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International Journal of Legal Medicine Jun 2024Cranial vault thickness (CVT) and its variations provide valuable insights into an individual's biological attributes such as age and sex. This paper aimed to assess the...
Cranial vault thickness (CVT) and its variations provide valuable insights into an individual's biological attributes such as age and sex. This paper aimed to assess the correlations of CVT with age and sex and develop a regression model for age estimation in Malaysian subadults using computed tomography (CT) images. A total of 521 CT images (male/female: 279/242; age range: 0-20 years; Malay/Chinese/Indian: 221/145/155) were included in the study. Correlations of CVT measurements with age and sex, including frontal bone thickness (FBT), occipital bone thickness (OBT), left parietal bone thickness (LPBT), and right parietal bone thickness (RPBT) were assessed and regression formulae were developed for age estimation in subadults. A significant correlation between CVT measurements and age was demonstrated (p < 0.001). Age estimation was most accurate in the younger age group (< 2 years) at frontal and occipital, and accuracy decreases in the older age groups. Additionally, sexual dimorphism was evident in the frontal and parietal bone thickness within the age range of 3-6 years and 16-20 years, respectively. In conclusion, the findings suggested CVT measurements could be used to corroborate other age estimation methods for subadults.
PubMed: 38940946
DOI: 10.1007/s00414-024-03276-2 -
Case Reports in Otolaryngology 2024Cocaine is the second most consumed drug worldwide, more than 0.4% of the global population, and has become a real public health problem in recent years. Its inhalation...
BACKGROUND
Cocaine is the second most consumed drug worldwide, more than 0.4% of the global population, and has become a real public health problem in recent years. Its inhalation causes significant centrofacial lesions, grouped under the name cocaine-induced midline destructive lesion (CIMDL). These destructions are due to the conjunction of the vasoconstrictor, local prothrombogenic effects, and cytotoxic effects of cocaine. The ischemia produced by this substance is due to vasoconstriction that leads to nasal tissue necrosis and perforation of the nasal septum secondary to chondral necrosis. . A 36-year-old man, previously grappling with cocaine addiction, was hospitalized to undergo comprehensive clinical, microbiological, and radiological examinations because he was suffering from the emergence of crusts and ulceration in the nasal mucosa, accompanied by a palate perforation, a 39°C fever, and chills. Standard bacteriological culture was positive for coagulase-negative staphylococci and , while mycological culture was positive for . The CT scan images of the sinuses confirmed the presence of palatal perforation and total destruction of the nasal septum, cartilaginous portion, maxillary sinus medial wall, lower and middle turbinates, and middle meatus. Nasal endoscopy revealed an exposition of the bony wall and displayed the exposition of the occipital bone's clivus. A diagnosis of CIMDL was confirmed. Antibiotic therapy was decided based on antibiogram results by the consulting microbiologist. Debridement of necrotic tissue was done by nasal endoscopy with local cleaning and was repetitive during the first week to maintain the best cleanliness possible. The patient was discharged with oro-nasal hygiene instructions and referred for prosthetic rehabilation. As for the cocaine addiction, the patient was in follow-up with a psychologist in a specialized centre.
CONCLUSION
The care is multidisciplinary. Psychological help and assistance are essential to guide patients to become cocaine free and to avoid a relapse. Weaning is a prerequisite for surgery. Rehabilitation of speech and swallowing is necessary. Many local flaps or micro-anastomoses are possible.
PubMed: 38939732
DOI: 10.1155/2024/7109261 -
Journal of Morphology Jul 2024Genetic diseases with craniofacial malformations can be associated with anomalies of the craniocervical joint (CCJ). The functions of the CCJ are thus impaired, as...
