Anterior Border Research Articles

A nonhealing scalp ulceration in a patient with a history of herpes zoster infection

A 63-year-old male smoker presented with a nonhealing, enlarging wound on his right parietal scalp and an associated 2-month history of pruritus and “needle-like” pains. Medical history was significant for a herpes zoster eruption in the same area 7 months prior, treated with acyclovir. Examination found right-sided facial asymmetry with alopecia of the eyebrow, a sharply demarcated scalp ulceration with exposed periosteum, an angulated erosion at the anterior border of the ulcer, and another angulated erosion over the right medial eyebrow (Figs 1 and 2).

When to consider a posterolateral descending aortopexy in addition to a posterior tracheopexy for the surgical treatment of symptomatic tracheobronchomalacia

PurposesThe descending thoracic aorta typically crosses posterior to the left mainstem bronchus (LMSB). We sought to evaluate patient factors that may lead one to consider a posterolateral descending thoracic aortopexy (PLDA) in addition to a posterior tracheopexy (PT) in the surgical treatment of symptomatic tracheobronchomalacia (TBM) that involves the LMSB. MethodsRetrospective review of patients who underwent PT with or without PLDA between 2012 and 2017.Severity and extent of TBM were assessed using dynamic tracheobronchoscopy. Aortic positioning compared to the anterior border of the spine (ABS) at the level of the left mainstem bronchus was identified on computed tomography (CT). Factors associated with performing a PLDA were evaluated with logistic regression. ResultsOf 188 patients who underwent a PT, 70 (37%) also had a PLDA performed. On multivariate analysis, >50% LMSB compression on bronchoscopy (OR 8.06, p < 0.001), >50% of the aortic diameter anterior to the ABS (OR 2.06, p = 0.05), and more recent year of surgery (OR 1.61, p = 0.003) were associated with performing a PLDA. ConclusionWhen performing a PT, a PLDA should be considered for patients who have >50% LMSB compression on dynamic bronchoscopy, and in those with a descending thoracic aorta located >50% anterior to the ABS. Level of evidenceIII Type of studyRetrospective comparative study.

Morphologic and morphometric analysis of mandibular lingula

Objectives: The aim of this study was to determine the morphology and location of mandibular lingula in relation to the surrounding structures in adult mandibles to provide data that can be used during oral and maxillofacial procedures. Methods: This study was performed on 50 dry adult mandibles of Turkish population. The shape of the lingula was examined bilaterally and classified into four types. Osteometric measurements were performed on both sides using a digital caliper. Statistical analysis was performed to determine the differences between right and left side measurements. Results: The most frequently encountered shape of lingula was triangular type (42%). The assimilated type was not observed among the mandibles studied. The mean distance between the lingula and the anterior border of the ramus of the mandible and between the lingula and the posterior border of the ramus of the mandible was measured as 16.86±2.73 mm and 14.7±1.6 mm, respectively. The mean height of the lingula was measured as 11.92±2.03 mm. No statistically significant differences were observed between the right and left side measurements for any parameters. Conclusion: The findings of present study may be used for various oral and maxillofacial surgical procedures and help surgeons in avoiding inferior alveolar nerve injury during mandibular osteotomies.

Validity of the distance between the anterior humeral line and capitellum as a quantitative measure of supracondylar humeral fracture in children

IntroductionThe anterior humeral line (AHL) is a radiographic marker used to quantify anterior-posterior displacement in supracondylar humeral fractures on lateral radiographs. As both the anterior border of the capitellum and the undeveloped ossific nucleus are clearly recognisable on lateral radiographs, we analysed the distance between the AHL and capitellum (AC distance). We hypothesised that the AC distance would provide a highly reproducible and useful index of correction losses in supracondylar humeral fractures. Materials and MethodsForty-two patients (mean age: 6.5 years) who had suffered supracondylar humeral fractures were enrolled in this study. The fractures were corrected by cross pinning in 28 patients and by lateral or lateral and posterior pinning in 14 patients. The AC distance, Baumann angle, and tilting angle were measured in radiographs of the supracondylar humeral fractures obtained immediately after surgery and after bone union. Correction losses were calculated and defined as changes in the AC distance, tilting angle, and Baumann angle. We investigated inter-observer and intra-observer variability in all three radiological parameters and also compared these parameters between children who underwent lateral pin fixation and those who underwent crossed pin fixation. ResultsAn analysis of intra-observer variability yielded values of 0.93, 0.73, and 0.92 for the AC distance, tilting angle, and Baumann angle, respectively. An analysis of inter-observer variability yielded corresponding values of 0.84, 0.46, and 0.79, respectively. Notably, the change in AC distance was significantly smaller in the cross pinning group than in the lateral pinning group. DiscussionCompared with the Baumann angle and tilting angle, the AC distance was identified as the most reliable method for measuring radiographs. Moreover, smaller correction losses were observed with cross pinning than with lateral pinning. Therefore, the AC distance is a useful and accurate quantitative parameter when analysing supracondylar fractures in children using sagittal plane images.

