Bone Expansion Research Articles

A Novel Approach of Periodontal Osseous Wall Piezosplitting and Sequential Bone Expansion in Management of Localized Intra-Bony Defects with Wide Angulation-A Randomized Controlled Trial.

Piezoelectric surgical instruments with various mini-sized tips and cutting technology offer a precise and thin cutting line that could allow the wider use of periodontal osseous wall swaging. This randomized controlled trial was designed to investigate the use of a minimally invasive piezo knife to harvest vascularized interseptal bone pedicles in treating intra-bony defects. Sixteen non-smoking patients (mean age 39.6 ± 3.9) with severe chronic periodontitis were randomly assigned into one of two groups (N = 8). The Group 1 (control) patients were treated by bone substitute grafting of the intra-bony defect, whereas the Group 2 patients were treated by intra-bony defect osseous wall swaging (OWS) combined with xenograft filling of the space created by bone tilting. In both groups, the root surfaces were treated with a neutral 24% EDTA gel followed by saline irrigation. Clinical and radiographic measurements were obtained at baseline and 6 months after surgery. The sites treated with osseous wall swaging showed a statistically significant probing-depth reduction and increase in clinical attachment compared with those of the Group 1 patients. The defect base level was significantly reduced for the OWS group compared to that of the Group 1 control. By contrast, the crestal bone level was significantly higher in the OWS group compared to Group 1. The crestal interseptal bone width was significantly higher in Group 2 at 6 months compared to the baseline value and to that of Group 1 (<0.001). The osseous wall swaging effectively improved the clinical hard- and soft-tissue parameters. The use of mini inserts piezo-cutting, sequential bone expanders for osseous wall redirection, and root surface EDTA etching appears to be a reliable approach that could allow the use of OWS at any interproximal dimension.

The Effect of Osseodensification on Ridge Expansion, Intraosseous Temperature, and Primary Implant Stability: A Pilot Study on Bovine Ribs.

Osseodensification is a novel technique based on nonsubtractive drilling to preserve and condense bone during osteotomy preparation. The aim of this ex vivo study was to compare osseodensification and conventional extraction drilling technique with regard to intraosseous temperatures, expansion of alveolar ridge width, and primary implant stability using different implant geometries: tapered and straight walled. A total of 45 implant sites were prepared in bovine ribs following osseodensification and conventional protocols. Changes in intraosseous temperatures were recorded at 3 depths using thermocouples, and ridge width was measured at 2 different depths before and after osseodensification preparations. The primary implant stability was measured using peak insertion torque and the implant stability quotient (ISQ) following placement of straight and tapered implants. A significant change in temperature was recorded during site preparation for all techniques tested but not at all depths. Osseodensification recorded higher mean temperatures (42.7°C) than conventional drilling, particularly at the midroot level. Statistically significant ridge expansion was observed at both the crestal and apical levels in the osseodensification group. The ISQ values were significantly higher only for tapered implants placed in osseodensification sites when compared with conventional drilling sites; however, there was no difference in the primary stability between tapered and straight implants within the osseodensification group. Within the limitations of the present pilot study, osseodensification was found to increase the primary stability of straight-walled implants without overheating the bone and significantly expanded the ridge width. However, further investigation is required to determine the clinical significance of the bone expansion created by this new technique.

Retraction notice to "The Effects of Clockwise and Counterclockwise Conventional and Osseodensification Drilling on the Dimensions, Density, and Biomechanical Properties of Bone" [Int J Oral Maxillofac Implants 2023;38:77-83

Purpose: To compare the effects of regular implant drills to osseodensifying drills used in clockwise and counterclockwise motions on bone dimension change and primary implant stability. Materials and Methods: A total of 40 bone models were made (20 × 15 × 4 mm) from porcine tibia to represent implants placed in soft bone. Implant osteotomies were prepared in the bone models using one of the following techniques: (1) regular implant drills in a clockwise direction (group A), (2) regular implant drills in a counterclockwise direction (group B), (3) osseodensifying drills in a clockwise direction (group C), and (4) osseodensifying drills in a counterclockwise direction (group D). Bone-level tapered titanium alloy implants (4.1 × 10 mm) were placed following osteotomy creation. The implant stability quotient (ISQ) was measured after implant placement. Each bone model was scanned with an optical scanner to convert to Standard Tessellation Language (STL) files before and after the osteotomy creation. Presurgical and postsurgical STL files were superimposed, and the dimensional changes were measured at 1, 3, and 7 mm from the crestal bone. Histomorphometric analysis was done, and bone-to-implant contact percentage (BIC%) was calculated. Results: There were no significant differences in ISQ values (P = .239) between any of the groups. Histomorphometric analysis showed implants in group D had significantly higher BIC% than groups A (P = .020) and B (P = .009). The amount of bone expansion decreased with distance from the crest (P < .001). Groups B (P = .039) and D (P = .001) showed significant expansions at all levels compared with group A. No other statistically significant differences in dimensional change were found between groups. Conclusion: Both regular and osseodensification burs used in a counterclockwise motion contribute to expansion of bone dimension compared to conventional drilling methods.

