Bony Growth Research Articles

Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study.

Objective:The dental and periodontal impact of GH/IGF-1 hypersecretion has been poorly investigated until now. Our aim is to precisely describe the oro-dental state of acromegalic patients and to study the impact of GH/IGF-1 hypersecretion on patients’ reported oral health-related quality of life (OHRQoL).Methods:After collecting characteristics of their disease, acromegalic patients answered the GOHAI questionnaire assessing their OHRQoL, the AcroQoL questionnaire and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam CT if necessary).Results:In total, 29 patients aged 59.1 ± 16.0 years were included. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0 ± 7.8. 16/29 patients had a gingivitis and 18/29 a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis was found, probably because the frequency of a protective thick gingival biotype was increased (9/29). No case of generalized gingival hypertrophy or diffuse hypercementosis was observed. According to the Add-GOHAI score, only 8/26 patients had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11/29 patients had bulky oral bony outgrowths (OBO), such as large maxillary or mandibular tori and multiple vestibular exostosis.Conclusions:The unsatisfactory OHRQoL reported by acromegalic patients contrasts with a rather good objective oro-dental state and annual oral examination seems relevant in this population. Finally, we report that huge OBO could be helpful signposts for the diagnosis of acromegaly.

Treatment recommendations for chronic knee osteoarthritis

Primary osteoarthritis (OA) hinders an aging global population as one of the leading causes of years-lost-to-disability (YLD). OA in most patients is considered to be an overuse injury that results in degenerative inflammation of the joints with the associated formation of bony outgrowths. Due to the escalating nature of this chronic pain disease, treatment management for OA can initially begin with a more conservative approach. It can eventually lead to more invasive surgical procedures. At present, the standard of care remains initial conservative management with lifestyle changes, including weight loss with concurrent anti-inflammatory regimens. Injections are frequently used for the escalation of care, but a significant number of patients ultimately resort to total knee arthroplasty. This review will focus specifically on knee OA, providing a brief overview of risk factors and early management and in-depth exploration of the invasive interventions that can offer symptomatic relief and return of function.

A Step-By-Step Approach of the In Situ Thin Split-Thickness Toe-Nail Bed-Graft for the Treatment of Subungual Exostosis

Subungual exostosis (SE) is a rather uncommon benign bony outgrowth of the distal phalanx of the toes, affecting mainly adolescents and young adults. While inherently painless, it grows progressively and leads to nail deformity which eventually produces pain and has negative impact on the quality of life of the affected individual. The present paper presents a step-by-step guide to the in situ split-thickness toenail bed graft technique. The outcome of our case was in line with the current literature, the preservation of the nail led to a highly satisfactory cosmetic result, while no recurrence of the lesion was reported.

External auditory exostoses and early Neolithic aquatic resource procurement in Cyprus: Results from Cypro-PPNB Kissonerga-Mylouthkia in regional context

ObjectiveThis research is designed to evaluate the occurrence of external auditory exostoses (EAEs) in skeletal remains from the oldest known water wells in the world (Kissonerga-Mylouthkia, Cyprus, 8,200-7,200 BCE). MaterialsSix individuals (MNI = 6), five fragmentary temporalia, two preserved auditory canals. MethodsMacroscopic and microscopic (up to x30) observation, with illumination; presence, type, side, severity, occlusion, number, and position of bony growths recorded. ResultsBony growths within two auditory canals were discovered. Differential diagnosis includes osteomata and external auditory exostoses, with the latter consistent with the bony growths (Grade 1 EAEs, two adult males, one with single, another with two EAEs). ConclusionsThe emergence of the Neolithic in Southwest Asia is thought to involve increases in dietary breadth among foraging societies (Broad-Spectrum Revolution). EAEs likely indicate maritime activity in this context, given the lack of freshwater bodies, and zooarchaeological evidence points to dietary and other uses of maritime organisms. SignificanceThis EAE evidence is the oldest known in maritime contexts in Eastern Mediterranean and the Middle East, and first in Cyprus. It contributes towards understanding the initial colonization events by Neolithic farming communities in the 9th millennium BC, and the emergence of broad-spectrum economies at the dawn of the Neolithic in Southwest Asia, crucial for re-considerations of paradigms on the transition to the Neolithic way of life in the Near East. LimitationsOnly a few skeletal remains from these prehistoric contexts were available for observation. Suggestions for further researchFurther intensive review of Cypriot skeletal collections for EAEs is advised.