Bailiaspis (Trilobita) with English affinities from the Mansilla Formation (Cambrian Series 3 of the Iberian Chains; NE Spain)

A new study of the trilobite record in the Mansilla Formation (Iberian Chains, NE Spain) has led to the discovery of the presence of Bailiaspis aff. tuberculata, B. cf. tuberculata and Bailiaspis sp., the first certain citation of this genus in the Mediterranean subprovince. The age of the findings extends from Eccaparadoxides asturianus Zone (upper Leonian) to the lowermost Badulesia tenera Zone (lower Caesaraugustan), which correspond to the upper part of Stage 5 of Cambrian Series 3 and, probably, the lowermost Drumian. The specimens show the cranidial anterior border expanding backwards, forming a plectrum that is characteristic of Bailiaspis. The main characters of the three taxa include: a low convexity of the cranidium, with a very short or absent preglabellar field, and a cranidial sculpture with numerous densely-packed coarse tubercles. The only species that shows these diagnostic characters is Bailiaspis tuberculata from the middle Cambrian of England (Nuneaton, Warwickshire) in horizons inconclusively dated as the Ptychagnostus gibbus Zone (Cambrian Stage 5). This zone has been previously correlated with the upper Leonian and lower Caesaraugustan; thus, the British and Spanish materials are probably of similar age.

Three-dimensional geometrical modelling of the femoral intramedullary cavity using ring cyclide model.

Objectives This study aims to investigate if geometrical modelling in addition to three-dimensional (3D) modelling will standardize models and allow performing mathematical calculations easily for the compatibility of femoral implant curvature.Patients and methods The study included 50 subjects (27 males, 23 females; mean age 55 years; range, 21 to 84 years). The femoral shaft intramedullary cavity was resembled into a chord of the ring cyclide, where the rotational radius was centered at its smallest radius. A 3D evaluation of the left femoral computed tomography data of the subjects was used to investigate the population parameters. The fitting was defined as being between the anterior and posterior border radii in the sagittal plane.Results The best fitting radius of implants was in between 90 to 99 cm in 72% of subjects in our sample. These radii values were lower than the mean intramedullary and cortical centerline radii which had only 62% and 50% fittings, respectively, among our population sample. The bowing radii and the smallest intramedullary width increased with the femoral length. These values were not affected by gender.ConclusionThis modelling may have value for understanding femoral shaft intramedullary cavity geometry and may be a good tool to assess implant fitting.

The trilobites Prophalaron gen. nov. (Calymenidae) and Dicranurus (Odontopleuridae) from the Upper Ordovician of New South Wales

Previously undescribed trilobites from the Late Ordovician (latest Eastonian, mid Katian) Gunningbland Formation of central New South Wales include the calymenid Prophalaron jonesi gen. et sp. nov. and the odontopleurid Dicranurus webbyi sp. nov. Prophalaron resembles some members of the Reedocalymeninae, in particular Neseuretinus, in the presence of a relatively long, convex preglabellar field and a short, upturned anterior border. However, this similarity is a result of convergence, and other characters such as the weaker vaulting of the cephalon and pygidium as well as the hypostomal morphology indicate that Prophalaron belongs to the Calymeninae. Dicranurus webbyi is the first odontopleurid recorded from the Ordovician of Australia. The species lacks the reduction in length of the fifth thoracic segment and its posterior pleural spine that have been suggested as diagnostic of the genus.David J. Holloway [dhollow@museum.vic.gov.au], Museums Victoria, GPO Box 666, Melbourne, Victoria 3001, Australia; Patrick M. Smith* [Patrick.Smith@austmus.gov.au], Australian Museum, 1 William Street, Sydney, New South Wales 2010, Australia; Geoff Thomas [fossilgt@gmail.com], PO Box 130, Southland Centre, Victoria 3192, Australia. *Also affiliated with: Department of Biological Sciences, Macquarie University, Sydney, New South Wales 2109, Australia.