Non-surgical management of a traumatic mid-palatal suture diastasis by novel use of an orthodontic appliance

Sutures are formed during embryonic development at the sites of approximation of the membranous bones of the craniofacial skeleton. They afford major sites of bone expansion during postnatal craniofacial growth, and also influence facial fracture patterns through offering a path of least resistance to force. There are some studies that have shown that the mid-palatal suture (MPS) fuses at 11–13 years and 14–16 years in females and males, respectively. This means that during childhood, the suture is open; thus force applied to the palate at this time tends to split the bone in the midline between the two unfused palatal shelves. The understanding of this biological process allows orthodontists to correct transverse growth discrepancies of the maxilla. Various appliances, including the hyrax appliance, can be used to allow rapid maxillary expansion (RME) by expanding the suture. Paradoxically, the same appliance can be used to allow rapid maxillary contraction (RMC) by contracting the suture. This method of application using a hyrax appliance is rare. We present a case report where this method of application allowed closure of a traumatic mid-palatal suture diastasis, correction of a traumatic transverse discrepancy of the maxilla and avoided an invasive surgical intervention in a 15-year-old male. CPD/Clinical Relevance: This article highlights the importance of considering a patient's age and anatomical development when exploring treatment options. It is prudent to take advantage of this to enhance the natural biological healing process.

Hronični granulomatozni invazivni gljivični sinusitis - pregled literature i prikaz slučaja netipičnog za balkansku regiju

Introduction. Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is an extremely rare form of invasive fungal sinusitis. The disease has a long-lasting and indolent course, so the invasion and destruction in the sinonasal and adjacent regions is progressing slowly. This disease has been reported primarily in Middle East, North Africa, India and Pakistan; however, it is very rare in western countries. It is primarily caused by Aspergillus flavus. Case Report. A 40-year-old man, who was repeatedly surgically treated for chronic rhinosinusitis with nasal polyps, was presented to our Otorhinolaryngology Department with a progressive, sudden right-sided proptosis. Contrast-enhanced paranasal sinus computed tomography (CT) showed almost complete soft tissue opacification of the sinonasal region, eroded bone structures and expansion into the right orbit. Erosion of the walls of the right frontal sinus was also seen but without intracranial propagation. Histopathological examination was necessary for the final diagnosis. The finding of granulomatous response along with fibrosis and strong inflammatory infiltrate was typical for chronic granulomatous invasive fungal sinusitis. The patient was successfully treated with a combination of surgery and postoperative medical therapy with voriconazole. To our knowledge, this is the first case of CGIFRS presented in Serbia. In addition, we reviewed the literature concerning this rare form of fungal sinusitis, especially for the Balkan region. Conclusion. Although we reported an extremely rare case of fungal sinusitis for the Balkan region, it is important to suspect on it in all cases where chronic inflammation of the paranasal sinuses does not respond to conventional treatment.

Clinical and radiological characteristics of odontomas: A retrospective study of 90 cases.

Odontomas represent a common clinical entity among odontogenic tumors, but are not well-addressed in the Vietnamese population. The present study aimed to determine the clinical and preclinical characteristics of odontomas and associated factors in the Vietnamese population. This retrospective study retrieved data from histopathological diagnoses from 2 central hospitals of Odonto-Stomatology in Ho Chi Minh City, Vietnam during 2004-2017. The odontomas were classified as complex (CxOD) or compound (CpOD) subtypes. The epidemiological, clinical, and radiological characteristics of the odontomas, stratified by subtype and sex, were obtained and analyzed. Ninety cases, consisting of 46 CxODs and 44 CpODs, were included. The average age of patients was 32.4 (±20.2) years. The patients with CxOD were older than those with CpOD (P<0.05). Clinically, 67% of patients showed an intraoral bone expansion. Approximately 60% of patients with CxOD exhibited a painful symptom, about 3-fold more than those with CpOD (P<0.05), whereas almost all patients with CpOD exhibited perturbations of dentition, unlike those with CxOD (P<0.05). Radiologically, CxOD was characterized by a larger dimension than CpOD in both sexes (P<0.05), and CpOD induced complications in adjacent teeth more often than CxOD (P<0.05). The development of odontoma with advancing age differed significantly in odontoma subtypes related to their pathological origins, and between the sexes, resulting from different physiological states. The findings of this study highlight the value of clinical and radiological features of odontomas and their associated factors for the early diagnosis and adequate treatment of younger patients.

