Anatomical Anomalies Research Articles

Blue rings in trees and shrubs as indicators of early and late summer cooling events at the northern treeline

The high temperature sensitivity of pine trees in northern Fennoscandia has led to some of the most reliable tree-ring climate reconstructions in the world for the past millennia. However, wood anatomical anomalies that likely reflect temperature-induced reductions in cell wall lignification, the so-called Blue Rings (BRs), have not yet been systematically investigated in trees and shrubs in northern Europe. Here, we present frontier research on the occurrence of BRs in Pinus sylvestris trees and Juniperus communis (L) s.l. shrubs from the upper treeline in northern Norway (69°N) in relation to instrumental temperature data covering the last ca. 150 years. The highest number of BRs was found in 1902, with 96% of Pinus trees and 68% of Juniperus shrubs showing BRs. These corresponded on average to a 42% vs. 27% proportion of the growth ring in 1902 which was less-lignified in Pinus trees and Juniperus shrubs, respectively. Another peak in BRs recorded for 1877 was more pronounced in Pinus trees (88%) than in Juniperus shrubs (36%), with a lower proportion of less lignified rings. We found the lowest monthly sums of growing degree days in June 1902 and August 1877, resulting in more uniform non-lignified BRs in 1902 than in 1877. Prolonged early growing season cooling shortened the growing season in 1902 and resulted in much thinner cell walls in trees and shrubs than in 1877, which was characterized by extended cooling at the end of the growing season. Also, after 1902 BR, Pinus trees exclusively showed no recovery in the mean cell wall thickness in the following year. Our study provides the first evidence for different impacts of early versus late growing season cooling on cell wall lignification in trees and shrubs at the northern treeline. Using the anatomy of BRs, we demonstrated the potential to refine summer cooling event reconstructions at an intra-annual resolution in northern Fennoscandia and beyond.

Effects of patent foramen ovale in migraine: a metabolomics-based study.

Patent foramen ovale (PFO), a cardiac anatomical anomaly inducing abnormal haemodynamics, leads to a paradoxical bypass of the pulmonary circulation. PFO closure might alleviate migraines; however, clinical evidence and basic experiments for the relationship are lacking. To explore the effect of PFO on migraine, 371 migraineurs finishing blood tests and contrast transthoracic echocardiography for the detection of PFO were prospectively included. Multivariate regression analysis revealed that PFO was independently associated with aura, and lower cystatin-C (cys-C) and calcium levels. Among them, patients with PFO who underwent percutaneous PFO closure were continuously followed up 1year after the operation. The intensity of migraine was significantly relieved and the levels of cys-C and calcium increased after PFO closure. Untargeted and targeted metabolomics of plasma from migraineurs before and after PFO closure revealed that 5-HT and glutathione (GSH) metabolites were differentially expressed after PFO closure. The differential metabolites were then validated in the plasma and brain tissues of PFO mouse models by LC-MS/MS analysis. Desorption electrospray ionization mass imaging demonstrated that these metabolic alterations occurred mainly in the posterior cerebral cortex. Collectively, aura, cys-C and calcium could be biomarkers of migraineurs with PFO. PFO might have an impact on the posterior head associated with the regulation of 5-HT and GSH. PFO closure might relieve migraine by improving 5-HT clearance metabolism and ameliorating redox reactions. Our results may provide evidence for an indication of PFO closure in migraine and support the related potential mechanism. KEY POINTS: Aura, and levels of cystatin-C and calcium are biomarkers of migraineurs with a patent foramen ovale (PFO). The clearance of pulmonary metabolism of 5-HT and deoxygenated blood might be the reason for the improvement of migraine symptoms in patients with PFO. The posterior region of the brain is the main area responsible for PFO-induced migraine.

Assessment of Outcomes & Anatomical Changes in the Upper Urinary Tract following Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath (FANS): 3-Month Results from a Multicenter Study.

