Foramen Area Research Articles

ProDesign Logic Files Effect on Apical Foramen Wear and Shape Transformation After Foraminal Enlargement.

This study aimed to evaluate the effect of ProDesign Logic files 45.01 and 50.01 on apical foramen wear and shape transformation after foraminal enlargement at tooth length (TL) and 1 mm beyond. Sixty freshly extracted single-rooted lower human premolars teeth were distributed randomly into five groups (n = 12): Group 1 (40.05 WL) (control): No foraminal enlargement, Group 2 (45.01 TL): Specimens underwent foraminal enlargement with 45.01 Prodesign Logic file at TL; Group 3 (45.01 TL + 1): Specimens underwent foraminal enlargement with 45.01 Prodesign Logic file at 1 mm beyond TL; Group 4 (50.01 TL): Specimens underwent foraminal enlargement with 50.01 Prodesign Logic file at TL; Group 5 (50.01 TL + 1): Specimens underwent foraminal enlargement with 50.01 Prodesign Logic file at 1 mm beyond TL. Scanning electron microscopy was used to evaluate apical foramen variations and shape alterations. Data were analyzed by Student's t-test, Kruskal-Wallis, and Mann-Whitney test. Significant differences (p < 0.01) were observed among all tested groups compared to the control group in terms of the average worn area of the apical foramen. Foraminal enlargement led to significant shape transformation, resulting in round-shaped foramina. ProDesign Logic 45.01 and 50.01 files at TL causes notable wear and round-shaped foramina.

Morphometric Analysis of the Dimension and Distance to Anatomical Structures From the Mental Foramen Using Cone Beam Computed Tomography.

This study aimed to determine the dimensions and differences in distances from several anatomical structures to the mental foramen (MtF) in Pakistani participants usingcone beam computed tomography (CBCT). For this cross-sectional study, retrospective CBCT data of Pakistani individuals from both genders were assessed using the Mimics software (Materialise NV, Leuven, Belgium). The participants were selected from the Mahajir and Pukhtoon ethnic groups in Pakistan. The dimensions of the MtF, which included vertical and horizontal diameterand area of foramen, were measured. The distance of the foramen to various anatomical structures was measured, which included the alveolar crest, inferior border of the mandible, and anterior mandible. Data were assessed using SPSS version 28 (IBM Corp., Armonk, NY). Statistical analysis was performed using an independent sample t-test and a paired t-test. P-values greater than 0.05 and 0.001 were considered significant. Greater measurements had been recorded for the Pukhtoon ethnicity with respect to the vertical, horizontal, and area of the foramen. In relation to the dimensions, males showed larger measurements than females. MtF's distance to the alveolar crest, inferior border of the mandible, and anterior mandible (p < 0.001) was greater in Pukhtoon ethnicity. Males displayed longer measurements. CBCT proved to be a highly accurate and useful tool for the analysis of the dimensions and distances from the MtF in both ethnicities. The Pukhtoon ethnicity exhibited overall greater measurements with respect to the dimensions, highlighting a significant difference between the two ethnicities. Analysis of MtF distance to various landmarks resulted in longer measurements being observed in males and Pukhtoon ethnicity.

Exploration of technique for preservation of external-middle ear structure in surgery of jugular foramen paraganglioma （appended 2 case reports）

Objective:To investigate the feasibility and effect of the modified surgery of the classic infratemporal fossa type A approach for the surgical treatment of jugular foramen paraganglioma with preservation of the external and middle ear structures. Methods:The medical data of 2 patients with jugular foraminal paraganglioma treated by sublabyrinthic-transmastoid approach were retrospectively analyzed. The clinical feature, degree of tumor resection, postoperative facial nerve function and hearing retention, and the incidence of postoperative complications were evaluated. Results:Two patients were both female, and were pathologically confirmed as paraganglioma. The tumor of case 1 was staged as C2De1, and case 2 as C1De1. Tumors were completely resected in both patients. Case 1 suffered infection after surgery, with residual tympanic membrane perforation and mixed deafness. Case 2 developed mild facial paralysis（grade Ⅱ） after surgery, and recovered after symptomatic treatment. There was no tumor residue or recurrence during half a year of follow-up. Conclusion:Surgical treatment of certain paragangliomas in the jugular foramen with a combined sublabyrinthic-transmastoid and upper neck approach might achieve both complete resection of the tumor and preserving the structure and function of the outer-middle ear. This procedure is suitable for paragangliomas restricted in the jugular foramen area, with no or limited involvement of the internal carotid artery（C1 or C2）, and with no or mild hearing loss.

