Bony Protrusion Research Articles

Osteochondroma of the distal tibia with associated varus deformity of ankle

Osteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. The most common site is the distal femur followed by the proximal humerus and proximal tibia. It is made up of a bony protrusion that is covered by a cartilage cap. Osteochondroma is asymptomatic and grows away from the nearby joint. It is very common in kids and young adults. Sometimes patient comes in 2nd decade with complaints of pain and swelling. This paper reports a presentation of osteochondroma present over the right distal tibia.

Research progress on labial protuberances of anterior teeth in orthodontic treatment

During orthodontic treatment, irregular and varying sized nodular bony protrusions may sometimes appear on the labial side of the patient's anterior alveolar bone, which is closely related to the differential bone remodeling on the inner and outer surfaces of the alveolar bone. Labial protuberances not only affect the aesthetic results of orthodontic treatment, but also pose potential risks to periodontal health. Currently, it is believed that the influencing factors of the formation of the labial protuberances may be related to the patient's gender and age, tooth movement speed, and extent of anterior teeth retraction. Labial protuberances typically resolve spontaneously, however, if persistent, alveoloplasty may be necessary for treatment. This review provides a summary on the occurrence, influencing factors of formation, potential biological mechanisms, and corresponding treatment methods of labial protuberances during orthodontic treatment.

Hallux Dorsal Curvature of the Distal Phalanx and Its Possible Implications for the Dorsal Osteophyte.

Background and Objective: The dorsal osteophyte on the distal phalanx of the first toe (hallux) is a reactive bony protrusion that may be associated with pathologies such as onychocryptosis or pincer nail. This study aims to describe and analyze the correlation between three novel measurements-dorsal osteophyte height (HDO), distal phalangeal hyperextension (DPHA), and distal phalangeal curvature (DCDP)-and to evaluate the impact of minimally invasive surgery on the dorsal osteophyte using fluoroscopic data. Materials and Methods: A total of 125 fluoroscopic images were analyzed. Baseline measurements for the variables were compared between groups. The key variables included distal phalanx curvature, distal phalanx hyperextension, and dorsal osteophyte height. Results: The analysis revealed statistically significant differences in the main group effect for distal phalanx curvature (F [2, 122] = 7.54, p < 0.001), distal phalanx hyperextension (F [2, 122] = 28.90, p < 0.001), and dorsal osteophyte height (F [2, 122] = 13.64, p < 0.001). Significant correlations were found between distal phalanx curvature and distal phalanx hyperextension, as well as between distal phalanx hyperextension and dorsal osteophyte height. However, no significant correlation was observed between distal phalanx curvature and dorsal osteophyte height. Conclusions: The findings suggest that minimally invasive dorsal osteophyte surgery effectively restores the distal phalanx to normal conditions, as indicated by the variables studied.

A RANDOMIZED COMPARATIVE CLINICAL STUDY TO EVALUATE THE AN-ALGESIC EFFECT OF JALOUKAVACHARANA AND SIRAVYADHA IN VA-TAKANTAKA WITH SPECIAL REFERENCE TO CALCANEAL SPUR

Vatakantaka (Calcaneal spur) is one among Vataja Nanatmaja Vyadhi. Kantavath Vedana (pricking pain) in Padatala Pradesha of Khudapradesha (Heel region) is a prominent characteristic feature, which is caused by Vishamampade (walking on irregular surfaces), Atishrama (excessive exertion over the heel) etc. This can be correlated to a Calcaneal Spur, which is a calcium deposit causing a bony protrusion on the underside of the heel bone, often frequently associated with plantar fasciitis; treatment includes Raktavasechana (bloodletting), Erandataila Pana, Agnikarma (cauterisation) and Samanya Vatavyadhi Chikitsha (general line of management). Jaloukavacharana (leech therapy) is a type of Ashastrakrita Raktamokshanopaya which is indicated in Avagadha Avastha (deeply situated), Grathita Avastha (complicated structures) of Doshas and by the word Sarvani Sarveva in all condition wherever Raktavasechana is indicated. At present, Jaloukavacharana (leech therapy) is taken. The study comprises 40 patients of Vatakantaka (Calcaneal spur). These patients were randomly selected based on inclusion and exclusion criteria. The duration of the study is 21 days. After evaluating therapy, it was observed that Jaloukavacharana provided better analgesic relief to the patients of vatakantaka (Calcaneal spur).

Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court.

Ponticulus posticus (PP) is a bony protrusion located between the posterior portion of the superior articular process and the posterolateral portion of a posterior arch of the atlas vertebrae in the cervical spine. The aim of this study is to verify the presence of different types of PP in a Southern Italian pre-orthodontic cohort to understand its correlation with skeletal class and maturity. A case-control retrospective study was conducted, utilizing 212 latero-lateral telecranium radiographs to analyze skeletal maturity according to the cervical vertebral maturation method, the Angle's classification of malocclusion (I, II, or III), and the presence or absence of the PP, whether complete (c-PP) or partial (p-PP). A total of 212 lateral cephalograms were analyzed. Of the 72 male patients, 67 (93%) exhibited PP, and 116 (88%) were PP. The chi-square value was 0.001, while Cramer's V was 0.270, indicating a significant correlation between age groups and PP presence, and a very strong association overall. Out of the 41 complete PP cases, class I was notably more prevalent than classes II and III. Orthodontists should carefully consider PP when assessing and treating individuals with or without skeletal discrepancies and dental anomalies.

Extended reduction malarplasty for Asians with flat and wide face: Comparison with L-shaped osteotomy.

Reduction malarplasty is effective in correcting prominent zygomatic body and arch in Asian populations, but periorbital zygomatic bony protrusion may not be sufficiently improved. In this study, we present the extended reduction malarplasty procedures to correct it simultaneously and compare the outcome with that of conventional L-shaped osteotomy. A retrospective review of consecutive patients who received reduction malarplasty between August 2021 and September 2023 at our hospital was conducted. Computed tomography images obtained before and after surgery were assessed to evaluate the facial skeletal changes, and to compare between the extended and conventional L-shaped malarplasty results. Twenty extended reduction malarplasty patients and 23 conventional reduction malarplasty patients were eligible for the study. Cephalometric analyses showed significant reduction in the zygomatic width in both groups, but the protrusion of the periorbital area was improved significantly greater in the extended reduction malarplasty group. In terms of facial angulation, the extended reduction malarplasty also provided more horizontal convexity in the periorbital area, whereas the angular change in the caudal part of zygoma was not significantly different. The extended reduction malarplasty enabled to reduce the protrusion of the periorbital area, as well as the prominent zygomatic body and arch, and provided more three-dimensionality and horizontal convexity with the midface contour. It is a viable option for harmonizing the facial profile for Asian patients with flat and wide face.

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery.

Background: The anatomical characteristics of the anterior ethmoidal artery (AEA) exhibit a high degree of variability, especially regarding its topography. Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all studies that included information regarding the morphometric and topographical characteristics of the AEA. Results: Ultimately, a compilation of 38 studies meeting the predetermined criteria, and possessing comprehensive and pertinent data, were incorporated into the current meta-analysis. In the overall analysis, reports of the AEA being embedded within the skull base or at the level of the skull base producing a bony protrusion were found in 56.91% of cases (95% CI: 43.55-69.80%). The mean diameters of the AEA in the intraorbital and intracranial areas were 0.94 mm and 0.76 mm, respectively. Moreover, the artery coursed most commonly between the second and third lamellae, with a prevalence of 65.82% (95% CI: 55.39-75.56%). Conclusions: The AEA may be at a high risk of iatrogenic injury during various sinus and skull base surgeries, especially if the surgeon performing these procedures is unfamiliar with the vast number of variations this vessel may exhibit. The spatial relationship between this vessel and the skull base is especially variable, and understanding this variability goes hand in hand with intraoperative safety.

Recurrence rate and patient-reported outcomes after wedge excision of carpal boss

The treatment of carpal boss is primarily conservative. Surgical treatment by performing a wedge excision of the bony protrusion, is possible. However, a common belief exists that carpal boss should not be operated because of the high recurrence rate. Additionally, little is known about the clinical outcomes of wedge excision and the preferred post-operative treatment. Patients with carpal boss and persisting pain who underwent wedge excision after conservative treatment were included. They received questionnaires before and three months after surgery. The primary outcomes were pain and hand function measured using patient-reported wrist evaluations (PRWE). Secondarily, recurrence, patient satisfaction and time until return to work were evaluated. These clinical outcomes were also compared between patients who received a plaster splint or a pressure dressing post-operatively. 76 patients were included. Three months after surgery, a significant improvement in PRWE was seen, for both pain and function. A re-operation rate for recurrent carpal boss of 13% was observed. After three months, 58% of patients were satisfied and 73% had returned to work. While no differences in clinical outcomes were found, patients were more satisfied after receiving a pressure dressing than a plaster splint post-operatively. The current study demonstrates encouraging early outcomes after wedge excision, and a low recurrence re-operation rate. Furthermore, a pressure dressing seems preferable post-operatively compared to a plaster splint.

