Complete Ossification Research Articles

Morphometric study of suprascapular notch

Abstract Background and aims: Suprascapular nerve may be compressed anywhere along its course but most commonly at the level of SSN (suprascapular notch) and spinoglenoid notch. The variation in the morphological and morphometric features of SSN, spinoglenoid notch, therefore plays a crucial role in the suprascapular nerve entrapment syndrome. The purpose of present study was to determine the variation in morphology and dimensions of SSN and to determine posterosuperior and posterior limits of safe zone for shoulder joint procedures from posterior approach. Material & methods: We conducted study on 134 dry scapulae of north Karnataka region and classified the SSN into various shapes according to Iqbal et al and I-VI types based on description by Natsis et al, along with this, the mean distance from the SSN to supraglenoid tubercle and the mean distance between posterior rim of glenoid cavity and medial wall of spinoglenoid notch at the base of scapular spine were also measured. Results: Based on Iqbal et al classification, 'U' shaped notch found to be most common (35%) whereas least common was W shaped (0.7%).The incidence of complete ossification of STSL was 12.6%. Based on Natsis classification most common was type II (TD>VL) seen in 69% and least common was type VI (notch & foramen) 0% .The mean distance from SSN to supraglenoid tubercle was 27.3 mms ± 1.7 and mean distance between posterior rim of glenoid cavity and medial wall of spinoglenoid notch at the base of scapular spine was 13mms ± 0.2 which are comparatively less than the other population studies which are mentioned in the article. Conclusions: There are variations in the shape and size of SSN and safe zone critical distance in different populations so it requires still more population specific studies on suprascapular notch.

Complete Ossification of the Superior Transverse Scapular Ligament in an Turkish Male Adult

La escapula tiene tres margenes y tres angulos, y se encuentra en la region posterolateral del torax. Una de las estructuras anatomicas de la escapula es la incisura supraescapular situada medial a la base del proceso coracoides. La incisura supraescapular puede tener diferentes formas y profundidad. Esta rodeada por el ligamento escapular transverso, un ligamento corto y fuerte. Con esta estructura, crea un pasaje osteofibroso por el cual pasa el nervio supraescapular. Se ha reportado que esta estructura osteofibrosa se puede osificar completa o parcialmente. Todas las lesiones de los nervios ocurren en su trayecto como resultado de la exposicion a compresion, tension y flexion, lo que se denomina neuropatia por atrapamiento. El nervio supraescapular puede estar expuesto a compresion al pasar por la incisura supraescapular, generando neuropatia por atrapamiento. Su etiologia puede ser por traumatismo directo, microtraumatismo repetitivo y lesiones compresivas progresivas. Una incisura supraescapular de forma oval puede ser un factor predisponente para la neuropatia por atrapamiento. En un estudio retrospectivo realizado en la Universidad Necmettin Erbakan, Facultad de Medicina de Meram, Departamento de archivo de Radiologia, se observo la imagen de un varon de 68 anos con variacion en la incisura supraescapular derecha, la cual se transformo en un foramen por un puente oseo. Los diametros del foramen fueron 5,27 mm transversales y 6,48 mm verticales. Creemos que el conocimiento detallado de la incisura supraescapular es necesario en el diagnostico y posible curso de dolor del hombro, debido al atrapamiento del nervio supraescapular en la incisura y la posible paralisis nerviosa, dando una guia a los clinicos en las practicas quirurgicas.

Evaluation of Elongated Styloid Process in Patients with Oral Submucous Fibrosis Using Panoramic Radiographs.

Oral submucous fibrosis (OSF) is an insidious disease affecting the oral cavity, pharynx, and upper digestive tract. It is characterized by a juxtaepithelial inflammatory reaction followed by fibroelastic change in the lamina propria and associated epithelial atrophy. Higher levels of TGF-β present in patients with OSF could be responsible for impetus to remnants of Reichert's cartilage present in styloid complex leading to partial or complete ossification of associated ligaments. So, a study was conducted to evaluate the elongation of the styloid process in patients with OSF by using panoramic radiographs. Panoramic radiographs of patients with OSF were studied from 2007-2011. The apparent lengths of styloid process were measured with the help of divider and steel metric ruler. The length of the styloid process and/or ossification of stylomandibular ligaments which were longer than 30 mm were considered. Out of 47 patients, 35 patients (34 males & 1 female) met the inclusion criteria. Eleven patients (31.4%) were found to have elongated styloid processes which included 10 male patients and 1 female patient. It had been estimated that between 2 % and 4% of the general population presents radiographic evidence of an ossified portion of the styloid complex. The high incidence of elongation of styloid process (31.4 %) in patients with oral submucous fibrosis highlights that progressive OSF might have some influence on elongation of styloid process.

