Bony Changes Research Articles

Predictors of osteoradionecrosis following irradiated tooth extraction

BackgroundTooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy.MethodsA retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted.ResultsSeventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular canal. Using multivariate analysis, the odds of developing an ORN from a surgical procedure was 6.50 (CI 1.37–30.91, p = 0.02). Dental extraction of more than 5 years after radiotherapy and invisible upper cortical line of mandibular canal on the DPT have the odds of 0.06 (CI 0.01–0.25, p < 0.001) and 9.47 (CI 1.61–55.88, p = 0.01), respectively.ConclusionExtraction more than 5 years after radiotherapy, surgical removal procedure and invisible upper cortical line of mandibular canal on the DPT were the predictors of ORN.

Meningoids: Lesions mimicking meningiomas

IntroductionDural based lesions, often misinterpreted as meningiomas, may have deleterious impact on patient care and may mislead the presurgical treatment algorithm. The study proposes the term ‘Meningoids’ for clubbing intracranial lesions which clinically and radiologically mimic meningiomas. The study also defines the various features of such lesions which help to raise a suspicion in surgeon’s mind and also prepares him for possible intra and post-operative challenges and surprises. Materials and methodsAll patients presenting with a preoperative radiological diagnosis of meningioma and a final histopathological diagnosis other than meningioma were included in the study. Patients were recognised and their relevant radiological profiles were retrospectively drawn and assessed in terms of variables based on plain and contrast enhanced CT scan and MRI findings. Data was presented in a tabulated form and variables were analysed based on features mimicking and atypical of meningioma. ResultsA total of 9 patients were included in the study. A final diagnosis of tuberculoma and hemangioblastoma were made in 2 patients each. One patient each had a final diagnosis of sarcoidosis, non hodgkin’s lymphoma, chondroma, ependymoma and metastasis from adenocarcinoma.On retrospectively analysing the data, the following findings were found to raise a high index of suspicion for a meningoid: cystic changes, disproportionate oedema, erosive bony changes, atypical dural tail, flow voids around the lesion and intraoperative gross features. ConclusionIts not uncommon for neurosurgeons to encounter dural based lesions mimicking meningioma and being prepared preoperatively with ‘meningoids’ would be important to optimise outcomes, minimise morbidity and most importantly forcing the neurosurgeon to think critically which is eventually helpful in prognostication.

Outcome of Midvastus versus Subvastus Approach in Single Stage Bilateral Total Knee Arthroplasty

Objective: To compare midvastus and subvastus approach regarding operative parameters(lateral retinacular release, operative time, neurovascular injury) and outcome (Knee Society Score, Straight Leg Raise) at 12 weeks in single stage bilateral total knee arthroplasty. Study Design: Randomized clinical trial study Place and Duration of Study: Institute of Orthopaedic Surgery and South City Hospital Karachi from 1st January 2016 to 31st December 2018. Methodology: Fifty two patients of both genders ofmore than 50 years with osteoarthritis grade III or IV and bony changes confirmed by AP and lateral radiographs of knee were included. Patients with previous knee surgeries including high tibial osteotomy, deformities &gt;20°(on mechanical axis), any neuromuscular problem and BMI ≥30 were excluded. Final assessment was done at 12 weeks. Isometric quadriceps strength was assessed by holding of contraction in seconds during the lifting (10cm above the plinth) phase of SLR (patient lying supine).Knee score (preoperative and final follow-up) was performed by Knee Society Score. Results: Thirty five were females and 21 males with mean age 65.3 years (50-78 years). Mean body mass index was 27.8 Kg/m2 (26.4-29.9). In midvastus TKR, the mean operative time was 61.7 minutes (range 52-70) whereas the same was 68.3 minutes (range 58-74) in subvastus TKR with p value 0.002. Rate of lateral retinacular release (LLR) was significantly (p=0.011) different between the midvastus TKR 5 (8.9%) and subvastus TKR 11 (19.6%). Neither group had neurovascular injury or early infection of the knee. Active SLR in subvastus group was achieved in shorter time (mean 3.1 days) as compared to midvastus group (mean 4.7 days). There was no difference (p=0.173) in isometric quadriceps strength at 12 weeks between subvastus TKR (mean 18 seconds) and midvastus TKR (mean 17 seconds). Knee society pain and functional scores were comparable between the two approaches at final follow up. Conclusion: Subvastus exposure has advantage of achieving active straight leg raise earlier while midvastus has lower frequency of lateral retinacular release. No difference in hospital stay and postoperative pain scores. Both subvastus and midvastus approaches are safe and offer comparable Knee Society Score outcomes. Keywords: Midvastus, Subvastus, Total knee arthroplasty, Knee Society Score, Straight leg raise