Superficial Femoral Artery Pseudoaneurysm Secondary to a Femoral Osteochondroma: A Case Report and Review of the Literature

Background: Osteochondromas or Osteocartilaginous Exostosis are cartilage-capped bony growths arising from external bone surfaces. They typically occur at the level of growth plates and account for 30% of benign bone tumors. Vascular complications from osteochondromas are rare with roughly 112 reported cases in the literature dating back as early as 1953. Vascular injuries are location dependent, with popliteal pseudoaneurysms being the most prevalent. The operative techniques to repair these injuries have varied over time and are related to the location, degree of vascular injury, presence of thrombosis or infection and involvement of nearby structures like named veins or nerves. We present a case of a superficial femoral artery (SFA) injury secondary to an osteochondroma and offer a review of the literature evaluating the trends on operative repairs and their association with the degree of vascular injury. Methods: A total of 112 publications were found and independently reviewed. Articles containing age, sex, presentation, size of the aneurysm and surgical technique for repair were included for evaluation. Mean follow up, use of anticoagulation, and whether there was associated trauma was also recorded if reported by the authors. Articles with insufficient reported variables were excluded. A total of 49 publications were selected for evaluation based on these criteria. The review of literature was performed through PubMed, MEDLINE, NCBI using the words "pseudoaneurysm", "superficial femoral artery", "popliteal artery", and "osteochondroma". Results: Young Males were the most prevalent group (79.4%) with a mean age of 21.4 years of age. The most common complaint at presentation was pain and a palpable mass (81%) with no history of trauma (51%). Popliteal aneurysms (85%) were the most common vascular injury while the average size of injury was 5 mm. Operative techniques included arterioplasty (30.6%), end to end anastomosis (20.4%), greater saphenous vein (GSV) patch (20.4%) GSV bypass (8.1%) GSV interposition graft (8.1%) and xenopericardial or polytetrafluoroethylene (PTFE) patch (2%). Smaller arterial injuries (<5 mm) were most commonly managed with arterioplasty or end-to-end anastomosis. Conclusion: Vascular injuries secondary to osteochondromas are rare. High suspicion and prompt diagnosis are necessary to prevent long-term sequelae from neurovascular compromise. Smaller arterial defects appear to be best suitable for primary reconstruction either by arterioplasty or aneurysmectomy with end-to-end anastomosis. Ultimately, the surgical reconstruction needs to be guided in a case-by-case basis.

The supracondylar process in subadult skeletal remains from Northern Italy (15th–18th century A.D.)

AbstractThis paper presents five uncommon examples of the supracondylar process in subadult skeletal remains from archaeological contexts. Human skeletal remains were recovered from the Baptistery of Settimo Vittone (Italy) that date to the 15th–18th centuries. A bony process was noted at the distal end of five immature humeri. The specimens were examined morphologically, and the following measurements were taken: length of the process and distance from the tip of the process to the medial epicondyle. The distal end of three right and two left immature humeri, from three full‐term individuals and two adolescents, revealed different stages of an unusual supracondylar bony outgrowth projecting from the anteromedial surface of the diaphysis. The processes in three individuals presented as a pointed bony spur, whereas in two cases, they appeared as bony ridges. The process was present more in right humeri and in one case occurred bilaterally. The supracondylar process begins its formation in the intrauterine period and continues throughout life, presenting as variable degrees of development. The occurrence of supracondylar process in very young individuals suggests the congenital nature of the trait, rather than a consequence of biomechanical stress. This case study describes a bony variant in humeri that has not been extensively discussed in the anthropological literature and provides evidence on the appearance of the supracondylar process in immature individuals. Also, an interesting presumed case of bilaterality is described: the asymmetry of the processes brings the aetiology of the trait into question. The small number of individuals presenting the supracondylar process does not allow a study of the incidence of this trait in this population sample. Furthermore, fragmentation of some remains precluded accurate measurements and age estimation. Additional studies on larger samples would help clarify the congenital and hereditary nature of the supracondylar process and the clinical implications in young individuals.

