Bony Bars Research Articles

Transphyseal Hemiepiphysiodesis: Is it Truly Reversible?

Although numerous studies reported the efficacy of percutaneous epiphysiodesis using transphyseal screws (PETS) in correcting angular knee deformities, many surgeons refrained from using it in younger children because of a lack of objective evidence of reversibility. Our hypothesis is that PETS is both truly reversible and effective. Twenty-one patients aged 8 to 13 years (36 lower limbs LL) with coronal plane knee deformity were enrolled into this prospective case series from January 2021 to September 2023. Besides the routine monitoring of PETS efficacy, low dose CT knee of 32 treated physes was done 6 months after screw removal. In addition, lower limb length, mechanical lateral distal femur angle (mLDFA), and medial proximal tibial angle (MPTA) were recorded preoperatively and 6 to 17 months after screw removal for 24 LL to investigate physis behavior, technique reversibility, and resumption of bone growth after screw removal. The mean mechanical axis deviation (MAD) correction rate was 3.46mm/mo and 1.78mm/mo for genu valgum and genu varum patients, respectively. No physeal bony bars could be detected 6 months after screw removal for all patients. Out of 24 physis that underwent computerized radiography (CR) of the whole lower limb, 12 LL resumed their growth, 4 were stationary, while 8 were excluded due to inadequate calibration. A single physis showed rebound deformity, and another showed overcorrection in the genu valgum group. In addition to being a highly effective method of hemiepiphysiodesis, PETS was found to be reproducible, safe, and reversible when used in the juvenile and early adolescent pediatric population. IV-Prospective case series.

Morphological Measurements of Innominate Foramina and Bony Spurs along the Base of Sphenoid as a Potential Risk Factor for Neurovascular Entrapment, Radiological Interpretation and Surgical Access.

Restricted access and compression of neurovascular structures at various anatomic variations at the skull base poses a challenge to surgeons, neurologists and anesthetists. The present study was performed with the objective of providing morphometric analysis of innominate foramina, and anomalous bony bars and spurs along the infratemporal surface of the greater wing of the sphenoid and reviewing the practical significance of dealing with this region. A total of 100 dry-aged human adult skulls from the archives of the osteology library of the Department of Anatomy were studied. A detailed morphometric analysis of such innominate foramina and anomalous osseous structures along the base of the sphenoid was performed using a sliding digital vernier caliper. Anomalous bony bar was found in 22 skulls (25.28%). A complete bar was observed at eight (9.1%). An innominate foramen was located inferomedial to foramen ovale (5 unilateral and 3 bilateral) with a mean anteroposterior diameter of 3.44 mm and a mean transverse diameter of 3.16 mm. Neurovascular structures may be compressed by abnormal bony outgrowths or while traversing through such unnamed bony foramina. The latter may also be overlooked and mistaken during radiological interpretation leading to delayed diagnosis. Such unnamed foramina and bony outgrowths need to be documented in the literature due to their surgical, and radiological implications and limited citations.

Nonmetrical Variants of the Sigmoid Sulcus

Background: Sigmoid sinus is an area of interest for anatomists, neurosurgeons, and radiologists. Different procedures such as mastoidectomy, thrombectomy in the sigmoid, and transverse sinus thrombosis have realized the need of proper morphological knowledge of the sigmoid sinus and its variations and their important relations. Therefore, the present study was conducted to report the prevalence of various nonmetrical attributes of the sigmoid sulcus in dry human skulls in India. Methodology: This study was conducted on 224 human skulls in which sex and origin were not known and these were taken from the departmental osteology laboratory. Interior of the skull base at the area of the sigmoid sulcus was carefully observed for the presence of any osseous projection on its anterior or posterior lips such as crest, plate, or bars. Shape, position, and side of projection were noted and frequency was calculated in percentage. Results: Out of 224 skulls, 80% of the sigmoid sulci showed one or other form of bony features. A total prevalence of 43.08% was observed for crests, whereas plates showed lesser frequency (28.57%) on the anterior lip of the sigmoid sulcus. Bony bars were the least common (9.14%) features, but were characteristically located at the angle region of the sigmoid sulcus. In 16.74% of skulls, sigmoid sulcus was shallow. Conclusion: Occurrence of bony attributes in the form of plates, crests, and bridges along the course of the sigmoid sulcus is quite high and shows frequent variability in location and laterality, which may adversely affect the morphology of the sigmoid sinus.

