Level Of Canal Research Articles

How I do it - endoscopic endonasal optic nerve decompression for traumatic optic nerve neuropathy.

Traumatic optic neuropathy (TON) consists of damage to the optic nerve following head injury and affects about 0.5-5% of patients with closed head injuries. It is characterized by a sudden decrease in visual acuity and/or visual field loss. Surgical treatment is usually warranted when ongoing compression occurs at the level of the optic canal. We describe the technical nuances of endoscopic endonasal approach for compressive TON and add evidence supporting this approach as a valid option to treat this condition.

Patterns of Pulpal Mineralization in Mandibular Anteriors: A Micro-computed Tomography Analysis

IntroductionCurrent understanding of the morphology of pulpal mineralizations is limited. Understanding the specific location and type of such mineralizations will aid clinicians in diagnosis, case complexity assessment, and treatment planning. Therefore, this study correlated the appearance of a reduced canal volume (CV) in conventional radiographs with the presence of pulp mineralizations (PMs) utilizing micro-computed tomography (CT) analysis. The morphology of PMs utilizing micro-CT technology was also analyzed. MethodsOne hundred and twenty-one extracted permanent mandibular incisors were collected. Periapical radiographs were taken of the teeth to determine if a reduced canal space was present, in which case the sample was included for micro-CT assessment. Various descriptors for PM were then determined and these labels were then applied to the entire sample to demonstrate PM. Numerical analysis was undertaken for all teeth scanned; the following data was extracted: the presence or absence of PMs, types of PM, and their morphological structures; CVs were determined. Cohen's kappa test was used to assess intraexaminer agreement. ResultsBased on radiographic appearance, forty-two teeth were included for micro-CT analysis. PMs were demonstrable in 57% and absent 43% of teeth. When PMs were absent, the CV was significantly smaller compared to when they were present (P < .05). Discrete mineralizations were more frequently located in the coronal and middle thirds compared to diffuse mineralization (P < .01). No differences in the prevalence of the individual features of discrete or diffuse mineralizations were detected (P > .05). ConclusionsTwo detectable forms of PMs were found in micro-CT analysis at all levels of the canal: discrete and diffuse mineralizations. A reduced CV on a PA was reflective of mineralized changes within the pulp but the type of PM could not be determined. PMs occurred at any level of the root canal; clinicians need to be aware of this when performing root canal treatment.

Transcutaneous Transmission of Light of Photobiomodulation Therapy Wavelengths at 808 nm, 915 nm, 975 nm, and 1064 nm to the Spinal Canal of Cadaver Dogs

This study compared the transcutaneous target level irradiances from the thoracic to lumbar segments of the interior spinal canal in three cadaver dogs, measured for light at four wavelengths (808 nm, 915 nm, 975 nm, and 1064 nm), common in photobiomodulation therapy (PBMT). Intra-spinal irradiances at nine sites spanning approximately 8 cm in length were measured using a flexible intra-spinal probe under surface application of continuous-wave (CW) light with powers ranging from 0.5 W to 2 W. Surface illumination was applied using an acupuncture treatment head in three modes: non-contact with skin removed, non-contact with skin intact, and contact with skin intact. During surface application, the treatment head was positioned over the spinal canal near the 13th vertebrae (T13, surface site 1), and approximately 4 cm (surface site 5) and 8 cm (surface site 9) caudal to T13. At each position of the treatment head, the light was multiplexed among the four wavelengths at the same power setting. In all three modes of surface application, the target level irradiance at the 1064 nm wavelength was significantly greater than that at the other three wavelengths (p ≤ 0.0017). At a surface irradiance of ~157 mW/cm2, corresponding to 0.5 W light applied with the treatment head directly in contact with the skin, the intra-spinal irradiance at 1064 nm reached 0.137 ± 0.095 mW/cm2. Obtaining a dosage of PBMT-associative wavelengths of this magnitude at the level of the spinal canal may guide focused research into the transcutaneous applicability of PBMT for spinal cord injuries.