Cranial Base Structures Geometric Morphometry and Description of a Clinical Relevant Anatomical Variation

The foramen magnum is a large median oval opening in the occipital bone in the base of the skull, which leads into the posterior fossa. The foramen magnum has a forwarded shift of its anterior border in humans causing a shortening of the cranial base. The foramen is described as oval, wider posteriorly than anteriorly, and its antero‐posterior diameter exceeds the transversal one. Anteriorly, the margin of the foramen magnum is slightly covered, on each side, by an occipital condyle. These condyles, oval in shape, are located obliquely, so that their anterior end is closer to the median plane. Thirty dry skulls, from adult individuals, present in the anatomy laboratory of our institution were evaluated and a study of the dimensional anatomy of the foramen magnum and the occipital condyles was performed. With the aid of an analog caliper (precision of 0.05mm), the antero‐posterior and transverse diameters of the foramen magnum (posterior to the occipital condyles) and occipital condyles were obtained. Our results showed that the mean antero‐posterior diameter of the foramen magnum was 36.1 ± 0.5 mm and the transverse diameter was 30.0 ± 0.4 mm. The mean antero‐posterior diameter of the right occipital condyle was significantly smaller than that of the left, being 22.2 ± 0.4 mm and 23.1 ± 0.4 mm, respectively. The mean transverse diameter of the right occipital condyle was also statistically smaller than that of the left, being 12.6 ± 0.2 mm and 13.2 ± 0.2 mm, respectively. One of the skulls studied (excluded from the previous statistic) showed anatomical variation in the shape and size of the foramen magnum. This foramen was narrow, with an antero‐posterior diameter of 26.75 mm and a transverse diameter of 22.50 mm. In addition, the occipital condyles were asymmetrical, with the right condyle being practically transverse in relation to the foramen magnum, making a protrusion into its interior, contributing to the transverse narrowing of this foramen. The left condyle presented antero‐posterior (22.95 mm) and transversal (15.95 mm) diameters larger than the right (19.35 mm and 13.10 mm respectively). There were no signs of fractures or previous craniotomies in this particular skull. The present study reports the geometric morphometry of some striking structures at the base of the skull, in addition to describing an important anatomical variation of these structures. We did not find reports of significant difference between the right and left condylar diameters in the literature. The anatomy of the skull base is useful for estimating the race and sex of individuals in forensic medicine. Furthermore, geometric morphometry is an important tool in primatology and anthropology.Support or Funding InformationFAPESP, CNPq, CAPES and FAEPA

Changing trabecular patterns in panoramic radiographs of Swedish women during 25 years of follow-up.

The radiographic trabecular pattern on dental radiographs may be used to predict fractures. The aim of this study was to analyze longitudinal changes in the mandibles of 145 females between 1980 and 2005. Panoramic radiographs were obtained in 1980 and 2005. On 290 radiographs, regions of interest (ROIs) were selected in the ramus, angle and body. In all ROIs, the orientation was measured in 36 directions with the line frequency deviation method. The effects of ageing were analyzed for the fracture and the non-fracture groups separately. During the follow-up, 61 females suffered fractures of the hip, wrist, spine, leg or arm. The fracture and non-fracture groups displayed dissimilar age changes in each investigated ROI. All significant changes pertained to increasing values of line frequency deviation. With increasing age, the trabecular network in the mandible lost details and the trabeculae became more aligned in their main direction. In the "ramus", the alignment was to the 110-120˚ axis, parallel to the posterior and anterior ramus border. In the "angle", the alignment was to the 135-150˚ axis, parallel to the oblique line, and in the "body" ROI to the 150-175˚ direction, approximately parallel to the occlusal plane and inferior cortex. Most changes were consistent with the notion that the bone aged less severely in the non-fracture group. In the fracture group, the findings indicate that bone loss leads to redistribution of the remaining bone tissue in such a way that the trabeculae are accentuated perpendicular to the principal loading.