Defining Pathological Iron Status in Children with Thalassemia

The purpose of this review is to summarize the recent knowledge that has been gathered, allowing a better understanding of iron status in children with thalassemia. Children with thalassemia major typically have severe anemia during the first two stages of life and receive regular red blood cell (RBC) transfusions. The results show that individuals with thalassemia major who are overtly or inadequately transfused have significant body changes that affect physical growth retardation, hostility, weak musculature, leg muscle fitness, extramedullary development of hematopoiesis, and bone expansion, as seen in some developing countries. Cases of thalassemia intermedia occur late and have mild anemia, and cannot tolerate regular blood transfusions. Treatment for thalassemia major includes regular red blood cell transfusions, iron chelating drugs, and bone marrow surgery. In addition, spleen scanning may be necessary in some cases. Also, a bone marrow transplant is the only definitive treatment currently available. The prognosis for patients with beta-thalassemia has improved most over the past 25 years, mostly due to recent medical advances in blood transfusions, iron-chelating drugs, and bone marrow transplants. However, heart disease (heart disease) has been found to remain the leading cause of death in iron-related cases.

Magnetic resonance imaging as a structural refinement to the American College of Rheumathology clinical classification criteria for knee osteoarthritis

To evaluate if fulfilment of the definition of osteoarthritis (OA) based on the American College of Rheumatology (ACR) clinical criteria corresponds to pathological knee findings evaluated by magnetic resonance imaging (MRI). To evaluate if any such criteria is associated with a specific MRI pattern. Forty-six consecutive patients aged 50 years or more referred by their general practitioners (GPs) to a radiology department because of non-traumatic knee pain underwent MRI using a dedicated low field (0.2 T) machine. MRI results were compared against the ACR criteria for knee OA. Patients with knee pain fulfilling the ACR criteria showed more severe synovial fluid effusion (OR 6.2, 95% CI 2.02 to 19.1), cartilage lesions in the medial area (OR 2.4, 95% CI 1.2 to 5) and higher mean number of osteophytes (OR 2.3, 95% CI 1.1 to 4.5). The association between single criteria and MRI features was more difficult to establish. Nonetheless, crepitus at joint movement was associated with synovial fluid effusion (p=0.02); bone enlargement was more frequent in patients with lesions of the posterior cruciate ligament (p=0.0001); no palpable warmth was associated with cartilage lesions (p=0.02), and morning stiffness shorter than 30 minutes was associated with the surface of bone edema (p=0.02). The ACR clinical criteria identify patients showing the most important features of OA. The association between individual clinical ACR criteria and OA pathology depicted by MRI may be difficult to explain on the basis of anatomical changes and needs further evaluation.

Factors related to microimplant-assisted rapid palatal expansion in teenagers and young adults: A cone-beam computed tomography study

For patients with maxillary transverse deficiency, selecting an appropriate therapeutic method is important for the treatment effect and prognosis. Our study aimed to explore factors related to microimplant-assisted rapid palatal expansion (MARPE) in teenagers and young adults using cone-beam computed tomography. Twenty-five patients who underwent MARPE were included in this retrospective study from February 2014 to June 2019. Midpalatal suture density (MPSD) ratio, midpalatal suture maturation (MPSM), bone effect, dentoalveolar effect, and dental effect in maxillary first molar were evaluated using cone-beam computed tomography. Spearman correlation analysis was used to analyze the correlation between the MPSD ratio, MPSM, age, and the expansion amount generated by MARPE. Twenty-five patients (mean age, 19.84 ± 3.96 years; range, 15-29 years) with maxillary transverse deficiency were analyzed. Age was negatively correlated with bone expansion, alveolar expansion, and alveolar change (all P<0.05). There was a negative correlation between MPSM and nasal cavity variation, bone expansion, and alveolar change (all P<0.05). The bone expansion was negatively correlated with MPSD ratio 3 (r= -0.417; P<0.05) and MPSD ratio 4 (all P<0.05). Age, MPSM, and MPSD ratio were significantly related to the MARPE effect. Age, MPSM, and MPSD ratio should be considered when choosing MARPE.