To study the long-term outcomes of the flexible and navigable suction ureteral access sheath (FANS) in flexible ureteroscopy (FURS). FANS has well-established efficiency and 30-day perioperative safety; however, its influence on pelvicalyceal and ureteric anatomy remains to be investigated. This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. 30-day postoperative stone free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications. 310 patients were analyzed. Median age was 51; median stone volume was 1584 mm3. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14min, median ureteroscopy time was 30min, and median total operation time was 45min. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. 30-day reintervention rate was 4.2% (13 cases). 3-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded. The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.

Analysis of shoulder motion with inertial sensors in Poland syndrome patients.

Poland syndrome is a congenital malformation characterized by agenesis or hypoplasia of pectoralis muscles. There is a limited literature on how the anatomic anomalies of PS may impact the movement of the shoulder. This study analyzes the effects of absence of the pectoralis muscles on the shoulder kinematic. Clinical evaluation was performed analyzing range of motion (RoM), stability, cuff disease and internal rotation strength. In all patients, we used inertial sensors to analyze scapular motion in three degrees of freedom: medium-lateral rotation, posterior tilting and protraction-retraction. The same analysis was performed by dividing the patients into two groups by age to evaluate the presence of age-related alterations. No differences in RoM between pathological and healthy side were observed. All patients were positive for posterior instability. No significant differences in strength in internal rotation were observed with average + 6,91% (s = 2,14) on the healthy side's strength. Kinematic analysis showed higher values of scapular medium-lateral rotation and anticipation of retraction of the pathological side during flexion and abduction. Reduced scapular tilt in under 18 years old was found. The absence of the pectoralis muscles seems not to affect the RoM. The increased scapular rotation on the medium-lateral axis is probably due to the absence of humeral insertion of the pectoralis major and the absence of the scapular insertion of the pectoralis minor. The increased retraction in abduction it can be explained by a hypercontraction of the scapular stabilizers. The reduced tilt in under 18 years old is influenced by the lack of adaptation by the muscle groups involved.

DIAGNOSTIC CAPABILITIES OF CONE-BEAM COMPUTED TOMOGRAPHY IN ORTHODONTICS

Advancements in medical technology, particularly in computer software, have facilitated the use of 3D cone-beam computed tomography (CBCT) for craniofacial cephalometry, which plays a crucial role in assessing and quantifying anatomical anomalies in three dimensions. However, a standardized method or algorithm for utilizing 3D CBCT in cephalometry has yet to be established. The aim of this study was to analyze and systematize scientific literature available in the PubMed electronic database regarding the use of 3D cone-beam computed tomography (CBCT) for cephalometric diagnosis in orthodontics. The analysis focused on the following areas: scientific articles describing methods for performing cephalometric analysis using CBCT; applications of CBCT-based cephalometric analysis for diagnosing dentofacial anomalies, treatment planning, and evaluating the effectiveness of orthodontic treatment; sStudies establishing cephalometric norms based on CBCT; analysis of tongue position in patients undergoing orthodontic treatment; evaluation of alveolar bone conditions of the jaws using CBCT; use of CBCT in diagnosing genetic disorders of the craniofacial region and associated pathologies; studies on the temporomandibular joint in orthodontic patients; morphological analysis of the lower jaw muscles; assessment of airway morphology using 3D CBCT. Thus, we can conclude that radiographic examination is an essential component of diagnosing and planning orthodontic treatment. It enables a detailed analysis of the facial skeleton's structure and its relationship with surrounding soft tissues, leading to a more accurate diagnosis. Cephalometric measurements performed on 3D CBCT images are more precise and reliable compared to those conducted on conventional radiographic images. Additionally, 3D CBCT provides comprehensive data for orthodontic analysis, eliminating the need for additional cephalometric radiographs.

