Fibrous Bands Research Articles

Thoracolumbar myelopathies in pug dogs.

Constrictive myelopathy (CM) involving a fibrous band around the spinal cord is a newly recognized disease in pug dogs. To identify the frequency of CM based on diagnostic imaging supplemented with necropsy; to determine whether a relationship exists between the sites of CM and other described T3-L3 myelopathies; and to determine the frequency of caudal articular process dysplasia (CAPD). Thirty-two client-owned pug dogs diagnosed with a chronic, progressive T3-L3 myelopathy based on neurological examination performed by a board-certified neurologist. This is a prospective study. All dogs underwent computed tomography (CT) and magnetic resonance imaging (MRI) reviewed by a board-certified radiologist. Magnetic resonance imaging abnormalities were categorized into diseases; CM only, CM plus other non-CM condition(s), or non-CM condition. Sites of CAPD were reported on CT. Nineteen dogs underwent necropsy. Magnetic resonance imaging revealed 3 dogs with CM only, 17 with CM plus at least 1 other myelopathy, 11 dogs with non-CM myelopathies only, and 1 with no MRI abnormalities. Nineteen of 32 dogs had >1 myelopathy diagnosis on MRI whereas 15/32 had >1 site of spinal cord compression. All dogs had CAPD at >1 site in the T3-L3 vertebral column on CT. Constrictive myelopathy affected more than half of pug dogs presenting with chronic thoracolumbar myelopathies. Most had multilevel disease, concurrent myelopathies, or both. There was no apparent relationship between anatomic locations of CAPD and most severe myelopathy or myelopathy type.

Detailed Anatomy of the Corpora-Glans Ligament via the P45 Plastination Method

The corporo-glans ligament is the ligament connecting the corpus cavernosum and the glans of the penis. The anatomical description of the corporo-glans ligaments shape is still uncertain, this knowledge affects penile reconstructive procedures. The anatomy of the corporo-glans ligament was analyzed and recorded via observing sagittal sections of 10 different penile P45 plastination sections. According to the P45 plastination sections, the corporo-glans junction displayed a fibrous tissue band connecting the distal ends of the two corpus cavernous (CC) with the glans penis (GP). The fibrous band was a round-obtuse shape and ran deep into the glans of the penis and occupied about 2/3 of the whole GP. The original end was laid in a socket embedded in the GP. The density of the fibers of the ligament at the original end close to the tunica albuginea was less than that of the other parts. The fibers originating from the tunica albuginea, directly extended to the blind end of the two CC, covering the distal end of the two CC.

Influence of smokeless tobacco in development of oral submucous fibrosis among industrial workers: A cross-sectional study

Background: Tobacco usage in any form can contribute toward the development of various precancerous and cancerous lesions. Oral submucous fibrosis (OSMF) is a chronic precancerous lesion which has the highest rates of malignant transformation. Therefore, the present study was conducted among industrial workers to observe the effect of various forms of smokeless tobacco (SLT) usage and development of OSMF. Materials and Methods: The present cross-sectional study was conducted among 3998 industrial after obtaining approval from concerned authorities. A self-administered questionnaire approved by specialists was used to collect data from the study participants. The clinical diagnosis (the presence of fibrous bands and blanching) was performed by trained examiners who were calibrated in the department. Mouth opening was recorded by Vernier caliper. Statistical analysis was done using the Chi-square test and statistical significance was set at P ≤ 0.05. Results: The mean age of the study population was 38.341 ± 9.89 years. OSMF was reported in 50.2% (1149) of participants who were consuming one or other forms of SLT. Fibrous bands were seen in 59.6% of participants chewing areca nut, 56.8% of participants who consumed pan masala, and 50.6% of participants consuming khaini. 48.9% of participants who chewed gutkha developed blanching over their intraoral mucosa. Fibrous bands and blanching of the oral mucosa were observed in 89.4% and 88.3% of participants, respectively, who consumed all four types of SLT. Conclusion: Consumption of SLT has a strong correlation with the development of OSMF, especially with the use of gutkha, pan masala, and khaini. There is a need for public education programs among such vulnerable population groups.

A rare case of popliteal pterygium syndrome

Popliteal pterygium syndrome is very rare genetic disorder, it can occur in multiple parts of the body, especially the kness with. This current case report describes an 14-day-old newborn admitted to the department of pediatric orthopaedic surgery for a popliteal pterygium syndrome. Clinical examination revealed an extensive bilateral popliteal webs. A doppler ultrasound was performed to specify the spatial relationship between the popliteal artery, the sciatic nerve, and the fibrous band. We proceeded to the resection of the webs with Z-plasties, and successive casts were performed.