Uniportal Full-endoscopic Foraminotomy for Lumbar Foraminal Stenosis: Clinical Characteristics and Functional Outcomes.

Uniportal full-endoscopic foraminotomy offers a promising alternative to conventional surgical methods for individuals afflicted by lumbar foraminal stenosis. This study aims to evaluate the efficacy and clinical outcomes of uniportal full-endoscopic foraminotomy in patients diagnosed with lumbar foraminal stenosis. A comprehensive retrospective analysis was conducted on individuals who underwent full-endoscopic foraminotomy in our medical center, between January 2018 and December 2019. The investigation encompassed the demographic data of patients and key clinical metrics such as the visual analogue scale of leg (VAS-L) and back pain (VAS-B), Oswestry disability index (ODI) scores, the Short Form-36 Health Survey physical component summary (SF-36 PCS) and the mental component summary (SF-36 MCS), as well as modified MacNab grades, were systematically assessed and compared. Furthermore, radiological parameters: Coronal Cobb angle (CCA), Intervertebral angle changes (IAC), Disc height index (DHI), the foraminal cross-sectional area (FCSA) and the FCSA enlargement ratio were also compared. A variety of statistical analyses including Student t-test, chi-square tests, Fisher's exact tests, Pearson's and Spearman's correlation analyses, and Interclass Correlation Coefficients (ICCs) were employed. 64 patients, including 34 males and 30 females were enrolled. The mean follow-up period extended to 22.66 ± 7.05 months. Distribution by affected segments revealed 26.6% at L4-5, 67.1% at L5-S1 level, and 6.25% at both L4-L5 and L5-S1 levels. At the final follow-up, VAS-L decreased from 7.26 ± 1.19 to 1.37 ± 1.25, while VAS-B decreased from 6.95 ± 0.54 to 1.62 ± 1.13 (p < 0.001). ODI score also demonstrated a substantial decrease from 74.73 ± 8.68 to 23.27 ± 8.71 (p < 0.001). Both SF-36 PCS and SF-36 MCS scores improved significantly (p < 0.001). Modified MacNab criteria revealed 58 excellent-good patients (90.7%), and 6 fair-poor patients (9.3%). No significant differences were founded in the CCA (p = 0.1065), IAC (p = 0.5544), and DHI (p = 0.1348) between pre-operation and the final follow-up. However, the FCSA significantly increased from 73.41 ± 11.75 to 173.40 ± 18.62 mm2 (p < 0.001), and the enlargement ratio was 142.9% ± 49.58%. Notably, the final follow-up FCSA and the FCSA enlargement ratio were found to be larger in the excellent and good group compared to the fair and poor group, according to the modified MacNab criteria. The utilization of uniportal full-endoscopic foraminotomy has demonstrated its safety and efficacy in addressing lumbar foraminal stenosis. The clinical success of this procedure appears to be closely associated with the radiological decompression of the intervertebral foramen area. Importantly, the application of this technology does not seem to compromise the overall stability of the lumbar region.

Short-term effectiveness of unilateral biportal endoscopy technique in treatment of lumbar lateral saphenous fossa combined with intervertebral foramina stenosis via contralateral sublaminar approach