English

INTRODUCTION : The scapula is a triangular, flattened bone. It extends from the second to the seventh rib in the posterolateral aspect of thorax. Its superior border extends between superior and lateral angles. The suprascapular notch is located in this border near the root of coracoid process. This notch is converted into a foramen called suprascapular foramen by transverse scapular ligament (suprascapular ligament). This ligament is a flat fasciculus which narrows its attachments to the base of the coracoid process and medial side of the suprascapular( scapular) notch . This ligament is sometimes ossified 1. The suprascapular nerve passes through the foramen and the suprascapular vessels cross above the ligament. The anatomical knowledge of this foramen is of extreme importance for clinicians as it can be a risk factor during surgical explorations involving a suprascapular nerve decompression. 2 MATERIALS AND METHODS: 100 (50- left and 50- right) dry scapulae were studied to search for ossification of transverse scapular ligament. RESULT: Ossified transverse scapular ligament (as shown in fig.) was observed in two dry left scapulae showing the presence of suprascapular foramen in dry scapula. Ossified transverse scapular ligament was not seen in right side. The ossification was complete in the two ossified ligaments. According to this study, the incidence of ossification of transverse scapular ligament is 2%. Ossification of left transverse scapular ligament is seen in 4% of individuals. DISCUSSION: The documented variations of the superior transverse scapular ligament include calcification, partial or complete ossification and multiple bands. 3 The ossification of the STSL has been reported to be 18% for the partial and 5% for the complete type. 3 Past studies have reported a 3.7% – 4% incidence of partial ossification of STSL. 5,6 In the present study, the incidence of complete ossification of STSL is 2%. 3 In another study, suprascapular foramen was present in 25 right and in 12 left sided scapulae i.e., 10.57% incidence 2 .Another study reported a case of completely ossified left superior transverse scapular ligament. 7 The presence of an ossified STSL may also pose a challenge during decompression of the suprascapular notch if the condition is not fully appreciated. There is a report of a familial case of calcification of superior transverse scapular ligament, affecting a 58 year old man and his son who had calcification of superior transverse scapular ligament, causing entrapment neuropathy of the suprascapular nerve 8.

Bilateral Extracapsular Soft-Tissue Ossification Affecting Range of TMJ Motion in an Airedale Terrier

A 3 mo old female Airedale terrier presented with decreased range of motion of the temporomandibular joint (TMJ), which was first recognized at weaning. Computed tomography (CT) revealed abnormal, bilateral ossification of the soft tissues extending from the region of the tympanic bullae to the medial aspect of the angular process of each mandible. Those ossified structures most closely approximated the location of the lateral pterygoid muscles. The ossified structures were present at presentation and initially manifested as complete ossification on the right side. The condition progressed to complete bilateral ossification by 3 yr of age. The mandibular condyles associated with the temporomandibular joints were malformed. The patient had severe mandibular distoclusion with deviation of the mandible to the left. The left mandibular cheek teeth were positioned in a caudal cross bite. A single treatment of manual stretching and breakdown of the ossified muscle of mastication by placement of tongue depressors within the oral cavity resulted in no increase in TMJ range of motion as measured by the incisal opening. This is the first reported case of spontaneous false ankylosis of the TMJ in an Airedale terrier.

English

ABSRTACT: The suprascapular notch is usually present in every scapula. Superior transverse scapular ligament is a strong fibrous band that bridges the suprascapular notch creating a foramen that gives passage to the suprascapular nerve, whereas the suprascapular vessels pass over the ligament superiorly. Suprascapular nerve supplies motor branches to the supraspinatus, infraspinatus and sensory to the rotator cuff muscles and ligamentous structures of the shoulder and acromioclavicular joint. In some cases variations of suprascapular notch is accompanied by a variation of the superior transverse scapular ligament. These variations have a role to play in suprascapular nerve entrapment. Previous work suggests that the incidence of complete ossification of the superior transverse scapular ligament varies in different populations. One of the causes of suprascapular nerve entrapment syndrome can be the complete ossification of superior transverse scapular ligament; therefore the clinician should keep this possibility in mind while dealing with patients of suprascapular nerve entrapment. But here, we are reporting a case of complete absence of suprascapular notch in a dried scapula in an adult south Indian female which could be a possible predisposing factor for suprascapular

Ossification of the suprascapular ligament: A risk factor for suprascapular nerve compression?