Genetic diseases with craniofacial malformations can be associated with anomalies of the craniocervical joint (CCJ). The functions of the CCJ are thus impaired, as mobility may be either limited by abnormal bone fusion causing headaches, or exaggerated in the case of hypermobility, which may cause irreparable damage to the spinal cord. Restoring the balance between mobility and stability requires surgical correction in children. The anatomy and biomechanics of the CCJ are quite unique, yet have been overlooked in the past decades. Pediatric evidence is so scarce, that investigating the adult CCJ is our best shot to disentangle the form-function relationships of this anatomical region. The motivation of the present study was to understand the morphological and functional basis of motion in the CCJ, in the hope to find morphological features accessible from medical imaging able to predict mobility. To do so, we have quantified the in-vitro kinematics of the CCJ in nine cadaveric asymptomatic adults, and estimated a wide range of mobility variables covering the complexity of spinal motion. We compared these variables with the shape of the occipital, the atlas and the axis, obtained using a dense geometric morphometric approach. Morphological joint congruence was also quantified. Our results suggest a strong relationship between bone shape and motion, with the overall geometry predicting best the primary movements, and the joint facets predicting best the secondary movements. We propose a functional hypothesis stating that the musculoligamental system determines movements of great amplitude, while the shape and congruence of joint facets determine the secondary and coupled movements, especially by varying the geometry of bone stops and the way ligaments are tensioned. We believe this work will provide valuable insights in understanding the biomechanics of the CCJ. Furthermore, it should help surgeons treating CCJ anomalies by enabling them to translate objectives of functional and clinical outcome into clear objectives of morphological outcome.
Topics: Humans; Cadaver; Biomechanical Phenomena; Adult; Male; Female; Range of Motion, Articular; Atlanto-Occipital Joint; Cervical Vertebrae; Middle Aged; Aged; Atlanto-Axial Joint
PubMed: 38938002
DOI: 10.1002/jmor.21748 -
BMC Musculoskeletal Disorders Jun 2024Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of...
OBJECTIVE
Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of children is less than ideal as a bone graft material. The matured rib bone of children presents a potential substitute material for iliac bone. The aim of this study was to evaluate the efficacy of autologous rib grafts for craniocervical junction surgery in children.
METHODS
The outcomes of 10 children with abnormalities of the craniocervical junction who underwent craniocervical junction surgery between January 2020 and December 2022 were retrospectively reviewed. All patients underwent posterior fusion and internal fixation surgery with autologous rib grafts. Pre- and post-operative images were obtained and clinical follow-ups were conducted to evaluate neurological function, pain level, donor site complications, and bone fusion rates.
RESULTS
All surgeries were successful. During the 8- to 24-month follow-up period, all patients achieved satisfactory clinical results. Computed tomography at 3-6 months confirmed successful bone fusion and regeneration of the rib defect in all patients with no neurological or donor site complications.
CONCLUSION
Autologous rib bone is a safe and effective material for bone grafting in craniocervical junction fusion surgery for children that can reduce the risks of donor site complications and increase the amount of bone graft, thereby achieving a higher bone fusion rate.
Topics: Humans; Child; Male; Female; Retrospective Studies; Spinal Fusion; Bone Transplantation; Ribs; Transplantation, Autologous; Treatment Outcome; Child, Preschool; Adolescent; Atlanto-Axial Joint; Follow-Up Studies; Cervical Vertebrae; Atlanto-Occipital Joint; Tomography, X-Ray Computed
PubMed: 38926741
DOI: 10.1186/s12891-024-07607-7 -
Surgical and Radiologic Anatomy : SRA Jun 2024The topic of osseous variations of the craniocervical junction is a complex morphological and embryological chapter of human anatomy, with a possible impact on...
PURPOSE
The topic of osseous variations of the craniocervical junction is a complex morphological and embryological chapter of human anatomy, with a possible impact on neurogical and vascular functionality in this morphological variable region.
MATERIAL & METHODS
An until now undescribed anatomical variation of the exoccipital part of the occipital bone has been observed after maceration at the outer skull base of a West-European 68-year-old male body donor.
RESULTS
On both sites of the foramen magnum accessory osseous processes were observed that arise from the jugular process and point towards the lateral margin of the foramen magnum. On the left site this process forms a full arc that bridges the condylar fossa completely.
CONCLUSION
The observed osseous bridge over the condylar fossa has not been reported on before and can be explained by the partial persistence of a primordial vertebra between atlas and occipital bone: the Proatlas. The resulting accessory structure may affect due to its topographic conditions the V3-Segment of the vertebral artery and its accompanying nerves, and thus, play a role in diagnosis and therapy of vascular and/or neurological symptoms of head and neck.