Extensive and Advanced Craniofacial Dysplasia

A 35-year-old Syrian patient presented to our department complaining of 7-year history of asymptomatic hard swelling in right side of the frontotemporal and naso-orbito-ethmoidal region, reaching the contralateral side (Panels A and B). Patient stated that from 1 year back his visual acuity has been decreased compared with the previous 6 years. Computed tomography (CT) with contrast (Panels C–F) showed diffuse bony expansion involving the frontal bones bilaterally. Bone expansion was more on the right side extending into the vertical plates as well as the horizontal plates forming the roof extending to involve the cribriform plates and into the crista galli extending posteriorly to involve the sphenoid bone including the body, greater and lesser wings of the sphenoid bone as well as the clinoid processes ends extending to the roots of the pterygoid plates. Multidisciplinary decision team meeting was done, with neurosurgery, anesthesiology, and maxillofacial surgery to decide the treatment. Under the general anesthesia the patient underwent remodeling and recontouring of the facial and cranial bones through bilateral occipital approach. Using the unilateral fronto-temporal extradural approach and retracting the dura and reaching the base of the skull the anterior clinoidectomy for optic nerve decompression was performed. Right clinoid process surgery reshaped the base of the skull releasing the bone which compressed the right orbital nerve. Affected bone which involved the frontotemporal area was removed and reconstruction was performed with cranioplasty fixed with osteosynthesis to the adjacent and healthy bony structures. The resected bone was submitted to Hamad general hospital histopathology laboratory which reported following fixation and decalcification irregular shaped trabeculae of immature woven bone scattered in a loosely hypercellular stroma histopathological diagnosed as fibrous dysplasia (Panels G and H: H&amp;E staining). After 5 days of medical management as inpatient, the patient was discharge with close follow up. Patient was followed up in a weekly basis with a normal postoperative status. 5 months after the surgery (Panel I, photography on postoperative day 120 showed remanent dystopia but generalized acceptable craniofacial projection), patient stated to have improvement in his visual acuity compared to his base line as well as craniofacial projection with a remanent vertical dystopia. Panels J and K compare preoperative CT (Panel J) where anterior clinoid process involved with the pathology is noted and postoperative CT (Panel K) which reveals removal of anterior clinoid process for orbital nerve decompression.

Evolution and development of the mammalian jaw joint: Making a novel structure.

A jaw joint between the squamosal and dentary is a defining feature of mammals and is referred to as the temporomandibular joint (TMJ) in humans. Driven by changes in dentition and jaw musculature, this new joint evolved early in the mammalian ancestral lineage and permitted the transference of the ancestral jaw joint into the middle ear. The fossil record demonstrates the steps in the cynodont lineage that led to the acquisition of the TMJ, including the expansion of the dentary bone, formation of the coronoid process, and initial contact between the dentary and squamosal. From a developmental perspective, the components of the TMJ form through tissue interactions of muscle and skeletal elements, as well as through interaction between the jaw and the cranial base, with the signals involved in these interactions being both biomechanical and biochemical. In this review, we discuss the development of the TMJ in an evolutionary context. We describe the evolution of the TMJ in the fossil record and the development of the TMJ in embryonic development. We address the formation of key elements of the TMJ and how knowledge from developmental biology can inform our understanding of TMJ evolution.

ОСОБЕННОСТИ РАСЩЕПЛЕНИЯ АЛЬВЕОЛЯРНОГО ГРЕБНЯ ПРИ ОДНОМОМЕНТНОЙ ИМПЛАНТАЦИИ (клинический случай)