Paleopathology of the Ychsma: Evidence of respiratory disease during the Late Intermediate Period (AD 1000-1476) at the Central Coastal site of Pachacamac, Peru

ObjectiveTo investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru. MaterialsThirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis. MethodsAll individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria. ResultsSome 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses. ConclusionsRespiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center. SignificanceThis paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study. LimitationsA limited sample was available for analysis. Additionally, the site’s skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage. Further ResearchThe results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.

NOVEL DLX3 VARIANTS IN AMELOGENESIS IMPERFECTA WITH ATTENUATED TRICHO-DENTO-OSSEOUS SYNDROME

<h3>Background</h3> Variants in <i>DLX3</i> cause tricho-dento-osseous syndrome (TDO; MIM accession no. 190320), a systemic condition with hair, nail, and bony changes, taurodontism, and amelogenesis imperfecta (AI) inherited in an autosomal dominant fashion. Different variants found within this gene are associated with different phenotypic presentations. To date, 6 different <i>DLX3</i> variants have been reported in TDO. The aim of this paper is to explore and discuss 3 recently uncovered new variants in <i>DLX3</i> and their resulting phenotypes. <h3>Objective</h3> To identify new variants associated with AI to increase the accuracy of genetic testing and elucidate the roles and functions of genes involved in amelogenesis. In this study, 3 new variants within <i>DLX3</i> were identified as being associated with AI. <h3>Methods</h3> Whole-exome sequencing identified a new <i>DLX3</i> variant in one family recruited as part of an ongoing study of genetic variants associated with AI. Targeted clinical exome sequencing of 2 further families revealed another new variant of <i>DLX3</i> and a complete heterozygous deletion of <i>DLX3</i>. For all 3 families, the phenotypes consisted of AI and taurodontism, together with other attenuated features of TDO. <h3>Conclusions</h3> c.574delG p.(E192Rfs*66), c.476G>T (p.R159L), and a heterozygous deletion of the entire <i>DLX3</i> coding region were identified in the families studied. These previously unreported variants add to the growing literature surrounding AI, allowing more accurate genetic testing and better understanding of the associated clinical consequences.

An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary).

Ancient human remains exhibiting bony changes consistent with osteoarticular tuberculosis (OATB) indicate that the disease has afflicted mankind for millennia. Nonetheless, not many pediatric OATB cases have been published in the paleopathological literature-from Hungary, only three cases have been described up to now. In our paper, we demonstrate a child (S0603) from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (northwestern Hungary), who represents a unique case of OATB regarding both the pattern and severity of the observed bony changes. During the macromorphological and radiological investigations, the most serious alterations were discovered in the upper thoracic spine-the development of osteolytic lesions led to severe bone loss and consequent collapse and fusion of several adjacent vertebrae. The pathological process terminated in a sharp, rigid angular kyphosis. Disruption of the normal spine curvature resulted in consequent deformation of the whole thoracic wall-it became "rugby-ball-shaped". The overall nature and pattern of the detected alterations, as well as their resemblance to those of described in previously published archaeological and modern cases from the pre-antibiotic era indicate that they are most consistent with OATB. Based on the severity and extent of the lesions, as well as on the evidence of secondary healing, S0603 suffered from TB for a long time prior to death. Besides body deformation, OATB resulted in consequent disability in daily activities, which would have required regular and significant care from others to survive. It implies that in the Árpádian Age community of Győrszentiván-Révhegyi tag, there was a willingness to care for people in need. Detailed archaeological case studies can give us a unique insight into the natural history and different presentations of OATB. Furthermore, they can provide paleopathologists with a stronger basis for diagnosing TB and consequently, with a more sensitive means of assessing TB frequency in past populations.