Changes of video head impulse test before and after translabyrinthectomy in patients with acoustic neuroma.

Acoustic neuroma (AN) is a benign tumor that usually affects a patient's hearing and balance function. For the screening and diagnosis of AN, the traditional approach mainly relies on audiological examination and magnetic resonance imaging (MRI), often ignoring the importance of vestibular function assessment in the affected area. As an emerging method of vestibular function detection, video head impulse test (vHIT) has been widely used in clinic, but research on its use in AN diagnosis is relatively limited. This study aims to explore the value of vHIT in the diagnosis of AN, vestibular dysfunction assessment, and postoperative compensation establishment in unilateral AN patients undergoing unilateral AN resection through labyrinthine approach. This retrospective study was conducted on 27 AN patients who underwent unilateral AN resection via labyrinthine approach from October 2020 to March 2022 in the Department of Otolaryngology-Head and Neck Surgery, the Second Xiangya Hospital, Central South University. vHIT was performed 1 week before surgery to assess vestibular function, pure tone audiometry (PTA) was used to assess hearing level, and ear MRI was used to assess tumor size. Follow-up vHIT was conducted at 1 week, 1 month, 6 months, and 1 year post-surgery. The correlation of vHIT with hearing and tumor size was analyzed. Preoperative vHIT showed that the posterior semicircular canal on the affected side was the most common semicircular canal with reduced vestibulo-ocular reflex (VOR) gain. There was a correlation between the VOR gain of vHIT on the affected side and the hearing level (r=-0.47, P<0.05) or tumor size (r=-0.54, P<0.01). The results of vHIT on the affected side showed that the hearing level and mean VOR gain of the anterior semicircular canal increased slightly with time, and the amplitude and saccade percentage of the dominant saccades of the 3 semicircular canals increased, while the latency time decreased, with the most obvious changes occurring 1 week post-surgery. vHIT can effectively monitor the changes of vestibular function in AN patients before and after surgery and has application value in assisting the diagnosis of vestibular dysfunction in AN patients.

The Utilization of Fine-Needle Vasography to Localize Obstruction of the Male Reproductive Tract

ObjectivesTo report our experience using fine needle vasography (FNV) to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia. MethodsWe report a multi-institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or cryptozoospermia, presence of palpable vasa, testicles ≥12 ml, and FSH <7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. FNV was performed using a 25-gauge angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR). ResultsA total of 16 patients underwent vasography from 2014-2022 with three surgeons. Twelve patients presented with azoospermia, and four with cryptozoospermia. A total of 7 (44%) men were found to have distal obstruction on FNV. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis. ConclusionFNV is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia / cryptozoospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction (EDO) and other causes of blockage.

CUBITAL TUNNEL SYNDROME LITERATURE REVIEW

The article describes the symptoms, main methods of diagnosis and treatment of ulnar nerve neuropathy at the level of the cubital canal. Indications for surgical treatment have been determined. The most common operations indicated for this pathology are described.