Usefulness of Preoperative Simulation: Skull Base Approach

Preoperative simulation images creates an accurate visualization of a surgical field. The anatomical relationship of the cranial nerves, arteries, brainstem, and related bony protrusions is important in skull base surgery. However, an operator's intention is unclear for a less experienced neurosurgeon. Three-dimensional(3D)fusion images of computed tomography and magnetic resonance imaging created using a workstation aids precise surgical planning and safety management. Since the simulation images allows to perform virtual surgery, a déjà vu effect for the surgeon can be obtained. Additionally, since 3D surgical images can be used for preoperative consideration and postoperative verification, discussion among the team members is effective from the perspective of surgical education for residents and medical students. Significance of preoperative simulation images will increase eventually.

Consistent Reconstruction of Sacrococcygeal Pressure Ulcers using Modification of En Bloc Sliding Gluteus Maximus Myocutaneous Flap Technique

Background: The en bloc sliding gluteus maximus myocutaneous flap was introduced to preserve the vasculature, muscular integrity, sensory innervation, and normal gluteal contour with a midline scar in sacrococcygeal pressure ulcer reconstruction. However, its critical disadvantages include incomplete detachment of the origin of the gluteus maximus and central tension of the closed wound due to round ulcer excision. Therefore, we reviewed the surgical anatomy and applied modifications to achieve sufficient flap mobilization and to decrease complications.Methods: After fusiform or rocket-shaped ulcer excision, submuscular flap elevation was initiated by completely detaching the origin of the gluteus maximus, including the posterior iliac crest, followed by comprehensive lateral submuscular dissection in the gluteal space while preserving the neurovascular pedicles. Bony protrusions were tangentially resected from the lower sacrum and upper coccyx. After en bloc medial advancement of the bilateral flaps, defects were closed in layers, with muscle ligament fixation at the midline.Results: Twenty-nine patients underwent surgery for sacrococcygeal pressure ulcers (primary, n=22; recurrent, n=7). Transverse width of the excised ulcers was 5–12 cm (final defect, 7–15 cm). During the follow-up period (6 months to 7 years), no early postoperative complications or late aesthetic or functional discomfort occurred; however, intermittent skin sloughing occurred in four cases and one coccygeal sore recurrence occurred. The recurrent ulcer was treated using the same surgical method, with no recurrence after 2 years.Conclusion: This modification can be successfully used for the reconstruction of primary and recurrent sacrococcygeal pressure ulcers.

How to Reduce Inferomedial Orbital Wall Fracture Using a Navigation System: Tips and Pearls.

The orbit is a confined space with a defined bony structure. Bony protrusion into the ethmoid or maxillary sinuses by the blowout fracture can displace orbital tissues, including rectus muscles and adjacent fascial septae. Especially, reconstructing the orbit's floor and medial wall can be challenging when the inferomedial strut or posterior bony ledge is affected, leading to a loss of critical anatomic landmarks and support. Correctly positioning an implant in the precise anatomic location can be challenging. Recent updates to the navigation system have addressed this issue. Despite its early application, using a navigation system in these orbital fractures advances plastic surgeons in a way that has more confidence and accuracy in surgical planning. The video demonstrates how these 2 can be combined in an operating room. Intraoperatively, the authors check the superior, anterior, and posterior ends of the medial wall fracture and the posterior end of the floor fracture. A single orbital implant was trimmed and reshaped to match defect measurements. The implant placement was meticulously executed to repair the fracture while ensuring the inferior oblique muscle was not injured. After confirming the correct placement of the implant, it was secured to the inferior orbital rim using a single screw. Depending on the medial orbital wall fracture depth or degree of soft tissue herniation, the authors used an artificial dermal matrix or trimmed absorbable mesh plate to cover the uppermost part of the medial wall fracture to prevent postoperative enophthalmos. Finally, a forced duction test was performed. Our study shows that navigation-assisted inferomedial orbital wall reconstruction using materials readily available in the market is safe and effective.

Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm

To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic. A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll's hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation. The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll's hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively. Congenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.

Reinforcing structures proliferated around a titanium implant inserted into the femur of female rabbits, in a hole smaller than the screw core

One of the basic conditions for the clinical success of osseo-integrated implants is implant stability (Albrektsson and Zarb, 1993). It comprises two components, the primary stability that should be ensured at the time of insertion and the secondary stability, which gradually replaces the primary stability. The primary stability is ensured by the direct contact between the implant surface and that of the bone walls of the insertion hole. Secondary stability begins with the first position of new bone on the implant surface. The aim of the present study was to verify the reinforcing structures proliferated around the titanium implant inserted into the femur of 5 adult female rabbits, in a groove smaller than the screw core diameter. The results suggested that inserting the titanium implant into a hole with a smaller diameter than the screw core produces excessive pressure on the bone, which is felt up to a distance from the bone-implant interface. Consequently, mechanical strength of the bone is decreasing and proliferating bone consolidation formations appears on both periosteum and endosteum areas. Additionally, it was observed that newly proliferated bone extends laterally from the interface to a great distance, causing thickening of the bone wall. The observed structures were represented by branched bone trabeculae and bony protrusions into the medullary cavity, together with bone reshuffling processes with the appearance of numerous osteons, most of which are present at the level of the wall opposite the insertion area.

Case Study : The Application of Extracorporeal Shockwave Therapy (ESWT), Transverse Friction Massage and Hold Relax Exercise On Movement and Function of Ankle Joint Due to Calcaneus Spur Dextra

Background : Calcaneal spurs are a common cause of heel pain. Calcaneus Spur is an abnormal bony protrusion condition. It can occur anywhere along the calcaneal tuberosity. It is caused by pressure in the region of the plantar aponeurosis attachment to the calcaneal bone. This causes heel pain, the pain will be more severe when waking up in the morning. Objective: This case study was aimed to determine the effect of Extracorporeal Shockwave Therapy (ESWT), transverse friction massage and hold relax exercise on movement and function ankle joint disorders caused by calcaneus spur dextra. Methods: This case studies were carried out 6 times for 2 weeks on one patient, female 44 years old with calcaneus spur dextra condition by evaluating the degree of pain by using the Visual Analogue Scale (VAS), Joint Range of Motion (RoM) by using a goniometer and functional activity ability of the foot by using Foot Function Index (FFI) questionnaire. Results: There was a decrease of unmotion pain degree from VAS 2 to VAS 0, motion pain degree from VAS 3 to VAS 2, while tenderness pain degree decreased from VAS 7 to VAS 4. There was an increase on movement of plantar flexi ankle joint dextra from (S) 300-00-200 to (S) 400-00-200, and the FFI value decreased from 95% to 61% at the end of therapy. Conclusion: The application of intervention Extracorporeal Shockwave Therapy (ESWT), transverse friction massage and hold relax exercise can significantly reduce the motion pain on movement of plantar flexi dextra, tenderness pain around calcaneus, increase the RoM plantar flexi ankle joint dextra, and functional activity ability of the foot as well on calcaneus spur dextra condition.&#x0D;

Morphometry and Morphology of the Acromion Process and Its Implications in Subacromial Impingement Syndrome.