The First Reported Case of Right Aortic Arch with Left Subclavian Artery Atresia Presenting with Heart Failure with Reduced Ejection Fraction: Exploring an Uncertain Causal Relationship

The largest artery in the body is the aorta. The ascending aorta, aortic arch, thoracic aorta, and abdominal aorta are the four sections that make up the aorta. The ascending aorta continues into the aortic arch. It moves inferiorly after arching superiorly, posteriorly, and to the left [1]. The right aortic arch is a rare anatomical anomaly of the aorta [2]. A case of a 43-year-old male was recently diagnosed with heart failure with reduced ejection fraction (HFrEF). Cardiac CT was performed as part of the ischemic heart disease evaluation. The cardiac CT revealed a right-sided aortic arch, along with the absence of the proximal segment of the left subclavian artery, and the perfusion of the left subclavian artery occurring via the left vertebral artery. This case represents the first documented instance in the literature of heart failure occurring concurrently with these vascular anomalies.

Heterotopic submandibular gland with herniation through the mylohyoid boutonnière: a unique radiological case.

To describe a rare case of heterotopic submandibular gland (SMG) tissue herniating through the mylohyoid boutonnière into the anterior submandibular space, diagnosed using imaging, and to provide insights into its clinical implications. A 59-year-old male with a history of smoking and type 2 diabetes presented with new-onset hoarseness. Imaging, including contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), was performed. The lesion's imaging characteristics, location, and tissue composition on CT and MRI were analyzed, and differential diagnoses were considered. CT and MRI revealed a well-defined soft tissue lesion in the right anterior submandibular space, exhibiting features consistent with ectopic SMG tissue. On MRI, the lesion was iso- to slightly hyperintense compared to surrounding muscle tissue and showed ductal structures leading to the sublingual space, with a discontinuity in the mylohyoid muscle. No malignancy or other pathologies were identified, and the patient's hoarseness improved with treatment for dyspepsia. This case highlights the diagnostic value of imaging in identifying rare anatomical anomalies like heterotopic SMG with herniation through the mylohyoid boutonnière. Accurate diagnosis can prevent unnecessary procedures and guide appropriate management.

Indications and Outcomes of Fetal Cystoscopy for Lower Urinary Tract Obstruction: A Comprehensive Review.

Fetal lower urinary tract obstruction (LUTO) encompasses a spectrum of rare congenital anomalies affecting the fetal urinary system, leading to significant morbidity and mortality. This condition, arising from various anatomical anomalies such as posterior urethral valves (PUV), urethral atresia, and cloacal malformations, disrupts normal urine flow, resulting in secondary complications such as pulmonary hypoplasia and renal impairment. Current management strategies, including fetal vesicoamniotic shunting (VAS) and fetal cystoscopy, aim to alleviate obstruction and mitigate associated risks. While VAS has been a longstanding intervention, fetal cystoscopy presents a promising alternative by enabling direct visualization and targeted treatment of urinary tract obstructions. However, fetal cystoscopy is not without challenges, including technical complexities and risks associated with invasive procedures. This review explores the rationale, indications, technical considerations, outcomes, and future innovations of fetal cystoscopy in managing LUTO. It highlights the critical role of accurate diagnosis, patient selection, and procedural expertise in optimizing fetal and maternal outcomes. Despite existing challenges, ongoing advancements in technology and clinical practice hold the potential for further enhancing the safety and efficacy of fetal cystoscopy, underscoring its evolving role in prenatal care.

Electroconvulsive Therapy With Brain Cyst: A Simulation Study.