PubMed: 38926224
DOI: 10.1007/s00276-024-03422-w -
Forensic Science International Jun 2024The pars basilaris forms a central component of the immature basicranium and owing to its resilience to post-mortem and taphonomic changes, holds significance across...
The pars basilaris forms a central component of the immature basicranium and owing to its resilience to post-mortem and taphonomic changes, holds significance across evolutionary, clinical, and forensic contexts. While size and shape parameters of the pars basilaris have been investigated, little is known about the influence of the underlying bone mineral density on the morphometry of this bone during growth. This study aimed to investigate the development and growth of the pars basilaris with specific reference to changes in bone density patterning and development of osteological features, during the prenatal and early postnatal periods of life. A total of 109 pars basilari were sourced from the Johannesburg Forensic Paediatric Collection, University of the Witwatersrand, South Africa. The study sample was subdivided into early prenatal (<30 gestational weeks), prenatal (30-40 gestational weeks) and postnatal (birth to 7.5 months) groups and micro-CT scanned to assess bone mineral density patterns across seven regions of interest. Size and shape changes were analysed using 11 digitized landmarks and geometric morphometrics. When comparing across age groups, the assessed dimensions increased with growth manifesting as a deepening at the anterior border of the foramen magnum, development of the lateral angles and widening of the bone at the lateral projections and spheno-occipital synchondrosis. However, no significant changes in the distribution of bone mineral density were observed. An appreciation of morphological changes and bone quality at specific growth sites in the pars basilaris is essential when analyzing remains of unknown provenance for the purposes of identification in disaster victim settings.
PubMed: 38908071
DOI: 10.1016/j.forsciint.2024.112111 -
Journal of Back and Musculoskeletal... May 2024Cervicogenic headache is characterized by chronic posterior neck pain radiating to one side of the head, resulting from cervical spine bone or soft tissue diseases....
BACKGROUND
Cervicogenic headache is characterized by chronic posterior neck pain radiating to one side of the head, resulting from cervical spine bone or soft tissue diseases. Cervical ganglioneuroma (GN), a rare benign neuroblastic tumor, especially in the cervical spine, may cause cervicogenic headache-like symptoms.
OBJECTIVE
We report a case of GN which was surgically removed successfully to relieve the symptom.
CASE REPORT
A 68-year-old male presented with right posterior neck pain with referred pain to the ipsilateral occipital area in May 2020. Despite administration of medications, physical therapy, and spine interventions, the symptoms intermittently recurred over one year. In July 2021, the patient complained of painful limitation of neck motion, especially on right-sided bending; no motor or sensory deficits, except for subjective numbness of the finger tips, were detected. Plain radiography of the cervical spine showed moderate degenerative changes in the mid-cervical spine. Cervical MRI revealed a cystic mass (1.5 cm × 0.5 cm × 1 cm-in size) around the right C2 dorsal root ganglion adjacent to the C1-C2 facet joint. His symptoms significantly improved after complete tumor excision.
CONCLUSION
GN of the upper cervical spine should be considered when persistent cervicogenic headache is refractory to conservative management. In such a case, advanced imaging studies such as MRI should be performed for early diagnosis and appropriate treatment.
PubMed: 38848167
DOI: 10.3233/BMR-230330 -
Surgical and Radiologic Anatomy : SRA Jun 2024This study aims to assess the anatomical possibilities of the jugular bulb (JB).
PURPOSE
This study aims to assess the anatomical possibilities of the jugular bulb (JB).
METHODS
Fifty archived CBCT scans were analyzed.
RESULTS
The average distance between the internal acoustic canal (IAC) and the JB was 7.97 mm on both sides (Right: SD = 2.56 mm, range 3.16-13.3 mm; Left: SD = 2.5 mm, range 2.9-13.6 mm). JB walls' pneumatization was classified into eight patterns. Deep petrosal cells (DPCs) prevailed in the lateral wall of the JB. The absence of pneumatization (NP) was commonly found on the left side. The presence of infralabyrinthine and hypotympanic cells varied. Less common types included accessory occipital cells (AOCs), posteromedial tracts (PMTs), and basi-occipital cells (BOCs), which determined a consistent variation of the lateral wall pneumatization patterns. Pneumatization of the medial wall was not observed in 50 right sides and 49 left sides. The inferior wall analysis revealed symmetry in AOC distribution and a predominant occurrence of NP. Cases with hypotympanum (HT) in the lateral wall showed a statistically significant IAC-JB distance increase by an average of 4.67 mm compared to NPs. Specific pneumatizations, particularly HT on the lateral side, have a significant effect on the IAC-JB distance, showing a clear pattern of increasing distance from DPC to NP and then to HT. A significant distance increase in HT pneumatization was noted. There were also recorded instances of JB hypoplasia and hyperplasia, JB diverticula, dehiscent JBs, and high JBs.
