Cortical Bone Erosion Research Articles

Morphological study of cortical bone damage caused by high-pressure water jet erosion based on SPH-FEM coupling algorithm

Currently, traditional processing methods such as drilling, sawing, and milling are primarily utilized in orthopedic surgery, generating a significant amount of heat during the cutting process, leading to irreversible damage to bone and surrounding tissues. High-pressure water jet technology has demonstrated the capability to effectively reduce cutting temperatures and prevent thermal damage during the cutting process. It holds promising potential as an alternative approach to traditional surgical techniques in orthopedic surgery. This study selected the SPH-FEM (Smoothed particle hydrodynamics-Finite element method) coupling algorithm and LS-DYNA software to simulate the effects of high-pressure water jet erosion on cortical bone. The study analyzed the impact of jet pressure on damage morphology and the degree of cortical bone breakage. The simulation results indicate that the concave section of cortical bone damaged by high-pressure water jet is “U” shape. The maximum damage depth of cortical bone increases with the increase in jet pressure. Specifically, as jet pressure increases from 80 MPa to 245 MPa, the increase rate of the average cortical bone damage depth increased from about 0.01 mm/s to more than 0.45 mm/s. The beginning of the concave section of cortical bone damage presents a “funnel” shape, and the width of cortical bone damage reaches its maximum. When the jet pressure is below 180 MPa, there is a significant fluctuation in the width of cortical bone damage. However, with increasing jet pressure, the fluctuation lessens. Physical experiments were carried out under identical technological parameters to verify the numerical results. The experimental results are basically consistent with the numerical results, which can provide a theoretical basis for improving the surface quality of jet erosion of cortical bone.

Radiological features of Stafne mandibular bone cavity in panoramic image and cone beam computed tomography

BackgroundStafne mandibular bone cavity (SMBC) is an asymptomatic radiolucent lesion observed in the mandible on X-ray images, with well-defined borders. This lesion does not require treatment, and size changes are very rare. The purpose of this article is to summarize the radiological and clinical features of SMBC, aiming to prevent misinterpretation of this benign lesion as other pathologies and aid in differential diagnosis within the field of dental practice.MethodsA total of 32 patients who visited our hospital and were radiologically diagnosed with SMBC based on cone-beam computed tomography (CBCT) and panoramic images between 2005 and 2021 were included in this study. Among them, surgical intervention was performed in one case. Gender and age distribution of the patients, radiographic location and size of the lesion, relationship with the mandibular canal in CBCT, presence of cortical bone erosion in the mandibular lingual area in panoramic images, and the amount of residual cortical bone on the affected side in CBCT were investigated.ResultPatients were 26 men (81.3%) and 6 women, with a mean age of 54.3 years. The average horizontal and vertical length was 16.6 mm and 10.6 mm. Out of a total of 32 cases, 29 cases were found in the posterior region of the mandibular body, while 3 cases were in the angle of the mandible. Lesions located below the mandibular canal were observed in 29 cases, while lesions involving the mandibular canal were present in 3 cases. Erosion of the mandibular lingual cortical bone was observed in 11 cases (34.4%), while 21 cases (65.6%) showed no erosion on panoramic images. Among the total of 14 cases (43.8%) where the cortical bone on the affected side was invaded, the average residual cortical bone thickness was 1.1 mm.ConclusionSMBC is a benign lesion primarily found in the mandibular angle and posterior body of the mandible. In most cases, treatment is not necessary, and differentiation from other lesions can be achieved by understanding its clinical characteristics and features on panoramic radiographs and CBCT.