MON-349 Left Hip Pseudofracture in a Patient with Refractory Paget Disease of the Bone

BackgroundPaget’s disease of the Bone (PDB) is a benign condition caused by focal abnormal bone remodeling. It is largely asymptomatic and is often discovered incidentally while investigating an elevated alkaline phosphatase (ALP) or imaging studies.Diagnosis relies on biochemical screening, ALP, as a first line test. X-rays and radionuclide scans can assist in determining the extent of disease. Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalizing total ALP in PDB.Clinical caseA 51-year-old, non-verbal female presented to the Endocrinology office with her legal guardian for a follow-up regarding Paget’s disease of the bone. The patient had a past medical history of mental disability and refractory Paget’s disease that was diagnosed 13 years prior in the setting of elevated alkaline phosphatase. At the time of diagnosis bone scan showed involvement of both tibias, pelvis and right femur stress fracture. She also had a right femoral fracture 7 years before the current presentation that was surgically fixed with an intramedullary rod. The patient had undergone 5 yearly infusions of Zoledronic acid with persistent elevated alkaline phosphatase.During her clinic visit the patient endorsed left non-traumatic hip pain as well as difficulty walking over the last 2 weeks. Vital signs were within normal limits. On physical exam she appeared well developed, no acute distress was noted, normal heart rate, regular rhythm and normal heart sounds. Pulmonary effort was normal, no respiratory distress or abnormal sounds were appreciated. Musculoskeletal exhibited bilateral lower extremity bowing. No skin warmth, bony growths or tenderness on palpation were noted.Lab work revealed ALP 277 u/l, bone specific alkaline phosphatase 95.9 (8.1 - 31.6), BUN 12 mg/dl, Creatinine 0.66 mg/dl, GFR 90, Calcium 9.0 mg/dl, Vitamin D 23.3 ng/mL.She had been treating the hip pain with as needed NSAIDs. An X-ray of the left femur was ordered, and the study showed possible acute subcapital minimally displaced femoral neck fracture with minimal impaction in the setting of known Paget’s disease. The patient was then contacted and asked to present to the ER emergently for further evaluation and treatment.Upon arrival to the Emergency Department, an MRI of the left hip was performed, demonstrating extensive Paget’s disease with no evidence of acute hip fracture.ConclusionsIt is essential to obtain an urgent x-ray in patients with Paget’s disease who presents with localized pain. However as this case demonstrates x-ray findings can be misleading due to underlying structural deformity of the bone and further imaging like CT or MRI may be necessary.

Subungual exostosis recurrence in a 16-year-old athletic male.

Subungual exostosis is a painful, benign bony outgrowth projecting from the distal phalanx of the toes. The present case consists of a 16-year-old male that presented to the primary clinic with a single circumscribed painful lesion underneath the nail of the first phalanx of the left foot that recurred after surgical extraction.

Association Between Uncemented vs Cemented Hemiarthroplasty and Revision Surgery Among Patients With Hip Fracture

Consensus guidelines and systematic reviews have suggested that cemented fixation is more effective than uncemented fixation in hemiarthroplasty for displaced femoral neck fractures. Given that these recommendations are based on research performed outside the United States, it is uncertain whether these findings also reflect the US experience. To compare the outcomes associated with cemented vs uncemented hemiarthroplasty in a large US integrated health care system. Retrospective cohort study of 12 491 patients aged 60 years and older who underwent hemiarthroplasty treatment of a hip fracture between 2009 and 2017 at 1 of the 36 hospitals owned by Kaiser Permanente, a large US health maintenance organization. Patients were followed up until membership termination, death, or the study end date of December 31, 2017. Hemiarthroplasty (prosthetic replacement of the femoral head) fixation via bony growth into a porous-coated implant (uncemented) or with cement. The primary outcome measure was aseptic revision, defined as any reoperation performed after the index procedure involving exchange of the existing implant for reasons other than infection. Secondary outcomes were mortality (in-hospital, postdischarge, and overall), 90-day medical complications, 90-day emergency department visits, and 90-day unplanned readmissions. Among 12 491 patients in the study cohort who underwent hemiarthroplasty for hip fracture (median age, 83 years; 8660 women [69.3%]), 6042 (48.4%) had undergone uncemented fixation and 6449 (51.6%) had undergone cemented fixation, and the median length of follow-up was 3.8 years. In the multivariable regression analysis controlling for confounders, uncemented fixation was associated with a significantly higher risk of aseptic revision (cumulative incidence at 1 year after operation, 3.0% vs 1.3%; absolute difference, 1.7% [95% CI, 1.1%-2.2%]; hazard ratio [HR], 1.77 [95% CI, 1.43-2.19]; P < .001). Of the 6 prespecified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality (1.7% for uncemented fixation vs 2.0% for cemented fixation; HR, 0.94 [95% CI, 0.73-1.21]; P = .61) and overall mortality (cumulative incidence at 1 year after operation: 20.0% for uncemented fixation vs 22.8% for cemented fixation; HR, 0.95 [95% CI, 0.90-1.01]; P = .08). Among patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision. These findings suggest that US surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures in the absence of contraindications.