The Pattern of EGR1 Expression During Chick Limb Development Suggests a Role in Regulating SHH Expression and/or Termination

Limb development is governed by a complex interplay between three signaling centers that mediate growth along three coordinate axes. The apical ectodermal ridge (AER), zone of polarizing activity (ZPA) and the dorsal ectoderm regulate the proximal‐distal, anterior‐posterior and dorsal‐ventral axes, respectively. Development occurs along these three axes to create an asymmetrical limb and is highly dependent on crosstalk between fibroblast growth factors (FGFs) from the AER and sonic hedgehog (SHH) from the ZPA. The mechanisms and intermediate players between FGF and SHH are poorly characterized. Previous work in our lab identified a number of FGF‐responsive candidate genes. Most notably early growth response 1 (EGR1), encoding a zinc finger type protein, was identified as the gene with the most robust induction in response to FGF. EGR1 has been shown to play a role in tendon development but to date its expression in the developing limb has not been well characterized. We found EGR1 to have low endogenous expression in the chick limb by whole mount in situ hybridization (WMISH). We highlighted the WMISH pattern of EGR1 using a 3 hr cycloheximide pretreatment to enhance RNA accumulation. This approach revealed that EGR1 is expressed subjacent to the AER and overlaps the ZPA during robust SHH expression (Hamburger‐Hamilton stage 17 (HH17) through HH24). In contrast, as SHH expression wanes (HH25–26), EGR1 expression recedes from the posterior ZPA, and persists in the anterior progress zone underlying the AER. In addition, EGR1 expression extends proximally from the anterior border of the progress zone. The reduction of EGR1 within the ZPA coincident with the decline in SHH may indicate a role for EGR1 in optimizing SHH expression and triggering termination.

Parapharyngeal schwannomma: a case report

&lt;p class="abstract"&gt;Schwannomas are uncommon neurogenic tumors that are typically benign, slow growing, and asymptomatic. Upto 45% of schwannomas arise from the head and neck region, the sites of origin are: face, scalp, intracranial cavity, orbit, nasal and oral cavities, parapharyngeal space, middle ear, mastoid, larynx, and medial and lateral regions of the neck. The age distribution is 30 to 70 years and male:female 3:1. Symptoms and signs are neck swelling (54%), pain (11%), cranial nerve palsy (10%), oropharyngeal swelling (8%), dysphagia (6%) and trismus, otalgia (11%). This case is being presented because it is the rare case of neck swelling. A young male patient aged 22 yrs, presented with complains of swelling in right side of neck since 6 months. Patient also complains of difficulty in swallowing, difficulty in breathing and change in voice since 4 months. On examination of neck, a diffuse swelling noted at right level III neck, extending from the superior border of thyroid cartilage up to the level of hyoid bone. Horizontally the swelling was extending from mid thyroid cartilage till the anterior border of sternocleidomastoid muscle. On examination of swelling, a pink smooth globular mass seen pushing the right aryepiglottic fold anteriorly obscuring the laryngeal inlet. No pooling of saliva. elective tracheostomy was done, through lateral cervical approach, mass was excised in toto and extubated after 7 days.&lt;/p&gt;

Safe angles of ATFL and CFL anchor insertion into anatomical attachment of fibula in a lateral ankle ligament repair