Performance of cone-beam computed tomography (CBCT) in comparison to conventional computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone invasion in oral squamous cell cancer (OSCC): a prospective study

BackgroundOral squamous carcinoma (OSCC) is often diagnosed at late stages and bone erosion or invasion of the jawbone is frequently present. Computed tomography (CT) and magnetic resonance imaging (MRI) are known to have high diagnostic sensitivities, specificities, and accuracies in detecting these bone affections in patients suffering from OSCC. To date, the existing data regarding the impact of cone-beam computed tomography (CBCT) have been weak. Therefore, this study aimed to investigate whether CBCT is a suitable tool to detect bone erosion or invasion in patients with OSCC.MethodsWe investigated in a prospective trial the impact of CBCT in the diagnosis of bone erosion or invasion in patients with OSCC who underwent surgery. Every participant received a CBCT, CT, and MRI scan during staging. Imaging modalities were evaluated by two specialists in oral and maxillofacial surgery (CBCT) and two specialists in radiology (CT and MRI) in a blinded way, to determine whether a bone affection was present or not. Reporting used the following 3-point system: no bony destruction (“0”), cortical bone erosion (“1”), or medullary bone invasion (“2”). Histological examination or a follow-up served to calculate the sensitivities, specificities, and accuracies of the imaging modalities.ResultsOur results revealed high diagnostic sensitivities (95.6%, 84.4%, and 88.9%), specificities (87.0%, 91.7%, and 91.7%), and accuracies (89.5%, 89.5%, and 90.8%) for CBCT, CT, and MRI. A pairwise comparison found no statistical difference between CBCT, CT, and MRI.ConclusionOur data support the routine use of CBCT in the diagnosis of bone erosion and invasion in patients with OSCC as diagnostic accuracy is equal to CT and MRI, the procedure is cost-effective, and it can be performed during initial contact with the patient.

RESECTION OF AMELOBASTOMA AND IMMEDIATE RECONSTRUCTION WITH MICROVASCULARIZED FIBULAR GRAFT: A CASE REPORT

A 35-year-old female presented an intraoral swelling in the right posterior region of the mandible, which was asymptomatic, with two years of evolution. She presented an anatomopathological report with a previous diagnosis of ameloblastoma, but she was unable complete the proposed treatment due to the COVID-19 pandemic. Clinical examination revealed a granulomatous lesion in the right retromolar region, extending to the vestibular mucosa of elements 46 and 47, together with,bone expansion. A facial tomography showed an expansive, cystic, multilocular lesion, with erosion of the adjacent cortical bone in the right body, angle, and mandibular ramus, measuring approximately 4.6 × 2.2 × 3.7 cm. The patient underwent partial resection of the right posterior mandible with immediate reconstruction of a microvascularized fibular graft and fixation with a reconstruction plate. In the postoperative period, the patient evolved with satisfactory mandibular contour, good mouth opening, and preserved masticatory function. A 35-year-old female presented an intraoral swelling in the right posterior region of the mandible, which was asymptomatic, with two years of evolution. She presented an anatomopathological report with a previous diagnosis of ameloblastoma, but she was unable complete the proposed treatment due to the COVID-19 pandemic. Clinical examination revealed a granulomatous lesion in the right retromolar region, extending to the vestibular mucosa of elements 46 and 47, together with,bone expansion. A facial tomography showed an expansive, cystic, multilocular lesion, with erosion of the adjacent cortical bone in the right body, angle, and mandibular ramus, measuring approximately 4.6 × 2.2 × 3.7 cm. The patient underwent partial resection of the right posterior mandible with immediate reconstruction of a microvascularized fibular graft and fixation with a reconstruction plate. In the postoperative period, the patient evolved with satisfactory mandibular contour, good mouth opening, and preserved masticatory function.

Management and long-term comorbidities of patients with necrotizing otitis externa.

