Canis mosbachensis (Mammalia, Carnivora, Canidae) from the latest Early Pleistocene of Kaiafas (Peloponnesus, Greece)

Silent sinus syndrome is a rare condition that typically affects the maxillary sinus, with only a few reported cases of frontal sinus involvement. Blockage of the sinus ostium leads to persistent hypoventilation, creating negative pressure and eventual sinus collapse. This report describes a previously undocumented case of facial asymmetry due to frontal silent sinus syndrome, following multiple childhood nasal injuries. A 23-year-old male presented with unilateral nasal obstruction, right-sided septal deviation and facial asymmetry. He sustained multiple childhood nasal injuries, requiring manipulation under anaesthetic of his nasal bones at four years old. Imaging reported symmetrical maxillary sinus volumes, with an opacified and collapsed left frontal sinus caused by obstruction of the sinus ostium, secondary to significant left-sided deviation of his bony nasal septum. Open septorhinoplasty was performed, with post-operative resolution of his cosmetic and functional nasal deformities. This report describes a case of frontal silent sinus syndrome causing ipsilateral hyperglobus and enophthalmos, successfully treated with open septorhinoplasty. Silent sinus syndrome rarely affects the frontal sinus and should be considered in asymptomatic patients with facial asymmetry. This advanced presentation highlights the importance of early recognition to prevent visual disturbance and proposes a perspective on disease progression.

In humans, the frontal sinus (FS) is located in the medial part of the supraorbital region, sometimes expanded throughout the frontal squama. It exhibits high morphological variability, but its general form appears to be constrained by surrounding structures. The goal of this study is to analyze FS growth and test for covariation between FS volume and the glabellar region, upper nasal region, bone thickness and endocranial size in a human sample from Argentina. The sample comprises 149 reconstructions derived from computed tomography images of individuals aged 0-31 years. Volume of the FS and measurements of the surrounding structures were recorded. The FS growth trajectory was assessed by parametric and nonparametric methods, and covariation was determined using correlations and partial correlations. The FS volume could be measured at an age of about 6 years and older; adults had no aplasia but hyperplasia was found in some cases. Since the most conspicuous characteristic found was variation among individuals, the nonparametric smoothing spline produced very poor fitting. The modified logistic function was the only parametric method providing significant parameters. Sexes differed in the age at which FS growth began and ended, with FS developing earlier but at a slower rate in females than in males. The FS volume did not correlate with either upper nasal width or endocranial volume, but it correlated with bone thickness measurements (mainly from the glabellar region), even when age was held constant. Expansion of the FS at the frontal poles also correlated with frontal bone thickness. Despite the difficulty in modeling and predicting the trajectory and morphology of FS, our results suggest that it is affected by its surrounding bony environment.

Background: In facial reconstruction, several kinds of grafts can be used, like bone grafting, cutaneous grafting, biological membranes, fasciae latae, biomaterials, and others. The advantage of using fasciae latae in the tissue reparation is the need of little blood supply, making it a viable option in the restoration of biological functions. The objective of this study was to describe the case of a female poodle, 12-year-old, and with subcutaneous emphysema due to fracture of the nasal bone, submitted to cranioplasty using fasciae latae.Case: It was attended a 12-year-old female poodle due to a traumatic brain injury. At physical examination, the animal had presented facial swelling and respiratory distress with inspiratory effort. Additionally, were verified subcutaneous emphysema and a depression in the nasal plane region with crepitus on palpation. Radiographic examinations revealed nasal bone and maxilla fractures. The animal was submitted to cranioplasty for nasal bone fracture repair. To access the nasal bone and frontal sinus was performed an incision in the dorsal midline from the level of medial orbital rim to the nasal plane. The subcutaneous tissue was divulsioned to allow the exposure of the nasal bone fracture, whose small fragments prevented the internal fixation. The bone defect was then repaired using free autologous fasciae latae of 2 cm wide x 3 cm long, sutured to the periosteum. Subcutaneous emphysema gradually decreased until its resolution at three days postoperatively. The surgical wound had complete healing at 10 days after surgery without concomitant complications.Discussion: The choice of the reconstructive technique is based on the operative planning and the surgeon’s experience. In the present case we opted for the autologous fasciae latae graft since its ready availability and lesser predisposition to immunogenic sensibilization and rejection. In addition, we opted for the autologous fasciae latae graft because it is an occlusive material that would prevent the air flow through it during the inspiration and expiration, and consequently the aggravation of the subcutaneous emphysema. In fact, the resolution of the subcutaneous emphysema occurred three days after grafting. Furthermore, the resolution of the subcutaneous emphysema was determined by the lower retraction of the autologous fasciae latae graft due to the scar fibrous tissue deposition. The choice of the reconstructive technique is also based on the viability of the recipient bed, which should provide adequate blood supply for the reception of the free graft. In the present case, however, the bone defect did not provide adequate blood supply and structural support. Due to this, the autologous fasciae latae graft was crucial to the verified results, since it requires less blood supply and structural support to remain the graft viable. We concluded that the autologous fasciae latae graft may be a viable option for the anatomical and functional reconstruction of traumatic lesions localized in the skull, particularly the nasal bone, due to the satisfactory follow-up in the present case without the occurrence of complications. A larger sample size, however, it is necessary to evaluate the real effectiveness of the autologous fasciae latae graft in reconstructive skull surgery on small animals.