Features of the reparative process after antiglaucoma surgery

Excessive fibrosis and scarring of newly created aqueous humor outflow pathways, mainly at the level of the intrascleral canal and filtering bleb, is a significant disadvantage of the so-called bleb-dependent antiglaucoma surgery. Taking into account the fact that aqueous humor, which flows evenly through the non-healing fistula under the hermetically sutured conjunctiva, is the forming substrate for the newly created outflow pathways, its composition also plays an important role in the body's response to surgical trauma. A large number of publications reliably demonstrate an increase in the concentration of various biologically active molecules in the aqueous humor of the anterior chamber of glaucoma patients. These are transforming growth factor β (TGF-β), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), interleukins IL-6 and IL-8, etc., which concentration in cases of unsuccessful outcome of trabeculectomy was significantly increased compared to patients who underwent successful surgeries. In addition, it has been established that an imbalance of various matrix metalloproteinase pools, fibroblast activation, wound infiltration by neutrophils and macrophages, which in turn express a significant amount of pro-inflammatory cytokines and growth factors, contribute to the prolongation of inflammation and fibrosis. An important condition for the removal of aqueous humor from the filtering bleb area is the postoperative activation of conjunctival lymphatic angiogenesis, which suppression may be associated with prolonged inflammation or the active use of cytostatics. This literature review presents the complexities of the pathophysiological mechanisms of postoperative healing and the formation of newly created aqueous humor outflow pathways after antiglaucoma operations. At the same time, the question remains open about the effect of initial changes not only on the tissues of the ocular surface, but also in the aqueous humor of the anterior chamber, as well as the general condition of patients on the outcome of the operation.The purpose of this review is to present modern literature data on the pathophysiological mechanisms of the wound healing process and the features of postoperative healing regulation after antiglaucoma surgery.

Topohistology of the cranial nerves IX-XII at the cranial base and upper parapharyngeal space: A histological study using human fetuses.

The topographical relationships among the lower cranial nerves, internal carotid artery (ICA), and internal jugular vein (IJV) in the upper parapharyngeal neurovascular bundle remain obscure. Thus, details of the anatomy were examined in human fetus histology. We observed the horizontal histological sections from 20 midterm (9-18 weeks) and 12 near-term (28-40 weeks) fetuses. At the external skull base, the glossopharyngeal nerve crosses the anterior aspect of the IJV to reach the medially located Hyrtl's fissure in the petrous temporal bone. The nerve crossed the anterior aspect of the ICA medially near or below the first cervical nerve root. Below the hypoglossal nerve canal, the accessory nerve crosses the anterior or posterior aspects of the IJV and moves laterally. During the half-spiral course, the hypoglossal nerve was tightly attached to the posterolateral-anterior aspects of the vagus nerve and surrounded by a common nerve sheath. The glossopharyngeal ganglia sometimes extended inferiorly to the level of the hypoglossal nerve canal but were absent along the inferior course. The inferior vagal ganglion rarely extends above the occipital condyle. The superior cervical sympathetic ganglion occasionally extends above the first cervical nerve root. The IJV (or ICA) descends to the lateral (or medial) margins of the parapharyngeal neurovascular bundle. The glossopharyngeal (or accessory) nerve crosses the ICA (or IJV) to exit the bundle at the base of the skull (or below the hypoglossal nerve canal). The glossopharyngeal and vagus inferior ganglia differ at each site.

Facial and Cochlear Nerves Outcomes in the Surgical Resection of Giant Vestibular Schwannoma: Is There Any Predictive Value for Intraoperative Neuromonitoring of the Facial Nerve?

Background: Giant vestibular schwannoma (VS) represents one of the most challenging interventions in skull base surgery. Preserving facial and cochlear nerves requires effective surgical planning and nuanced techniques. Objectives: The present study evaluates the role of intraoperative neuromonitoring (IONM) in predicting the outcome of facial and cochlear nerves. Methods: This retrospective cohort comprised 34 patients with a giant (Samii IV/IVb grade) VS during 2016 - 2019. The retrosigmoid approach was used for tumor resection. Pre- and postoperative facial exams were graded according to the House-Brackmann Scale. Hearing ability was also classified according to the Hannover Hearing Classification. Intraoperative findings included the location of the nerve complex, tumor consistency, the surgical plane of the tumor from the facial nerve/ brainstem, and the level of internal auditory canal (IAC) decompression. Intraoperative neuromonitoring was used for all surgeries. The amplitude required for a positive response was recorded during the facial nerve's direct electrical stimulation (DES). All patients were followed 6 and 12 months postoperative. Results: The preoperative facial nerve function was normal in 91.2% of patients, and 8.8% had slight facial nerve impairment (FNI). Considering preoperative hearing status, 9 cases (26.5%) had moderate hearing loss or impairment, while 25 patients (73.5%) complained of severe hearing impairment. The mean intraoperative direct facial nerve stimulation threshold was 1.38 ± 0.89. Hearing impairment was moderately severe in 7 (20.6%) and severe in 25 patients (73.5%) postoperation. In addition, postoperative assessment revealed 13 (38.2%) cases with moderate FNI and 12 (35.2%) with moderately severe FNI. The tumor size did not affect the postoperative hearing loss, and the postoperative hearing loss did not improve significantly (P = 0.32). There was no statistically significant correlation between the intensity of intraoperative DES and postoperative facial nerve function (P &gt; 0.05). No significant correlation was observed between tumor consistency and postoperative hearing status (P &gt; 0.05). Conclusions: The retrosigmoid approach combined with IONM appears to be associated with favorable facial and cochlear nerve outcomes in giant VS. The postoperative facial nerve function may improve, but sensorineural hearing status may not improve significantly. Moreover, the intensity of intraoperative DES may not predict the postoperative facial function. Therefore, the findings of IONM should be interpreted carefully.