We aimed to present the management of the patients with necrotizing otitis externa (NOE) and its comorbidities in early and long-term follow-up. Between 2011 and 2022, 30 patients with the diagnose of NEO, who had cortical bone erosion or trabecular demineralization in temporal bone computed tomography and administered at least 6-week antimicrobial therapy were included in the study. Clinical, laboratory and imaging findings of patients, and comorbidities during follow-up were analysed. NOE extending further from the petro-occipital fissure on magnetic resonance imaging was accepted as medial skull base (MSB) involvement. 30 patients, (8 women, 22 men, mean age 66.2 ± 1.7), with NOE were followed 36.4 ± 29.6months. The mortality rate was 23.33% and the mean survival time was 12.37 ± 11.35months. Repeated cultures reveal a new or second pathogen in 5 patients (20%). Severe and profound sensorineural hearing loss (SNHL) were observed in 4 and 12 patients, respectively. Labyrinthitis ossificans emerged in 3 of 6 surviving patients with profound SNHL during follow-up. Chronic disease anemia (CDA) (66.66%), cerebrovascular disease (CVD) (43.33%), chronic renal failure (CRF) (30%), and retinopathy (26.66%) were the most frequent comorbidities in patients with NOE. Cranial nerve paralysis (CNP) (P < 0.001), SNHL (P < 0.04), CDA (P < 0.005), and mortality (P < 0.022) were significantly associated with the presence of MSB involvement. NOE is a disease that requires long-term follow-up, causes severe morbidity, and has a high mortality rate. MSB involvement is associated with CNP, SNHL and labyrinthitis ossificans. Moreover, CDA, CVD, CRF and retinopathy are the most common comorbitidies needed to be managed.

Open-source image analysis tool for the identification and quantification of cortical interruptions and bone erosions in high-resolution peripheral quantitative computed tomography images of patients with rheumatoid arthritis.

Identification of bone erosions and quantification of erosion volume is important for rheumatoid arthritis diagnosis, and can add important information to evaluate disease progression and treatment effects. High-resolution peripheral quantitative computed tomography (HR-pQCT) is well suited for this purpose, however analysis methods are not widely available. The purpose of this study was to develop an open-source software tool for the identification and quantification of bone erosions using images acquired by HR-pQCT. The collection of modules, Bone Analysis Modules (BAM) - Erosion, implements previously published erosion analysis techniques as modules in 3D Slicer, an open-source image processing and visualization tool. BAM includes a module to automatically identify cortical interruptions, from which erosions are manually selected, and a hybrid module that combines morphological and level set operations to quantify the volume of bone erosions. HR-pQCT images of the second and third metacarpophalangeal (MCP) joints were acquired in patients with RA (XtremeCT, n=14, XtremeCTII, n=22). The number of cortical interruptions detected by BAM-Erosion agreed strongly with the previously published cortical interruption detection algorithm for both XtremeCT (r2=0.85) and XtremeCTII (r2=0.87). Erosion volume assessment by BAM-Erosion agreed strongly (r2=0.95) with the Medical Image Analysis Framework. BAM-Erosion provides an open-source erosion analysis tool that produces comparable results to previously published algorithms, with improved options for visualization. The strength of the tool is that it implements multiple image processing algorithms for erosion analysis on a single, widely available, open-source platform that can accommodate future updates.

The effect of disease-modifying antirheumatic drugs (DMARDs) on bone homeostasis in rheumatoid arthritis (RA) patients.

The autoimmune disease known as rheumatoid arthritis (RA) has been linked to the deterioration of bone. Bone erosion is a hallmark of RA and is linked to the severity of the disease as well as a poor functional result. Erosion of periarticular cortical bone is a common feature seen on plain radiographs of patients with RA. This characteristic feature is the result of excessive bone resorption and inadequate formation of bone. It has been determined that there is a complex interaction between the inflammatory condition seen in RA and bone destruction. Increased knowledge of the pathways and other mechanisms involved in osteoclastogenesis has resulted from advances in both animal and clinical investigations. Also, Biological and targeted medicines have modified RA's bone metabolism. Here, we provide a narrative overview of the literature on the pathomechanisms of bone structure involved in biological and targeted treatments for RA and also, the clinical implications of disease-modifying antirheumatic drugs (DMARDs) are discussed. In light of the fact that these newer treatments present patients with RA with new possibilities for disease improvement and symptom control, it is imperative that additional rigorous evidence be gathered to provide a clinical reference for both patients and their treating physicians.

Tietze's syndrome presenting as enthesitis diagnosed by ultrasound: A case report.