Electroconvulsive therapy (ECT) is effective in treating severe depression and other neuropsychiatric disorders, but how the presence of an anatomical anomaly affects the electrical pathways between the electrodes remains unclear. We investigate the difference in electric field (E-field) distribution during ECT in the brain of a patient with an arachnoid cyst relative to hypothetical condition where the cyst was not present. Magnetic resonance imaging scans of the head of a patient with a large left frontal cyst were segmented to construct a finite element model to study the E-field distribution during ECT. Five electrode configurations were investigated: right unilateral, left unilateral, bifrontal, and bitemporal and left anterior right temporal. The E-field distributions for all montages were compared with a hypothetical condition where brain tissue and electrical conductivity from the right frontal region was mirrored across the longitudinal fissure into the cyst. Differences in mean E-field and 90th percentile E-fields were mainly observed in brain regions closest to the cyst including the left inferior frontal gyrus and left middle frontal gyrus. This trend was most pronounced in montages where the electrodes were closest to the cyst such as left unilateral and bitemporal. The presence of a highly conductive cyst close to the ECT electrode tended to attract current into the cyst region, altering current pathways, with potential implications for therapeutic efficacy and safety. Placing electrodes farther away from the cyst is likely to minimize any effects on the E-field distribution and potentially clinical outcomes.

Sonographic Evaluation of an Urachal Remnant: A Case Report

Urachal anomalies are rare and often identified incidentally during diagnostic imaging examinations, such as sonography. These anatomical anomalies are being detected with increasing frequency due to advancements in cross-sectional imaging. Early detection facilitates effective management and treatment options. When these anomalies go undetected and persist into adulthood, patients are at an increased risk for adverse health outcomes. Urachal anomalies have the potential to undergo pathological changes, leading to inflammation, infection, and even malignancy. Therefore, it is imperative for sonographers to be proficient in identifying and understanding sonographic characteristics of urachal abnormalities. This is crucial, given that sonography continues to be a key diagnostic technique due to its lack of radiation, cost-effectiveness, and widespread availability.

Therapeutic endoscopic retrograde cholangiopancreatography in a patient with asplenia-type heterotaxy syndrome: A case report

BACKGROUND Asplenia-type heterotaxy syndrome (HS) is rare and refers to visceral malposition and dysmorphism. It is associated with a high infant mortality rate due to cardiac anomalies, and related digestive endoscopic interventions are poorly understood. With the improved long-term prognosis of these individuals after modern cardiac surgery, intra-abdominal anomalies have become increasingly significant. CASE SUMMARY Herein, we report successful endoscopic retrograde cholangiopancreatography (ERCP) in a 14-year-old male with asplenia-type HS that involved unique imaging findings and technical difficulties. His anatomic anomalies included complex congenital heart disease, midline liver placement, an absent spleen, a left-sided inferior vena cava, and dextroposition of the stomach and pancreas. He suffered from choledocholithiasis with obstructive jaundice, and the stone was successfully extracted with a basket following endoscopic papillary balloon dilation. CONCLUSION Although anatomic anomalies in HS increase the degree of technical difficulty when performing ERCP, they can be safely managed by experienced endoscopists, as illustrated by the present case. Identifying these variations with imaging modalities and being aware of them before initiating an invasive intervention are crucial to preventing potential complications.

Sacralization of lumbar vertebrae-prevalence and association with low back ache and radiculopathy

Background: Low back pain (LBP) is a prevalent condition, often associated with various anatomical anomalies, including lumbar sacralization, that is, the fusion of the fifth lumbar vertebra (L5) with the sacrum. This study aims to evaluate the prevalence of sacralization among LBP patients and its relationship with radiculopathy. Methods: A retrospective study was conducted at the department of orthopaedics, Justice KS Hegde charitable hospital, from January 1, 2023, to July 31, 2024. Patients aged 18-75 years presenting with LBP who underwent lumbosacral radiographs were included. Demographic and clinical data were collected, and sacralization types were classified using the Castellvi system. Statistical analyses were performed using the chi-square test. Results: Among 771 radiographs analysed, the prevalence of sacralization was 10.1%. Most subjects were over 41 years old (81.6%), with a majority being female (54.5%). Type I A was the most common form of sacralization (30.77%). A significant association between sacralization and radiculopathy was observed, with 70 of the 78 subjects with sacralization experiencing radiculopathy (p<0.0005). Conclusions: This study indicates a noteworthy association between sacralization and radiculopathy in patients with LBP. Given the low prevalence of sacralization, the findings emphasize the importance of recognizing anatomical variations in clinical evaluations of patients with low back ache, particularly in older populations. Further research is warranted to explore the implications of these anatomical anomalies on treatment strategies and patient outcomes.

