Acute aortic dissection usually presents with abrupt chest or back pain, but neurological symptoms may dominate the presentation and mimic acute ischemic stroke. We report a case of a 50-year-old woman who presented with recurrent transient left-sided weakness. The initial episode persisted during early hospital assessment and resolved as brain magnetic resonance imaging was initiated. A second episode occurred during subsequent aortic computed tomography angiography and lasted approximately 20 minutes. Brain computed tomography and diffusion-weighted magnetic resonance imaging showed no acute abnormality, while magnetic resonance angiography of the head and neck showed no large-vessel occlusion or cervical arterial involvement. A marked inter-arm blood pressure difference prompted computed tomography angiography of the chest, abdomen, and pelvis, which demonstrated an acute Stanford type B aortic dissection extending from the proximal descending thoracic aorta to the infrarenal abdominal aorta. The dissection occurred in a Type I right-sided aortic arch with mirror-image branching, consisting of a left brachiocephalic trunk followed by the right common carotid and right subclavian arteries. The dissected descending thoracic aorta measured up to 6.7 × 5.4 cm. The patent false lumen supplied the right renal artery, with delayed right renal enhancement suggesting impaired perfusion despite preserved serum creatinine. These high-risk imaging findings supported early intervention after multidisciplinary evaluation. On hospital day 3, the patient underwent a single-session hybrid repair consisting of bilateral carotid-subclavian bypasses, proximal embolization of both subclavian arteries, and thoracic endovascular aortic repair using two overlapping stent grafts. Completion angiography showed exclusion of antegrade false-lumen flow through the treated proximal entry region and preserved right renal perfusion through distal false-lumen re-entry. Cerebrospinal fluid drainage and perioperative pressure augmentation were used for spinal cord protection. The patient was discharged without neurological deficit or major postoperative complication. Clinical evaluation and surveillance computed tomography angiography were planned at the one-month post-repair interval. Completion angiography documented immediate procedural success, while durable technical success remained to be confirmed by surveillance computed tomography angiography because of the residual focal graft malapposition and continued false-lumen-dependent right renal perfusion. This case highlights the importance of considering acute aortic disease in patients with recurrent focal neurological deficits, normal cerebral imaging, and marked inter-arm blood pressure asymmetry, even in the absence of typical thoracic pain. It also illustrates how Type I right-sided aortic arch anatomy and severe arch angulation can complicate proximal landing-zone planning and require an individualized hybrid repair strategy.

Chronic Monteggia lesions are difficult to treat when longstanding radial head dislocation results in severe radial head deformity. In such cases, corrective ulnar osteotomy with or without annular ligament repair may not achieve stable or congruent radiocapitellar reduction. This technical note describes a combined reconstructive technique using corrective ulnar osteotomy, radial head replacement, and annular ligament/lateral ligament complex repair. Through a Boyd approach, the deformed radial head is resected, and the proximal ulna is osteotomized and dorsally angulated to restore radiocapitellar alignment. The resected radial head may be used as an intercalary graft at the osteotomy site. After trial radial head replacement, the capitellum, radial head notch, and proximal ulna are contoured as needed to improve prosthetic congruity. The annular ligament, lateral ulnar collateral ligament remnant, and capsule are repaired with suture anchors to enhance stability. In chronic Monteggia lesions with severe radial head deformity, this combined technique may be useful when isolated ulnar osteotomy is unlikely to restore stable radio-capitellar articulation. A longer follow-up is needed to evaluate durability, functional outcomes, and complications.

A detailed understanding of the dural anatomy of the trigeminal nerve, particularly the Meckel's cave, and the petrous apex is essential to accomplish an interdural approach in dumbbell-shaped trigeminal schwannomas (TSs) from the middle fossa side. A 34-year-old gentleman with left hemifacial pain and masseter weakness on examination was found to have a dumbbell-shaped TS around the petrous apex occupying the adjacent middle cranial fossa, posterior fossa, and the cavernous sinus. We performed an extended middle fossa approach (EMFA), taking an interdural route, and with the addition of an extradural anterior petrosectomy (AP), the tumor was completely resected. Postoperative imaging revealed a complete tumor excision, and the patient has been doing well at follow-up examinations. An EMFA with tailored AP provides an excellent control of the posterior fossa component of TS due to improved angulation and blind spot visualization.