Jednoaktna procedura po Mutafu za urođene konstriktivne prstenove - bezbedna i efikasna

Introduction: Congenital constriction ring is a rare congenital malformation that especially affects the limbs. It is associated with fibrous bands that could encircle, strangle, or amputate some parts of the fetus. However, there are only a few techniques described for the correction of this anomaly. We aim to present a successful treatment of congenital constriction ring by means of the one-stage Mutaf technique. Patient Review: In our report, we presented two infants with congenital constriction rings. In the first case, we presented an infant with a constriction band on the right arm accompanied by deformity of the distal part and lymphoedema. In the second case, we presented an infant with multiple constriction bands on the distal part of the right leg with clubfeet and severe lymphoedema. They were both treated by the one-stage Mutaf technique using rectangular dermofat grafts to fill the groove. Using this technique we obtained a normal limb contour, with no oedema or neurovascular compromise. Filling the groove with the rectangular dermofat flaps parallel to the relaxed skin tension lines provides a better scar in comparison with multiple Zor W-plastics techniques. Additionally, advantages of the one-stage procedure are reduction of surgical and psychological trauma in patients and their parents, less time spent under general anesthesia and lower amount of anesthetic the patient receives, and lower treatment costs. Conclusion: We find the Mutaf technique to be an effective and safe technique for the treatment of congenital constriction rings.

From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland

Introduction. Langerhans cell histiocytosis (LCH), as a hematopoietic neoplasm, is a clonal proliferation of Langerhans dendritic cells. A comprehensive clinical examination is sometimes crucial for detecting rare adult diseases, such as LCH with concomitant autoimmune thyroid disease. Case report. A 43-year-old female patient first presented for an endocrinology consultation due to front neck pain and swelling accompanied by fatigue and malaise. The physical examination revealed an enlarged right thyroid gland lobe of extremely firm consistency that was painfully tender on palpation. Echosonographic findings confirmed that the right thyroid gland lobe was enlarged and was not clearly demarcated from the surrounding tissue while exhibiting pronounced parenchyma inhomogeneity characterized by reduced echogenicity of the anterior aspect and pronounced hypoechoicity of the posterior aspect, permeated with fibrous bands and calcifications. The structure of the left thyroid lobe was pseudonodular, with the characteristics of a chronic inflammatory process. Biohumoral findings indicated chronic auto-immune thyroiditis and primary hypothyroidism. Medical history, clinical findings, and personal and family predisposition to malignancy confirmed the need for accelerated additional diagnosis. Fine-needle aspiration biopsy was indicative of atypia of undetermined significance involving Hurthle cells, nuclear overlaps, anisocytosis, anisonucleosis, and the presence of nuclear incisions. Analyses performed after thyroidectomy pointed to the fibrous form of chronic thyroiditis, with suspected monoclonal proliferation of histiocytic and/or lymphoid cells. Immunohistochemical findings confirmed Hashimoto?s thyroiditis and LCH. As the post-operative course was favorable, the patient was prescribed L-thyroxine replacement therapy, along with continuous and systematic monitoring for histiocytosis. Conclusion. Histiocytosis should be suspected more often, given the high incidence of autoimmune thyroid disease in adulthood. A timely LCH diagnosis largely determines the outcome.

Malrotation and Midgut Volvulus in Children: Diagnostic Approach, Imaging Findings, and Pitfalls

Malrotation and midgut volvulus are surgical emergencies that commonly occur within the first month of life. The classic symptom is acute bilious vomiting, while nonspecific symptoms such as recurrent abdominal pain may be present in older children. Malrotation can be associated with duodenal obstruction caused by an abnormal peritoneal fibrous band or congenital anomalies, such as an annular pancreas or a preduodenal portal vein. Volvulus can lead to bowel ischemia and a life-threatening condition, thus prompt and accurate diagnosis is crucial. Diagnosis can be made through upper gastrointestinal series, ultrasonography, and CT, with ultrasonography being preferred as a screening tool due to its rapid and accurate diagnosis, without radiation exposure, in children. This pictorial essay discusses the key imaging findings and diagnostic approaches for malrotation and midgut volvulus, as well as diagnostic pitfalls based on actual cases.