Neurological Analysis Based on the Terminal End of the Spinal Cord and the Narrowest Level of Injured Spine in Thoracolumbar Spinal Injuries.

This study aimed to clarify neurological differences among the epiconus, conus medullaris, and cauda equina syndromes. Eighty-seven patients who underwent surgery for acute thoracolumbar spinal injuries were assessed. We defined the epiconus as the region from the terminal end of the spinal cord to the proximal 1.0 to 2.25 vertebral bodies, the conus medullaris as the region proximal to < 1.0 vertebral bodies, and the cauda equina as the distal part of the nerve roots originating from the spinal cord. On the basis of the distance from the terminal end of the spinal cord to the narrowest level of the spinal canal, the narrowest levels were ordered as follows: the epiconus followed by the conus medullaris and cauda equina. The narrowest levels were the epiconus in 22 patients, conus medullaris in 37 patients, and cauda equina in 25 patients. On admission, significantly more patients had a narrowed epiconus of Frankel grades A-C than a narrowed cauda equina. At the final follow-up, there were no significant differences in neurological recovery among those with epiconus, conus medullaris, or cauda equina syndrome. Anatomically classifying the narrowest lesion is useful for clarifying the differences and similarities among these three syndromes.

Accuracy of Root ZX Electronic Apex Locator in Relation to Two Different Employment Protocols: An In Vitro Study.

Objective The aim of this study is to determine the apical level of the root canal, whether it is the apical foramen or a level coronal to it, that Root ZX (J. Morita Co., Kyoto, Japan) targets and to identify its employment protocol that provides better accuracy. Methods Actual lengths (ALs) of 75 extracted single-rooted teeth were obtained by inserting a K-file size 8 until its tip was in level with the most coronal border of the apical foramen. Reference length (RL) was calculated by deducting 0.5 mm from AL. Roots were placed in porous sponge block soaked with Ringer's solution, and canals were irrigated with 2 mL of 5% sodium hypochlorite. The blinded operator used Root ZX to measure lengths with K-file size 8. In the first tested employment protocol, the file was advanced to the "APEX mark" of the digital display, and the length was obtained. The second employment protocol followed the manufacturer's recommendations by inserting the file until the "APEX mark" followed by its withdrawal to the "0.5 mark." Stability of the digital meter for 5 seconds was mandatory before recording the lengths. All measurements were repeated one week later and then both measurements were averaged to represent "APEX mark" and "0.5 mark," respectively. Data were analyzed using t-test, with significance set at 0.05. Results Regardless of the employment protocol, most registered lengths were longer than targeted. The mean "APEX mark" was significantly longer than the mean AL (P=0.000), and the mean "0.5 mark" was significantly longer than the mean RL (P=0.000). Although the mean "0.5 mark" was longer than the mean AL, the difference was not significant (P=0.07). Conclusion The apical level of the root canal targeted by the Root ZX was the apical foramen. The most accurate employment protocol to achieve that is to use the Root ZX according to the manufacturer's recommendations.