Dental implants are a predictable treatment option for the replacement of missing teeth; however, complications related to implant positioning and proximity to adjacent anatomical structures may result in discomfort and compromise long-term outcomes. Cone beam computed tomography (CBCT) plays an important role in the diagnosis and management of implant-related complications by providing detailed three-dimensional evaluation of implant position and surrounding anatomy. This case report describes the management of a symptomatic maxillary implant in a patient who presented with intermittent pain during mastication and occasional discomfort in the region of a previously restored implant-supported crown. The patient subsequently reported accidental ingestion of the implant crown and was referred to a hospital to rule out aspiration or airway involvement. Following medical evaluation, CBCT imaging was obtained and revealed a wide-diameter implant positioned in close proximity to the Schneiderian membrane. Based on the clinical and radiographic findings, treatment consisted of CBCT-guided explantation of the existing implant followed by site redevelopment using bone grafting and a collagen membrane. Three-dimensional digital planning was performed to optimize the position, angulation, and dimensions of the replacement implant while maintaining a safe relationship with the Schneiderian membrane. A narrower implant was subsequently placed according to the digital treatment plan. Postoperative healing was uneventful. After six months of osseointegration, a second-stage procedure was performed, and a healing abutment was placed for soft tissue maturation. A digital impression was obtained using a scan body, and a definitive implant-supported crown was fabricated and delivered. At follow-up, the patient reported complete resolution of symptoms, satisfactory function, and improved comfort during mastication. Clinical and radiographic evaluation demonstrated successful implant integration and stable peri-implant tissues. This case highlights the value of CBCT-guided diagnosis, explantation, and reimplantation in the management of symptomatic implants located near the Schneiderian membrane and demonstrates the importance of three-dimensional planning in achieving predictable functional and restorative outcomes.

Ti-base abutments with angulated screw channel (ASC) designs have been developed to address the esthetic challenges associated with labial screw access in anterior implant-supported single crowns, as well as the ergonomic limitations caused by restricted mouth opening in posterior crowns. Despite their increasing clinical use, there is limited research evaluating the impact of this design on the fracture resistance of various monolithic restorative materials across different anatomical regions, particularly after aging. This study aims to investigate the effect of angled screw channel design on the fracture resistance of implant-supported single crown restorations made of different materials in different anatomical regions after long-term thermal aging. In the study, a total of 80 implant-supported single crown restorations were prepared and then divided into subgroups (n = 10) considering anatomical region (anterior/posterior), restoration material (monolithic zirconia/lithium disilicate), and screw channel design (straight 0[°]/angled 20[°]). Monolithic zirconia and lithium disilicate crowns were fabricated in the form of maxillary central incisors for anterior, and mandibular first molars for posterior specimens. After cementation on Ti-base abutments, the specimens were aged with 40,000 thermal cycles (5[°]C/55[°]C), and the fracture resistance of the crowns was subsequently determined using a universal testing machine under compressive loading. Fracture patterns were examined under a stereomicroscope. Three-way analysis of variance followed by a Bonferroni post hoc test was used in data analysis (α = 0.05). According to the results, anatomical region, restorative material, screw channel design, and the interactions between these variables had a significant effect on the fracture resistance of implant-supported single crown restorations (p < 0.001). The use of ASC design reduced the fracture resistance of the restoration material in all groups, regardless of anatomical region and material type (p < 0.001). In the anterior region, using the ASC design resulted in a statistically significant strength loss, which was similar across all materials. In the posterior region, although zirconia material showed significantly higher fracture strength than lithium disilicate, the strength loss was more pronounced. The fracture loads observed in all specimens remained within reported physiological bite force ranges under the present experimental conditions. In conclusion, although the ASC design offers clinical advantages for implant-supported restorations, its effect on reducing the mechanical strength of the restorative material should be taken into account in clinical practice. While the fracture loads observed in this study remained within physiological limits, further investigations under long-term and in vivo conditions are warranted.

Background: Distal radius malunion accompanied by increased dorsal angulation tends to alter wrist biomechanics, leading to a range of carpal malalignment patterns, which may affect both the radiocarpal (radiolunate) and midcarpal (capitolunate) joints. One type has radiocarpal malalignment with an aligned midcarpal joint, and the second type has midcarpal malalignment with an aligned radiocarpal joint. Previous studies have demonstrated that corrective osteotomy tends to restore normal radiocarpal and midcarpal alignment. However, we observed that radiocarpal and midcarpal malalignment persist in a subset of patients, despite appropriate correction of the malunited distal radius. The primary aim was to assess the effects of postoperative persistent carpal malalignment on functional outcomes by comparing the Patient-Rated Wrist Evaluation (PRWE) of patients with and without persistent radiocarpal or midcarpal malalignment following a corrective osteotomy of the distal radius. Methods: For this retrospective study, we screened all consecutive adult patients who had an extra-articular corrective osteotomy between January 2019 and 2024 for a distal radius malunion. Radiocarpal and midcarpal malalignment was assessed on pre- and postoperative radiographs by two researchers. The PRWE was evaluated during the standard postoperative follow-up. Results: This study showed that PRWE scores of patients with carpal malalignment did not differ from those of patients with normal carpal alignment, both preoperatively and postoperatively. Furthermore, the prevalence of all types of malalignment decreased following the corrective osteotomy, and all patients reported improved hand and wrist function, with a median improvement of 50 points on the PRWE. Conclusions: Midcarpal malalignment is common in distal radius malunions and may exist simultaneously with radiocarpal malalignment. Despite the presence of malalignment, all patients experienced improved function after the corrective osteotomy. Therefore, we conclude that persistent radial or midcarpal malalignment following a corrective osteotomy does not have an adverse effect on functional outcome. Level of evidence: Level III (Therapeutic).