Motor vehicle collisions (MVC) are a leading cause of unintentional death and injury in the US pediatric population. Compliance with prevention measures such as seatbelts and child safety seats varies considerably with patient demographics. In this study, the authors examine facial fracture secondary to MVC in an urban pediatric population. A retrospective chart review was performed of all facial fractures as a result of MVC in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. Seventy-five patients met inclusion criteria for the authors' study. Mean age was 14 years old. Common fracture sites included orbital, mandible, nasal bone, and frontal sinus. Patients were more likely to incur fracture of the zygoma, orbit, nasal bone, frontal sinus, and nasoorbitoethmoid (NOE) if involved in an MVC compared to all other etiologies. Common concomitant injuries included traumatic brain injury, intracranial hemorrhage, and skull and long bone fractures. Open reduction and internal fixation with titanium plates was the most common surgical procedure indicated. Motor vehicle collisions related injury has significant health implications in the urban pediatric population. Orbital, zygoma, and nasal facial fractures and TBI are injuries commonly associated with MVC. The facial fractures are likely due to lack of proper utilization of safety equipment and airbags. Development of effective prevention techniques relies heavily on analysis of injury patterns and management strategies.

The stage of maturation of the pediatric facial skeleton at the time of injury has a significant impact on both facial fracture patterns and management strategies. For instance, the relative prominence of the pediatric cranium during the early years of life affords protection to the structures of the midface, whereas delayed aeration of the frontal sinuses may predispose younger patients to frontal bone fractures. The dentition status of a pediatric patient may have similar implications in the setting of facial fracture. In this study, the authors examine the effect of dentition status on facial fracture patterns and management strategies at an urban, level 1 trauma center. A retrospective chart review was performed for all cases of facial fracture occurring in the pediatric patient population at a level 1 trauma center (University Hospital in Newark, NJ) between 2002 and 2014. A database including patient demographics, facial fracture, and concomitant injury patterns, and operative management data was constructed and analyzed. A total of 72 patients with mixed dentition met inclusion criteria for our study and were compared against patients with primary (n = 35) and permanent (n = 349) dentition. The mean age at presentation was 9.2 years, with a male predominance of 68%. The most common fracture etiology was pedestrian struck accident (n = 23), fall (n = 21), motor vehicle collision (n = 12), and assault (n = 9). The most frequently identified facial fractures were that of the orbit (n = 31), mandible (n = 21), nasal bone (n = 19), and frontal sinus (n = 14). Additionally, 8 Le Fort and 4 nasoorbitoethmoid fractures were identified. Twenty-one patients (29%) required operative management for 1 or more facial fractures. Operative intervention was required in 38% of mandibular fractures, with 6 patients requiring only maxillomandibular fixation and 2 requiring open reduction and internal fixation with titanium plating. Nine cases of orbital fracture (29%) were managed operatively - 4 with absorbable plates, 3 with Medpor implants, and 8 with titanium plating. Management of all nasal fractures requiring operative intervention was accomplished through closed reduction. Concomitant injuries included traumatic brain injury (TBI) (n = 35), skull fracture (n = 24), intracranial hemorrhage (ICH) (n = 20), and long bone fracture (n = 12). Seventeen patients required admission to the intensive care unit. Patients with mixed dentition were significantly more likely to sustain frontal sinus and Le Fort fractures (P < 0.01), as well as skull fracture, ICH, and TBI (P < 0.01) as compared to those with permanent dentition. The dentition status of a pediatric patient may have significant implications in both patterns of injury and operative management strategies in the setting of acute facial trauma. Our study finds that Le Fort and frontal sinus fractures were significantly more common in patients with mixed dentition. Severe concomitant injuries such as ICH and TBI were also significantly more likely in this cohort. A patient's dentition status may also play a role in the decision for ridged fixation of mandibular and orbital fractures, as well as the method of maxillomandibular fixation in maxillary and mandibular alveolar fracture.