Tietze's syndrome (TS) is an inflammatory disorder characterised by painful, non-suppurative swelling in the sternocostal or sternoclavicular joint. The aetiology of TS is unknown. Herein, we described a case of isolated enthesitis in the sternocostal joint in a 42-year-old male patient whose clinical course led to the diagnosis of TS. A 42-year-old male Japanese patient (HLA-B27 negative) presented with chronic anterior chest wall pain. Mild swelling and tenderness were found in the right, third sternocostal joint (rt.3STCJ). No other arthralgia was present. Ultrasonography (US) of the rt.3STCJ showed hypoechoic thickening and power Doppler signal in the anterior radiate sternocostal ligament with mild synovial hypertrophy of the STCJ. US also depicted cortical bone erosion at the sternum with neovascularisation. Magnetic resonance imaging with T2-weighted short-tau inversion recovery showed high signal intensity in the bone marrow of the sternum and adjacent soft tissue around the rt.3STCJ. Based on these findings, TS with the enthesitis in the rt.3STCJ was diagnosed. The patient received a US-guided corticosteroid injection, and the symptoms completely resolved 10months later. Enthesitis may cause TS. US is a readily available, sensitive imaging technique useful for diagnosing TS.

Prognostic Impact of Pattern of Mandibular Involvement in Gingivo-Buccal Complex Squamous Cell Carcinomas: Marrow and Mandibular Canal Staging System.

PurposeTo study the pattern of mandibular involvement and its impact on oncologic outcomes in patients with gingivo-buccal complex squamous cell carcinoma (GBC-SCC) and propose a staging system based on the pattern of bone involvement (MMC: Marrow and mandibular canal staging system) and compare its performance with the 8th edition of the American Joint Committee on Cancer (AJCC8).MethodsThis retrospective observational study included treatment-naïve GBC-SCC patients who underwent preoperative computed tomography (CT) imaging between January 1, 2012, and March 31, 2016, at a tertiary care cancer center. Patients with T4b disease with high infratemporal fossa involvement, maxillary erosion, and follow-up of less than a year were excluded. The chi-square or Fisher’s exact test was used for descriptive analysis. Kaplan–Meier estimate and log-rank test were performed for survival analysis. Multivariate analysis was done using Cox regression analysis after making adjustments for other prognostic factors. p-Value <0.05 was considered as significant. Based upon the survival analysis with different patterns of bone invasion, a new staging system was proposed “MMC: Marrow and mandibular canal staging system”. “Akaike information criterion” (AIC) was used to study the relative fitted model of the various staging (TNM staging—AJCC8) with respect to survival parameters.ResultsA total of 1,200 patients were screened; 303 patients were included in the study. On radiology review, mandibular bone was involved in 62% of patients. The pattern of bone involvement was as follows: deep cortical bone erosion (DCBE) in 23%, marrow in 34%, and marrow with the mandibular canal in 43% of patients. Patients with DCBE and no bone involvement (including superficial cortical) had similar survival [disease-free survival (DFS) and locoregional recurrence-free survival (LRRFS)], and this was significantly better than those with marrow with or without mandibular canal involvement (for both DFS and LRRFS). Patients with DCBE were staged using the MMC, and when compared with the AJCC8, the MMC system was better for the prediction of survival outcomes, as AIC values were lower compared with those of the AJCC8. There was a significant association (p = 0.013) between the type of bone involvement and the pattern of recurrence.ConclusionsFor GBC-SCC, only marrow with or without mandibular canal involvement is associated with poorer survival outcomes. As compared with the AJCC8, the proposed Mahajan et al. MMC staging system downstages DCBE correlates better with survival outcomes.

Employing radiography (X-rays) to localize lesions in human skeletal remains from past populations to allow accurate biopsy, using examples of cancer metastases.

Clinical research into biomolecules from infectious diseases and cancers has advanced rapidly in recent years, with two key areas being DNA analysis and proteomics. If we wish to understand important diseases and their associated biomolecules in past populations, techniques are required that will allow accurate biopsy of lesions in excavated human skeletal remains. While locating lesions visible on the surface of a bone is simple, many lesions such as cancer metastases are located in the medulla of bones, unseen on visual inspection. Here, we use two novel image guided techniques to investigate how plain radiographs may improve accuracy in the localization of lesions within bones from medieval individuals. While both techniques were effective, we found the grid technique required fewer radiographs than the pointer technique to employ and so was responsible for a lower overall radiation dose. We then discuss methods available for biopsy in archeological bone and how the optimal location for the biopsy of malignant lesions will vary depending upon whether the tumor is blastic or lytic in nature. Limitations of this X‐ray guided approach include that not all cancer metastases are visible on plain radiographs, as erosion of cortical bone is frequently required for visualization of lytic metastases using this imaging modality.