Multiplanar analysis of proximal humerus anatomy of patients with rotator cuff arthropathy and relevance to reverse shoulder press-fit stems

Short stems have become increasingly popular in reverse shoulder arthroplasty (RSA) due to their ability to preserve bone stock for revision surgery. However, short stems may be more at risk for malalignment or loosening, and commercially available stems have varied designs. The purpose of this study was to perform a multiplanar analysis of proximal humerus anatomy in patients with rotator cuff arthropathy to better define canal geometry and identify differences based on sex. A retrospective review was performed of a consecutive series of patients undergoing RSA for rotator cuff arthropathy. A total of 117 patients were identified with preoperative computed tomography scans. Measurements were undertaken following multiplanar reconstruction of the computed tomography scans. Measured parameters included the following: transition point (TP), anteroposterior (AP) and mediolateral (ML) distances, intramedullary (IM) and bone diameter, and cortical thickness. The TP was defined as the distance from the periosteal border of the greater tuberosity to the level of the IM canal where the endosteal borders became parallel. Measurements started at the metaphysis, and then proceeded 25 and 50 mm distal to the metaphysis followed by 10 mm increments thereafter. Each level was compared to the level above with t tests in the overall cohort and separately by sex. Height was correlated to ML-AP difference and IM diameter with Pearson correlation coefficient. Potential stem sizes that extended 50, 60, 70, and 80 mm from the metaphysis were analyzed to record the percentage of patients in whom the stem would reach past the TP. The mean TP for all patients was 55.6±7.4 mm (37.5-78.4) from the greater tuberosity, 53.3±6.6 mm (37.5-67.0) in females and 58.1±7.5 mm (41.9-78.4) in males. ML and AP distances and IM diameter became consistent at level 3 (mean, 83 mm distal to the greater tuberosity) in the overall cohort and in both sexes. Height positively correlated with IM diameter. Males had significantly larger IM diameters compared to females at all levels. Cortical thickness remained relatively consistent throughout the proximal humerus. A stem length of 70 mm would extend past the TP in 98% of patients. Humeral implants in RSA with a stem of at least 70 mm in length would extend distally past the TP in the majority of cases regardless of sex. At this point, the canal's area remains consistent which would facilitate diaphyseal fixation if required.

(248) Utility of Fine-needle Vasography in Men with Obstructive Azoospermia

Abstract Introduction Obstructive azoospermia accounts for up to 14% of patients presenting for fertility evaluation. Fine-needle vasography (FNV) is a diagnostic procedure that can be performed to identify an obstruction proximal to the ejaculatory duct. Compared to traditional vasography, FNV utilizes a less-invasive method to perform imaging of the vas deferens and distal ejaculatory structures. Herein we report our experience performing FNV in a series of patients with suspected complete or near-complete obstruction. Objective To report our experience using FNV to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia. Methods We report a multi-Institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or severe oligoasthenospermia, presence of palpable vasa, testicles ≥12 ml, and FSH &amp;lt;7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. Fine-needle vasography was performed using a 25F angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR). Results A total of 16 patients underwent vasography between 2014 and 2022 with three surgeons. Twelve patients presented with azoospermia, and four with severe oligoasthenospermia. Median age at vasography was 35.0 (IQR 17) years. Median pre-vasography semen parameters were sperm concentration 0 million/mL (IQR 0.3), sperm motility 0% (IQR 1), semen volume 2.5 mL (IQR 2.5), and semen pH 8.0 (0.7). Median total testosterone was 445 ng/dL (IQR 433), and FSH 4.5 IU/L (IQR 3.6). Half of patients had a history of inguinal hernia repair, unilateral in two and bilateral in six cases. History of genitourinary infection was present in six (35.3%) patients. A total of 7 (44%) men were found to have distal obstruction on FNV, while 8 (50%) were offered epididymovasal reconstruction. Of the seven patients diagnosed with obstruction/atresia of the vas deferens within the inguinal canal and/or pelvis, only two were related to prior inguinal hernia repair. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis. Conclusions Fine-needle vasography is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia or severe oligoasthenospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction and other causes of blockage. Disclosure No