Introduction:Entrapment of the suprascapular nerve at the suprascapular notch may be due to an ossified suprascapular ligament. The present study was conducted in order to investigate the incidence of this anomaly and to analyze the resultant bony foramen (foramen scapula) for gross nerve compression.Materials and Methods:We evaluated 104 human scapulae from 52 adult skeletons for the presence of complete ossification of the suprascapular ligament. When an ossified suprascapular ligament was identified, the diameter of the resultant foramen was measured. Also, the suprascapular regions of 50 adult cadavers (100 sides) were dissected. When an ossified suprascapular ligament was identified, the spinati musculature was evaluated for gross atrophy and the diameters of the resultant foramen scapulae and the suprascapular nerve were measured. Immunohistochemical analysis of the nerve was also performed.Results:For dry scapular specimens, 5.7% were found to have an ossified suprascapular ligament. The mean diameter of these resultant foramina was 2.6 mm. For cadavers, an ossified suprascapular ligament was identified in 5% of sides. Sections of the suprascapular nerve at the foramen scapulae ranged from 2 to 2.8 mm in diameter. In all cadaveric samples, the suprascapular nerve was grossly compressed (~10-20%) at this site. All nerves demonstrated histologic signs of neural degeneration distal to the site of compression. The presence of these foramina in male cadavers and on right sides was statistically significant.Conclusions:Based on our study, even in the absence of symptoms, gross compression of the suprascapular nerve exists in cases of an ossified suprascapular ligament. Asymptomatic patients with an ossified suprascapular ligament may warrant additional testing such as electromyography.

Neglected Fracture-Dislocation of the Cervical Spine without Neurological Deficits

Dear Sir, Neglected spinal injuries, either secondary to overlooked diagnosis [1] or due to circumstantial and socio-economic factors [2], are not uncommon but discussed infrequently in the literature [1,2]. A 72-year-old male had history of a slip and fall episode three years ago in a construction field. At that time, he had weakness of all four limbs with bowel and bladder involvement. He was managed conservatively because of financial instruments. He recovered completely over a period of six months. Now, he presented with mild persistent neck pain. On examination, except mild spasticity, there were no motor or sensory deficits. Initial magnetic resonance imaging of the cervical spine showed dislocation of C5 over C6, and the spinal cord was stretched over the dislocated vertebral bodies (Fig. 1). There was no evidence of cord edema or cord contusions. He had one follow up X-ray of the cervical spine at one year after the injury, and it showed a fusion of the C5 and C6 vertebral bodies (Fig. 2A). Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies (Fig. 2B). In view of the solid fusion and no neurological deficits, the patient continued with conservative management with analgesics. Fig. 1 Initial magnetic resonance imaging of cervical spine showing dislocation of C5 over C6 and the spinal cord was stretched over the dislocated vertebral bodies. Fig. 2 (A) One follow-up X-ray of the cervical spine at one year after the injury showed fusion of C5 and C6 vertebral bodies, and (B) Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies. Patients with neglected spinal injuries can present with neck pain, restricted neck movements, or clinical features of progressive myelopathy [2-4]. Treatment of neglected spinal injuries needs to be individualized, depending on patient's age, medical condition, severity of myelopathy, and stability spine [5-8]. Aggressive surgical treatment is reserved for younger patients with progressive myelopathy, secondary to dynamic instability [9]. Conservative approach has been suggested for elderly patients with stable, non-progressive deformity [5-8]. In the present case, the reactive new bone formation around the fractured segments might have helped in preventing abnormal movements and development of myelopathy. Neglected spinal injuries are defined as injuries not treated in a timely fashion and found late when options for care are limited [1]. Also, neglected spinal injuries may result when the comprehensive management is not initiated in a timely fashion [2]. These lesions have a much higher incidence of complications, which are more severe and difficult to manage, requiring longer hospitalization, adding to the costs and adversely affecting the functional outcomes [1,2]. In summary, for neglected spinal injuries, either untreated or inadequately treated with progressive deformity, persistent pain and late presentation are more often seen in the developing countries [1]. In rare circumstances (as in present case), neglected complete fracture-dislocations patients can make excellent recovery without neurological deficits [10].

Foramen of civinini: a new anatomical guide for maxillofacial surgeons.