Open-Source Image Analysis Tool for the Identification and Quantification of Cortical Interruptions and Bone Erosions in High-Resolution Peripheral Quantitative Computed Tomography Images of Patients with Rheumatoid Arthritis

Open-Source Image Analysis Tool for the Identification and Quantification of Cortical Interruptions and Bone Erosions in High-Resolution Peripheral Quantitative Computed Tomography Images of Patients with Rheumatoid Arthritis

Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis

ObjectiveTo characterise the impact of dactylitis in disease-modifying antirheumatic drug (DMARD)-naive early psoriatic arthritis (PsA).MethodsPatients with early PsA meeting the classification criteria for PsA (CASPAR) were recruited. Clinical outcomes were...

GLANDULAR ODONTOGENIC CYST: CLINICOPATHOLOGIC PROFILE OF 4 CASES

Glandular odontogenic cyst (GOC) is a rare aggressive developmental cyst with epithelial features that simulate glandular differentiation. It has a tendency for erosion of cortical bone and propensity for recurrence. GOC occurs mainly in the anterior mandible with a painless swelling. It is characterized by variable thickness of the epithelium cyst, epithelial spheres, luminal layer of cuboidal to low columnar cells, apocrine metaplasia of the luminal cells, cilia, papillary projections, intraepithelial microcysts, clear cells, mucous cells, and multiple cystic compartments. We report 4 cases of GOC and highlight their main clinicopathologic aspects. Two females and two males, 33, 46, 49, 62 years old, respectively, presented with swellings in the anterior mandible. The lesions were multilocular or unilocular. The diagnostic hypotheses were a dentigerous cyst and ameloblastoma. Microscopically, the cysts exhibited at least 7 criteria necessary for the diagnosis of GOC. The patients remain free of any recurrence 3 years after surgery. Glandular odontogenic cyst (GOC) is a rare aggressive developmental cyst with epithelial features that simulate glandular differentiation. It has a tendency for erosion of cortical bone and propensity for recurrence. GOC occurs mainly in the anterior mandible with a painless swelling. It is characterized by variable thickness of the epithelium cyst, epithelial spheres, luminal layer of cuboidal to low columnar cells, apocrine metaplasia of the luminal cells, cilia, papillary projections, intraepithelial microcysts, clear cells, mucous cells, and multiple cystic compartments. We report 4 cases of GOC and highlight their main clinicopathologic aspects. Two females and two males, 33, 46, 49, 62 years old, respectively, presented with swellings in the anterior mandible. The lesions were multilocular or unilocular. The diagnostic hypotheses were a dentigerous cyst and ameloblastoma. Microscopically, the cysts exhibited at least 7 criteria necessary for the diagnosis of GOC. The patients remain free of any recurrence 3 years after surgery.

Osteosarcoma of the Jaws: A Literature Review.

Osteosarcoma of the jaws (OSJ) is a relatively rare disease, accounting for between 2% and 10% of all cases of osteosarcoma. It is morphologically and radiologically identical to the trunk and extremity variant, but distinct in several crucial aspects. The lesion is characterized by sarcomatous cells which produce a variable amount of osteoid bone. It arises centrally within the bone and can be subdivided into osteoblastic, chondroblastic and fibroblastic subtype, depending on the predominant cell type. Radiographically, these tumors display a spectrum of bone changes from well-demarcated borders to lytic bone destruction with indefinite margins and variable cortical bone erosion or, in some cases, images of sclerotic bone. Therapeutic options for OSJ include surgery, chemotherapy and radiotherapy, which are employed according to age of the patient, histological classification and localization of the tumor. Today, there is no general consensus in the treatment guidelines for the OSJ though surgery represents the key to the treatment. The main prognostic factor deeply influencing the patient's prognosis remains the complete tumor resection with negative surgical margins. The aim of the present review is to describe state of the art regarding diagnostic and surgical treatment aspects of the primary osteosarcoma of the jaws.