To investigate the short-term effectiveness of unilateral biportal endoscopy (UBE) in treatment of lumbar lateral saphenous fossa combined with intervertebral foramina stenosis via contralateral sublaminar approach. A clinical data of 15 patients with lumbar lateral saphenous fossa combined with intervertebral foramina stenosis, who were admitted between September 2021 and December 2023 and met selective criteria, was retrospectively analyzed. There were 5 males and 10 females with an average age of 70.3 years (range, 46-83 years). Surgical segment was L 4, 5 in 12 cases and L 5, S 1 in 3 cases. The disease duration was 12-30 months (mean, 18.7 months). All patients were treated by UBE via contralateral sublaminar approach. The operation time, intraoperative blood loss, postoperative hospital stay, and the occurrence of complications were recorded. The visual analogue scale (VAS) score was used to evaluate the degree of lower back and leg pain before and after operation; the Japanese Orthopaedic Association (JOA) score and the Oswestry disability index (ODI) were used to evaluate the lumbar function; and the clinical outcome was evaluated using the MacNab criteria at 6 months after operation. Postoperative MRI and CT were taken to observe whether the lateral saphenous fossa and intervertebral foramen stenosis were removed or not, and the cross-sectional area of the spinal canal (CSA-SC), cross-sectional area of the intervertebral foramen (CSA-IVF), and cross-sectional area of the facet joint (CSA-FJ) were measured. The operation time was 55-200 minutes (mean, 127.5 minutes); the intraoperative blood loss was 10-50 mL (mean, 27.3 mL); the length of postoperative hospital stay was 3-12 days (mean, 6.8 days). All patients were followed up 6-12 months (mean, 8.9 months). At 1 day, 1 month, 3 months, and 6 months after operation, the VAS scores of low back and leg pain and ODI scores after operation were significantly lower than preoperative scores and showed a gradual decrease with time; the JOA scores showed a gradual increase with time; the differences in the above indexes between different time points were significant ( P<0.05). The clinical outcome was rated as excellent in 10 cases, good in 4 cases, and poor in 1 case according to the MacNab criteria at 6 months after operation, with an excellent and good rate of 93.33%. Imaging review showed that the compression on the lateral saphenous fossa and intervertebral foramina had been significantly relieved, and the affected articular process joint was preserved to the maximum extent; the CSA-SC and CSA-IVF at 3 days after operation significantly increased compared to the preoperative values ( P<0.05), and the CSA-FJ significantly reduced ( P<0.05). The UBE via contralateral sublaminar approach can effectively reduce pressure in the lateral saphenous fossa and the intervertebral foramina of the same segment while preserving the bilateral articular process joints. The short-term effectiveness is good and it is expected to avoid fusion surgery caused by iatrogenic instability of the lumbar spine. However, further follow-up is needed to clarify the mid- and long-term effectiveness.

СПОСОБЫ ВЫПОЛНЕНИЯ МЕСТНОГО ПРОВОДНИКОВОГО ОБЕЗБОЛИВАНИЯ НА ВЕРХНЕЙ ЧЕЛЮСТИ (ЛИТЕРАТУРНЫЙ ОБЗОР)

Currently, both classical and improved methods of performing local conduction anesthesia on the upper jaw in the area of the infraorbital foramen are used in dental practice. Classical techniques for performing infraorbital anesthesia do not provide a wide area of anesthesia and the palatal surface of the alveolar process is not anesthetized, so an intraosseous method of administering an anesthetic in the area of the “crow’s foot” projection was proposed, but this method has the disadvantage of traumatizing the cortical plate of the alveolar process of the upper jaw in areas of intraosseous injection of local anesthetic. The Ushnitsky-Chakhov apparatus is used to perform infraorbital anesthesia using the extraoral method, but its use does not provide individualization of all parameters and structural features of the infraorbital canal, which often opens on the anterior surface of the body of the upper jaw with not one hole, but two or three, and therefore the clinical effectiveness of this type of pain relief in certain clinical cases is low. The variability of the anatomical and topographic parameters of the location of the infraorbital foramen, the structural features of the facial skeleton of each patient necessitates the search for new personalized methods of performing infraorbital anesthesia through individualization and the process of performing local conduction anesthesia by using a combination of x-ray and digital diagnostic methods, as well as the use of an individual navigation template that allows ensure the accuracy, safety and high clinical effectiveness of this method of conduction anesthesia when performing dental and other types of medical manipulations on the upper jaw.

The postoperative clinical effects of utilizing 3D printed (Ti6Al4V) interbody fusion cages in posterior lumbar fusion: A retrospective cohort study.