BackgroundLateral ankle ligament repair for chronic lateral ankle instability is common, and arthroscopic repair of the anterior talofibular ligament (ATFL) has been widely performed. However, it is desirable to repair of calcaneofibular ligament (CFL) combined with arthroscopic ATFL repair to obtain good long term clinical outcomes. Repairing CFL through small skin incision, there is the possibility to interfere with ATFL and CFL anchors because of close attachment of ATFL and CFL at fibula. The purpose of this study is to determine the safety anchor insertion angles for ATFL and CFL on CT images and to achieve ATFL and CFL repair with minimally invasive technique. MethodsFifty ankles in 50 patients were included in this study. On a sagittal CT image, the anchor drill hole angles for ATFL and CFL were measured to avoid interference with these anchors. Then, arthroscopic ATFL repair combined with CFL repair was performed on 15 patients according to the safety insertion angles obtained by CT. CFL repair was performed through 1.5 cm length of accessory anterolateral portal. Clinical outcome was evaluated using the Japanese Society for the Surgery of the Foot (JSSF) ankle hindfoot scale and the Karlsson score before surgery and at final follow-up. ResultsOn the CT image, the mean angles between the ATFL drill hole and anterior border of the fibula was 59.4 ± 6.5°, and those between the longitudinal axis of the fibula and ATFL drill hole, and the CFL drill hole were 34.6 ± 5.0°, and 15.1 ± 5.7°, respectively. Postoperative CT after arthroscopic ATFL repair combined with CFL repair showed that no interference with 2 anchors, and JSSF scale and the Karlsson score were significantly improved from preoperative to final follow-up. ConclusionsThis study showed how safety ATFL and CFL anchor insertion angles comprise a minimally invasive anatomical repair technique.

Morphology of the resident's ridge, and the cortical thickness in the lateral wall of the femoral intercondylar notch correlate with the morphological variations of the Blumensaat's line.

The purpose of this study was to reveal the morphological correlation between the lateral wall of femoral intercondylar notch and the Blumensaat's line. Forty-one non-paired human cadaveric knees were included in this study (23 female, 18 male: median age 83). Knees were resected, and 3 dimensional computed tomography (3D-CT) was performed. In the axial CT image, bony protrusion (resident's ridge) and cortical thickness in the lateral wall of the femoral intercondylar notch were detected. The length between the top of the ridge, or the most anterior, middle, and most posterior border of cortical thickness and posterior femoral condylar line was measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill types (small and large hill types). In the hill types, the length between the hilltop and the posterior border of the Blumensaat's line or the posterior border of the femoral condyle was evaluated. Statistical correlation was calculated between the top of the ridge location, cortical thickness location in the notch, and hilltop location. There were 7 straight type knees and 34 hill type knees (9 small hill type knees and 25 large hill type knees). Only the hill types of knees were evaluated. The top of the ridge, anterior margin, middle, and posterior border of cortical thickness in the lateral wall of the femoral intercondylar notch existed at 61.8 ± 4.6%, 58.3 ± 12.3%, 42.1 ± 7.9%, and 25.5 ± 5.4% from the posterior condylar line, respectively. The hilltop existed at 24.9 ± 5.9% and 30.7 ± 5.0%, from the posterior border of the Blumensaat's line and from the posterior border of the femoral condyle, respectively. Significant correlation was observed between resident's ridge top, cortical thickness location and hilltop location. In all cadaveric knees, cortical thickness was detected in the lateral wall of the femoral intercondylar notch. The resident's ridge and cortical thickness location had significant correlation with the hill location in the Blumensaat's line, indicating a continuation of the cortical bone from the posterior cortex of the femoral shaft via the hilltop of the Blumensaat's line to the cortical thickness in the lateral wall of the femoral intercondylar notch. For clinical relevance, hilltop location in the Blumensaat's line is a new bony landmark in anterior cruciate ligament surgery.

Morphometric and Topographic Features of Stylomastoid Foramen and its Clinical Significance in Facial Nerve Block

Objective This study aims to determine the topographic localization of the stylomastoid foramen (SF) and its morphometric relationship with the surrounding bony landmarks. Design A descriptive anatomical study. Setting Anatomy Laboratory of the Faculty of Medicine. Participants Measurements were performed on 53 dry temporal bones. Main Outcome Measures On the inferior and lateral aspects of photographic images, lines and angles were defined. The most lateral end of the SF (SF1) and the transverse medial-lateral line that passes through the upper end of the anterior border of mastoid process (line 1) were used as reference points for topographic evaluation. The upper end of the anterior border of mastoid process (A) and the tip of mastoid process (B) were considered in defining angles. The dates about SF were evaluated using the ImageJ 1.46r software and digital caliper. Results SF1 was classified into three different types based on its topographical localization, stated as Type 1, Type 2, and Type 3. In Type 1, SF1 was located anterior to line 1 (54.7%). SF1 was located posterior to line 1 in Type 2 (34.0%). SF1 was located just over line 1 in Type 3 (11.3%). We also detected angular variations between these types in the inferior and lateral aspects. Conclusion The recommended angles of application are 30 degrees on the horizontal plane and 55 degrees on the sagittal plane for Type 1 when point B is considered. A needle length below 10 mm is more suitable to minimize the potential complications of the nerve block.