ObjectiveTo describe a novel two-stage surgical approach for managing complex craniomaxillofacial trauma in a military working dog, including the use of an individualized 3D-printed polymethylmethacrylate (PMMA) plate for frontal bone reconstruction.Case summaryA 3-year-old Belgian Malinois sustained severe head trauma during combat. Clinical examination revealed facial deformation, respiratory distress, and neurological signs. computerized tomography (CT) imaging confirmed multiple fractures, including the frontal and nasal bones, cribriform plate, and frontal sinus, with pneumocephalus. A two-stage approach was employed: (1) Initial stabilization, including a tracheostomy to address respiratory issues and manage intracranial pressure, along with surgical debridement and closure of the frontal sinus. (2) Reconstruction using an individualized 3D-PMMA plate using a customized 3D-printed mold to restore frontal bone integrity.New or unique information providedThis report presents a novel approach to managing complex craniomaxillofacial trauma in dogs, particularly those involving extensive frontal sinus and nasal bone fractures with intracranial complications. The use of an individualized 3D- PMMA plate for frontal bone reconstruction represents a significant advancement in veterinary CMF trauma management, offering a potential solution for achieving both functional and cosmetic outcomes in challenging cases. This case contributes to the limited existing literature on the management of severe frontal sinus fractures in dogs.

Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.

The etiology of fractures of the maxillofacial skeleton varies among studies, with motor vehicle accidents and assaults oftentimes the most common. The number of males outnumbers females throughout most studies. Fractures of the zygoma, orbit, and mandible are usually cited as most common fracture types. This study examines a single center's experience with regards to etiology and distribution of fractures. A retrospective review of all radiologically confirmed facial fractures in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patient demographics, etiology of injury, and location of fractures were collected. During this time period, 2,998 patients were identified as having sustained a fracture of the facial skeleton. The average age was 36.9 years, with a strong male predominance (81.5%). The most common etiologies of injury were assault (44.9%) and motor vehicle accidents (14.9%). Throughout the study period, the number of fractures as a result of assault remained relatively constant, whereas the number as a result of motor vehicle accidents decreased slightly. The most common fracture observed was of the orbit, followed by mandible, nasal bones, zygoma, and frontal sinus. Patients sustaining a fracture as a result of assault were more likely to have a mandible fracture. Patients in motor vehicle accidents were more likely to suffer fractures of the maxilla, orbit, and frontal sinus. Mandible fractures are more common in cases of assault. Motor vehicle accidents convey a large force, which, when directed at the craniofacial skeleton, can cause a variety of fracture patterns. The decreasing number of fractures as a result of motor vehicle accidents may represent improved safety devices such as airbags.

To compare the radiographic and computed tomographic (CT) findings and to evaluate the sensitivity of radiography and CT for diagnosis of nasal aspergillosis in dogs, the radiographic and CT studies of 48 dogs with chronic nasal disease were reviewed separately. The radiographic and CT findings were recorded, and a diagnosis was made. The results obtained in the dogs with nasal aspergillosis (n = 25) were used. Based on definite aspergillosis as diagnosis, CT had a sensitivity of 88% and radiography of 72%. Considering definite and probable aspergillosis as equivalent, CT had a sensitivity of 92% and radiography of 84%. The sensitivity was higher in dogs with lesions affecting the entire nasal cavity and frontal sinus on at least one side (n = 20) with a sensitivity of 100% for CT and 90-95% for radiography than in dogs with lesions restricted to the nasal cavities (n = 5) where CT had a sensitivity of 60-80% and radiography of 0-40%. CT was superior to radiography for evaluation of the nasal cavities (mucosal thickening along the nasal bones, surrounding bone hyperostosis/lysis), frontal sinuses (mucosal thickening along the frontal bone, fluid/soft tissue, frontal bone hyperostosis/lysis), and differentiation between a cavitated-like or a mass-like process. This study suggests that CT is more sensitive than radiography for diagnosis of nasal aspergillosis in the dog because of a better demonstration of some changes suggestive of nasal aspergillosis. A diagnosis of a nasal aspergillosis restricted to the nasal cavities or associated with an FB is challenging, even with the use of CT.