CONCLUSION
This study establishes a novel classification of JB pneumatizations to aid in the understanding of the temporal bone anatomy.
PubMed: 38847825
DOI: 10.1007/s00276-024-03401-1 -
Nigerian Journal of Clinical Practice May 2024The occipital spur (OS) can be described as an abnormal elongation of the external occipital protuberance (EOP). The cephalic index (CI) refers to the ratio of width to...
BACKGROUND
The occipital spur (OS) can be described as an abnormal elongation of the external occipital protuberance (EOP). The cephalic index (CI) refers to the ratio of width to length in any skull.
AIM
The aim of the present study was to evaluate the frequency and types of OS. It also aimed to determine the mean CI and the distribution of skull types using cone beam computed tomography (CBCT). And to determine if there was a relationship between the cephalic index and the presence and types of OS.
METHODS
CBCT scans from 523 patients were included in the study. OSs were classified as type 1 (flat), type 2 (crest), and type 3 (spine). Skull length and width were measured on axial sections and the CI was calculated. Based on the cephalic index (CI), skull types were classified as dolichocephalic (CI < 75), mesocephalic (75 < CI < 80), brachycephalic (80 < CI < 85), and hyperbrachycephalic (CI > 85).
RESULTS
The most common cranial types in the study group were brachycephalic (44.7%), mesocephalic (28.3%), hyperbrachycephalic (21.2%), and dolichocephalic (5.7%). Regarding the presence of OS, 54.3% of the participants had no OS, 23.1% had flat type, 15.3% had crest type, and 7.2% had spin type OS. There was a statistically significant difference (P < 0.05) in the frequency of OS according to skull type.
CONCLUSION
This study, the first to evaluate CI and OS using CBCT, concludes that brachycephaly is the most common cranial type. OS is more common in mesocephalic and dolichocephalic skulls, at older ages, and in males.
Topics: Humans; Cone-Beam Computed Tomography; Male; Female; Occipital Bone; Adult; Middle Aged; Cephalometry; Adolescent; Young Adult; Child; Aged; Child, Preschool; Skull
PubMed: 38842715
DOI: 10.4103/njcp.njcp_45_24 -
Surgical Neurology International 2024The radiographic presentation of the primary intraosseous cavernous hemangiomas (PICHs) is nonspecific. We report a case of clival PICH mimicking a chordoma with a...
BACKGROUND
The radiographic presentation of the primary intraosseous cavernous hemangiomas (PICHs) is nonspecific. We report a case of clival PICH mimicking a chordoma with a literature review.
CASE DESCRIPTION
A 57-year-old woman presented with diplopia that started a few days before the presentation. She had transient diplopia at the right lateral gaze and upper gaze with normal eye movement. The symptoms disappeared spontaneously 1 week later. She had no other complaints or neurological deficits. Computed tomography revealed an intraosseous mass lesion and bone erosion of the middle and lower clivus, extending laterally to the right occipital condyle. Magnetic resonance imaging (MRI) showed hyperintense and hypointense components on T2- and T1-weighted images, respectively. The lesion was larger than on MRI performed 10 years earlier. Chordoma or chondroma was considered a possible preoperative diagnosis. An endoscopic transsphenoidal approach removed the tumor. In the operating view, the lesion appeared as "moth-eaten" bony interstices filled with vascular soft tissue. Histologically, an intraosseous cavernous hemangioma was diagnosed.
CONCLUSION
Diagnosis before surgery is difficult without characteristic radiographic findings. When making a differential diagnosis of malignant skull lesions, PICH should be considered.
PubMed: 38840598
DOI: 10.25259/SNI_106_2024