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Journal of Oral Biology and... 2024The human skull is the part of the skeleton most frequently used in population studies, as it was more exposed to genetic factors and less exposed to environmental...
BACKGROUND
The human skull is the part of the skeleton most frequently used in population studies, as it was more exposed to genetic factors and less exposed to environmental factors. The skull is an important component in human forensic identification.
MATERIALS AND METHODS
The craniometric characteristics of 186 male and 114 female skulls found on the territory of Kazakhstan were studied. Dimensions were measured using standard anthropometric methods and instruments. The results of measurements of 25 craniometric parameters are presented. Methods of descriptive and parametric statistics were used.
RESULTS
Statistical analysis showed significant regional dimorphism, confirming theindividuality of the Kazakhstan population. Statistically significant deviations werefound in 6 male craniometric characteristics and 4 female craniometric characteristics(p<0.05). The most dimorphous variables for regional identification in Kazakhstanmales were the higher skull base and frontal chord width , full face height , condylarand bigonial width , and low mandibular body reference values (p<0.05). For females,significant statistical discrepancies were seen in the transverse diameter and skullbase width, mastoid and occipital aperture width (p<0.05).
CONCLUSION
The recorded variations and changes in the morphology of the humanskull of the population of Kazakhstan indicate the need to develop and updateosteometric standards used in practice for specific populations. All this will significantlyimprove the accuracy of forensic identification and more fully study the biologicalpatterns of population formation, as well as evaluate the comparative effectiveness ofindividual features in the reconstruction of the population history of various populationgroups.
PubMed: 38832291
DOI: 10.1016/j.jobcr.2024.04.004 -
British Journal of Hospital Medicine... May 2024An elderly male with type 2 diabetes presented with a 2-month history of otalgia and severe headaches. He was diagnosed with malignant otitis externa (MOE) and was...
An elderly male with type 2 diabetes presented with a 2-month history of otalgia and severe headaches. He was diagnosed with malignant otitis externa (MOE) and was commenced on empirical treatment with oral ciprofloxacin. Pseudomonas is the most common cause of MOE. A baseline CT scan was undertaken that demonstrated skull base osteomyelitis (SBO) due to findings of bone erosion at the mastoid tip and an infiltrating soft tissue mass eroding the clivus. Eight weeks later, he returned with worsening and bilateral symptoms of otitis externa, hearing loss, temporomandibular pain and dysfunction. Worsening and now bilateral malignant otitis externa were confirmed with an MRI scan that also demonstrated a small fluid collection in his left temporal region. The collection was aspirated and grew scedosporium apiospermum. He was diagnosed with fungal SBO and was commenced on treatment with the antifungal voriconazole, with significant improvement in symptoms and radiological findings. Fungal osteomyelitis is more likely in immunosuppressed patients, particularly those with type 2 diabetes. Fungal aetiology should be suspected in patients with progressive symptoms, despite treatment. A microbiology diagnosis of fungal SBO or MOE can be challenging to obtain and can lead to diagnostic delay. A sampling of the external auditory canal can aid in diagnosing MOE; however, scedosporium may also be isolated as a commensal organism. Aspirations from accessible fluid collections, infratemporal fossa needle sample and bone biopsy can provide material for diagnosis. Scedosporium is a rare cause of disease in humans, however, fungal infections are increasing in humans, due to an increase in susceptible populations. Scedosporium apiospermum is a rare cause of SBO and should be considered in patients not responding to standard treatment.
Topics: Humans; Otitis Externa; Osteomyelitis; Male; Skull Base; Antifungal Agents; Scedosporium; Diabetes Mellitus, Type 2; Tomography, X-Ray Computed; Voriconazole; Aged; Magnetic Resonance Imaging; Mycoses
PubMed: 38815968
DOI: 10.12968/hmed.2023.0421 -
3D Printing in Medicine May 20243D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding...
INTRODUCTION
3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation.
METHODS
Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model.
RESULTS
Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures.
CONCLUSION
This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes.
PubMed: 38814431
DOI: 10.1186/s41205-024-00218-x -
Cureus Apr 2024Accurately identifying and avoiding crucial anatomical structures within the posterior cranial fossa using superficial landmarks is essential for reducing surgical...