A diagnostic model for differentiating tuberculous spondylitis from pyogenic spondylitis on computed tomography images.

To develop and evaluate a logistics regression diagnostic model based on computer tomography (CT) features to differentiate tuberculous spondylitis (TS) from pyogenic spondylitis (PS). Demographic and clinical features were collected from the Electronic Medical Record System. Data of bony changes seen on CT images were compared between the PS (n = 61) and TS (n = 51) groups using the chi-squared test or t test. Based on features that were identified to be significant, a diagnostic model was developed from a derivation set (two thirds) and evaluated in a validation set (one third). The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. The width of bone formation around the vertebra and sequestrum was greater in the TS group. There were significant differences between the two groups in the horizontal and longitudinal location of erosion and the morphology of axial bone destruction and sagittal residual vertebra. Kyphotic deformity and overlapping vertebrae were more common in the TS group. A diagnostic model that included eight predictors was developed and simplified to include the following six predictors: width of the bone formation surrounding the vertebra, longitudinal location, axial-specific erosive morphology, specific morphology of the residual vertebra, kyphotic deformity, and overlapping vertebrae. The simplified model showed good sensitivity, specificity, and total accuracy (85.59%, 87.80%, and 86.50%, respectively); the AUC was 0.95, indicating good clinical predictive ability. A diagnostic model based on bone destruction and formation seen on CT images can facilitate clinical differentiation of TS from PS. • We have developed and validated a simple diagnostic model based on bone destruction and formation observed on CT images that can differentiate tuberculous spondylitis from pyogenic spondylitis. • The model includes six predictors: width of the bone formation surrounding the vertebra, longitudinal location, axial-specific erosive morphology, specific morphology of the residual vertebra, kyphotic deformity, and overlapping vertebrae. • The simplified model has good sensitivity, specificity, and total accuracy with a high AUC, indicating excellent predictive ability.

Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study

Background and purpose — Observing serious adverse events during treatment with the Precice Stryde bone lengthening nail (NuVasive, San Diego, CA, USA), we conducted a nationwide cross-sectional study to report the prevalence of adverse events from all 30 bone segments in 27 patients treated in Denmark. Patients and methods — Radiographs of all bone segments were evaluated regarding radiographic changes in February 2021. We determined the number of bone segments with late onset of pain and/or radiographically confirmed osteolysis, periosteal reaction, or cortical hypertrophy in the junctional area of the nail. Results — In 30 bone segments of 27 patients we observed radiographic changes in 21/30 segments of 20/27 patients, i.e., 19/30 osteolysis, 12/30 periosteal reaction (most often multi-layered), and 12/30 cortical hypertrophy in the area of the junction between the telescoping nail parts. Late onset of pain was a prominent feature in 8 patients. This is likely to be a prodrome to the bony changes. Discoloration (potential corrosion) at the nail interface was observed in multiple removed nails. 15/30 nails were still at risk of developing complications, i.e., were not yet removed. Interpretation — All Stryde nails should be monitored at regular intervals until removal. Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation of the regenerate.

Computed Tomography Evaluation of Unilateral Chronic Maxillary Sinusitis With Osteitis.