Bilateral bony bar bridging of the sigmoid sulcus : a case report

AbstractThe crest, plate and bars like bony projections may be present on sigmoid sulcus. The bony connection between petrous temporal and occipital bone may divide the jugnlar foramen. A skull with bilateral curved bony plate connecting the inner margin of groove for sigmoid sinus and petrous temporal was observed during routine osteology classes. The shape, size and location of both the bars were almost identical. These bony bars were connecting the posterior margin of petrous temporal and postero-lateral part of sigmoid sulcus. Structurally, they resembled as a part of ring. The location of the bar was more lateral on left side as compared to right side. Some bony erosion was also seen in the floor of sigmrid sulcus. Bilateral ossification and formation of bar at sigmoid sulcus is associated with venous sinus anomalies, dural ossification and intracranial calcifications.

An Anatomical Study of Occurrence of Pterygospinous Bar in Indian Skulls

Background: Pterygospinous ligament is present at the base of the skull that may sometimes get ossified to form bony bars that are related to the foramen ovale. Aim: This study aims at finding the prevalence of pterygospinous bar among Indian skulls present in Saveetha Dental College. Method: The study was done in 40 adult human dry skulls from. The skulls were checked for the presence of pterygospinous bar and was analysed for the problems it might cause due to its presence. Result: Among 40 skulls, pterygospinous bar is present only among 3 skulls which is 8% of the skulls. Conclusion: Pterygospinous bar is present only in a small fraction of skulls. The foramen ovale is related to it and its presence may lead to the compression of the contents passing through the foramen.

Anatomical Study of Pterygospinous and Pterygoalar Bar in Human Skulls with their Phylogeny and Clinical Significance.

Pterygospinous and pterygoalar ligaments present at the cranial base may sometimes get ossified leading to the formation of complete or incomplete bony bars in relation to foramen ovale. These are of clinical importance because these may obliterate the foramen ovale causing mandibular neuralgia. They may cause trouble in performing thermocoagulation and anaesthesia for trigeminal neuralgia. They may pose surgical difficulty in approaching the retro and parapharyngeal spaces and hence the anatomy of these bony bars is very important. The present study was conducted in 100 dry human skulls of unknown sex to know the incidence, side, degree of ossification (complete/ incomplete) and relation of the pterygospinous and pterygoalar bars to the foramen ovale. Pterygospinous and pterygoalar bars were seen in 41 skulls which were classified into Type I (26.83%), Type II (58.54%) and Type III (14.63%) based on the presence of pterygospinous bar, pterygoalar bar or both together. Pterygospinous bars were seen in 17 skulls of which, one skull (5.88%) had complete and 16 skulls (94.12%) showed incomplete bars. Out of the 30 skulls with pterygoalar bars, complete bar was seen in one (3.33%) and incomplete in 29 skulls (96.67%). These bars were seen more on the left side of the skull than on the right. They were in close relation to the foramen ovale; the pterygospinous bar was inferior or medial to foramen ovale and pterygoalar bar was lateral, inferior or medial to the foramen ovale. The presence of the pterygospinous and pterygoalar bars cause variety of symptoms due to neurovascular entrapment and also obstruct surgical approaches to the base of skull. Hence the anatomical knowledge of these osseous bars is essential for anaesthetists, radiologists, dentists and neurosurgeons to increase the success of diagnostic evaluation and surgical approaches to the cranial base.