This paper describes an endoscopic transseptal approach to identify and access the frontal sinus and reviews the clinical cases. Between May 2004 and July 2010, endoscopic modified Lothrop procedure (EMLP) with transseptal approach was performed on sixteen patients. The indications for EMLP were complicated frontal sinusitis or cyst, revision surgery for failed frontal sinusotomy or Lynch procedure, or trauma cases. The first step of this procedure was to open a window in the bilateral anterior portion of the middle turbinates and nasal septum. The nasal septum, which could be observed through the window, should be the landmark of the midline during the surgery. A drill bur was raised up just behind the nasal bone along the midline of the nose. After the bilateral frontal sinuses and their posterior walls were confirmed, the interfrontal septum was removed superiorly. We reviewed the clinical records of patients who underwent the EMLP with transseptal approach. We have managed sixteen patients in this fashion. Neither intracranial nor orbital complications were encountered during or after surgery. Endoscopic transseptal frontal sinus surgery is simple to perform, and does not cause severe complications.

Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove,which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." The clinical applications of this new anatomic description concern both cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans.

Huge aggressive mixed-type osteoma in a young patient

Subdorsal septal resection and radix osteotomy are distinctive surgical steps in preservation rhinoplasty. The aim of this study was to evaluate the nasal bone thickness, the level of the septal bony-cartilaginous junction (K area), and the distances of the frontal sinus and skull base from the transverse osteotomy line in the Turkish population by means of conventional computed tomography (CT). A retrospective evaluation was made of 203 consecutive preoperative paranasal CT scans of patients (classified in terms of age and gender) who had undergone rhinoplasty surgery between January 2020 and June 2021. The nasal bone thickness at the medial canthus level, and the distances between the transverse osteotomy line and the K area, the frontal sinus, and the cribriform plate were measured. The mean measurements were similar in terms of age groups (P = 0.402, P = 0.542, P = 0.134 and P = 0.276 for ages 18-30, 30-40, 40-50, and >50 years, respectively). The mean nasal bone thickness and the distance between the transverse osteotomy line and the K area showed statistical significance (P = 0.001 and P = 0.001, respectively). In both genders, the mean distances between the transverse osteotomy line and the frontal sinus and the cribriform plate were similar (P = 0.921 and P = 0.280, respectively). The nasal bone was thinner and the K area position more cephalic in females. CT plays an important role in preoperative planning. The need for resection of the ethmoid perpendicular bone may be greater in males when lowering the dorsal hump, and hence they may be more prone to skull base complications. It is therefore necessary to be more careful in the surgical stage of subdorsal septal excision in males.

Primary frontal sinus carcinoma is rare, with an incidence of 0.3-1% of all paranasal sinus carcinomas. We present an 84-year-old woman who, about a month ago, developed erythema and edema of the skin of the upper eyelids and glabella, accompanied by eye discharge and slight tenderness to touch. We performed an X-ray and CT examination of paranasal cavities that found no pathological changes. The patient underwent several consultations and treatments from different specialists without any effect. Due to the growth of edema and the formation of a dense lesion at the base of the nose and frontal sinus, a repeat CT examination of the paranasal cavities was performed, which established the presence of a soft tissue oval lesion frontally in the area of the glabella with dimensions of 38/36/40 mm, which infiltrates and lyses the upper part of the right nasal bone, anterior ethmoid cells, medial wall of the right orbit, and anterior wall of the frontal sinus. The patient was referred to an otorhinolaryngology clinic, where a diagnosis of low-differentiated squamous cell carcinoma was made with the help of a biopsy and immunohistochemical examination. Due to the judgment of inoperability, definitive large-fractionated percutaneous radiotherapy was performed. The presented case illustrates the need for broad differential-diagnostic thinking in cases with edema in the head region.

The dentition of Tupaia glis was observed. The materials for this study are 7 dry skulls of common tree shrew.The following results are obtained: 1. The upper molar pattern of the Tupaia glis is the typical dilambdodont type. The paracones of the upper molars are well-developed. And the metacone of the third molar is less developed. 2. Three stylar cusps and two bucal cusps of the first and second molar are well-developed, but metastyle of the third molar is absent. The parastyle and metastyle are also observed in the third and fourth premolars. 3. The protocones of the upper molars and the fourth premolar are well-developed but those of the third premolar is less developed. 4. The hypocone is derived from distolingual elevation of the cingulum. This cusp of the upper first molar is well-developed. 5. The lower molar is composed of a trigonid and talonid. There are three cusps in the trigonid and talonid. The lower fourth and third premolar are also composed of a trigonid and talonid, but there is only one cusp in the talonid. The upper and lower second premolars and the front teeth are haplodont. The lower first and second incisors are procumbent, and form a dental comb.