Congenital Torticollis : Surgical Approach and Outcome

Introduction. Torticollis, also known as crooked neck, is a contraction or contracture of the neck muscles that causes the head to tilt to one side. This is accompanied by rotation of the chin to the opposite side with flexion. The congenital form of torticollis usually appears within a few weeks of birth. The basis of diagnosis is clinical examination findings, and the mainstay of treatment is physical therapy. Surgical management is an option only when medical and physical treatments are not producing the desired results or for cosmetic reasons. Case Report. A-11 year young girl came with a chief complaints of a tilted head to the right, she also had difficulty shaking her head and nodding and had an asymmetrical face. This has been experienced since birth. Result. The patient underwent bipolar removal of the lower end of the sternocleidomastoideus muscle (SCM). The patient’s neck was extended with a sandbag, and then the patient’s head was turned toward the shoulder on the opposite, uninvolved side. First, the distal portion of the SCM was released by making a skin incision 3 to 5 cm long on the medial end of the clavicle, with consideration given to palpable fibrous bands, and then deepening the incision to the tendons of the sternal and clavicular attachments of the SCM. The tight band and muscle tendon were dissected to pass a right angle instrument posterior to the tendons and were then resected by electrocautery near the insertion site to the clavicle. The SCM was then carefully dissected and released near the bone, while checking the nearby nerves and vessels. Outcomes were assessed using the cervicalmandibular angle (CMA), calculated using the radiological head tilt, which was defined as the angle between the line crossing the upper border of the C7 vertebral body and another line connecting the lower border of the mandibular angle. Conclusion. Release of the bipolar CMT in the patient in this study increased head tilt, leading to a better quality of life since surgery, and the patient adapted fairly well to her new neck position.

Focal Nodular Hyperplasia-Like Lesions With Glypican-3 Positivity in Infancy.

Glypican-3 is often used to discriminate between neoplastic and nonneoplastic liver. In focal lesions, positivity may be considered suggestive of a malignancy such as hepatoblastoma. However, glypican-3 is also normally expressed in the immature liver. We present a series of 5 cases of focal nodular hyperplasia (FNH)-like lesions arising in very young patients with glypican-3 expression and highlight the challenges these lesions present in the differential diagnosis of hepatoblastoma. Cases were obtained from the files of 3 tertiary pediatric hospitals. Clinical data were obtained from the electronic medical record and histopathologic material including immunohistochemical stains were reviewed. Patients were aged 2 weeks to 6 months with peak AFP levels ranging from 88.6 to 204,696 ng/mL. Microscopically, all were variably demarcated hepatocellular lesions with cords of hepatocytes, marked sinusoidal dilatation, and occasional fibrous bands and areas reminiscent of central scar with bile ducts. No significant cytologic atypia or increased mitotic activity were present. All showed glypican-3 expression and were negative for nuclear beta-catenin with intact reticulin framework. Our study highlights the pitfalls of evaluating focal liver lesions in infants when high AFP levels and glypican-3 expression may reflect immaturity rather than neoplasia.

The Treatment for Type II First Branchial Cleft Anomalies With Abnormalities Lateral to the Tympanic Membrane.

The present study aimed to introduce the surgical method for addressing type II first branchial cleft anomalies (FBCAs) in patients with visible abnormalities lateral to the tympanic membrane. Retrospective analysis. Beijing Children's Hospital of Capital Medical University from January 2016 to January 2020. We performed a retrospective analysis of data from patients with type II FBCAs with visible abnormalities lateral to the tympanic membrane. All patients underwent magnetic resonance imaging, (MRI), computed tomography (CT), and otoscopy examinations before surgery. Data regarding the patient's age, location of the opening, side affected, MRI/CT results, otoscopy findings, the relationship between the lesion and the external auditory canal (EAC), complications, and surgical procedure were recorded. 15 patients with type II FBCAs (Work's classification) were included in our study. There were 3 different types of visible abnormalities lateral to the tympanic membrane: white masses (Type A), a fibrous band between the tympanic membrane and the EAC floor (Type B), and defects in the inferior wall of the EAC (Type C). Types A and C demonstrated internal fistulas of the FBCA. The roots of the FBCA in all 3 types were deep. Endoscopy was required for complete exposure of the fistula, especially for Types A and C. Some type II FBCAs patients had visible abnormalities lateral to the tympanic membrane. Otoscope was recommended for routine examination. For these kinds of patients, combined endoscopy during surgery was helpful for reducing the recurrence rate. Level 3.