English

INTRODUCTION: The cervical vertebrae are seven in number. They are the smallest of the vertebrae and can be identified by the presence of a foramen in each transverse process. The dorsal and ventral roots terminate laterally as dorsal and ventral tubercles. The roots are connected lateral to the foramen by an intertubercular lamella. The vertebral artery which arises from the superoposterior aspect of the first part of the subclavian artery, passes through the foramina in the transverse processes of all of the cervical vertebrae except the seventh. It then curves medially behind the lateral mass of the atlas and enters the cranium through the foramen magnum 1 . The vertebral vein begins in suboccipital venous plexus and descends in foramen transversarium (FT). At the lower end the plexus unites into a single vein, which lies in front of the vertebral artery and terminates into the posterior surface of the first part of Brachiocephalic vein, or lower end of internal jugular vein2. Thus FT transmits the second part of vertebral artery with its accompanying veins and a sympathetic plexus from the lower cervical ganglion. The seventh foramen transmits a vein and a grey ramus from the lower ganglion running up to join the seventh nerve. The ganglion is situated beside the vertebral artery below the level of the seventh costal process, so that its filament to the eighth nerve reaches it directly, but that for the seventh must ascend through the foramen3. MATERIALS AND METHODS: During inspection of 72 cervical vertebrae housed in the Department of Anatomy, Meenakshi Medical College and Research Institute, divided foramen transversarium was noticed in four vertebrae, which were photographed. The length of bony bars and the diameters of the foramina were measured by digital vernier caliper.

Incidence of osseous interclinoid bars in Indian population

Parasellar interclinoid bars are significant in surgical management while dealing with the vascular, neoplastic or traumatic lesions of the central skull base and can also compress the surrounding structures giving rise to various clinical symptoms. The literature cites several case reports but systematic study of these bars has not been done. Therefore this study was carried out to see the incidence of osseous interclinoid bars in Indian population. Two hundred and fifty adult dried human skulls were studied. It was observed that the bony bars between the three clinoid processes can be divided into four types (Types I, II, III, IV). Due to the presence of these bars three types of interclinoid foramina were formed. A total incidence of 22% of various types of interclinoid bars was observed, out of which 12% were Type I, 5.6% Type II, 4% type III and only 0.4% were of type IV variety.

Bony Sheathed Chorda Tympani

To describe a unilateral conductive hearing loss caused by restriction of the movements of malleus and incus due to chorda tympani in a bony sheath. A 23-year-old man with a stable mild conductive hearing loss in the left ear and mild sensorineural hearing loss in the right ear. An exploratory tympanotomy was performed. Immobility of the ossicles due to a bony structure, which was found to be chorda tympani encircled in a bony sheath. Ossicular system regained its mobility with the severance of the chorda tympani. Hearing was improved both subjectively and audiographically. This is the second case of chorda tympani with a bony sheath and the first case of this pathologic finding affecting both malleus and incus. Bony sheathed chorda tympani is considered to be a congenital anomaly of the chorda tympani that causes incudomalleolar fixation and behaves as posterior bony bars.

Pterygospinous bar and foramina in Indian skulls: incidence and phylogenetic significance

Incomplete or complete ossification of the pterygospinous ligament is uncommon. Entrapment of mandibular nerve and its branches was reported due to this anatomical variation, when found. The aim of the present study is to investigate the incidence of the pterygospinous bony bridges in Indian dry skulls. A total of 416 adult dry skulls of Indian origin were studied. In 9.61% of the samples the pterygospinous bony bars were found, out of which 5.76% was complete and 3.84% was incomplete. Such variations are of clinical significance while dealing with mandibular nerve and its branches and various clinical symptoms related to it.

The Use of Helical Computed Tomographic Scan to Assess Bony Physeal Bridges

Summary: Coronal and sagittal reformatted images of the physis obtained with the helical computed tomography (CT) scanner were studied in five children. This technique allows tomographic slices at 1.0-mm thickness and can be performed in ≈20 s. The distal femora were studied in two children, the distal tibia in two children, and the distal radius in one child. In three children, after physeal mapping, bar resections were performed. In all cases, the location and size of the bar was accurately predicted by the map constructed from the helical CT scan. We recommend the helical CT scan to prepare physeal maps to determine the extent and location of physeal bony bars because of excellent bony detail, radiation doses one half to one quarter those of conventional tomography, and the rapidity of scanning, which bypasses the need for sedation.

The use of helical computed tomographic scan to assess bony physeal bridges.