The research focused on the postoperative effect of using interbody fusion cage in lumbar posterior lamina decompression and interbody fusion with pedicle screw by comparing the postoperative effect of using 3D printing (Ti6Al4V) and PEEK material interbody fusion cage. Ninety-one patients with lumbar degenerative diseases from the Department of Spine Surgery of Tianjin Hospital were included in the study cohort. They were divided into 3D group (n = 39) and PEEK group (n = 52) according to the use of interbody fusion cage. The imaging data of the patients were collected and the postoperative data of the 2 groups were compared to evaluate patients' health status and the recovery of lumbar structure and function after operation. Combined with the degree of fusion, the clinical effect of 3D printing titanium alloy interbody fusion cage was comprehensively judged. At the last follow-up, the JOA score, ODI index, VAS, prolo function score, and SF-36 scale of the 2 groups showed that the clinical symptoms were better than those before operation (P < .05). The height of intervertebral disc, the area of intervertebral foramen and the physiological curvature of lumbar vertebrae increased in varying degrees after operation (P < .05). At the last follow-up, the vertebral cage fusion rates were as high as 89.13% and 90.91% in the 3D and PEEK groups, with collapse rates of 6.5% and 4.5%, respectively. There were 10 cases of cage displacement in 3D group and 7 cases of cage displacement in PEEK group. There was no significant difference between the 2 groups (P > .05). In conclusion, 3D printed (Ti6Al4V) interbody fusion cage can obtain good clinical effect in the surgical treatment of lumbar degenerative diseases. Posterior lumbar lamina decompression, bilateral pedicle screw fixation combined with 3D printed cage interbody fusion is excellent in rebuilding the stability of lumbar vertebrae. 3D printed interbody fusion cage can be an ideal substitute material for intervertebral bone grafting. The stable fusion time of interbody fusion cage after lumbar fusion is mostly from 3 months to half a year after operation.

Infraorbital nerve block for pain management in pediatric cleft lip surgery in resource-limited areas of Indonesia: A case series

Introduction and importanceCleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery. Case presentationThis case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively. DiscussionThe combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively. ConclusionInfraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.

Assessment and Identification of Improvement Areas for Facial Symmetry in Hemifacial Microsomia (Type IIB) Using Three-dimensional Measurements.

Surgical planning for hemifacial microsomia (HFM) patients often involves planning the amount of maxillary movement and mandibular bone distraction from three-dimensional (3D) volumetric images constructed from computed tomography scans. By representing anatomical indicators for facial symmetry in X, Y, and Z coordinates, we identified the more challenging areas in correcting facial asymmetry. The study included five HFM patients with a mean age of 22.2 years, all diagnosed with HFM (type IIB). We established measurement points with high reproducible 3D coordinates on the 3D volumetric images obtained from computed tomography scans for before surgery, treatment objectives, and after surgery. We assessed the symmetry of measurement points between the affected side and nonaffected side at each time point. In the before-surgery group, significant differences were observed between the affected side and nonaffected side in X,Y (excluding Palatine foramen, upper molar, canine) and Z coordinates for measurement items. In the treatment objectives group, no differences were observed between the affected side and nonaffected side in X, Y, and Z coordinates, resulting in facial symmetry. In the after-surgery group, significant differences were observed in Y coordinates in the mental foramen area, and significant differences were observed in z axis measurement items in the canine and mental foramen areas. It is evident that relying solely on a front view assessment is insufficient to achieve facial symmetry. Particularly, both anterior-posterior and vertical improvements in the area near the mental foramen on the affected side are necessary.

Morphometric analysis of cervical neuroforaminal dimensions from C2–T1 using computed tomography of 1,000 patients

BACKGROUNDRace and sex differences are not consistently reported in the literature. Fundamentally, anatomical differences of cervical neuroforaminal dimensions (CNFD) amongst these groups would be important to know. PURPOSETo establish normative radiographic morphometric measurements of CNFD and uncover the influence of patient sex, race, and ethnicity while also considering anthropometric characteristics. STUDY DESIGNRetrospective radiographic morphometric study. PATIENT SAMPLEA total of 1,000 patients between 18 and 35 years of age who were free of spinal pathology. OUTCOME MEASURESForaminal height, axial width, and area of cervical neural foramen. METHODSCervical CTs were reviewed to measure CNFD, defined as follows: foraminal height, axial width, and area. Statistical analyses were performed to assess associations between CNFD, and patient height, weight, sex, race, and ethnicity. RESULTSCNFD measurements followed a bimodal distribution pattern moving caudally from C2–T1. Irrespective of disc level, cervical CNFD were as follows: left and right widths of 6.6±1.5 and 6.6±1.5 mm, heights of 9.4±2.4 and 9.4±3.2 mm, and areas of 60.0±19.5 and 60.6±20.7 mm2. Left and right foraminal width were highest at C2–C3 and lowest at C3–C4. Left and right foraminal height were highest at C7–T1 and C6–C7, respectively and lowest at C3–C4. Left and right foraminal areas were highest at C2–C3 and lowest at C3–C4. Significant differences were observed for all CNFD measurements across disc levels. CNFD did not vary based on laterality. Significant CNFD differences were observed with respect to patient sex, race, and ethnicity. Male height and area were larger compared to females. In contrast, female foraminal width was larger compared to males. The Asian cohort demonstrated the largest foraminal widths. White and Hispanic patients demonstrated the largest foraminal heights and areas. Black patients demonstrated the smallest foraminal widths, heights, and areas. Patient height and weight were only weakly correlated with CNFD measurements across all levels from C2–T1. CONCLUSIONSThis study describes 36,000 normative measurements of 12,000 foramina from C2–T1. CNFD measurements vary based on disc level, but not laterality. Contrasting left- versus right-sided neuroforamina of the same level may aid in determining the presence of unilateral stenosis. Patient sex, race, and ethnicity are associated with CNFD, while patient anthropometric factors are weakly correlated with CNFD.