An inter-observer assessment of mastoid pneumatization and degree classification using sigmoid sinus: comparing two levels of temporal bone computed tomograms

BackgroundThe degree of mastoid pneumatization of the temporal bone (TB) has been implicated in the pathogenesis of TB diseases and surgical implications, and planning of a few otologic surgeries. However, there is lack of consensus in the classification of the degree of pneumatization. This study aimed to suggest a simple, quick, and less-burden classification system for assessing and rating the degree of pneumatization by comparing two levels of TB computed tomographs (CTs) using the SS as a reference in an inter-observer assessment among otologists.MethodsThis was a randomized pilot survey among otologists. A questionnaire consisting of different axial CTs of TB taken at two levels: the level of malleoincudal junction (MIJ) and the level of lateral semicircular canal (LSCC), with different pneumatization patterns, was used to assess participants' impressions of the degree of pneumatization. The terms “hypo-,” “moderate,” “good,” and “hyper-” pneumatization were listed as options to rate their impressions on the degree of mastoid pneumatization of the TB images using the SS as a reference structure. Likert scale was used to assess their level of agreement or disagreement with using SS as a reference in evaluating mastoid pneumatization.ResultsParticipants who correctly rated images taken at the level of LSCC according to their respective degree of pneumatization were significantly higher (p < 0.05) regardless of their year of experience compared to those that correctly rated corresponding images taken at the level of MIJ. A 76% positivity in their level of agreement with the use of sigmoid sinus in evaluating mastoid pneumatization was observed on the Likert-scale chart.ConclusionFindings from this study suggest that evaluating air cells around the SS at the level of LSCC on CTs could be easier in assessing and classifying the degree of mastoid pneumatization.

Lumbar spinal bony canal measurement in a Palestinian population using CT scan: a retrospective study

Purpose: Establishing the normal range of lumbar spinal canal in the Palestinian population helps provide a quantitative method for assessing spinal canal abnormalities in the lumbar region. Materials and Methods: The data was gathered from Governmental Hospital in Nablus from January to July 2018. It is a cross-sectional descriptive study among 400 patients (201 males, 199 females), ranging from 20 to 60 years. CT scan radiographs were used to measure the canal and the vertebral body diameters to obtain the canal body ratio. Results: The results represent the normal ratio of dimensions at each level of the bony lumbar spinal canal. The measurements presented are taken at the level of each lumbar vertebra starting from the 1st down to the fifth lumbar vertebra. It was found that the mean ratio of the spinal canal increases from L1 down to L5. Conclusion: After analyzing each lumbar level's results, the mean ratio of the spinal canal increases from L1 to L5. In addition, there were no significant differences between males and females regarding the measurement tool.

A radioanatomical study of 3rd segment terminal branches of the maxillary artery in the pterygopalatine fossa