Coronal and sagittal reformatted images of the physis obtained with the helical computed tomography (CT) scanner were studied in five children. This technique allows tomographic slices at 1.0-mm thickness and can be performed in approximately 20 s. The distal femora were studied in two children, the distal tibia in two children, and the distal radius in one child. In three children, after physeal mapping, bar resections were performed. In all cases, the location and size of the bar was accurately predicted by the map constructed from the helical CT scan. We recommend the helical CT scan to prepare physeal maps to determine the extent and location of physeal bony bars because of excellent bony detail, radiation doses one half to one quarter those of conventional tomography, and the rapidity of scanning, which bypasses the need for sedation.

Bone structure and the patterns of force transmission in the cat skull (felis catus).

AbstractProjection microradiography was used to determine the density and orientation of the force transmitting structures, i.e., trabeculae and bone lying between approximately parallel vascular canals, within the bones of cat skulls. The organisation in the skulls was confirmed statistically for a total of ten cats. The results of the observations showed that within specific areas of the skull a high degree of structural orientation and an increased density of osseous structures was present. The distribution of these characters corresponded in contiguous bones such that a continuum of structural organisation was established between the alveolar region and the site of attachment of the temporalis and masseter muscles and the glenoid region.The patterns of force transmission during jaw closure were determined when a resistance was placed initially between the canines and then the carnassials. An analysis was first carried out on dry skulls using colophonium resin to determine the direction of the force distribution. The nature and the approximate magnitude of the forces were ascertained by replacing the resin with strain gauges. The basic similarities in the strain patterns recorded from the dry skulls and those from the ten anaesthetised cats in which strain gauges had been intra‐vitally implanted, substantiated the recordings made on the dry skulls. Combination of the results from the three sets of experiments defined the patterns of force distribution in the cat skull during the closure of the mandible against a resistance. The results showed that: (1) the combined action of the temporalis and masseter muscles tended to reduce the overall strain in the skull bones, and that the deformations produced by the action of the masseter were greater than that exerted by the temporalis muscles; (2) during biting, whether the resistance was placed between the canines or carnassials, compressive forces predominated in the facial bones; (3) small movements observed between facial bones indicated the presence of a flexible component within the skull, thus allowing large forces to be exerted during biting without overstressing the facial bones; (4) the glenoid fossa is part of a force bearing joint; (5) forces generated during biting were resisted within the skull by forces of an opposite nature generated within the system, the incompressible nature of bone and by the effect of the soft tissues; (6) the nature and the magnitude of the strain altered when a resistance was placed at the canines and then at the carnassials; however, the pattern of force distribution within the skull remained the same; (7) there was a direct correspondence between the detailed structural organisation of the bones and the patterns of force distribution. This conclusion would appear to apply in general to mammalian skulls. The study also emphasises the importance, neglected hitherto, of carrying out a variety of experiments to determine the patterns of force distribution in bones.The Trajectorial Theory of bone organisation is discussed and, on the basis of the results obtained, a modified theory is proposed. This states that: the structural continuum is common to the compact and cancellous bone and comprises bony bars which are aligned in the optimum direction for the transmission of force to a region in the bone or bones where it is effectively resisted.

Radiologic examination of trismus as a complication of cancrum oris

In the radiologic examination of trismus complicating cancrum oris, abnormalities can be detected in the soft tissues, osseous tissues, and temporomandibular joint. In the soft tissue, scar formation may show as a depression in the normal smooth, convex contour of the lateral aspect of the face. There may be a myositis ossificans in the soft tissue, producing bony bars that lead to extra-articular ankylosis. By far the most important changes are in the temporomandibular joint, where there can be varying degrees of joint narrowing, sclerosis of the articular cortex, flattening of the mandibular condyle and occasionally also of the eminentia articularis, osteophytosis, and intra-articular bony ankylosis. Hypoplasia may involve the entire hemimandible or be restricted to its condyloid process. The latter may lead to compensatory enlongation and hypertrophy of the coronoid process. Bony ankylosis of the coronoid process to the posterior wall of the maxilla was seen in three cases. The pathogenesis of these changes is discussed.