Analysis of clinical manifestations and imaging features of facial nerve schwannomas

Objective:To explore the clinical manifestations and imaging characteristics, and to clarify the imaging value in the diagnosis of facial nerve schwannomas. Methods:Retrospectively analyze the data of 23 patients with facial nerve schwannomas confirmed by surgery and pathology in the Department of Otorhinolaryngology of the First Affiliated Hospital of the Air Force Military Medical University from September 2020 to September 2022, including 8 males and 15 females, aged 18-66 years old. Summarize and analyze their clinical symptoms, specialized examinations, and imaging findings. Results:The clinical manifestations were facial nerve paralysis in 15 cases（2 cases of HB Ⅳ, 6 cases of HB Ⅴ, 7 cases of HB Ⅵ）, hearing loss in 14 cases（5 cases of conductive deafness, 2 cases of mixed deafness, and 7 cases of severe sensorineural hearing loss）, 8 cases tinnitus, 7 cases ear pain, 4 cases dizziness, 4 cases headache, 2 cases ear pus, and parotid gland tumors in 6 cases presenting as local masses. Endoscopic examination revealed 8 cases of external ear canal tumors and 3 cases of intratympanic tumors. Combining temporal bone HRCT, MRI enhanced scanning, and CPR imaging techniques, 1 case involved the internal auditory canal segment, 2 cases in the tympanic segment, 6 cases in the parotid gland area. A total of 14 cases involved two or more segments of the internal auditory canal segment, the labyrinthine segment, geniculate ganglion, the tympanic segment, and the mastoid segment. When the tumors were large, adjacent structures were involved. It was found that 8 cases invaded the external auditory canal and tympanic cavity, ossicles were displaced or bony destruction; 3 cases invaded the jugular foramen area, and 1 case grew to the middle cranial fossa region with temporal lobe brain parenchymal compression. Conclusion:The clinical manifestations of facial nerve schwannomas are diverse. The combination of various imaging techniques will be conducive to topical and qualitative diagnosis and provide an important basis for treatment strategies.

Clinical Observation of 10-mm Endoscopic Minimally Invasive Interlaminar Decompression in the Treatment of Ossified Lumbar Spinal Stenosis

This study aims to observe the safety and effectiveness of 10-mm endoscopic minimally invasive interlaminar decompression in the treatment of ossified lumbar spinal stenosis. The clinical data of 50 consecutive patients with ossified lumbar spinal stenosis were retrospectively analyzed. All patients underwent minimally invasive interlaminar decompression with 10-mm endoscope. Patient demographics, perioperative data, and clinical outcomes were recorded. Visual analog scale scores, Oswestry disability index scores, and modified Macnab criteria were used to assess clinical outcomes. The lateral recess angle, real spinal canal area, and effective intervertebral foramen area were used to assess the effect of decompression. The mean age of all patients was 59.0±12.3years. The mean operative time and intraoperative blood loss were 43.7±8.7minutes and <20ml, respectively. Two years after surgery, the leg pain Visual analog scale score decreased from 7.4±1.0 to 1.6±0.6 (P<0.05) and the Oswestry disability index score decreased from 63.8±7.6 to 21.7±3.4 (P<0.05). The lateral recess angle, real spinal canal area and effective intervertebral foramen area were significantly larger than before surgery (P<0.05). The overall excellent and good rate at the last follow-up was 92.0% according to the modified Macnab criteria. The 10-mm endoscopic minimally invasive interlaminar decompression can safely and effectively remove the ossification in the spinal canal and achieve adequate decompression in patients with ossified lumbar spinal stenosis.