This study describes the clinical anatomical topography and relationship of the terminal branches of the maxillary artery to the bony wall of the maxillary sinus in the pterygopalatine fossa (PPF) to estimate the bleeding risk during surgical interventions. Using contrasted computer tomography records, (i) the route of the maxillary artery in the infratemporal fossa, (ii) the number of the arteries in the critical PPF surgery plane, (iii) the diameter of the largest artery in the area and (iv) its relation to the posterior wall of the maxillary sinus were examined. Furthermore, measurements were extended with (v) the minerality of the bony posterior wall of the maxillary sinus on bone-window images. For statistical analyses Student’s t- and Fisher-test were applied. 50 patients (n = 50, 100 cases including both sides) were examined in this study. The maxillary artery reached the pterygomaxillary fissure on the lateral side of the lateral pterygoid muscle in 56% of the cases (n = 32), in 37% (n = 23) on its medial side and in 7% (n = 4) on both sides. The number of arteries at the level of the Vidian canal in the PPF varied between 1 and 4 with a median of 2. The diameter of the biggest branch was 1.2–4.7 mm, the median diameter was 1.90 mm. In 41% (n = 30) of the cases the biggest artery directly contacted the posterior wall of the maxillary sinus, and the mineral density of the posterior wall was decreased in 14.3% (n = 12) of all investigated cases. The present description and statistical analysis of the vasculature of the PPF optimizes operative planning—like clip size or the type and direction of the surgical approach—in this hidden and deep head/neck region.

The effect of two different root canal sealers on treatment outcome and post-obturation pain in single-visit root canal treatment: A prospective randomized clinical trial.

This randomized clinical trial aimed to evaluate and compare the effect of mineral trioxide aggregate (MTA)-based bioceramic- and resin-based sealers on the incidence and intensity of post-obturation pain and treatment outcome in asymptomatic vital molar teeth in single-visit root canal treatment. One hundred asymptomatic mandibular molar teeth with vital pulp were randomly assigned into two groups according to the sealer used: MTA Fillapex or AH Plus sealer. WaveOne Gold instruments were used for root canal preparations. Root canals were obturated with WaveOne Gold gutta-percha cones corresponding in size and taper to the last instrument used. MTA Fillapex was used in the first group and AH Plus was used in the second group as the root canal sealer. The effects of age, gender, tooth types and the level of root canal filling on the treatment outcome were evaluated after 1 and 2 years. Postoperative pain at 6, 12, 24, 48, 72 h, 4, 5, 6, 7 and 30 days after root canal treatment was measured with the Numerical Rating Scale. Chi-square test was used for the treatment outcome and Mann-Whitney U, chi-Square and Spearman correlation analyses were used for postoperative pain. α=.05 was the level of significance. Twelve patients did not complete the 2-year follow-up and the study finished with 88 patients. In the MTA Fillapex group 41 correct, one short, two extruded, and in the AH Plus group 40 correct, one short and three extruded root canal fillings were detected. No significant differences were observed between the first- and second-year treatment outcomes between the groups (p > .05).There was no association between age, gender, tooth number, root canal filling length and the treatment success in all evaluated teeth (p > .05). The differences between the groups in terms of postoperative pain incidence and intensity at all time-points were not significant (p > .05). There was no correlation between the age and postoperative pain (p > .05), but pain was statistically higher in women (p < .05). Mineral trioxide aggregate Fillapex showed similar success rate and post-obturation pain incidence and intensity as AH Plus sealer and can be used as a root canal sealer in asymptomatic mandibular molars with irreversible pulpitis.

Endonasal Exposure of Lateral Recess of the Sphenoid Sinus: Significance of Pterygoid Process Pneumatization.

Caudal pneumatization of the pterygoid process may impact endonasal exposure of the lateral recess of sphenoid sinus (LRSS). This study aims to explore the implications of a pneumatized pterygoid process for an endonasal transpterygoid approach to the LRSS and to define strategies regarding the preservation or sacrifice of the vidian nerve. Dissection of the LRSS (11 sides) was performed on 6 cadaveric specimens, preselected for the radiographic presence of an LRSS. In addition, the dimensions of the LRSS were measured on the deidentified CT images of 120 patients (240 sides). The sphenoid sinus was subdivided into 3 categories: Type 1 (no identifiable LRSS), Type 2 (lateral pneumatization of the greater wing above the vidian canal), and Type 3 (pneumatization of both the greater wing and the pterygoid process). On the cadaveric specimens, a Type 2 pneumatization often allowed access to the LRSS above the level of the vidian canal; thus, sparing the vidian neurovascular bundle. In Type 3 pneumatization, a frontal corridor through the pterygoid base could be created to reach the LRSS with preservation of the vidian nerve. Extreme Type 3 pneumatization, however, required the transposition or sacrifice of the vidian nerve to facilitate a full direct access to the superolateral LRSS. Measurements on CT images revealed that the extent of caudal pneumatization of the pterygoid process had no statistically significant correlation with the superolateral extension of the lateral recess in patients with Type 3 LRSS (P > .05). Pneumatization of the LRSS toward a caudal or superolateral direction may develop independent from each other. Caudal pneumatization of the pterygoid process seems to variably impact the endonasal exposure of the LRSS.