Elective brachial plexus decompression in neurogenic thoracic outlet syndrome

We aimed to evaluate functional outcome following elective brachial plexus decompression by compressive fibrous band resection and limited on-demand bone abnormality resection in patients with neurogenic thoracic outlet syndrome (N-TOS). A retrospective continuous observational study was conducted in 17 patients (15 women and 2 men), with a mean age of 42 years, operated on between 2013 and 2021. Twenty brachial plexus decompressions were performed, for 13 objective and 7 subjective N-TOSs, including 3 recurrent N-TOSs. At last follow-up, outcomes were evaluated in terms of residual pain, paresthesia and hand motor deficit, plus patient-reported assessment and Quick-DASH functional scoring. No postoperative complications occurred. At a median follow-up of 12 months (range 6–48 months), complete pain relief and paresthesia resolution were found in 11/15 and 9/14 cases, respectively. All patients reported that their symptoms had improved. In contrast, hand muscle atrophy persisted in all cases (n = 11). Sensorimotor recovery seemed to be poorer and mean Quick-DASH score better in objective than subjective N-TOS patients. Elective brachial plexus decompression seemed to be a safe procedure, providing constant improvement in subjective symptoms related to lower trunk irritation. However, nerve release did not provide hand muscle recovery in patients with objective N-TOS. Level of evidenceIV.

Pseudoainhum and lepromatous leprosy: a very rare association in the modern world

Introduction: Pseudoainhum (dactylolysis spontanea) is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation. Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions. Case presentation: The current report describes a very rare association of pseudoainhum with leprosy. The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum. Discussion: Conclusion: This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits, especially in leprosy.

PSAT198 Atypical Parathyroid Adenoma is an Unusual Cause of Primary Hyperparathyroidism

Abstract Background Atypical parathyroid adenomas (APA) are considered tumors of uncertain malignant potential and have a biochemical and clinical phenotype that is generally more aggressive than typical parathyroid adenomas (PA). Low incidence as an etiology of primary hyperparathyroidism (PHPT) presents a challenge in understanding the pathological features and natural history of APA. We present a case of PHPT due to an APA and review the published literature for these tumors. Case A 37 year-old male was referred for evaluation of hypercalcemia, with serum calcium level 13.6 mg/dL (8.6-10.3). Repeat serum calcium measurement was 12.7 mg/dL, and two measurements of intact PTH were 870 pg/mL and 919 pg/mL (12-88), respectively. The patient's laboratories raised concern for parathyroid carcinoma (PC), but there was no palpable neck mass and no enlarged parathyroid glands were visualized on ultrasonography. Parathyroid scintigraphy was notable for faint but persistent Tc-99 m sestamibi uptake in the left inferior neck. Additional preoperative evaluation revealed significantly reduced bone mineral density in the distal third of the radius (0.638 g/cm2, Z-score -3.2), silent nephrolithiasis of the right kidney, and vitamin D deficiency (25-OH vitamin D 13.4 ng/dL, 30-100). An unequivocally enlarged (175 mg, 2.5 cm in largest diameter) left inferior parathyroid gland was removed, with the remaining glands unremarkable by inspection. Extensive nuclear atypia and cellular pleomorphism indicated an APA, and invasive features of PC were absent. One month after surgery, serum calcium improved to 10.2 mg/dL and intact PTH was 40 pg/mL. Conclusions APA account for 1-2% of PHPT cases. This patient's case has several features that distinguish it from a PA including degrees of preoperative hypercalcemia and intact PTH elevation, low vitamin D level, significantly reduced bone density in the distal third of the radius, nephrolithiasis, relatively young age, and male gender. Fibrous bands, pseudocapsular invasion, and trabecular growth pattern are the most common histologic features of APA, but nuclear atypia and cellular pleomorphism are well established diagnostic criteria. APA may be biochemically similar to PC but are distinguished from PC by the absence of gross invasion into adjacent anatomic structures, distant metastases, and vascular or perineural invasion. Additionally, CDC73 mutations are present in nearly all cases of PC but not in APA. Over 90% of patients with APA are successfully treated by parathyroidectomy. Careful follow up of APA patients is recommended, though there are no specific guidelines regarding a minimum satisfactory duration of postsurgical monitoring. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Thoracic outlet syndrome: a review