Comparison of initial percutaneous balloon compression versus radiofrequency thermocoagulation followed by percutaneous balloon compression in the treatment of trigeminal neuralgia.

There are a variety of minimally invasive interventional treatments for trigeminal neuralgia, and the efficacy evaluation is different. The preferred treatment scheme is still controversial. This study aims to investigate the differences in treatment effects between patients with primary trigeminal neuralgia (PTN) treated with percutaneous balloon compression (PBC) for the first intervention and patients with pain recurrence after radiofrequency thermocoagulation (RT) who then received PBC for PTN, and to offer clinicians and patients more scientifically grounded and precise treatment alternatives. We retrospectively analyzed 103 patients with PTN admitted to the Department of Pain Management of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to December 2021, including 49 patients who received PBC for the first time (PBC group) and 54 patients who received PBC for pain recurrence after RT (RT+PBC group). General information, preoperative pain score, intraoperative oval foramen morphology, oval foramen area, balloon volume, duration of compression, and postoperative pain scores and pain recurrence at each time point on day 1 (T1), day 7 (T2), day 14 (T3), 1 month (T4), 3 months (T5), and 1 year (T6) were collected and recorded for both groups. The differences in treatment effect, complications and recurrence between the 2 groups were compared, and the related influencing factors were analyzed. The differences of general information, preoperative pain scores, foramen ovale morphology, foramen ovale area, T1 to T3 pain scores between the 2 groups were not statistically different (all P>0.05). The balloon filling volume in the PBC group was smaller than that in the RT+PBC group, the pain scores at T4 to T6 and pain recurrence were better than those in the RT+PBC group (all P<0.05). Pain recurrence was positively correlated with pain scores of T2 to T6 (r=0.306, 0.482, 0.831, 0.876, 0.887, respectively; all P<0.01). The choice of PBC for the first intervention in PTN patients is superior to the choice of PBC after pain recurrence after RT treatment in terms of treatment outcome and pain recurrence.

Comparison of bone reamer and trephine for foraminoplasty in percutaneous endoscopic lumbar discectomy based on 3D slicer and Digimizer software

ObjectiveTo explore the applicability of bone reamer and trephine for foraminoscopy in percutaneous endoscopic lumbar discectomy (PELD), and to provide a theoretical basis for foraminoplasty options in clinical practice.MethodsThis study was a prospective cohort study. Sixty-three consecutive patients who underwent PELD for lumbar disc herniation between May 2021 and July 2022 were analysed. Foraminoplasty were performed by bone reamer or trephine. The amount of bone removed and the foramen area enlarged during foraminoplasty by both tools were measured by 3D slicer and Digimizer software, and the numbers of fluoroscopic views were recorded.ResultsThe bone reamer removed less bone in the Superior Articular Process (SAP) than the trephine (t = 17.507, P < 0.001), and the area enlarged by the bone reamer was smaller than that of the trephine (t = 10.042, P = 0.002). The overall numbers of fluoroscopic views were significantly more in the bone reamer group than in the trephine group (t = 19.003, P < 0.001). In the bone reamer group, when the area of preoperative (FPZ) was no less than 54.55 mm2, the mean number of fluoroscopic views significantly decreased (t = 14.443, P = 0.001).ConclusionBone reamer was safer and trephine was more efficient for foraminoscopy in PELD. An area of preoperative (FPZ) of 54.55 mm2 can be used as a critical value: bone reamer reduced the risk for cases above the value, while trephine improved the efficiency for cases less than the value.

A digital redescription of the Middle Miocene (Langhian) carettochelyid turtle Allaeochelys libyca

Allaeochelys libyca is a carettochelyid turtle from the Middle Miocene of Libya. The species is the only valid carettochelyid taxon recovered from Africa and was named based on fragmentary material that includes a partial cranium and isolated shell remains. The description of the holotype cranium was limited to external aspects, and micro-computed tomography was only performed later on that material. Here, we use these micro-computed tomography scans to reinvestigate the external and internal anatomy of the holotype cranium to document several erroneous anatomical interpretations and provide new insights into the morphology of the trigeminal foramen area, the endosseous labyrinth, and circulatory system of Allaeochelys libyca. The anatomical insights provided herein have the potential to be translated into new phylogenetic characters that are expected to improve the resolution among the Anosteira and Allaeochelys lineages, which are still poorly resolved.