Determining the optimum anatomical coverage of side plates for the VIRTUS body armour and load carriage system

IntroductionSide plates are worn by UK Armed Forces as part of the VIRTUS body armour and load carriage systems to protect the thorax and abdomen from high-velocity threats. The VIRTUS...

Extraocular muscle insertion shift after disinsertion during strabismus surgery

ABSTRACT Purpose To quantify the amount of insertion shift after disinsertion of the rectus muscles and identify factors that may influence the shift. Methods Patients who underwent rectus muscle surgery between November 2018 and April 2019 were included. During surgery, the limbal-insertion distance (LID) distance was measured in millimeters with calipers from the limbus to the center of the insertion at the anterior border of the rectus muscle prior to and after disinsertion. The primary outcome was the shift of the rectus muscle insertion after disinsertion. This was calculated by subtracting the LID after disinsertion from the LID before disinsertion. The secondary outcome was the identification of preoperative and intraoperative factors that influenced insertion shift. Randomization was performed to select one rectus muscle per patient. Patients with a history of prior scleral buckle procedure, glaucoma drainage device, orbital wall fracture and strabismus surgery in the same rectus muscle were excluded. Results 110 patients were included. The median (Q1, Q3) LID before disinsertion was shortest for the medial rectus muscle [5.0 (4.5, 6.0)], followed by lateral rectus muscle [6.0 (6.0, 7.0)] and inferior rectus muscle [6.0 (5.5, 7.0)]. The overall median (Q1, Q3) insertion shift was 1.0 (0.8, 1.0) mm (p < .001), which did not significantly differ between each rectus muscle subgroup (p = .158). Factors that influenced the amount of shift were moderate to severe restriction on forced duction testing (FDT) (B = 0.320, SE = 0.105, p = .003) and longer LID before disinsertion (B = 0.172, SE = 0.036, p < .001). Conclusions We found a significant anterior insertion shift after disinsertion of rectus muscles. Moderate to severe restriction on FDT and longer LID before disinsertion can result in larger insertion shifts.

Intestinal Flukes Recovered from a Herring Gull, Larus argentatus, in the Republic of Korea.

Trematode specimens were collected from the intestine of a herring gull, Larus argentatus, which was found in a critical condition on the shore of a small island (Yubu-do, Seocheon-gun, Chungcheongnam-do) located at the western coast of the Korean peninsula. Total 11 specimens of intestinal flukes, including 3 Cryptocotyle lingua (Heterophyidae), 1 Himasthla alincia (Echinostomatidae), 5 Cardiocephaloides medioconiger (Strigeidae), and 2 Diplostomum spathaceum (Diplostomidae), were recovered. C. lingua was morphologically characterized by the presence of a large ventrogenital apparatus and 2 obliquely tandem testes. H. alincia had an elongated body and a head collar equipped with 31 collar spines. C. medioconiger had a bisegmented body and a voluminous copulatory bursa containing the seminal vesicle and ejaculatory duct. D. spathaceum also had a bisegmented body and its vitellaria extended up to the anterior border of the tribocytic organ. It is of note that C. lingua is potentially zoonotic that can occur in birds and humans. Three of them, i.e., C. lingua, C. medioconiger, and D. spathaceum, are new trematode fauna in Korea. Studies on trematode fauna of migratory birds should be continued in Korea.