STUDY OF DORSAL SACRAL TRIANGLE IN HUMAN SACRA

Introduction:&#x0D; Sacrum is a triangular bone shaped by combination of five sacral vertebrae. It is embedded as a wedge between the two innominate bones at the upper and back portion of pelvic bone. The opening show at the caudal conclusion of sacral canal is known as sacral rest. It is shaped due to the disappointment of combination of laminae of the fifth (every so often 4th) sacral vertebra. It is situated inferior to the 4th (or 3rd) fused sacral spines or lower end of median sacral crest. Sacrum is a vital bone for recognizable proof of sex in human skeletal framework. Since it may be a component of hub skeleton and and pelvic support, it has an applied significance in deciding sexual orientation with the assistance of estimation carried upon it. The well- known strategy for assurance of male and female sacra has been the Sacral file (SI). The varieties within the structure of dorsal divider of sacral canal are various. It may be open all through its whole length or there may be moo lying lamina of to begin with sacral vertebra. Other varieties incorporate lacks between its predominant and second rate limits, pulverization of lumen of sacral canal and hard abundance annihilating the break. The nearness of any gaps may allow the needle to elude the canal coming about in subcutaneous statement of anesthetic operator. The sacral hiatus has been used for administration of caudal epidural anesthesia in obstetrics as well as orthopedic practice for treatment and diagnosis. The foremost visit issue experienced in caudal epidural square is needle situation as in some cases it is troublesome to decide the anatomical area of sacral rest particularly in grown-ups. Clinical assessment of needle arrangement can be done with ultrasonography or fluoroscopy. In any case, it isn't continuously doable to do so since of time and cost limitations. Varieties have been found within the shape and level of sacral break. Anatomical points of interest and the information of real shape and size of sacral rest and its varieties play a major part within the victory of needle situation. &#x0D; Aim: The main of this study is to find out the anatomical variations of sacral hiatus of the cadaver in human.&#x0D; Material and Methods: This is a Cross-sectional study carried out on dry human sacra to study the anatomical variations of sacral hiatus. Total 80 human sacra were collected from Department of Anatomy. Only dry sacra with complete sacral hiatus were included in this study. Damaged sacra were excluded in this study. For the study various parameters and measurement were used for the study. With the help of naked eye the shape of the sacral hiatus was noted. The length of sacral hiatus was measured from apex to the midpoint of base; the antero-posterior depth of sacral hiatus at the apex was measured with the help of vernier calipers and recorded as data. With the help of vernier caliper the transverse width of sacral hiatus at the base was also measured between the inner aspects of inferior limit of the sacral cornu with the help of divider and then adjusted and calculated.&#x0D; Result: In this all the sacrum studied was composed of five segments in 80 cases. There were many variations in the shape of sacral hiatus. In 38 (47.5%) sacra the shape was Inverted-U whereas sacra Inverted V was seen in 21(26.3%). Both the over sorts were considered as ordinary and the sacral break was show against 4th and 5th sacral sections. The irregular shaped of sacral hiatus was observed in 12(15%) cases. A “Dumbbell” shaped sacral hiatus was observed in 5(6.3%) cases with a nodular bony growth projecting medially from both margins. The dorsal wall of sacral canal was entirely absence in 3(3.8%) cases. a rare phenomenon, absence of sacral hiatus was observed in 1(1.3%) only.&#x0D; Conclusion: There was variability in the anatomical structure of the sacral hiatus. The inverted U shape of sacral hiatus was most commonly seen. Apex and base of the hiatus were most commonly seen at the level of S4 and S5 respectively. These estimations will be of colossal esteem in administration of caudal epidural anesthesia and variations in shape and estimate of sacral rest will help in preoperative assessment of patients. There are anatomical varieties within the sacral break, which may relate to the complication to caudal epidural anesthesia. Understanding of these varieties may progress the victory rate of caudal epidural anesthesia.&#x0D; Keywords: Sacrum, Sacral hiatus, apex, base, caudal epidural anaesthesia