BACKGROUND AND OBJECTIVE
Accurately identifying and avoiding crucial anatomical structures within the posterior cranial fossa using superficial landmarks is essential for reducing surgical complications. Our study focuses on the top of the mastoid notch (TMN) as an external landmark of the cranium, aiming to assist in the strategic placement of the initial burr hole. In this study, we present a method for predicting the path of the transverse sinus (TS) and explore the relationship between the junction of the transverse-sigmoid sinus and the TMN.
METHODS
Following anatomical dissections of the brain in cadaveric specimens, we conducted intracranial drilling from the inside surface of the cranium on 10 adult skulls (20 sides). A coordinate system was established on the posterolateral surface of the skull to assist the analysis. Using a self-leveling laser level, we set up a horizontal Frankfurt line (X-axis) and identified a vertical perpendicular line passing through the TMN to serve as the Y-axis. To identify the course of the TS, we divided the segment between the two inferomedial points into six equidistant points along the Frankfurt line.
RESULTS
No significant difference was observed between the inferomedial points of the transverse-sigmoid sinus junction (TSSJ) on the left and right sides. The inferomedial point was positioned at a median of 6.6 mm (Q1: 3.7 mm, Q3: 9.4 mm) dorsally and at a median of 19.2 mm (Q1: 16.1 mm, Q3: 23.2 mm) cranially from the TMN. The upper edge of the TS was located at distances of 6.4 mm (5.7; 12.7), 10.3 mm (8.8; 12.3), and 13.8 mm (11.9; 16.3) on the right, and 4.9 mm (4.1; 7.9), 8.6 mm (7.6; 13.0), and 12.8 mm (11.7; 17.5) on the left side from the Frankfurt horizontal plane at the ¼, ½, and ¾ line points, respectively. The bottom edge was positioned at distances of 0.6 mm (-2.7; 2.0), 2.1 mm (-0.8; 3.8), and 4.8 mm (2.4; 6.7) on the right, and 1.1 mm (-3.4; 2.4), 2.0 mm (0.2; 4.8), and 3.9 mm (3.7; 5.3) on the left from these respective points. The upper edge of the right TS was found to be statistically more distant from the Frankfurt horizontal plane at the ¼ line point (p-value = 0.027) compared to that on the left side. The confluence of the sinus center was identified as having a median distance of 7.8 mm (4.5; 8.3) and an inferior point of 1.5 mm (0.1; 3.0) cranially to the inion. In all examined bodies (n = 10), the confluens sinuum was consistently 4.7 mm (3.3; 5.6) to the right in relation to the inion. Notably, the median of the right transverse sinus diameter (median = 9.3 mm) was found to be significantly larger than that of the left transverse sinus (median = 7.0), with a statistically significant p-value of 0.048.
CONCLUSIONS
The literature regarding the external identification of the TSSJ and the course of the TS varies. In our efforts to provide a description, we have utilized the TMN as a reliable landmark for locating the TSSJ. To delineate the trajectory of the TS after its exit from the confluence of sinuses, we employed a Frankfurt horizontal plane to the inion. These findings may assist surgeons by using external skull landmarks to identify intracranial structures within the posterior fossa, particularly when image guidance devices are not available or to complement a neuronavigational system.
PubMed: 38813277
DOI: 10.7759/cureus.59278 -
Complementary Therapies in Medicine Aug 2024Dizziness often occurs after microvascular decompression (MVD), and therapeutic options are limited. The aim of this trial was to determine the potential efficacy of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Dizziness often occurs after microvascular decompression (MVD), and therapeutic options are limited. The aim of this trial was to determine the potential efficacy of transcutaneous electrical acupoint stimulation (TEAS), against dizziness and its safety in patients undergoing MVD.
METHODS
Adult patients scheduled to undergo MVD for hemifacial spasm under total intravenous anesthesia were randomized at a 1:1 ratio to receive, after extubation, 30-min TEAS in the mastoid region as well as Fengchi acupoints (GB20) and Neiguan acupoints (PC6) or 30-min sham stimulation. The primary outcome was the incidence of dizziness at 2 h after surgery. Secondary outcomes included dizziness, postoperative nausea and vomiting (PONV) or headache severity, rescue medication, changes in intraocular pressure before and after surgery, length of stay, dizziness symptoms 4 weeks after discharge, and surgical complications.