Cartilage Fascia Composite Canalplasty for External Auditory Canal Cholesteatoma: Case Analysis and Long-term Surgical Results.

To analyze surgical outcomes of cartilage-fascia composite canalplasty (CFCC) for external auditory canal cholesteatoma (EACC). Retrospective case review study. Tertiary referral center. A total of 13 patients with EACC (n = 14 ears due to one patient with bilateral EACC). Surgical method of CFCC using well designed-conchal cartilage and temporalis muscle fascia after complete removal of EACC. Clinical characteristics and EACC stages were determined by oto-endoscopic examination and computed tomography (CT) findings. The surgical results of CFCC were analyzed. The median age of patients was 43 years (range, 12-75 yr), with a male to female ratio of 6 to 7. EACC stages were from II to IV. Cortical bone erosion in the inferior part of the bony EAC was the most common finding. All patients had satisfactory results: no more ear symptoms related with cholesteatoma and no need of dressing. Postoperative hearing gain was observed in four patients. No complications or recurrence occurred during the mean follow-up period of 34.4 months. Surgical technique of CFCC was effective for EACC not responding to conservative management.

SAPHO syndrome of the right temporomandibular bone and joint in a 25-year-old man

SAPHO syndrome is an association of specific bone, joint, and skin lesions. The acronym SAPHO refers to synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. However, not all these clinical manifestations need to be present to establish the diagnosis. It is a rare disease in which genetic predisposition or an autoimmune response to a microorganism in the skin mimicking a normal bone or joint molecular structure has been proposed. We present a 25-year-old man who presented with 2-year history of difficulty in opening the mouth with associated pain in the right jaw. He also developed progressive right hearing impairment and multiple acne-like rashes on his face 10 months prior to presentation. Examination of the right jaw revealed a tender firm immobile swelling in the region of the temporomandibular joint which was slightly warm to touch. CECT revealed cortical bone erosions of the right temporal squama and condyle with diffuse endosteal sclerosis and hyperostosis of the mandibular condyle and ramus. The temporal squama was partially resorbed with areas of bone remodeling. The right temporomandibular joint was also involved in the sclerotic changes with marked narrowing of its joint space. Based on the clinical and radiological features, a diagnosis of SAPHO syndrome was established. It is essential to make such diagnosis in order to avoid unnecessary and futile treatment.

Magnetic resonance imaging features of pubic symphysis urinary fistula with pubic bone osteomyelitis in the treated prostate cancer patient.

Pubic bone osteomyelitis with pubic symphysis urinary fistula represents a debilitating complication of radiation and ablative treatments for prostate cancer. The definitive radiographic diagnosis of this clinical entity is not described. In this study, we characterize the plain film and magnetic resonance imaging findings of pubic osteomyelitis. We reviewed a database of prostate cancer survivors with diagnosed pubic osteomyelitis from 2011 to 2015. These patients underwent pelvic plain radiographs and magnetic resonance imaging with T1-weighted and fat-suppressed T2-weighted fast spin echo sequences. Intravenous gadolinium was utilized. The diagnosis was verified with extirpative surgery. 16 patients with diagnosed pubic osteomyelitis from 2011 to 2015 underwent imaging at our institution. All patients demonstrated increased signal on T2- weighted sequences and decreased signal on T1-weighted sequences along the pubic symphysis and the marrow of the involved pubic rami. Inflammatory myositis with diastasis of the pubic symphysis and cortical bone erosion were identified in the majority of patients. Fluid collections were identified in 75% of patients. 63% of conventional radiographs demonstrated no radiographic evidence of pubic osteomyelitis. Magnetic resonance imaging of pubic symphysis osteomyelitis in the prostate cancer survivor is characterized by high signal on T2-weighted images and low signal on T1-weighted images of the involved pubic rami, with the majority of patients demonstrating regional myositis. Imaging data combined with clinical assessment should prompt diagnosis and management of pubic osteomyelitis. Conventional radiography is generally insensitive to these findings. We consider magnetic resonance imaging to be the definitive diagnostic modality for this clinical entity.