Unilateral double fenestration of the same posterior cerebral artery at P1 segment: first cadaveric case report and literature review.

Arterial fenestration involves an artery emerging from the same embryological origin, with its lumen divided into two channels that subsequently rejoin. This kind of vascular variant has consequences, such as focal defects in the histologic layers of the arteries, hemodynamic stress, and challenges for endovascular procedures in the management of vascular pathologies. The main objective of this work is to present a rare vascular variant, a double fenestration of the same P1 segment of a cadaveric specimen, and a literature review of these kind of vascular variants. A cadaveric study was performed in which 20 central nervous system specimens, from patients without neurological pathology obtained as a donation from the National Institute of Legal Medicine and Forensic Sciences, were dissected for educational and research purposes. In one specimen it was found a double fenestration of the right P1 segment, associated with a single fenestration of the right superior cerebellar artery. Few cases of posterior circulation fenestration, beyond the vertebrobasilar trunk are reported in the literature, with limited understanding of the potential hemodynamic consequences thereof. In all the literature available, only eight cadaveric cases of P1 segment fenestration are documented, often linked with other central nervous system vascular abnormalities such as aneurysms or duplications. There is a single report of unilateral double P1 segment fenestration in a living patient. To our knowledge, this is the second case reported in the literature on this specific anatomical anomaly, and the first such report in a cadaver.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Rare Presentation of an Anatomical Congenital Anomaly of the Coronary Arteries on Computed Tomography Angiography

Rare Presentation of an Anatomical Congenital Anomaly of the Coronary Arteries on Computed Tomography Angiography

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Advances in Diagnostic Parameters and Surgical Techniques for Patellofemoral Instability and Extensor Mechanism Disorders: A Comprehensive Review.

Extensor mechanism misalignment in the knee, particularly patellofemoral instability (PFI), requires detailed diagnostic and therapeutic approaches. This comprehensive review intends to present recent advancements in diagnostic imaging technologies as well as surgical approaches that have significantly advanced the management of this condition. An extensive literature review covered recent studies and clinical practices related to diagnosing and treating knee extensor mechanism misalignment, such as three-dimensional imaging technologies, arthroscopic surgical techniques, postoperative rehabilitation protocols, and others. Three-dimensional imaging technologies such as MRI and CT scans have revolutionized diagnosing and managing PFI by providing detailed assessments of anatomical anomalies, leading to personalized treatment plans tailored specifically for each individual's anatomy. Arthroscopic surgery, with techniques such as lateral release, medial patellofemoral ligament reconstruction, and tibial tubercle osteotomy, has become an efficient minimally invasive solution, with advancements like digitally calibrated measurement tools further improving surgical precision and outcomes. The combined use of advanced imaging technologies and surgical methods has greatly advanced the management of knee extensor mechanism misalignment. Personalized medicine approaches combined with minimally invasive surgical techniques have yielded promising recovery times and outcomes, and future directions include exploring biological therapies, improving rehabilitation protocols, and expanding diagnostic technologies to address misalignments more comprehensively. With modern diagnostic tools and innovative surgical techniques, more effective and personalized treatments for extensor mechanism misalignment in the knee have become possible. These advances could significantly enhance the quality of life for individuals suffering from PFI disorders; ongoing research collaboration should serve to optimize diagnosis, treatment, and prevention strategies further.