Study on Morphometric and radiological aspect on existence of foramen of civinini. Sphenoid bone comprises of some rare ossified ligaments, may encounter difficulty in surgical procedures. Incidence of Pterygospinous bars various with different racial groups and they are genetically controlled. Complete ossification of pterygospinous ligament form foramen of civinini. Entrapments of vessels or nerves may occur due to existence of pterygospinous bar. The bar may locate medially or inferiorly to formen ovale as seen in Hawaiian and lemurs. Co - existence of bar with the wide lateral pterygoid plate exhibits development of the bar from herbivore, carnivore and old world monkeys. Comparatively absence or small spine of civinini noted in new world monkeys, rodents and platyrrhines. Pterygospinousbar represents the phylogenetic remnant of Human beings. By using digital vernier caliper, the measurements of length, width of the pterygospinous bar and area of foramen of civinini including the length and breadth of lateral pterygoid plate were measured. Using X rays the radiological view was determined. In this study from 160 cases of skull and sphenoid bones revealed that complete and incomplete foramen of civinini in 1.25% and 7.5% of cases respectively. Peculiarly accessory foramen of civinini noticed in 1.25% of cases. Maximum area of foramen of civinini was 94.2mm(2). The maximum width of lateral pterygoid was noted as 19.6mm respectively. Mentocoronal view of skiagram clearly shows the bar. During Anaesthesia for trigeminal neuralgia may encounter difficult to pass the needle. The bar compress the mandibular nerve branches can cause lingual numbness, pain and speech impairment. Conductive anaesthesia on the mandibular nerve through the lateral subzygomatic route may be difficult to approach. Exploring the anatomical and clinical updates of pterygospinous bar may guide the surgeons and radiologists to overcome any difficulties in infratemporal and para or retropharyngeal regions.

Prevalence and Dimensions of Complete Sella Turcica Bridges and Its Clinical Significance

The ossification of ligamentous structures in various part of the body may result in clinical problems. The complete sella turcica bridge corresponds to the complete ossification of the interclinoid ligaments. Fifty dry adult skull bones were studied for presence of ossified interclinoid ligaments. Three skull bones show sella turcica bridge, of which one shows bilateral and two show unilateral. The ligamentous or bony interclinoid connections have important neuronal and vascular relations and are both clinically and surgically important. The knowledge of detailed anatomy of the interclinoid ligament can increase the success of diagnostic evaluation and surgical approaches to the region. The existence of a bony caroticoclinoid foramen may cause compression, tightening, or stretching of the internal carotid artery. Further, removing the anterior clinoid process is an important step in regional surgery; the presence of a bony caroticoclinoid foramen may have high risk.

Developmental structure of the vertebral column, fins, scutes and scales in bester sturgeon, a hybrid of beluga Huso huso and sterlet Acipenser ruthenus

In the larval bester, a hybrid sturgeon of beluga Huso huso and sterlet Acipenser ruthenus, development of cartilage around the notochord began 7 days post hatch (dph) (14.0 mm, total length, L(T)). The vertebral cartilage develops in the following sequence: basidorsals and basiventrals, neural canals, neural spines and ribs. The development of ribs remained incomplete in the largest specimen (181 dph, 179 mm L(T) ) that was examined. Endoskeletal development of the fins began 4 dph for the dorsal and anal fins, 6 dph for the pectoral fin and 10 dph for the caudal and pelvic fins. Complete elements of all fins were observed by 91 dph and complete ossification of fin rays was observed by 122 dph in the double-stained specimens. Observation of the histological sections, however, suggested that ossification occurred soon after the formation of the organic matrix in the fin rays. Dorsal scutes were first visible by 25 dph, followed by the lateral and ventral scutes, which were visible by 37 and 44 dph, respectively. The number of scutes was fixed at 44, 59 and 91 dph and ossification was complete by 59 (dorsal) and 91 dph (lateral and ventral scutes) in the double-stained specimens. Ossification occurred soon after the formation of the scute organic matrix in the histological sections. Four types of scales were observed in the H. huso×A. ruthenus hybrid. Median predorsal, preanal and small scales on the anterior section of the head were visible by 59 dph. Scales on the caudal fin were visible by 91 dph and a variable assemblage of scales anterior to the anal fin was visible by 122 dph. Both the scutes and scales developed in a process that is similar to that of intramembranous ossification.