Evaluation of the Bond Strength of Epoxy Resin-based Sealer Following Different Calcium Hydroxide Paste Removal Methods in Oval-shaped Root Canal

The study aimed to investigate the bond strength of epoxy resin-based sealer following five different calcium hydroxide paste removal methods in oval-shaped root canals. Sixty single-rooted human mandibular premolars having an oval-shaped root canal as evidenced by radiographs were decoronated and instrumented to size 40/0.04, medicated with calcium hydroxide paste for 7 days, before being randomly assigned to the conventional needle irrigation (CNI), manual dynamic agitation (MDA), sonic irrigation (SI), passive ultrasonic irrigation (PUI), and XP-endo Finisher (XP) groups to be irrigated using different irrigation systems. All specimens were then obturated using an epoxy resin-based root canal sealer and warm vertical compaction obturation technique. After 7 days, each specimen was sectioned into 1 mm root slices at the coronal, middle, and apical third of the root canal and tested for the push-out bond strength using a universal testing machine. The XP group was the only group that had comparable bond strength to the control group at every level of the root canal following removal of calcium hydroxide medicament (p >0.05). The control group had higher bond strength than the CNI group at every level of the root canal (p < 0.05). Calcium hydroxide interfered with the bonding of epoxy resin-based sealer to root canal walls. Irrigation with the XP increased the bonding sealer at every level of the root canal. The XP was efficacious as a final rinse agitation technique to promote the bonding of the epoxy resin-based sealer at every level of the root canal following calcium hydroxide medication.

The anatomical relationship between the mandibular first molar roots and the mandibular canal based on breed size and skull type.

The first molar is the largest tooth in the dog mandible with roots often extending to the level of the mandibular canal (MC). The anatomical relationship between the roots and MC is variable and the normal relationship between those structures in a diverse population of dogs has not been established. The lingual location of the roots relative to the MC poses a risk for iatrogenic trauma during dentoalveolar surgery, and it is unknown if certain skull conformations are predisposed to this relationship. This study aimed to identify associations between patient weight and skull type with molar tooth root location. CT scans performed for reasons unrelated to the study were retrospectively analyzed. Subjects were sorted into one of 12 groups (n=16 per group) based on skull type (brachycephalic, mesaticephalic, and dolichocephalic) and weight (extra small: ≤ 6.8 kg, small: >6.8 to ≤ 13.6 kg, medium: >13.6 to ≤ 25 kg, and large >25 to ≤ 38.6 kg). The mandibular first molar roots were categorized as lingual, buccal, or dorsal relative to the MC. Lingual root location was diagnosed in 50.0% of all roots evaluated, and 64.2% of all dogs assessed had at least one root in the lingual position. The size was shown to be protective, with lingual root location being significantly less likely as size increased. The exception to this was in large brachycephalic patients, which had rates of lingual roots similar to smaller dogs. Buccal roots were rarest, diagnosed in only 9.7% of all roots, and were most common in brachycephalic patients, which had 83.8% of all buccal roots. Additional caution should be employed when removing alveolar bone during surgical extraction in dogs ≤ 13.6 kg and in large brachycephalic patients (boxers) to avoid iatrogenic trauma to the neurovascular bundle.