Carotid Endarterectomy with Twisted Internal Jugular Vein Located Anterior to the Common Carotid Artery

AbstractThe knowledge of both normal and abnormal anatomy of the veins of the neck may be important for surgeons performing carotid endarterectomy (CEA), to avoid inadvertent injury to vascular structures. We present three cases of abnormal course of the internal jugular vein (IJV) which run anterior to the common carotid artery, named twisted IJV, that usually run posterolateral to the common carotid artery in patients undergoing CEA. These twisted IJV cases were detected by preoperative multidetector computed tomography angiography evaluation. During the CEA procedure, before identifying the common carotid artery, we dissected the retromandibular space to find the common facial vein. Then, dissection proceeded along the common facial vein caudally to find the IJV. After ligation and cutting of the common facial vein, a carotid sheath with the IJV turned laterally revealed the common carotid artery safely, and CEA was accomplished. Our clinical experience shows that knowledge of the anatomical anomaly of the IJV allows safe dissection of the carotid triangle avoiding inadvertent injury to the vasculature and vagus nerve.

Syndrome Sinistre: Left Brachiocephalic Vein Compression and its Neurological Manifestations.

Embryologically, the left brachiocephalic vein (LBV) originates as an anastomotic channel between the right and left anterior cardinal veins. This positions the LBV between the manubrium sterni anteriorly and the innominate artery posteriorly. This pattern of adjacency of the aorta to the LBV is unique to mammals and results from a quirk of evolution. With age, the ascending aorta unfolds, elongates and dilates. Simultaneously, there is a change in the thoracic geometry that reduces the thoracic volume primarily from disc height loss and kyphosis. These transitions progressively compress the LBV. Normally, this compression is circumvented via collateral pathways and "Blood finds a way". However, traversing these circuitous pathways comes at a cost and can result in delayed transit times and venous congestion. While it is possible that compression of the LBV in the setting of adequate collateral channels may fail to provoke any pathologic sequelae, we propose a phenomenon in which such compression in the setting of inadequate collateral circulation may lead to a state of pathologic venous congestion. This anatomic anomaly and its associated clinical features, if identified, can offer a new avenue for treatment options for some of the hitherto unexplained neurologic disorders.

Modern views on the etiology and role of microbial persistence in the development of inflammatory processes in the periodontal complex (review)

Alveolar tissue diseases cause the appearance of dentition defects, thereby reducing the patients' work capacity and quality of life. The purpose of this research was to investigate, modern views on the etiology of periodontitis and the role of microbial persistence in the development of inflammatory processes of periodontal complex basing on a review of literary sources. Literature review was conducted using PubMed, Web of Science, Scopus, Google Scholar from 2018 to March 2024. There were no restrictions on the date of publication or the language of scientific sources. Searches were conducted according to MeSH (Medical Subject Headings) with using the following search terms: "periodontitis", "oral mucosa", "gums", "dental plaque", "periodontium", "traumatic occlusion", "microorganisms". In total, during the initial analysis 82 literary sources were selected and processed, after further systematization of the selected information using general scientific methods, 70 of them remained. Used methods: bibliographic and analytical. Generalized perio­dontitis is a chronic inflammatory-dystrophic process that occurs as a result of various factors. In the pathogenesis of this disease, the key role is played by the inflammatory process, which is a complex interaction of microcirculatory, he­matological and connective tissue reactions to the lesion. Local (exogenic) and general (endogenic) causative factors are distinguished. The main factors that cause pathological changes in periodontium are bacterial biofilm, traumatic occlusion and various anatomical anomalies. Dental plaque occupies a special and main place among the causes of periodontitis. At present, leading pathogenetic links in the development of the inflammation in the periodontium, in par­ticular, the disruption of free radical oxidation, the processes of peroxide oxidation of lipids and proteins, the disorder of the functional state of the antioxidant system, the formation of oxidative stress, as well as the humoral link of adaptive immune protection and cytokinesis, have not been sufficiently studied. There is no doubt about the role of the microbial factor in the etiology of periodontal diseases, but the penetration of microbes into the periodontium does not always lead to the development of the disease, because the organism has a number of protective mechanisms that counteract the development of inflammation.