Multiscale bone quality analysis in osteoarthritic knee joints reveal a role of the mechanosensory osteocyte network in osteophytes

Osteophytes - bony outgrowths on joint structures - are found in healthy individuals but are specifically present in late osteoarthritis (OA). Osteophyte development and function is not well understood, yet biomechanical stimuli are thought to be critical. Bone adapts to mechanical forces via the cellular network of osteocytes. The involvement of osteocytes in osteophyte formation and maturation has not been unravelled. Forty-three osteophytes from tibias of 23 OA patients (65 ± 9 years) were analysed. The trabecular bone structure of osteophytes presented with fewer trabeculae of lower bone mineral density compared to subchondral bone. We identified 40% early stage and 60% late stage osteophytes that significantly differed in their trabecular bone characteristics. Osteophyte bone revealed a higher number of osteocytes and a lower number of empty osteocyte lacunae per bone area than the subchondral bone. We found that OA osteophytes consist of younger bone material comprised of woven and lamellar bone with the capacity to develop into a late stage osteophyte potentially via the involvement of the osteocyte network. Our analysis of OA osteophytes implies a transition from woven to lamellar bone as in physiological bone growth within a pathological joint. Therefore, osteophyte development and growth present a valuable research subject when aiming to investigate the osteogenic signalling cascade.

Bony outgrowths on the base of skull near foramen spinosum

Objectives: Ossification of the various ligaments at the base of the skull is quite common. Ossified pterygospinous and pterygoalar ligaments have been extensively described in the literature. We observed some bony outgrowths extending from the bar of bone between foramen spinosum (FS) and foramen ovale (FO). The objective of the present study was to report the incidence of these bony outgrowths near the FS. Materials and Methods: Fifty-five dried adult skulls and 20 sphenoid bones were examined for the bony outgrowths (if present) near the FS. Results: Bony outgrowths extended posteriorly from the bar of bone between FO and FS in 60% of cases. These bony outgrowths when long were seen meeting the spine extending from the spine of the sphenoid, forming a complete or incomplete bar of the bone. At times, a thick bony plate joined the bar of bone between FO and FS to the spine of the sphenoid. Conclusions: The bony outgrowths near FS become clinically important in surgeries involving middle meningeal artery. In spite of such implications, these bony outgrowths are neither named nor have they received the due attention in the literature. Detailed studies of these bony outgrowths could be of interest to radiologists, anesthetists, and neurosurgeons.

Morphometric analysis and prevalence of plantar calcaneal spurs among the adult population of the Province of Vojvodina

Introduction. Plantar calcaneal spur is a bony outgrowth which is most often located on the inferior aspect of the calcaneus, penetrating the surrounding soft tissues. Symptomatic and asymptomatic cases of plantar calcaneal spurs have been described and their analysis suggested that they may be a variation in regular bone development, but the exact cause is still unknown. The goal of this study was to determine the size, shape and prevalence of plantar spurs in the population of the Province of Vojvodina. Material and Methods. This retrospective research included a total of 272 foot X-rays. The X-rays belonged to the Clinic of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. The images were analyzed using a publicly available software Xrayline Workstation for 32-bit. Results. There was no statistically significant difference in the size of calcaneal spurs between sexes, as well as between the right/left foot. In regard to their shape, irregular calcaneal spurs were more frequent (61.9%) and all of the spurs were positioned horizontally. Conclusion. The results of this research were in agreement with the available literature data, showing no significant difference in morphometric analysis of the plantar spurs between sexes. Future researches should include data regarding the age, body weight, and comorbidities among examinees.