RESULTS
A total of 86 patients (51.9 ± 9.4 years of age; 67 women) were enrolled. One patient (in the TEAS arm) was excluded from analysis due to conversion to sevoflurane anesthesia. The rate of dizziness at 2 h after surgery was 31.0 % (13/42) in the TEAS arm vs. 53.5 % (23/43) in the sham control arm (P = 0.036). TEAS was also associated with significantly lower severity of dizziness, based on a 10-point scale, during the first 24 h after surgery. None of the other secondary efficacy outcomes differed significantly between the two arms. All postoperative complications were Clavien-Dindo grade I or II. The rate of postoperative complications was 21.4 % (9/42) in the TEAS arm vs. 16.3 % (7/43) in the sham control arm (P = 0.544).
CONCLUSIONS
Compared with sham control, TEAS was associated with a lower incidence of dizziness within 2 h and lower severity of dizziness within 24 h post-operatively, but no improvement in other outcomes, in adult patients undergoing MVD for hemifacial spasm.
Topics: Humans; Middle Aged; Female; Male; Hemifacial Spasm; Acupuncture Points; Transcutaneous Electric Nerve Stimulation; Dizziness; Microvascular Decompression Surgery; Adult; Postoperative Complications
PubMed: 38782080
DOI: 10.1016/j.ctim.2024.103055 -
Cureus Apr 2024The facial nerve supplies motor, sensory, and parasympathetic innervation to the head and neck, and its paralysis can have significant physical and psychological...
The facial nerve supplies motor, sensory, and parasympathetic innervation to the head and neck, and its paralysis can have significant physical and psychological impacts. This study discusses a compelling case involving a 21-year-old male who developed delayed facial nerve palsy (DFNP) on the eighth day after cortical mastoid surgery. Through conservative management, the patient achieved a full recovery by the 52nd day. Our experience underscores the importance of approaching DFNP with patience, emphasizing the need for thorough counseling of both the patient and their family members.
PubMed: 38774163
DOI: 10.7759/cureus.58691 -
IEEE Journal of Translational... 2024Sleep monitoring has extensively utilized electroencephalogram (EEG) data collected from the scalp, yielding very large data repositories and well-trained analysis...
OBJECTIVE
Sleep monitoring has extensively utilized electroencephalogram (EEG) data collected from the scalp, yielding very large data repositories and well-trained analysis models. Yet, this wealth of data is lacking for emerging, less intrusive modalities, such as ear-EEG.
METHODS AND PROCEDURES
The current study seeks to harness the abundance of open-source scalp EEG datasets by applying models pre-trained on data, either directly or with minimal fine-tuning; this is achieved in the context of effective sleep analysis from ear-EEG data that was recorded using a single in-ear electrode, referenced to the ipsilateral mastoid, and developed in-house as described in our previous work. Unlike previous studies, our research uniquely focuses on an older cohort (17 subjects aged 65-83, mean age 71.8 years, some with health conditions), and employs LightGBM for transfer learning, diverging from previous deep learning approaches.
RESULTS
Results show that the initial accuracy of the pre-trained model on ear-EEG was 70.1%, but fine-tuning the model with ear-EEG data improved its classification accuracy to 73.7%. The fine-tuned model exhibited a statistically significant improvement (p < 0.05, dependent t-test) for 10 out of the 13 participants, as reflected by an enhanced average Cohen's kappa score (a statistical measure of inter-rater agreement for categorical items) of 0.639, indicating a stronger agreement between automated and expert classifications of sleep stages. Comparative SHAP value analysis revealed a shift in feature importance for the N3 sleep stage, underscoring the effectiveness of the fine-tuning process.
CONCLUSION
Our findings underscore the potential of fine-tuning pre-trained scalp EEG models on ear-EEG data to enhance classification accuracy, particularly within an older population and using feature-based methods for transfer learning. This approach presents a promising avenue for ear-EEG analysis in sleep studies, offering new insights into the applicability of transfer learning across different populations and computational techniques.