The widespread use of dental implants for the restoration of missing teeth has expanded the possibilities of treatment for both patients and dentists. After tooth extraction, the jaw bones decrease significantly in volume over time (atrophy). During the first year, 25% of bone tissue is lost in the area of the removed tooth, and in the next 2–3 years, bone tissue is reduced by 50% of the original volume. After the implants are installed, the loss of bone tissue stops. The increasing use of implants also necessitates both new studies of implant designs, materials, and technologies for the use of dental implants. Such research has increased dramatically over the past two decades and is expected to expand. The scientific literature we have studied shows that the success of dental implants largely depends on the quality and quantity of available bone in the recipient site. However, this may be disrupted or unavailable due to bone diseases, trauma, periodontal disease, etc., which, in turn, requires additional manipulations with the bone.&#x0D; Subject. Professional and psychological capabilities of a doctor to work effectively in a situation of uncertain outcome of a surgical operation.&#x0D; The relevance of this study is due to the need to prevent complications of implantation surgery in the professional activity of a dentist-surgeon in conditions of insufficient thickness of the alveolar process. The need for this study was also dictated by the needs of patients using implantological systems in maintaining the quality of life.&#x0D; The aim is to study the installation and preservation of the implant with insufficient thickness of the alveolar process.&#x0D; Methodology. A retrospective study of patients with insufficient thickness of the alveolar process who underwent implantation treatment was conducted. Patients were included in the study if they had one or more implants without clinical signs of implant mobility.&#x0D; Results. The patient was treated with surgical tactics with insufficient thickness of the alveolar process; antibacterial therapy; chemical decontamination and the imposition of an allogeneic graft.&#x0D; Conclusions. Bone expansion using a piezoscalpel is a reliable and relatively safe way to expand narrow ridges. The method of expansion of the bone ridge allows to obtain the optimal thickness of the bone for implantation of the implant. The expansion of atrophic rollers with the use of piezoscalpel is a technique that does not require bone collection, reducing the time of surgery and postoperative morbidity, which leads to a reduction in the duration of rehabilitation.

Alveolar bone changes after tooth-borne surgically assisted rapid maxillary expansion: A three-dimensional study

IntroductionSurgically assisted rapid maxillary expansion (SARME) with a dental-anchorage appliance can induce dental and skeletal complications adjacent to the teeth supporting the device. The purpose of this study was to quantify the dentoskeletal changes observed after SARME using a tooth-borne device. Materials and methodsCone beam CT images from 39 patients were compared between the preoperative (T1) and the postoperative period (T2). The mean time to complete the second imaging was 13.8 ± 6.9 months after the SARME. Dental and bone parameters were assessed: the vestibular bone height (BH), the bone thickness (BT), the existence of fenestrations, and the root resorption at the level of first upper premolar (P1) and the first upper molar (M1). The maxillary expansion parameters were also collected. ResultsBoth vertical and horizontal vestibular bone loss were observed mainly in the first upper molar sectors: The BT decreased from 0.93 ± 0.50 mm to 0.53 ± 0.51 mm (p < 0.0001) and the BH decreased from 1.84 ± 1.05 mm to 0.93 ± 1.02 mm (p < 0.0001) for tooth #16. The bone loss also affected the first upper premolars but in a more limited manner. Significant fenestrations were observed at the apex of the mesio-vestibular root of teeth #16 and #26. We noted significant root resorption affecting the mesio-, disto-vestibular and palatal roots of tooth #16 (mean reductions of 0.32, 0.35, and 0.55 mm, respectively; p < 0.05), and the palatal root of tooth # 26 (loss of 0.58 mm; p = 0.004). The mean bone expansion was 3.76 mm and 1.41 mm at the premolar and molar levels, respectively (p < 0.0001), while a mean 6.24 mm and 4.23 mm inter-cuspid expansion was noted at the P1 and M1 levels (p < 0.0001). ConclusionOur results document the vestibular bone changes and low root resorption, mostly in the molar sectors, associated with SARME using dental-anchorage devices.

Single-Cell Map of Childhood Acute Myeloid Leukaemia Using Variational Auto-Encoders