Computed tomography (CT) is the preferred noninvasive method for the evaluation of osteitis in chronic sinusitis. Some scholars believe that the bone changes associated with chronic sinusitis always show high attenuation (high density) and are positively correlated with the severity of the disease. However, sinus bone remodeling is a complex process that may cause high or low attenuation. There have been few reports on the spread of osteitis. Therefore, additional research on sinus CT is necessary. To observe bony changes in chronic maxillary sinusitis (CMS) by CT and reveal the mechanism. A retrospective study was conducted in 45 patients with unilateral CMS with bony changes in the sinus walls. The patients' clinical data and CT results were analyzed and compared between the affected and normal sides. We propose the location, involvement, attenuation, and thickness method to evaluate CMS with osteitis. Of the 45 patients, 40 (88.9%), 2, 12, and 7 had posterior external, medial, anterior, and superior lesions, respectively. The nasal region, sphenoid bone, palatine bone, and zygomatic arch were involved in 3, 12, 8, and 18 (40%) patients, respectively. Computed tomography indicated high attenuation in 30 (75.0%) and low attenuation in 10 (25.0%) patients; 6 (15.0%) showed new bone marrow cavities. The bone thickness was significantly different between the affected and normal sides in 40 patients (P < .001), including members of both the high- and low-attenuation groups (high-attenuation group: P < .001; low-attenuation group: P < .01). However, there was no significant difference in the thickness of the affected side between the high- and low-attenuation groups (P > .05). Chronic rhinosinusitis with bony changes may occur in the maxillary sinus walls and spread to adjacent bones. Both increased and decreased attenuation may occur in these circumstances. Analyzing the CT features of bone changes in unilateral CMS can improve the accuracy of disease diagnosis.

Lacrimal Fossa Bony Changes in Chronic Primary Acquired Nasolacrimal Duct Obstruction and Acute Dacryocystitis

ABSTRACT Purpose This study aims to assess the bony lacrimal fossa changes in chronic cases of primary acquired nasolacrimal duct obstruction versus acute dacryocystitis. Methods A prospective study was performed on 25 bony lacrimal fossae of 25 eyes of 15 patients who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service over a period of 6 months. Ten patients with chronic PANDO (> 1 year) with bilateral involvement and five patients of unilateral acute dacryocystitis were recruited in the study. None of the patients had a history of trauma or previous surgeries or nasal disease in the past. The bone samples from the frontal process of the maxilla and the lacrimal bone were obtained during the osteotomy and subjected to routine histopathological examination. Special stains used were von Kossa, Masson trichrome, periodic acid Schiff, and Alcian blue. Immunohistochemistry was performed using CD68 antibodies. Patient demographics, clinical presentation, duration of the disease, and bony changes were analyzed in different patient subsets. Results The mean disease duration in the chronic PANDO subset was 3.1 years, whereas acute dacryocystitis was 6.8 days. There was no correlation between the bony changes and the laterality in the chronic subset. Periosteal thickness and fibrosis were universal in the chronic group but not in the acute dacryocystitis. There were also differences in the number of osteocytes per sq mm, osteoblast, osteoclast, bony remodeling, bony canals structure, and intrastromal fibrosis between the subsets. These changes within the chronic group increased with the duration of the disease. Interestingly, there was no evidence of any bony inflammation across the subsets in all the samples studied. Conclusion Characteristic bony changes can be demonstrated in patients with chronic PANDO but not in acute dacryocystitis. The lack of bony inflammatory infiltrates may provide clues in understanding the peri-sac disease pathogenesis in acute dacryocystitis.

Depression of the Medial Tibial Plateau in Infantile Blount Disease – Can Pathologic Bony Changes be Reversed with Guided Growth Treatment?

Depression of the Medial Tibial Plateau in Infantile Blount Disease – Can Pathologic Bony Changes be Reversed with Guided Growth Treatment?

Assessment of bone marrow fat fractions in the mandibular condyle head using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method.