The distribution of stylohyoid chain anatomic variations by age groups and gender: an analysis using MDCT

The aim of this study is to investigate the frequency of the SHC variations, and the distribution of the SP lengths in different age and sex groups using MDCT. MDCT scans were performed in 805 patients (401 males, 404 females). The patients were divided into six groups according to their ages. The length of the styloid process (SP) and its angulation on the transverse (TA) and sagittal (SA) planes were measured. Structural variations of the SHC were observed by means of three-dimensional (3D) and multiplanar reconstruction (MPR) images. Absence of the styloid process (n = 10), double proximal origin (n = 13), segmentation (n = 223), complete ossification (n = 24), and an SP with three proximal parts in one patient were among the anomalies detected. The mean length of the SP was greater in males than in females (33.2 ± 13.2 vs. 29.6 ± 10.5 mm, P < 0.001). Elongated SP (ESP) was observed in 56 % of the patients in the study group, and this ratio was the highest in Group 3 with 65.4 % (P < 0.05). TA and SA were 70.2° ± 4.1°, 69.9° ± 4.2° and 86.6° ± 6.5°, 88.3° ± 6.6° for the right and left sides, respectively. Besides, 3D and MPR images also present detailed and reliable data to radiologists and surgeons for the evaluation of the SHC. ESP has been detected in more than half of the patients, being more frequent in males and in individuals in the fifth decade of life. For an accurate diagnosis, clinicians should consider the ESP while evaluating the patients in this age group.

Supra-scapular foramen in Indian dry scapulae

Abstract Background and aims : Supra-scapular notch is roofed by superior transverse scapular ligament and converted into a foramen which provides passage for suprascapular nerve. When it is completely ossified that time it manifest as supra-scapular foramen in dry scapulae. Variations of superior transverse scapular ligament include calcification, partial or complete ossification and multiple bands. Presence of this foramen in dry scapulae is considered to be rare. Aim of the study was to verify the prevalence of supra-scapular foramen in Indian dry scapulae. Materials and methods : A total of three fifty dry scapulae were analyzed (Right- 176, Left-174) to see the presence of supra-scapular foramen. Results : In the present study, suprascapular foramen was present in 25 right and in 12 left sided scapulae i.e., 10.57% incidence which is alarming. Conclusion : Present study demonstrates that suprascapular foramen which is the result of complete ossification of superior transverse scapular ligament, is common in Indian population. The anatomical knowledge of this foramen is of extreme importance for clinicians; it can be a risk factor during surgical explorations involving a suprascapular nerve decompression.

Surgical treatment of a complete symptomatic ossification of quadratus femoris muscle in a young haemophilic patient

Surgical treatment of a complete symptomatic ossification of quadratus femoris muscle in a young haemophilic patient

Successful Treatment of Aggressive Aneurysmal Bone Cyst of the Pelvis With Serial Embolization

Intralesional surgery is most commonly used for aneurysmal bone cysts. Rarely is en bloc resection used for active, aggressive, recurrent lesions and those located in expendable bones. However, persistence or recurrence of aneurysmal bone cysts is common. The clinical behavior of aneurysmal bone cysts is more aggressive in younger patients. Selective embolization is used as the primary treatment for aneurysmal bone cysts in surgically difficult anatomical locations and as an adjuvant to surgical treatment to reduce intraoperative blood loss and facilitate curettage.This article describes a 3-year-old boy with an aggressive aneurysmal bone cyst of the pelvis involving the right ischiopubic rami that achieved curative treatment with 3 embolizations with N-2-butyl-cyanoacrylate. Biopsy was diagnostic; however, the clinical course was misleading. Twenty days after the first embolization, despite complete occlusion of the feeding vessels, the patient experienced severe pain, increased size of the lesion, and lateral subluxation of the right hip. Based on the imaging and histological diagnosis, intralesional hemorrhage was assumed, and repeat embolization was performed. After the second embolization, the patient experienced perineal skin necrosis from normal vessel embolization; it was treated with wound dressing changes and healed uneventfully. A third embolization was performed because of a persistent lesion. Six years after treatment, the patient was symptom free, and imaging showed complete ossification of the cyst.Selective catheterization and occlusion of the feeding arteries with the appropriate embolic agent provide tumor devascularization, size reduction, pain relief, and induction of new bone formation. Multiple procedures are often necessary, and complications may occur.