Acute myeloid leukaemia (AML) is a haematological cancer in the bone marrow, with accumulation and expansion of immature cells of the myeloid lineage. Standard treatment of childhood AML is chemotherapy, which does not achieve durable remission in many patients. Personalised medicine including immunotherapies against surface antigens can potentially target chemotherapy resistant cells and achieve long-term remission. Identifying AML blasts and suitable targets for AML therapy are hampered by the heterogeneity and complex clonal and phenotypic composition of the cancer, as well as its complex evolution as the disease progresses into relapse. Aberrant expression of surface antigens on AML blasts measured by flow cytometry is an established strategy to monitor measurable residual disease. Although the likelihood to find blasts is increased as more markers are included in a staining, manual interrogation of all possible combinations exceeding 10 markers becomes extremely difficult. We aim to identify malignant cells based on expression of 23 surface markers normally or aberrantly expressed during hematopoiesis using spectral flow cytometry and machine learning. The goal of this high-dimensional approach is to distinguish leukaemia cells from normal myeloid cells with high confidence, and to place the blasts along the normal myeloid developmental trajectory. We built a single-cell AML map from 20 paediatric AML patients enrolled in the Children's Oncology Group Phase III trial, AAML1031. All patients were treated with standard chemotherapy on Arm A and consented to provide tissue for research. Cryopreserved samples were obtained for three time-points: diagnosis, remission, and relapse. We assumed full remission samples to be healthy and used them to train variational auto-encoders with different hyper-parameters in a cross validated manner. These models subsequently learned to encode the expression of healthy cells in a reduced dimension and to reconstruct their expression from this latent space. We selected the top-10 models that best reconstruct the healthy cells and used it to encode and reconstruct cells from non-remission samples. Since the model works well for encoding and reconstructing healthy cells, we expect a good reconstruction of healthy cells in non-remission samples. For malignant cells we expect a poor reconstruction, as their expression pattern differs from healthy cells. Thus, we use the reconstruction error of cells from non-remission samples to classify them as healthy or malignant. We annotated some cells with clear aberrant expression as malignant and shuffled them with remission cells not used for model development. This resulted in multiple synthetic mixtures with known percentages of malignant cells (ranging from 10 to 90% blasts). Using these synthetic mixtures, we evaluated how well we can classify malignant cells based on their mean-squared reconstruction error. We can achieve an average area under the receiving operator curve of 0.9 over all synthetic mixtures (Fig. 1). The latent space of the variational auto-encoder captures the developmental trajectory of myeloid lineage bone marrow cells (Fig. 2), and we can use this to identify where among the developmental trajectory the leukaemia occurs. We aim to use the trajectory assignment to study the time evolution of the disease in terms of the distribution of malignant cells across the myeloid lineage as well as investigate differences between diagnosis and relapse. We expect that this work will reveal patterns of evolution from diagnosis to relapse that will inform the development of novel strategies to predict and prevent relapse. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Cross-sectional evaluation of FGD-avid polyostotic fibrous dysplasia: MRI, CT and PET/MRI findings

A 42-year-old male with left hip pain was diagnosed of several right femoral and tibial bone tumours. All lesions were osteolytic with sclerotic margins. The symptomatic lesion in the proximal femur also showed bone expansion and focal cortical thinning. Whole-body [18F]-fluorodeoxyglucose (FDG) PET/CT and segmental PET/MRI of the left hip and femur were performed for metabolic characterization of the lesions and for biopsy guidance. The lesions showed a heterogenous degree of FDG uptake corresponding to different metabolic stages of the disease. A biopsy of the tumour portion showing the highest FDG uptake revealed a fibrous dysplasia (FD). In conclusion, although generally affecting paediatric and adolescent subjects, polyostotic FD may be detected in the adulthood. Despite the benign nature of the disease, increased glucose metabolism can be seen in some lesions. Hybrid imaging combining morphological and functional information may help guide biopsy and better define the treatment strategy.

Case report on aggressive Hemangioma

Hemangioma is a benign tumor characterized by the proliferation of blood vessels. A few hemangiomas are aggressive, characterized by bone expansion and extra-osseous extension. The vertebral hemangiomas are most often found in the thoracic and lumbar spine. The aggressive type refers to the presence of extension beyond the vertebral body, destruction of the cortex and invasion of the epidural and paravertebral spaces. An aggressive hemangioma can occur at any age with peak prevalence in young adults. We hereby present a case of an Aggressive Hemangioma in a young patient with no co-morbidities exhibiting symptoms of low backache and progressive lower limb weakness and urinary symptoms.

A common cyst in an uncommon location

OKC is the rare and noteworthy developmental odontogenic cyst which arises from dental lamina. Around 7.8% of all cysts of the jaw are categorized in to this type and grow in an antero-posterior direction in the medullary cavity of the bone without causing bone expansion until &amp; unless when expansion is large. The frequent location is the mandibular posterior body. It is uncommon in the maxilla and only 13% occur in the anterior region. An interesting case of OKC in the maxillary central and lateral incisor region of a 36-year-old male patient is being presented. Such a case can be a diagnostic challenge for the clinician, as it can closely mimic the inflammatory cysts in the anterior region.