The prevalence of temporomandibular joint disorder (TMD) is gradually increasing, and magnetic resonance imaging (MRI) is becoming increasingly common as a modality used to diagnose TMD. Edema and osteonecrosis in the bone marrow of the mandibular condyle have been considered to be precursors of osteoarthritis, but these changes are not evaluated accurately and quantitatively on routine MRI. The iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method, as a cutting-edge MRI technique, can separate fat and water using three asymmetric echo times and the three-point Dixon method. The purpose of this study was to analyze the quantitative fat fraction (FF) in the mandibular condyle head using the IDEAL-IQ method. Seventy-nine people who underwent MRI using IDEAL-IQ were investigated and divided into 1) the control group, without TMD symptoms, and 2) the TMD group, with unilateral temporomandibular joint (TMJ) pain. In both groups, the FF of the condyle head in the TMJ was analyzed by two oral and maxillofacial radiologists. In the TMD group, 29 people underwent cone-beam computed tomography (CBCT) and the presence or absence of bony changes in the condylar head was evaluated. The FF measurements of the condyle head using IDEAL-IQ showed excellent inter-observer and intra-observer agreement. The average FF of the TMD group was significantly lower than that of the control group (p < 0.05). In the TMD group, the average FF values of joints with pain and joints with bony changes were significantly lower than those of joints without pain or bony changes, respectively (p < 0.05). The FF using IDEAL-IQ in the TMJ can be helpful for the quantitative diagnosis of TMD.

A Case of 73-Year-Old Male with Chronic Invasive Fungal Sinusitis Mimicking Sino-Nasal Malignancy

Fungal sinusitis is a sinus infection caused by fungal species, most of which are aspergillus species. They can be classified mainly into two groups, invasive fungal sinusitis and non-invasive fungal sinusitis. Invasive fungal sinusitis is characterized by fungi not confined to the paranasal sinuses or the nasal cavity but invading the adjacent tissue and bone. Chronic invasive fungal sinusitis is one type of invasive fungal sinusitis and is a relatively rare disease. It can invade the adjacent sinus bone and tissue for months to years, resulting in bony sclerotic change, formation of mass and bony destruction, which can be mistaken for pseudotumor or malignant tumor. In this report, we report a case of a patient with chronic invasive fungal sinusitis, which was mimicking sino-nasal malignancy.

Comparison of CT features of 79 cats with intranasal mass lesions.

ObjectivesThis retrospective multicentre study compared the CT characteristics of cats diagnosed with intranasal mass lesions to determine if defining imaging features exist between different tumour types and between neoplastic and non-neoplastic lesions.MethodsThe medical records of two institutions were reviewed for cats with CT findings consistent with an intranasal mass lesion with subsequent histopathological examination. For each CT scan the mass location, growth pattern, margin distinction, contrast enhancement pattern and presence of intralesional areas of mineralisation or necrosis were recorded. The presence of facial deformity, the location and type of bone changes, extranasal extension of the mass lesion and the regional lymph nodes size, contrast pattern and hilus visibility were also documented.ResultsThirty-five cats with nasal lymphoma, 28 cats with non-lymphomatous nasal neoplasia (carcinoma or sarcoma) and 16 cats with inflammatory lesions met the inclusion criteria. Cats with non-lymphomatous nasal neoplasia were more likely to show unilateral nasal changes (odds ratio [OR] 3.9), areas of intralesional calcification (OR infinity) and extension of the mass lesion within the frontal sinus (OR 4.5), while cats suffering from nasal lymphoma were more likely to show a mixed (OR 4.5) and expansile growth pattern (OR 7.8), and a regional lymphadenomegaly (OR 2.4). The CT findings in cats diagnosed with inflammatory mass-like lesions were highly variable and overlapped with findings for nasal neoplasms but were significantly associated with the absence of bony changes to the nasal cavity boundaries (OR 10.2).Conclusions and relevanceFindings from the current study support the ability of CT to aid in the discrimination of tumour type in cats presented with an intranasal mass lesion.

Role of Urinary Calcium and Creatinine Ratio in Assessing Bone Resorption in Lepromatous Leprosy

