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ggesting the usefulness of gastroesophageal manometry for continuously evaluating the degree of expiratory effort without influence by the laryngeal condition.
Current treatments for benign vocal lesions consist mainly voice therapy and phonomicrosurgery. However, these options are not always suitable for professional voice users because of their tight performance schedule and limited time for voice rest. This study investigated vocal fold steroid injection (VFSI) as an alternative treatment.

Matched case series.

We retrospectively enrolled 28 professional voice users (i.e., singers, actors and news anchors) who received VFSI for vocal nodules and polyps in an office setting of a tertiary teaching hospital. Outcomes were evaluated using videolaryngostroboscopy (VLS), the 10-item Voice Handicap Index (VHI-10), maximum phonation time, and acoustic and perceptual analyses before and 1 month after VFSI. Study results were compared with 56 patients of nonprofessional voice users (i.e., routine or high occupational vocal demands), matched in a 12 ratio by age, sex, and treatment date.

After VFSI, VLS revealed substantial lesion resolution in 82% professional voice users. One professional voice user developed a self-limited vocal fold hematoma after VFSI. VHI-10 scores in the professional group decreased from 21 to 14 points, compared with 23 to 16 points in the non-professional group, demonstrating a significant within-group effect (P < 0.01, GEE) and a nonsignificant between-group effect (P=0.86). Other outcomes also improved significantly after VFSI (P < 0.05), without significant differences between the two groups.

VFSI can be an effective and safe alternative treatment for professional voice users with benign vocal lesions.
VFSI can be an effective and safe alternative treatment for professional voice users with benign vocal lesions.
Granular cell tumours are extremely rare on peripheral nerves, with an incidence of 0.029% of pathologic samples. check details In a literature review, we found only 5 cases involving the ulnar nerve, although considered the most frequently involvement nerve.

A 32 year-old female from the French West Indies presented a severe arm pain with deficit of interosseous hand muscles. Imaging studies were in favour of a Schwanoma, but during surgery, we found an unremovable intra-neural tumour. Nerve biopsy revealed a granular cell tumour. Initial decision was observation only. However, within two years, tumour increased in size, along with pain aggravation and functional deficit. We performed a nerve resection (with adequate margins) with reconstruction using sural nerve graft associated with a neurotisation of the motor branch with the anterior interosseus nerve. At two years follow-up, no recurrence was observed. The scar is hypersensitive with moderate neuropathic pain. There is a sensory reinnervation of the fourth finger, with no motor recovery of the hand. We observed a slight recovery of flexor profundus tendons, which, in turn increased the claw hand.

The five cases described in the literature were managed differently (biopsy only, excision, excision with reconstruction), with modest results. There is no recommended treatment. Our case is the first at arm level. We were able to perform complete resection, but functional result is poor.

Granular cell tumours require treatment if symptomatic (pain, function loss), but, at the moment, there is no recommended treatment.
Granular cell tumours require treatment if symptomatic (pain, function loss), but, at the moment, there is no recommended treatment.
The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device.

From February 2019to October 2019, 8forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room asepsy, sterile draping, assistant and instrumentation including electrocoagulation.

The procedure was decomposed in 13distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training.

Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.
Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.
In addition to understanding the basic standards of a smile and patient's opinion, dentists should take into account smile aesthetics, an essential factor for optimal outcomes. This study aimed to evaluate the factors that affect the perception of an aesthetic smile and determine its morphological characteristics and measure the gingival aesthetic parameters.

In all, 200 Vietnamese aged 18-35 years were recruited to have their spontaneous smiles captured. These smile images were assessed by 50 laypersons and 50 dentists using a visual analogue scale measurement. The images were analysed to evaluate perceptions of evaluators, determine smile attractiveness, and measure gingival aesthetics.

The difference in the judgements of laypersons and dentists, males and females, and laypersons aged 18-25 and 26-35 years were nonsignificant. High or average anterior smile line, parallel smile arc, upward upper lip curvature, second premolars as the posterior-most teeth displayed, smile index of 5.23-5.63, and dynamic smile symmetry of 1 were scored highly on smile attractiveness.
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