Mutation of the galectin-3 glycan-binding domain (Lgals3-R200S) enhances cortical bone expansion in male mice and trabecular bone mass in female mice.

We previously observed that genomic loss of galectin‐3 (Gal‐3; encoded by Lgals3) in mice has a significant protective effect on age‐related bone loss. Gal‐3 has both intracellular and extracellular functionality, and we wanted to assess whether the affect we observed in the Lgals3 knockout (KO) mice could be attributed to the ability of Gal‐3 to bind glycoproteins. Mutation of a highly conserved arginine to a serine in human Gal‐3 (LGALS3‐R186S) blocks glycan binding and secretion. We generated mice with the equivalent mutation (Lgals3‐R200S) and observed a subsequent reduction in Gal‐3 secretion from mouse embryonic fibroblasts and in circulating blood. When examining bone structure in aged mice, we noticed some similarities to the Lgals3‐KO mice and some differences. First, we observed greater bone mass in Lgals3‐R200S mutant mice, as was previously observed in Lgals3‐KO mice. Like Lgals3‐KO mice, significantly increased trabecular bone mass was only observed in female Lgals3‐R200S mice. These results suggest that the greater bone mass observed is driven by the loss of extracellular Gal‐3 functionality. However, the results from our cortical bone expansion data showed a sex‐dependent difference, with only male Lgals3‐KO mice having an increased response, contrasting with our earlier study. These notable sex differences suggest a potential role for sex hormones, most likely androgen signaling, being involved. In summary, our results suggest that targeting extracellular Gal‐3 function may be a suitable treatment for age‐related loss of bone mass.

Differentiating Enchondromas and Atypical Cartilaginous Tumors in Long Bones with Computed Tomography and Magnetic Resonance Imaging.

The differentiation between the atypical cartilaginous tumor (ACT) and the enchondromas is crucial as ACTs require a curettage and clinical as well as imaging follow-ups, whereas in the majority of cases enchondromas require neither a treatment nor follow-ups. Differentiating enchondromas from ACTs radiologically remains challenging. Therefore, this study evaluated imaging criteria in a combination of computed tomography (CT) and magnetic resonance (MR) imaging for the differentiation between enchondromas and ACTs in long bones. A total of 82 patients who presented consecutively at our institution with either an ACT (23, age 52.7 ±18.8 years; 14 women) or an enchondroma (59, age 46.0 ± 11.1 years; 37 women) over a period of 10 years, who had undergone preoperative MR and CT imaging and subsequent biopsy or/and surgical removal, were included in this study. A histopathological diagnosis was available in all cases. Two experienced radiologists evaluated several imaging criteria on CT and MR images. Likelihood of an ACT was significantly increased if either edema within the bone (p = 0.049), within the adjacent soft tissue (p = 0.006) or continuous growth pattern (p = 0.077) were present or if the fat entrapment (p = 0.027) was absent on MR images. Analyzing imaging features on CT, the likelihood of the diagnosis of an ACT was significantly increased if endosteal scalloping >2/3 (p < 0.001), cortical penetration (p < 0.001) and expansion of bone (p = 0.002) were present and if matrix calcifications were observed in less than 1/3 of the tumor (p = 0.013). All other imaging criteria evaluated showed no significant influence on likelihood of ACT or enchondroma (p > 0.05). In conclusion, both CT and MR imaging show suggestive signs which can help to adequately differentiate enchondromas from ACTs in long bones and therefore can improve diagnostics and consequently patient management. Nevertheless, these features are rare and a combination of CT and MR imaging features did not improve the diagnostic performance substantially.

Optic compressive neuropathy secondary to anterior clinoid mucocele: diagnostic approach, a case report

Anterior clinoid process (ACP) mucoceles are an uncommon entity and an even rarer cause of visual impairment. We review the case of a 62-year-old female with a 2-year history of progressive right-sided monocular vision loss. Paranasal sinus computed tomography (CT) scan showed bilateral ACP pneumatization. A soft tissue density mass occupied the right ACP with bone expansion and compression of the right orbital canal. An endonasal approach was performed with total vision recovery. Dedicated images are necessary to diagnose ACP. On CT, the affected sinus will have bone erosions. On magnetic resonance imaging, the signal intensity is determined by its protein concentration and mobile water protons. ACP mucoceles’ accurate diagnosis determinates the treatment and surgical approach. Finally, the correct management selection will determine the retrieval of the visual ability.