Bony changes in lepromatous leprosy are one of the causes of deformity and disability. Fasting calcium and creatinine ratio in urine is used as a bone resorption marker in a number of diseases such as hyperthyroidism, osteoporosis, multiple myeloma, paget’s disease and sarcodosis. In lepromatous leprosy assessment of bone resorption might be done with that marker. To assess the role of fasting urinary calcium and creatinine ratio as a marker of bone resorption in patients with lepromatous leprosy. A case control study was conducted on 28 patients diagnosed as lepromatous leprosy and 28 age-matched healthy control. The participants who fulfilled all inclusion and exclusion criteria were studied by measuring fasting urinary calcium and creatinine level as well as observing X-rays of both hands and feet of affected individuals. The mean age of cases 38.1±14.2 years and 38.9±12.9 years was in control group. Male - female ratio was 3.6: 1. It was observed that 10.7% leprosy patients showed urinary Ca/Cr ratio &gt;0.20 (0.13±0.12) and 10.7% healthy control showed urinary Ca/Cr ratio ratio&gt;0.20 (mean ±SD 0.11±0.7). the difference was not statistically significant (p&gt;0.05). X-ray finding was positive in 14.3% leprosy patients and none of the control group. That difference was not significant statistically (p&gt;0.05). there was no relation between raised urinary Ca/Cr ratio and positive findings of bone resorption on x-rays among the leprosy cases.&#x0D; Bangladesh Med J. 2019 Sep; 48 (3): 28-33

Magnetic resonance imaging evaluation of patients with clinically diagnosed medial Epicondylitis.

We evaluated magnetic resonance imaging (MRI) findings in patients with clinically diagnosed medial epicondylitis (ME) and determined whether any of the MRI findings correlated with the follow-up pain level after nonoperative treatment. We retrospectively reviewed 83 patients who had undergone elbow MRI examinations for clinically diagnosed ME and who were followed-up for more than 6months. Five categories of MRI findings were selected for qualitative grading: common flexor tendon (CFT) origin signal changes, ulnar collateral ligament (UCL) insufficiency, ulnar neuritis, bony changes of the medial epicondyle, and calcification. The mean follow-up after MRI examination was 21months. We performed multivariate regression analysis to analyze whether any of these MRI findings were associated with the follow-up pain level after nonoperative treatment. Positive MRI findings included CFT origin signal changes (66%), ulnar neuritis (40%), UCL insufficiency (30%), calcification (27%), and bony changes (18%). Multivariate analysis indicated that CFT origin signal changes were independently associated with the follow-up pain level (β = 3.387; p = 0.004). In patients with clinically diagnosed ME, MRI demonstrated diverse abnormal findings in the CFT origin, ulnar collateral ligament, ulnar nerve, and bone. Among the findings, the severity CFT origin signal changes, which indicates the severity of tendon degeneration in ME, was associated with the follow-up pain level. This information can be helpful in consulting on the prognosis of nonoperative treatment in patients with clinically diagnosed ME.

Malar augmentation with zygomatic osteotomy in orthognatic surgery: Bone and soft tissue changes threedimensional evaluation

BackgroundThe aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery. Materials and methodsFrom January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score.For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes. ResultsConsidering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr – Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03.Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR). ConclusionThe malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures.

An International Survey on Temporomandibular Joint Surgeon’s Implementation and Management of Discectomy in Treating Temporomandibular Joint Internal Derangement

To survey temporomandibular joint (TMJ) surgeons to determine current practice trends and perceptions regarding the role of discectomy for the treatment of TMJ internal derangements. An anonymous 5-part web-based survey was sent to TMJ surgeons. The survey was created and distributed, and the data were collected with the University of Michigan Qualtrics platform. Responses were compared based on operative volume, tendency to replace the disc, and likelihood of requiring temporomandibular joint replacement (TJR) after discectomy. Spearman correlations were used to test statistically significant differences. Domain-level analyses were also performed by summarizing items into 3 domain scores. Analyses were performed in SAS V9.4 (SAS Institute Inc., Cary, NC, USA). Fifty-nine surgeons (33.9%) completed the survey. Discectomy was not considered to be a useful procedure by 85% of respondents, and 74% would not consider discectomy as a first surgical option. Most would consider discectomy (64%) before alloplastic total joint replacement. Discectomy was preferred over discopexy for the management of anterior disc displacement with reduction by high volume surgeons (89%), but most (72%) did not feel that discectomy was beneficial over arthroscopy in the treatment of anterior disc displacement without reduction and concomitant degenerative bony changes. In managing symptomatic disc perforation, 66% agreed that discectomy is the procedure of choice and 49% felt that interpositional tissue is indicated in most cases after discectomy. Respondents who reported fewer re-operations requiring alloplastic TJR after discectomy had, onaverage, more positive perceptions of discectomy on the benefits domain (P=.03), better than alternatives domain (P=.03), and fewer concerns on the perceived adverse effects domain (P=.03). TMJ surgeons do not employ TMJ discectomy in most cases of TMJ internal derangement. However, discectomy is considered useful in cases of disc perforation or for persistent symptomatic disc displacement without reduction, in an attempt to avoid alloplastic TJR. Common adverse effects included joint noises and osteoarthrosis, and the use of interpositional disc replacement tissue did not alter the incidence of adverse effects or complications reported.

