 2 male llamas, and, in 1, an incidental cyst in the wall of the pelvic urethra. The urethral recess was similar to that found in cattle, sheep, goats, and camels. The presence of a urethral recess in llamas makes catheterization of the urinary bladder as difficult in this species as it is in the other species with urethral recesses.

Animals↗