Peridens – Case series of nonsyndromic patients with varied clinical presentations

Supernumerary tooth may be encountered by the general dental practitioner as an incidental finding on a radiographic examination or as the cause of an impacted tooth. However, in certain cases, it may be misinterpreted as a bony growth (mandibular torus) when it makes its appearance in the lingual aspect of mandibular arch. We present two cases of peridens, a form of supplemental tooth, the former case with the clinical feature of bony swelling and ending in a dilemmatic differential diagnosis and another case of impacted supernumerary tooth, accidentally found on radiograph, thereby stressing the role of radiographs in arriving at final diagnosis apart from clinical counterpart.

Uncommon bilateral maxillary exostosis: case report

ABSTRACT Exostoses or hyperostoses are benign bony outgrowths originating from the cortical bone and depend on their location for a more precise designation. The most common types found in the oral cavity are the torus palatinus and the torus mandibularis. Buccal and palatal exostoses are located along the buccal aspect of the maxilla and/or the mandible (commonly in the premolar and molar areas) and on the palatal aspect of the maxilla (usually in the tuberosity area), respectively. The etiology of exostoses still hasn’t been enlightened but an interaction between environmental and genetic factors is accredited. They are usually asymptomatic, unless the mucosa becomes ulcerated. The frequency of exostoses increases with age, having their biggest prevalence from 60 years old, being more common in men and suffering ethnic influences. A thorough evaluation is important for the correct diagnosis since other lesions have similar clinical characteristics to the exostoses such as osteomas. The majority of exostoses are diagnosed clinically along with radiographic interpretations, making the biopsy dispensable and the treatment is usually unnecessary. The aim of this article was to describe a case report of bilateral maxillary exostosis, unusual, in a female patient. If an excessive amount of bone is present the exostoses may exhibit a relative radiopacity on dental radiographs. Initially, periapical and panoramic radiographs were performed to evaluate the alterations. Due to the size of the exostoses a concomitant Cone Beam Computed Tomography was performed to confirm the diagnosis. The patient is in follow-up.

Internal auditory canal osteoma: Wait or operate – Case report and literature review

Internal auditory canal osteomas (IACOs) are rare, slow-growing, and benign bone tumors. They are most often found incidentally with few-reported cases. Osteomas involving the internal auditory canal (IAC) are particularly rare. The symptoms of the IACO usually arise due to direct pressure on the vestibulocochlear nerve; however, etiology, mechanism, and management remain unclear. The present report describes the rare case of IACO involving a 15-year-old male who was referred to a tertiary referral center with a history of chronic supportive otitis media, which was otherwise asymptomatic. The ensuing discussion and brief literature review address whether to wait or operate. IACO in this patient exhibited slow-growing features, and audiology assessment revealed no sensory neural hearing loss. Computed tomography (CT) revealed a round, radiopaque pedunculated bony outgrowth in the right IAC. Magnetic resonance imaging using a selected T2-weighted sequence revealed the osteoma projecting from the posterior superior aspect of the right IAC. Accordingly, clinical observation was recommended. Observation, including serial CT, is recommended for asymptomatic patients. Surgery is not advisable in slow-growing and asymptomatic cases because the risks are due to its dangerous location. Decisions regarding the management must consider according to symptom severity, progression, and risks in surgery. The question of whether to operate, therefore, should be carefully considered depending upon patient complaints and medical findings.

Prevalence of Tertiary mandibularis and its association with para-functional activity in tertiary care centre in Shimla, H.P., India: A hospital based cross sectional study

Introduction: Oral tori are bony growths present in oral cavity and are not considered as pathological lesions. Torus mandibularis (TM) is usually present in lingual aspect of alveolar process in canine-premolar region of mandible. The objective of the study is to determine the TM' prevalence among outpatients attending tertiary care center and its relevance with parafunctional activities. Materials and Methods: The study was conducted in the out patients attending the hospital between December 2017 and May 2019. Fourteen thousand and two hundred and eight patients were screened for the presence of TM as per inclusion and exclusion criteria. The data were collected and subjected to the statistical analysis. Results: Out of 14,208 patients, 157 patients were presented with TM. The prevalence found to be 1.1%. Tori were more frequent in males than females. The most commonly observed type was bilateral solitary type. The association of TM with parafunctional activities and temperomandibular disorder was found to be significant. The higher frequency of TM was seen in the subjects residing at high altitudes. Discussion: The prevalence of TM in our study was found to be low. The study was undertaken to record the preliminary data regarding TM in this region and its association with parafunctional activity. Conclusion: We suggest performing thorough clinical examination and imaging to rule out underlying parafunctional activity, if TM is incidental finding.