Normal Ossification Patterns of Atlas and Axis: A CT Study

Development of the CVJ is a complex process rarely analyzed by CT. Cartilaginous remnants within the atlas and axis have been shown to variably persist throughout childhood and may be mistaken for fractures. The purpose of this study was to better estimate the fusion timeline of the synchondroses at the CVJ. We retrospectively reviewed singular CT scans in 550 children without known skeletal dysplasia or maturation delay (from neonate to 17 years) and analyzed the ossification of atlas and axis. Normal closing age for synchondroses was defined as soon as a complete ossification rate of 80% or more per age category was achieved. No separate OC was observed in 38 of 230 incompletely ossified AAAs, whereas single, bipartite, or multiple OCs were observed in, respectively, 196, 86, and 16 of 298 AAAs in which OCs could be identified. Synchondroses at the AAA closed after 12 years (range 4.5-17 years). Posterior midline synchondrosis of the atlas closed after 4 years (range 2-13 years). The axis ossified from 6 OCs and 4 synchondroses. Subdental and neurocentral synchondroses closed simultaneously after 9 years (range 7-9.5 years). Apicodental synchondrosis and chondrum terminale were completely ossified after 10.5 years (range 5.5-13.5 years). Analysis of the CVJ using triplanar CT reconstructions allows secure identification of characteristic developmental features of the atlas and axis, and helps to separate normal variants from true osseous lesions.

Dual Midfacial Distraction Osteogenesis for Crouzon Syndrome: Long-Term Follow-Up Study for Relapse and Growth

Rigid external distraction osteogenesis is regarded as a standard treatment for congenital midfacial hypoplasia. However, external distraction for the upper portion of the midface is not as effective and tends to rotate the midfacial segment in a counterclockwise direction. Moreover, patients poorly tolerate it because of the device's bulkiness. To prevent such drawbacks of an external distractor, both external and internal distractors were synchronously applied to patients with Crouzon syndrome. In 6 patients with Crouzon syndrome in whom a dual-distraction technique was applied, distraction of the midfacial region was performed for up to a mean length of 15.3 mm. The external distractor was removed after a 1-month consolidation period, but the internal distractor was maintained for more than 6 months. The degree of advancement of the midface and ossification was measured with lateral cephalometry and 3-dimensional computed tomography imaging, respectively. At long-term follow-up (mean, 4.6 years), the facial contours retained the initial distraction geometry with almost no relapse, showing that the ideal facial contour and occlusion could be obtained. Bone deposition was found to be continually progressing even 6 months postoperatively, and more than 6 months of consolidation was required for complete ossification that mainly occurred in the pterygomaxillary junction and lateral orbital wall. The dual-distraction technique can induce balanced growth without the recurrence of hypoplasia, and it may eventually yield satisfactory outcomes in Crouzon syndrome.

Auditory brainstem implant outcomes and MAP parameters: Report of experiences in adults and children

The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (CI). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention. Objective The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center. Methods Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate. Results The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 μs. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores. Conclusion We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist.

Supra-scaular foramen in Indian dry scapulae

Background and aims : Supra-scapular notch is roofed by superior transverse scapular ligament and converted into a foramen which provides passage for suprascapular nerve. When it is completely ossified that time it manifest as supra-scapular foramen in dry scapulae. Variations of superior transverse scapular ligament include calcification, partial or complete ossification and multiple bands. Presence of this foramen in dry scapulae is considered to be rare. Aim of the study was to verify the prevalence of supra-scapular foramen in Indian dry scapulae. Materials and methods : A total of three fifty dry scapulae were analyzed (Right- 176, Left-174) to see the presence of supra-scapular foramen. Results : In the present study, suprascapular foramen was present in 25 right and in 12 left sided scapulae i.e., 10.57% incidence which is alarming. Conclusion : Present study demonstrates that suprascapular foramen which is the result of complete ossification of superior transverse scapular ligament, is common in Indian population. The anatomical knowledge of this foramen is of extreme importance for clinicians; it can be a risk factor during surgical explorations involving a suprascapular nerve decompression.

Surgical excision of heterotopic ossification of hip in a rare case of Moyamoya disease with extra articular ankylosis

We report a case of isolated ossification of iliopsoas with ankylosis of the left hip in a 27-year-old female. The patient was diagnosed to have Moyamoya disease, a rare chronic occlusive disorder of cerebrovascular circulation following an acute onset of hemiplegia. The patient presented 9 months later to us with ankylosis of left hip which was successfully treated by surgical excision of the heterotopic bone and there was no recurrence at the end of 5 years. A review of literature failed to reveal a similar case with isolated and complete ossification of iliopsoas muscle associated with Moyamoya disease which required surgical intervention. Surgical excision resulted in dramatic improvement in the quality of life. Surgical excision of neurogenic type of heterotopic ossification is a very successful procedure and timely intervention after maturity of mass is very important to prevent the onset of secondary complications and to avoid recurrence.