Sex Determination and Foramen Magnum Measurement (CT Study Case in Sulaimani Population)

Foramen magnum that is positioned under the sagittal suture and surrounded by the lateral, squamous, and basilar parts of the occipital bone is one of the most important structures in the base of the skull. Genetic, socioeconomic, and environmental factors have a significant impact on sexual dimorphism in F M dimensions which is population-specific. The present retrospective study was carried out in Sulaimani teaching hospital, Sulaimani, Iraq. The study sample consisted of 100 adult patients including 50 females and 50 males aged 20-70 years. All of the patients had CT scanned for their necks and heads over the period June 2017 to March 2019. In order to examine the foramen magnum, its sagittal diameter, transverse diameter, area, index, and circumference were measured. St udent’s t-test and histogram were used to analyze the data, and Receiver Operating Characteristic (ROC) curve and B inary Logistic Regression model were employed to obtain a model for sex determination. We found that women had a low er average value than men in our study. According to the independent t-test results; the genders were significantly different in terms of all measured parameters (p&lt;0.05). As demonstrated by the ROC curve, the predictability of the dimensions in sexing the crania for sagittal diameter, tr ansverse diameter, and area of foramen was respectively 76.0%, 66.0%, and 74.0%. The current study indicated a high per centage of sex predictability regarding the dimensions, areas, and circumference, which is because of the highly significant dif ference between the genders.

Correlation between Preoperative MRI Parameters and Oswestry Disability Index in Patients with Lumbar Spinal Stenosis: A Retrospective Study.

Background and Objectives: Lumbar spinal stenosis (LSS) is a degenerative condition posing significant challenges in clinical management. Despite the use of radiological parameters and patient-reported outcome measures like the Oswestry Disability Index (ODI) for evaluation, there is limited understanding of their interrelationship. This study aimed to investigate the correlation between preoperative MRI parameters and ODI scores in patients with LSS undergoing surgical treatment. Materials and Methods: A retrospective analysis was conducted on 86 patients diagnosed with LSS over a 5-year period. Preoperative MRI measurements, including the cross-sectional area of the psoas muscle, lumbar canal stenosis, neural foramina area, and facet joint osteoarthritis, were assessed. ODI scores were collected preoperatively and at a 1-year follow-up. Statistical analyses were performed using IBM SPSS Statistics software (version 26). Results: Weak to moderate correlations were observed between certain MRI parameters and ODI scores. The initial ODI score had a weak positive correlation with the severity of lumbar canal stenosis according to Schizas criteria (rho = 0.327, p = 0.010) and a moderate negative correlation with the relative cross-sectional area of the psoas muscle (rho = -0.498, p = 0.000). At 1-year follow-up, the ODI had a weak negative correlation with the relative cross-sectional area of the psoas muscle (rho = -0.284, p = 0.026). Conclusions: While the severity of LSS showed a weak correlation with initial ODI, it was not a predictor of 1-year postoperative ODI. Furthermore, although the cross-sectional area of the thecal sac, the sagittal area of the neural foramen, and the grade of facet joint osteoarthritis influence the imagistic severity, none of them correlate with ODI. These findings underscore the need for a comprehensive model that integrates multiple imaging and clinical parameters for a holistic understanding of LSS and its functional outcomes.

Case Report - Trauma Induced Vernet’s Syndrome

Trauma induced Vernet’s syndrome is a rare presentation and very few case reports exist in medical literature. Here we report a 40-year-old male with no significant medical history who presented with clinical features of right IX, X, and XI cranial nerve palsy after trauma to the neck and was diagnosed with right internal jugular vein thrombosis on imaging causing compression and symptoms. Patient symptomatically improved with anti-coagulation and was advised regular follow-up.&#x0D; This case report emphasizes on the need for identifying trauma induced thrombosis as one of the uncommon causes of Vernet’s syndrome with better prognosis and the need for early imaging techniques in such cases.&#x0D; The jugular foramen-crossing IX, X, and XI cranial nerves are paralyzed in Vernet syndrome. The posterolateral sulcus of the medulla oblongata is where the glossopharyngeal nerve, vagus nerve, and spinal accessory nerves emerge. They then travel via the basal cistern before leaving the skull by the jugular foramen.[1] Primary tumours like paraganglioma, meningioma, and schwannoma, metastatic tumours at the base of the skull, inflammation like meningitis and malignant otitis external, sarcoidosis, Guillain-Barre syndrome, vascular events like dissection, thrombosis, or aneurysm, and trauma are the main causes of Vernet syndrome.&#x0D; Vernet syndrome caused by trauma is incredibly rare and is typically brought on by penetrating trauma or fractures impacting the posterior skull base. Approximately 30 cases of Jugular foramen syndrome caused by a fracture in the jugular foramen area have been documented to date.[2,3] Only one posttraumatic Vernet case without a fracture has, however, been documented so far,[4] and this is one of them.