Panoramik Radyografinin Temporomandibular Eklem Kemik Değişikliklerini Belirlemedeki Etkinliğinin Değerlendirilmesi

Objective: To investigate the utility of panoramic radiography in determining bony changes in temporomandibular joint (TMJ) based on cone-beam computed tomography (CBCT) images. Material and Methods: Two hundred eight TMJs on panoramic radiography and CBCT images of 104 (55 male, 49 female) patients were examined. Erosion, flattening, subcortical sclerosis or cyst, osteophyte, loose joint bodies, generalized sclerosis and deviation in form on the mandibular condyle, flattening, subcortical sclerosis and erosion of the articular eminence and articular fossa were evaluated both on CBCT and panoramic images. Data were scored as follows: false positive, false negative, true positive and true negative, and statistically analyzed with SPSS software using chi-square test (p<0.05), Cohen's kappa, receiving operating characteristic curve analysis. Results: Flattening (51.4% on CBCT, 24% on panoramic) and erosion (50% on CBCT, 15.9% on panoramic) was most commonly detected on the condylar head (p˂0.05). In the articular eminence, flattening in 2.4% and erosion in 12.5% and the articular fossa flattening in 1% and erosion in 20.2% were detected on CBCT. Flattening and erosion of the articular eminence and articular fossa could not be determined by panoramic radiography. Bony change that the most (38.5%) scored as the false negative was erosion. Accuracy values of panoramic radiography for the detection of any osseous change was poor compared with CBCT images (≤50%). Conclusion: Panoramic radiography was inadequate for detecting bony changes in TMJ especially in articular eminence and articular fossa. Therefore, radiological examination should be supported with more reliable imaging modalities like CBCT to examine hard tissues of TMJ.

Effect of amlodipine and L-carnitine on bone metabolism in ovariectomized rats

Background Amlodipine as a calcium channel blocker has anti-inflammatory effect through overaugmentation of nitric oxide production and antioxidant effect by reduced superoxide radicals and increased level of superoxide dismutase. l-carnitine has anti-inflammatory action through reaction with acyl group that is accumulated in anoxic cells and antioxidant effect through decreasing the superoxide anion production. Aim The aim was to evaluate the possible ameliorating effect of amlodipine (AML) and L-Carnitine (L-C) combination on osteoporotic bony changes in ovariectomized (OVX) rats versus each drug separately. A total of 50 adult female albino rats (weighting 100–125 g) of local strain were chosen as an animal model for this study. The animals were randomly divided into five groups. Each group comprised ten rats: group 1, negative control; group 2, OVX rats, positive control; group 3, AML-treated OVX rats; group 4, L-C-treated OVX rats, and group 5, AML and L-C-treated OVX rats. Bony changes were examined through evaluating markers of bone turnover, such as alkaline phosphatase and osteocalcin; femoral metaphyseal histomorphology; and serum proinflammatory cytokines, such as tumor necrosis factor-α, expression. Results alkaline phosphatase, osteocalcin, and tumor necrosis factor-α were significantly elevated in positive control group, which was associated with marked deterioration of bone microarchitecture. Treatment with AML and L-C combination significantly mitigated inflammation and histopathological osteoporotic changes compared with each of AML and L-C drugs separately. Conclusion AML and L-C combination could have a synergistic role in management of radical osteoporosis in OVX rats over each drug separately.