Introduction Subacromial impingement syndrome (SIS) is a common shoulder disorder characterized by pain and limited range of motion in the shoulder joint. It is frequently attributed to the compression or impingement of the rotator cuff tendons and bursa between the humeral head and the acromion process of the scapula during arm elevation. Subacromial impingement syndrome may arise as a result of the morphology of the acromion process, a bony protrusion at the top of the scapula that is important in the biomechanics of the shoulder joint. In order to detect potential anatomical differences that can predispose people to subacromial impingement syndrome, medical professionals and researchers need to have a thorough understanding of the morphometry and morphology of the acromion process. Aims and objectives The aim of the present study wasto measure the morphometric and morphological characteristics of the acromion process in dried human scapulae that belonged to the North Indian population. Materials and methods This was a cross-sectional study that was carried out on 120 undamaged adult human scapula, of which 52 belonged to the right side and 68 belonged to the left side. Our study focused on analyzing the morphology of the acromion process as well as determining its maximum length, maximum breadth, acromio-coracoid distance, acromio-glenoid distance, and thickness. A statistical analysis of the observed parameters was carried out using the chi-square test and independent t-test with the help of Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) 24.0. Statistical significance was set at 0.05 (if the P-value ≤ 0.05, it is significant). Results We observed that the quadrangular shape (51.67%) of the acromion process was most commonly reported in our study, while the tubular (9.99%) shape was the least common. The difference in the incidences of various shapes of the acromion process on the right and left sides of the scapula was found to be statistically significant (p-value ≤ 0.05). In this study, the curved or type II acromion process was the most common type (53.34%) observed, while the least common shape reported was the hooked type (18.33%). The average length of the right acromion process was 44.52±6.61 mm, and the left acromion process was 45.13±6.35 mm. For the breadth, the right acromion had an average value of 28.31±4.67 mm, while the left had an average of 28.34±4.92 mm. The thickness of the right acromion measured 7.10±1.73 mm, and the left acromion was 7.53±1.44 mm. The acromio-coracoid distance on the right side was 34.59 ± 6.47 mm, and the left side was 37.46±6.22 mm. The acromio-glenoid distance was measured to be 32.31±5.87 mm on the right side and 33.18±5.39 mm on the left side. Conclusions Planning and carrying out an acromioplasty require an understanding of the morphometric parameters of the acromion process. Although there is a paucity of research on its morphometric evaluation in the North Indian population, the surgeons would be able to use these data as a reference.

Morphological, anatomical and histological studies on knob and beak characters of six goose breeds from China.

The knob serves as both a sexual indicator of a goose's maturity and a significant packaging attribute that garners consumer attention. However, studies regarding the morphological, anatomical and histological traits of different breeds and ages on the on knob in goose are lacking. In this study, six breeds with typical goose knob types were selected, and their knob size, morphological, anatomical and histological traits were characterized. The results showed that: Knob was more prominent in gander than in female goose, and the difference was the most obvious in Magang goose. Wanxi white goose and Shitou goose had the largest knob bulge, while Magang goose and Sichuan white goose were smaller. The total knob volume of Wanxi White goose and Shitou goose was significantly higher than that of other breeds, regardless of male or female (p < 0.05). The beak volume of Wanxi White goose and gander was significantly higher than that of other goose breeds (p < 0.05). Furthermore, the observation revealed that the "knob" primarily consisted of skin-derived tissue and bony protrusions. As age advances, the knob of both male and female geese undergoes synchronous development, with the knob of male geese typically surpassing that of their female counterparts during the same period. The growth rate of knob in male goose was the fastest from 70 to 120days of age, and slowed down from 300 to 500days of age. The growth rate of knob in female goose was slower than that in male goose. There were essential differences in the composition of Yangzhou goose knob and Magang goose knob. The subcutaneous tissue of Magang goose was rich, and the thickness of epidermis, dermis and various layers was significantly smaller than that of Yangzhou goose (p < 0.05). With the growth of goose knob, the cells of the epidermal spinous layer became denser and gradually condensed into an overall structure, and there was a clear boundary between the dermis and epidermis after adult. In adulthood, the fiber fascicle network was staggered and dense, with greater toughness and elasticity, and the stratum corneum, epidermis, reticular layer, dermis and other skin structural layers became thicker.

One-Bone Forearm Procedure for Severe Recalcitrant Forearm Deformities in Masada IIb Hereditary Multiple Exostoses.