Contralateral laryngeal reinnervation in the patient with the right-sided vocal cord paralysis – case-report

Introduction: Paralysis of the nerves supplying the larynx leading to the vocal fold paralysis may have iatrogenic, proliferative, idiopathic or post-traumatic etiology. The most common etiology is iatrogenic, including a complication of the removal of paraganglioma tumors. One of the therapeutic options for vocal cord paralysis in the course of nerve damage is reinnervation of the larynx. One of the most frequently used reinnervation techniques is the anastomosis of the recurrent laryngeal nerve with the cervical ansa, usually ipsilateral or, less often, contralateral. Case presentation: The description concerns a 41-year-old patient with right-sided laryngeal paralysis after removal ofa paraganglioma of the parapharyngeal space, the area of the jugular foramen and the skull base who underwent laryngeal reinnervation using a contralateral cervical ansa. Conclusion: Laryngeal reinnervation procedure involving anastomosis of the recurrent laryngeal nerve with the contralateral cervical ansa allows recovery of the vocal fold function in a situation when the ipsilateral cervical ansa is damaged. This reinnervation involves taking a much longer section of the cervical ansa than in cases of ipsilateral reconstruction. Moreover this method requires creating a tunnel under the prelaryngeal muscles and passing the cervical ansa over the trachea or larynx.

Efficacy of OLIF combined with pedicle screw internal fixation for lumbar spinal stenosis on spinal canal changes before and after surgery

PurposeThe purpose of the study was to evaluate the efficacy of OLIF combined with pedicle screw internal fixation in the treatment of lumbar spinal stenosis by assessing the changes in spinal canal before and after surgery.MethodsIn this retrospective study, we included sixteen patients who underwent a combination of single-segment OLIF and pedicle screw internal fixation for the treatment of lumbar spinal stenosis at the Affiliated Hospital of Jiangxi University of Chinese Medicine between February 2018 and August 2022. The patients' pre- and post-operative data were compared. Intraoperative bleeding, duration of surgery, visual analogue score (VAS), Oswestry Disability Index (ODI), disc height (DH), cross-sectional area of vertebral canal (CSAVC), cross-sectional area of dural sac (CSADS), cross-sectional area of intervertebral foramen (CSAIF), spinal canal volume (SCV), spinal canal volume expansion rate, lumbar lordosis, and sagittal vertical axis were observed and recorded. The efficacy of OLIF combined with pedicle screw internal fixation for lumbar spinal stenosis on spinal canal changes before and after surgery was summarized.ResultsThe results showed that OLIF combined with pedicle screw internal fixation effectively restored disc height and increased the cross-sectional area of the spinal canal. It also had an indirect decompression effect. The intraoperative bleeding and duration of surgery were within acceptable ranges. The VAS and ODI scores significantly improved after surgery, indicating a reduction in pain and improvement in functional disability. The CSAVC, CSADS, CSAIF, SCV, and spinal canal volume expansion rate were all increased postoperatively. Additionally, there was improvement in lumbar lordosis and sagittal vertical axis. We conducted a follow-up of all patients at 1 year after the surgery. The results revealed that the parameter values at 1 year post-surgery showed varying degrees of decrease or increase compared to the immediate postoperative values. However, these values remained statistically significant when compared to the preoperative parameter values (P < 0.05).ConclusionsOLIF combined with pedicle screw internal fixation effectively restores disc height and increases the cross-sectional area of the vertebral canal in patients with LSS, reflecting the indirect decompression effect. Measuring parameters such as DH, CSAVC, CSADS, CSAIF, SCV, and SCV expansion rate before and after surgery provides valuable information for evaluating the efficacy and functional recovery of the lumbar spine in LSS patients treated with OLIF surgery.