Prevalence of radiographic findings on jaws exposed to antiresorptive therapy: a meta-analysis.

Determine the prevalence of radiographic findings (RF) on both jaws among patients receiving antiresorptive bone therapy. Six electronic databases and partial grey literature were searched. Data was collected based on predetermined criteria. The key features from the included studies were extracted. The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence. 29 studies were identified and included in the qualitative analysis, totalling 1133 patients. 27 studies had sufficient data to be included in a series of meta-analysis reporting 12 types of radiographic findings, and were split in two groups based on their study design. G1 comprised descriptive observational studies and G2 analytical cross-sectional studies. Two studies presented a high RoB, 16 had a moderate RoB, and 11 had low RoB. The overall level of evidence identified was very low. The most frequent RF were mixed lytic-sclerotic areas (73.88%), followed by osteolytic changes (66.18%), osteosclerosis (65.75%), cortical bone erosion (50.83%), persisting alveolar socket (45.77%), periodontal ligament (PDL) widening (44.69%), and inferior alveolar canal (IAC) involvement (43.40%). Less frequent, but equally important, were the periosteal reaction (34.27%), lamina dura thickening (32.97%), sequestrum (29.94%), pathologic fracture (20.90%), and density confluence of cortical and cancellous bone (16.61%). 20 patients reported no signs. RF prevalence was high and mainly included mixed lytic-sclerotic areas, osteolysis, osteosclerosis, cortical bone erosion, persisting alveolar socket, PDL-widening, IAC-involvement. Due to the very low level of evidence (GRADE) caution should be exercised when considering these findings.

Percutaneous Cement Injection for the Palliative Treatment of Osseous Metastases: A Technical Review.

The technical art to percutaneous injection of polymethyl methacrylate (PMMA) cement for the palliative treatment of osseous metastases is not without pitfalls. Pathologic fracture, cortical bone erosion, large lytic tumor, aggressive tumor biology, and tumor vascularity may increase the risk of cement leakage or limit complete consolidation. A calculated and determined approach is often necessary to achieve satisfactory patient-tailored results. This article reviews the challenges and potential complications during the consolidation of osseous metastases. Case examples are presented to facilitate early detection of impending cement leakage, minimize procedural risks, and provide management suggestions for complications. Technical pearls are provided to refine consolidative techniques and improve the comprehensive treatment of painful osseous metastases.

Eight Days of Earth Reambulation Worsen Bone Loss Induced by 1-Month Spaceflight in the Major Weight-Bearing Ankle Bones of Mature Mice.

Spaceflight induces bone alterations with site-specific rates of bone loss according to the weight-bearing function of the bone. For the first time, this study aimed to characterize bone microarchitecture and density alterations of three ankle bones (calcaneus, navicular, and talus) of mice after spaceflight and to evaluate the impact of 8 days of Earth reambulation. Ten C57BL/6N male 4-month-old mice flew on the Bion-M1 biosatellite for 1 month; half were euthanized within 24-h of return and half after 8-days recovery on Earth. Bone microarchitecture and quality was assessed by microtomography (μCT). Whole calcaneus bone volume fraction decreased in Flight group (−6.4%, p < 0.05), and worsened in the Recovery group (−11.08%, p < 0.01), when compared to Control group. Navicular and talus trabecular bone volume fraction showed trends toward decrease in Flight and differences reached statistical significance in Recovery group (−8.16%; −8.87%, respectively; p < 0.05) when compared to Control group. At calcaneus, cortical thickness decreased in Recovery vs. Control groups (−11.69%; p < 0.01). Bone surface area, reflecting periosteal bone erosion, significantly increased in all bone sites analyzed. Qualitative analyses of 3-D bone reconstruction revealed local sites of cortical thinning and bone erosion, predominantly at articulations, muscle insertions, and ground contact bone sites. Overall, spaceflight-induced bone loss in ankle bones was site and compartment specific whilst the tissue mineral density of the remaining bone was preserved. Eight days after landing, bone status worsened as compared to immediate return.