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Face is one the most injured part of the body after burn injuries. Facial burns due to electrical insults, caustic agents, flame and even hot liquids can cause peri-oral scar and mouth contracture named as microstomia. One of the most important action of the physical therapist for prevention of microstomy is usage of oral splints. These splints apply continuous traction in mouth in all directions that prevent contracture. Many kinds of splints are available. Their manufacturing is time consuming and expensive. They are made from metals or silicone or other components. We used tongue blade as a good tongue splint. We insert one end of tongue blades into the mouth between the teeth and cheeks to the level of sixth tooth posteriorly in both sides. As both sides of jaws and teeth ore more closer to each other frack to front the exterior ends of tongue blades will touch each other. This angled semi fixed position of tongue blades applies outward traction on mouth and works as an oral splint. Mouth splints are expensive and not available for everyone. Otherwise as these aren't disposable, repeated cleaning of them is very important. We used tongue blade as a mouth splint. Advantages of this device is its lightweight, very low cost, disposability and being healthy. It's very easy to use. So we recommend tongue blade as a simple, disposable, cheap, light, effective and available device for prevention of mouth contracture and microstomy.

Ventriculoatrial (VA) shunts remain as one of the valid options for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Atrial shunt revision surgeries are sometimes difficult due to venous occlusion and are impossible in bilateral stenosis or thrombosis of internal jugular vein. There is not substitute technique in these situations. Here, a new technique for the insertion of ventriculoatrial shunt via innominate vein in bilateral internal jugular vein stenosis is described.Case Report:We performed a new technique for treating a 20-years old man with dysfunctional bilateral ventriculo-atrial shunt. The surgery was performed with cooperation of vascular surgery and neurosurgery teams. Initially, previous shunt was removed by neurosurgery team and patient was underwent implantation of flow-regulating shunt OSVII (Orbis Sigma Valve). Then, partial sternotomy was done by team of vascular surgery and innominate vein was explored. Following purse string suture and perforation of vein, end of catheter was inserted in the innominate vein and the tip of catheter was placed in the right atrium. Correct positioning of the distal end of the catheter in the right atrium was evaluated by C-arm portable radiography.This technique should be considered for use in patients with a history of failed ventriculo-atrial shunts due to internal jugular vein occlusion.

I ntroduction: Transhiatal esophagectomy and gastric replacement with cervical esophagegastrostomy by stapler or hand sutures is the most common surgical intervention in esophagial cancer. Anastomotic leak and stricture are the main complications. This study performed to compare the complication rate in the two methods of esophagogastric anastomosis with and without partial gastric fonduplication. This prospective clinical trial study was carried out in 2005 – 2007, at Omid and Ghaem Hospitals of Mashhad University of Medical Sciences on sixty patients with distal two third esophageal cancers, who underwent transhiatal esophagectomy. Patients divided into two groups randomly. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fonduplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. All cases were followed for 6 months and anastomosis leak and stricture were assessed by clinical exams and barium swallow study. Suspected strictures underwent esophagogastroscopy to prove benign stricture. Data analyzed by χ2 test. In the present study male to female ratio was 36 to 24 and mean age was 53.6±7.4 years. Squamoas cell carcinoma was observed in 76.7% and adenocarcinoma was reported in 22.3%. 77.7% of tumours were located in distal third and 23.35 were in medial third of esophagus. Esophagogastric anastomotic leakage was observed in 2 cases of fonduplication group and 3 cases of simple anastomosis technique, with no significant difference (p=0.64). Benign anastomosis stricture wasn’t reported in any of patients who underwent esophagogastric anastomosis with fonduplication but was observed in 4 cases with simple anastomosis technique, so there was a significant difference between the two groups (p=0.03). Esophagogastric anastomosis with partial gastric fonduplication decreased benign anastomosis stricture and appropriate leakage rate, so it is suggested as the preferred Esophagogastric anastomosis technique, although further studies are indicated.