CLINICAL IMPACT
An enhanced ear-EEG method could be pivotal in remote monitoring settings, allowing for continuous, non-invasive sleep quality assessment in elderly patients with conditions like dementia or sleep apnea.
Topics: Humans; Electroencephalography; Aged; Scalp; Aged, 80 and over; Male; Female; Sleep; Signal Processing, Computer-Assisted; Ear; Machine Learning; Polysomnography
PubMed: 38765887
DOI: 10.1109/JTEHM.2024.3388852 -
Ear, Nose, & Throat Journal May 2024
PubMed: 38757675
DOI: 10.1177/01455613241256427 -
Radiology Case Reports Aug 2024Bony hemangiomas are benign vascular lesions with an expansive growth; usually they tend to obliterate the entire bony cavity. They are typical lesion of the spinal...
Coexistence of mastoid, frontal and vertebral hemangiomas in a patient with diabetic neuropathy: Possible correlation between diabetic angiopathy and intraosseous neoangiogenesis.
Bony hemangiomas are benign vascular lesions with an expansive growth; usually they tend to obliterate the entire bony cavity. They are typical lesion of the spinal bones, but they can rarely arise within other bones of the neurocranium. Diabetic microangiopathy is a condition characterized by the development of aberrant vessel tangles anastomosed to each other due to dysregulated neoangiogenesis. We report the case of a 56-year-old woman, suffering from type 2 diabetes mellitus, admitted to the neurology department due to a reported worsening of paresthesias and dysesthesias of the upper and lower limbs. She performed a contrast-enhanced brain CT scan that showed the presence, at the level of the right mastoid process, of an hypervascular angioma. A subsequent MRI study of the brain and spine showed the presence of multiple bone angiomas, at the level of the right frontal theca and C7, Th3, and Th7 vertebral bodies. Due to the absence of further symptoms and clinical and radiological signs of intracranial compression, the patient did not perform surgery. A radiological follow-up was advised. Although possible pathophysiological correlations between diabetes and vertebral hemangiomas are mentioned in literature, vascular lesions of this type involving vertebrae and skull base simultaneously can be discovered in a patient with chronic diabetic disease. As long as these lesions remain asymptomatic, surgical treatment is not indicated, and the patient is followed over time with radiological follow-up.
PubMed: 38737173
DOI: 10.1016/j.radcr.2024.03.087 -
Journal of Clinical Medicine Apr 2024: Our primary objective was to monitor nonprogressive unilateral vestibular schwannomas (VSs) to assess the efficiency of rapid bedside examinations, such as the video...
: Our primary objective was to monitor nonprogressive unilateral vestibular schwannomas (VSs) to assess the efficiency of rapid bedside examinations, such as the video head impulse test (vHIT) and skull vibration-induced nystagmus test (SVINT), in identifying vestibular damage. : An observational study was conducted from March 2021 to March 2022 on all adult patients (>18 years old) with a confirmed nonprogressive VS (no active treatment). The SVINT (using a 100 Hz vibrator with two (SVINT2) or three (SVINT3) stimulation locations) and vHIT (for the six semicircular canals (SCCs)) were performed on all patients. The asymmetry of function between the vestibules was considered significant when the gain asymmetry was greater than 0.1. Rapid and repeatable assessment of VSs using two- and three-stimulation SVINT plus vHIT was performed to quantify intervestibular asymmetry. : SVINT3 and SVINT2 triggered VIN in 40% (24/60) and 65% (39/60) of patients, respectively. There was significant asymmetry in the vestibulo-ocular reflex (VOR), as shown by a VS-side gain < healthy-side gain in 58% (35/60) of the patients. Among the patients with significant gain asymmetry between the two vestibules according to the vHIT (VS-side gain < healthy-side gain), the proportion of patients expressing vestibular symptomatology was significantly greater than that of patients without any symptoms [67% (29/43) vs. 35% (6/17), respectively; = 0.047]. : The SVINT2 can be combined with the vHIT to form an interesting screening tool for revealing vestibular asymmetry. This work revealed the superiority of mastoid stimulation over vertex stimulation for SVINT in patients with unilateral vestibular loss.
PubMed: 38730984
DOI: 10.3390/jcm13092454