Hereditary multiple exostoses (HME) Masada IIB has traditionally been treated by gradual ulnar lengthening with questionable efficacy in reducing the dislocated head. One-bone forearm (OBF) has been used as a reconstructive procedure in forearm deformities with very scarce literature for HME. The study aims to report short-term results of OBF as a definitive procedure for severe forearm deformities in Masada IIB patients with respect to clinical and radiological parameters. Four patients with HME Masada IIb were included in this retrospective study. All patients complained of forearm and wrist deformity with an abnormal bony protrusion restricting elbow motion. Indications for OBF were ulnar shortening > 3cm, dysplastic proximal radius with convex radial head and restricted prono-supination. All patients were examined pre-operatively and post-operatively clinically and radiographically using the Peterson's outcome score. The average age was 13 years (12-14years). Pre-operative ulnar shortening, carpal slip percentage, and radial articular angle was 3.4 cm, 79.5%, and 47.5°, respectively. All radial heads were dislocated with convex articular surface restricting elbow extension and forearm prono-supination. At the latest follow-up, the mean elbow flexion was 110° with forearm in 10° supination. The mean carpal slip percentage, radial articular angle, and Peterson functional grade was 15%, 22.5°, and 8 points, respectively. The mean follow-up period was 30.25 months with no recurrence. We recommend one bone forearm as a definitive procedure in HME Masada IIB patients with severe forearm deformities with ulnar shortening > 3cm and dysplastic proximal radius with a dislocated radial head, for faster return to function.

Rare discovery of sacral "ribs": a cadaveric case report.

Supernumerary ribs are a well-documented congenital anomaly that can occur at any point of the vertebral column, most commonly in the cervical or lumbar region. However, accessory ribs found in the sacrococcygeal region are exceptionally rare and may be difficult to distinguish from other bony manifestations of the pelvic girdle. During cadaveric dissection, a pair of sacral "ribs" were found projecting from the left posterolateral sacral region. The bony projections shared a broad base from the posterior sacrum. The projections followed an anteroinferior trajectory, mimicking the thoracic rib structure. Computed tomography (CT) revealed further bony anomalies, including bilateral ossifications embedded in the sacrotuberous ligament, and a blunt bony protrusion extending toward the ischial spine. Most documented supernumerary ribs in the lumbar and sacrococcygeal regions are asymptomatic and are incidental findings in radiographic studies during the exploration of other medical complaints. Correlated symptoms mentioned in the literature include pelvic pain and decreased hip range of motion, with potential obstetric complications. Owing to their asymptomatic nature, sacral ribs may be underreported. The primary aim of this report is to provide a detailed description of these sacral "ribs" in the unique setting of a cadaveric dissection supplemented with medical imaging to enhance visualization.

The M-Point A Novel Landmark in Middle Fossa Surgery: A Cadaveric Morphometric Study

The arcuate eminence (AE) is an anatomically consistent bony protrusion located on the upper surface of the petrous bone that has been previously studied as a reference for lateral skull base approaches. There is a paucity of information in the neurosurgical literature seeking to improve the safety of the extended middle cranial fossa (MCF) approach using detailed morphometric analysis of the AE. To evaluate the use of the AE as an anatomical landmark to help with early identification of the internal acoustic canal (IAC) in MCF approaches by means of a cadaveric study, using a new morphometric reference termed the "M-point." A total of 40 dry temporal bones and 2 formalin-preserved, latex-injected cadaveric heads were used. The M-point was established as a new anatomic reference by identifying the intersection of a line perpendicular to the alignment of the petrous ridge (PR), originating from the midpoint of the AE, with the PR itself. Subsequent anatomical measurements were performed tomeasure the distance between M-point and IAC.Additional distances, including PR length and the anteroposterior and lateral AE surfaces, were also measured. The mean distance between the M-point and the center of the IAC was 14.9mm (SD ± 2.09), offering a safe drilling area during an MCF approach. This study provides novel information on identification of a new anatomic reference point known as the M-point that that can be used to improve early surgical identification of the IAC.

Can exostoses of the external occipital protuberance and superior nuchal lines cause headache? A report of two cases

Compression of the occipital nerves can cause occipital headache. Several potential compression points have been identified along their course. One of these points is the hitherto undescribed instance of exostoses of anatomic structures of the occipital bone. A 34-year-old man with a prominent external occipital tuberance and superior nuchal lines complained of headache in the area of distribution of the greater occipital nerve with tenderness near the bony protrusion on palpation. A 44-year old woman experienced stabbing pain in the lateral orbital region with pressure on the ossified insertion of the ipsilateral trapezius muscle near the external occipital protuberance. Local nerve block achieved temporary relief of pain. Exostosis of the external occipital protuberance and superior nuchal lines may impinge on the greater and third occipital nerves. The characteristics of the pain in our cases differ in some aspects from those of occipital neuralgia.