Thoracic outlet syndrome (TOS) is a rare condition (1-3 per 100,000) caused by neurovascular compression at the thoracic outlet and presents with arm pain and swelling, arm fatigue, paresthesias, weakness, and discoloration of the hand. TOS can be classified as neurogenic, arterial, or venous based on the compressed structure(s). Patients develop TOS secondary to congenital abnormalities such as cervical ribs or fibrous bands originating from a cervical rib leading to an objectively verifiable form of TOS. However, the diagnosis of TOS is often made in the presence of symptoms with physical examination findings (disputed TOS). TOS is not a diagnosis of exclusion, and there should be evidence for a physical anomaly that can be corrected. In patients with an identifiable narrowing of the thoracic outlet and/or symptoms with a high probability of thoracic outlet neurovascular compression, diagnosis of TOS can be established through history, a physical examination maneuvers, and imaging. Neck trauma or repeated work stress can cause scalene muscle scaring or dislodging of a congenital cervical rib that can compress the brachial plexus. Nonsurgical treatment includes anti-inflammatory medication, weight loss, physical therapy/strengthening exercises, and botulinum toxin injections. The most common surgical treatments include brachial plexus decompression, neurolysis, and scalenotomy with or without first rib resection. Patients undergoing surgical treatment for TOS should be seen postoperatively to begin passive/assisted mobilization of the shoulder. By 8 weeks postoperatively, patients can begin resistance strength training. Surgical treatment complications include injury to the subclavian vessels potentially leading to exsanguination and death, brachial plexus injury, hemothorax, and pneumothorax. In this review, we outline the diagnostic tests and treatment options for TOS to better guide clinicians in recognizing and treating vascular TOS and objectively verifiable forms of neurogenic TOS.

PSAT211 Low Grade Parathyroid Carcinoma: A Challenging Diagnosis in the Evaluation of Primary Hyperparathyroidism

Abstract Background Parathyroid carcinoma often presents with severe symptomatic hypercalcemia, bone and kidney involvement, and PTH > 4x the upper limit of normal. Diagnosis is challenging and requires classic pathologic findings. Case Presentation A 34-year-old woman presented with hypercalcemia. She was found to have primary hyperparathyroidism with elevated total calcium (11.8 mg/dL), elevated PTH (352.8 pg/mL), and elevated 24-hour urine calcium (758 mg/24hr). A 99mTc sestamibi scan showed focal uptake in the right inferior thyroid pole. Intraoperatively, there was a lobulated, fibrotic right parathyroid mass sized 3.5×2.5×2.0 cm. Pathology showed low-grade parathyroid carcinoma with lymphovascular invasion, extension into soft tissue, and focal positivity in resection margin. Post-operative PTH was 19.5 pg/mL. One month later, PTH was elevated to 82.0 pg/mL with calcium of 9.1 mg/dL. PET scan did not show metastases. The patient then underwent a right thyroid lobectomy with central compartment lymph node dissection. Pathology showed residual parathyroid carcinoma within the perithyroidal scar tissue but was negative for lymph node involvement. Postoperatively, her PTH was 52.5 pg/mL. Genetic studies showed no mutations in CDC73, MEN1, RET, RB1, and TP53 genes. She underwent external beam radiation treatment. Following radiation, her total calcium and PTH level remained in the normal range with no recurrence on thyroid ultrasound. Clinical Lessons On ultrasound, parathyroid carcinomas are large, have increased heterogeneity and lobulations, as well as suspicious lymph nodes. Intraoperative suspicion is based on large size, capsular or local tissue invasion, and lymph node metastases. Histologic assessment can be challenging as findings of parenchymal mitoses, trabeculated parenchyma, and thick fibrous bands are also seen with parathyroid adenomas. Local tissue invasion (angiolymphatic, perineural or adjacent structures) or metastases such as lymph nodes seen on pathology are diagnostic of parathyroid carcinoma. PET can be used post-operatively to identify recurrence or metastases. Genetic studies especially for mutations in CDC73 can be helpful in diagnosis as it is the most common cause of syndromic and sporadic parathyroid carcinoma.Resection of the tumor and adjacent tissues is the mainstay of treatment. A regional lymph node dissection should be done if there are suspicious lymph nodes. Neither thyroidectomy, chemotherapy nor radiation has been shown to improve overall survival. Radiation has shown to have some benefit for local recurrence and disease-free survival. Lifelong monitoring of calcium and PTH levels is required, and if elevated, should prompt imaging with thyroid ultrasound and PET scan. Prognosis is generally poor but does improve if there is complete surgical resection on initial diagnosis. Almost all patients experience recurrence within 2-23 years after resection Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

RARE PRESENTATION OF A THYMOMA AT AN INFREQUENT LOCATION

RARE PRESENTATION OF A THYMOMA AT AN INFREQUENT LOCATION

A Simplified Intraoral Appliance for Protecting the Flap in a Patient with Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is a chronic, debilitating premalignant condition of the oral cavity predominantly caused by betel chewing. In this condition, the sub mucosal tissues (lamina propria and deeper connective tissue) show inflammation and progressive fibrosis that results in inability to open the mouth. Surgical excision of fibrous bands is usually the treatment of choice. Postsurgical trauma to the flap during occlusion is one of the common complications that may occur in those patients. Hence, an intraoral appliance which could protect the flap is necessary. This article explains about the fabrication of an intraoral appliance in a simplified manner to protect the flap from trauma during the occlusion of a patient diagnosed with OSMF who underwent surgical excision of fibrous tissue. The appliance helped in better healing of the surgical site, avoided the trauma to the flap, comfortable and cost effective.