Intraoral temporalis transposition for facial reanimation: A novel technique in facial nerve palsy

BackgroundFacial palsy patients require reconstructive surgery because they suffer from an expressionless and deformed appearance especially during smiling. To gain a natural smile, various dynamic procedures rather than static procedures are performed. Through cadaveric studies with clinical implications on temporalis muscle and intraoral transposition, we were able to come up with a more effective and less invasive procedure than the conventional temporalis muscle transposition or lengthening temporalis myoplasty. The aim of this study is to describe our novel surgical technique for facial reanimation and evaluate its efficacy. MethodTwo intraoral incisions were made. Through the posterior incision, the tendinous portion of the temporalis was separated from the coronoid process and anterior border of the ramus. Through the anterior incision, submucosa tunneling was performed to fixate the temporalis tendon onto the new perioral site. Results14 patients with facial palsy underwent intraoral temporalis transposition and their mouth corner excursion was measured for objective assessment after surgery. At resting state, mouth and cheek drooping was improved. At smiling, the excursion of the unaffected side was 10–17 mm. For the reconstructed side, 8 cases were considered excellent (exceeding 75% of normal side), 5 cases were considered good (exceeding 50%), and 1 case fair (exceeding 25%). ConclusionThis temporalis transposition through the intraoral approach is a novel technique for facial reanimation reconstruction. It is s less invasive, immediately effective method with rapid recovery and minimal donor site morbidity without visible scar. Level of evidenceIV.

The image characteristics of optical coherence tomography of the posterior cortical anterior vitreous capsular bag in human eyes

Objective To observe the OCT image characteristics of the posterior cortical anterior vitreous capsular bag (PPVP) in human eyes. Methods A retrospective clinical study. From May 2012 to February 2017, 107 PPVP patients (173 eyes) diagnosed by OCT in Ophthalmology Department of The Third People's Hospital of Chengdu were included in the study. One hundred and three eyes underwent examination of frequency-domain OCT (SD-OCT) and 70 eyes underwent examination of frequency-scanning light source OCT (SS-OCT), respectively. SD-OCT the German Heidelberg Spectralis OCT instrument. SS-OCT was performed by the vitreous enhancement scan mode of Japan's Topcon DRI OCT instrument. The differences of different types of PPVP OCT imaging and image characteristics were observed. Results SD-OCT and SS-OCT showed that the PPVP structure was clear and manifested as macular weakly reflective in the shape of a boat-shaped cavity, the front boundary was vitreous collagen, and the rear boundary was vitreous cortex. There was a weakly reflective Martegiani area on the nasal side of PPVP, and there was a connection channels between them. The two examinations showed a similar pattern, but SS-OCT with the clearer imaging of PPVP. Conclusions The OCT image of PPVP in the human eye is characterized by an anterior weakly reflecting boat-shaped cavity in the macula, with anterior border of vitreous collagen and posterior border of vitreous cortex. Martegiani area is located on the nasal side. Key words: Tomography, optical coherence; Posterior precortical vitreous pockets

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele.

Objective Congenital frontoethmoidal encephaloceles are associated with a shallow sloping forehead. We (1) sought to determine if early repair reverses abnormal forehead slope, and (2) assessed a modification of the fetal profile (FP) line to assess results. Design Study of two cases. Participants Newborns with frontoethmoidal encephaloceles repaired prior to the age of 4 months with cranial base bone grafting. Main Outcome Measures Forehead slope was assessed using a modification of the FP line, defined as the line that passes through the anterior border of the mandible and nasion, on pre and postoperative magnetic resonance imaging (MRI) in the midsagittal plane. A modified FP (mFP) line anterior to the forehead was " - ", while a posterior (normal) mFP line was " + ." The largest distance from the mFP line to the forehead was measured. Results Both infants underwent bifrontal craniotomy, excision of encephalocele, and repair of cribriform plate defect using full-thickness autologous parietal bone before the age of 4 months. Preoperatively, the mFP line was -20.6 mm in case 1, and -9.8 mm in case 2. In both cases, follow-up MRI showed excellent reversal of forehead slope and normal calvarium development. The mFP line improved to +7.4 (age = 16 months) in case 1, and +7.6 (age = 11 months) in case 2. The parietal bone donor site ossified completely within 3 months in both cases. Conclusion Early repair with bone grafting can promote normal frontal bone development and improve forehead slope. The mFP line is a useful method to measure degree of forehead slope.