OSTEOCHONDROMA OF THE MANDIBULAR CONDYLE: A CASE REPORT

Osteochondroma, also known as osteocartilaginous exostosis, is a rare exophytic lesion that arises from the cortex of the bone and is capped with cartilage. A 28-year-old woman presented with a 10-month history of increasing dentofacial asymmetry. Clinical examination revealed the left border of the mandible more inferiorly placed compared with the other side, with deviation of her chin pointing to the right. Computerized tomography demonstrated a bony outgrowth present between the head of the left condyle and the glenoid fossa, with a maximum anteroposterior dimension of 3 cm. Union between the condyle and the glenoid fossa was not observed, although the fossa was irregular in outline. Excision of the lesion with condylar remodeling and disk repositioning was performed. Microscopically, sections showed a benign neoplasia from mesenquimal origin composed of immature cartilaginous tissue with binucleate chondrocytes inserted in columns. These features described confirm the diagnosis of osteochondroma. Follow-up examinations continue to be performed.

Bony Ingrowth of Coil-Type Open-Architecture Anchors Compared With Screw-Type PEEK Anchors for the Medial Row in Rotator Cuff Repair: A Randomized Controlled Trial

To evaluate outcomes of screw-type and coil-type open-architecture suture anchors with respect to bony ingrowth, release of biological markers, and patient-reported outcome measures when used in rotator cuff repair (RCR). Forty patients undergoing arthroscopic RCR for full-thickness rotator cuff tears were enrolled and prospectively randomized to receive a screw-type (19 patients) or coil-type (21 patients) suture anchor for the medial row during repair. All repairs used a transosseous-equivalent configuration with footprint anchors laterally. Marrow elements released during surgery were evaluated for 9 cytokine markers (insulin-like growth factor 1, fibroblast growth factor 2, bone morphogenetic proteins 7 and 2, platelet-derived growth factors AA and BB, epidermal growth factor, transforming growth factor beta1, and vascular endothelial growth factor). Postoperative computed tomography scans were performed at 6 months. Range of motion, strength, and validated patient-reported outcome measures (Simple Shoulder Test, Single Assessment Numeric Evaluation, visual analog scale, and American Shoulder and Elbow Surgeons scores) were gathered before the operation and at 6 months and 1 year postoperatively. Bone mineral density surrounding the coil-type anchor was significantly greater than that surrounding the screw-type anchor (P= .005). Bone mineral density values within the coil-type and screw-type anchors were comparable (P= .527); however, a larger amount of total bone mineral mass (in milligrams) was shown within the coil-type anchor owing to its larger volume (P < .01). Marrow elements released at the repair site were similar between groups (P > .05). Postoperatively, no statistically significant difference was found between groups for clinical outcome measures at 6 months or 1 year. Retear and complication rates were similar between groups (P > .05). Both the coil-type and screw-type anchors can be reliably used for RCR and produce similar clinical outcomes. The coil-type anchor resulted in superior bony growth surrounding the anchor and a larger total bone mineral mass within the anchor owing to its larger volume. Level II, randomized prospective comparative study.

A Rare Case of Multiple Osteochondromas with Short Metatarsals and Seizure

Multiple Osteochondromas desribed first in 1786 is an autosomal dominant inherited disorder with 100% penetrance manifesting more in males (M:F =1. 5:1) with a prevalence rate of 1:50000. The defect involves the tumour suppressor gene EXT 1 and EXT2. They appear in first decade of life with two or more bony outgrowths from the end of growing long bones and grow till puberty. They can arise from any bone except facial bones. They present with pain and symptoms due to pressure effects on the nerves, muscles, tendons, ligaments, brain and spinal cord and cause many type of deformities. Brachydacty l and relative shortening of metatarsals as well as possibility of seizure consequent to exostoses of skull bones have been described but has rarely been reported. Here we are presenting a case of MO with distinct shortening of metatarsals and seizure.