Evaluation of thyroid hormones in liver cirrhosis patients on the basis of child pugh score

Introduction: Cirrhosis is an advanced stage of liver fibrosis that is accompanied by distortion of the hepatic vasculature. It is the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury. Objectives: The study was intended to assess serum Triiodothyronine (T3), Thyroxine (T4) levels and Thyroid Stimulating Hormone (TSH) on the basis of Child Pugh Score in patients with Liver Cirrhosis. Methodology: 100 clinically diagnosed cases of Liver Cirrhosis patients were enrolled for the study. Estimation of Thyroid Hormones were performed. Statistical evaluation was done for analysis of the results. Result: The study documented a significant decrease in T3 levels (P= <0.0001), a non-significant increase in T4 levels (P=0.997) and a slightly significant increase in TSH levels (P=0.034) on the basis of CP Score. Conclusion: The patients with liver cirrhosis have significantly decreased levels of T3 with increased CP Score. The routine liver enzymes like AST, ALT and ALP may be unable to predict the risk of development of liver cirrhosis specially in the early stages. Therefore, screening of serum T3 levels is strongly recommended in patients with early-stage liver diseases like ALD, NAFLD, NASH and CLD.

Clinical characteristics of patients with oral submucous fibrosis—hospital‐based retrospective study in a Sri Lankan cohort

AbstractObjectiveOral submucous fibrosis (OSF) is a well‐established oral potentially malignant disorder (OPMD) that affects South Asian countries including Sri Lanka where the traditional habit of areca nut chewing prevails. The main aim of this study was to evaluate the demographic and clinical characteristics of OSF among patients presented to the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka.Materials and methodsA retrospective cohort of 503 patients, diagnosed with OSF, followed up in the Oral Medicine Clinic, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka for the past 22 years were included in this study.ResultsPatients ranging from 3 to 81 years (394 males [78.3%] and 109 females [21.7%]; mean age, 43.4 years) with the diagnosis of OSF were included in this study. The main presenting complaint of the patients was a burning sensation (45.3%), whereas 56 patients complained either of an ulcer or a white/red patch. The majority of 69.8% had the habit of betel chewing only, whereas 18.1% had the synergistic habit of betel chewing and smoking. About 69.8% had the involvement of the buccal mucosa with the presence of fibrous bands on the initial visit with 25.8% demonstrating restricted tongue movements. A large number of patients (35.2%) presented with dysplasia in the initial biopsy indicating severe disease at presentation.ConclusionThe clinical characteristics of OSF disease patterns may vary in different regions due to habit variations.

The medial wall and medial compartment of the cavernous sinus: an anatomic study using plastinated histological sections

The medial wall of the cavernous sinus (CS) has a significant role in evaluation and treatment of pituitary adenomas. This study was conducted to clarify the fine architecture of the medial wall and medial compartment of the CS at both macro- and micro-levels in twenty-one human cadaveric heads by using the epoxy sheet plastination technique. The sellar part medial wall is an intact dural layer that separates the CS from the pituitary gland. This dural wall adhered to the diaphragma sellae and the periosteum of the sella turcica to form fibrous triangles. Eight micro-protrusions of the pituitary gland were found at both sides of that wall. The thickness of the sellar part medial wall at its central portion was significantly thinner than that at the other surrounding portions. From the superior view, tortuous intracavernous carotid arteries can be divided into outward bending type and inward bending type. The inward bending intracavernous carotid was apt to bent towards the central part of the sellar part medial wall, where there were usually wide and short fibrous bands with more densely stained connective tissues between them. The micro-protrusion of the pituitary gland in the medial wall of the CS could provide an anatomical basis for the occult tumor invasion and the recurrence of residual tumor. Different bending facing states of tortuous intracavernous carotid arteries in the lateral direction may be a factor of the determination of the direction of growth of pituitary tumors.