Level Of Canal Research Articles

Root and root canal morphology of the permanent dentition in a Caucasian population: a cone-beam computed tomography study.

To investigate invivo the number of roots, the configuration of the root canal system and the root canal splitting and merging levels in the permanent dentition of a Caucasian population. A total of 11892 teeth were inspected in cone-beam computed tomography examinations that were collected from a pre-existing database. The number of roots was identified, and canal configurations were classified according to Vertucci's classification and its supplemental configurations. In addition, the merging and separation positions along the length of the root canal were identified. The Z-test was used to analyse the differences between independent groups. A value of P<0.05 was considered significant. The majority of tooth types had considerable variation in the number of roots and root canal configuration types. Radix entomolaris and paramolaris were rare occurrences. The mesiobuccal root of the maxillary first and second molars had two root canals in 71% and 44% of cases, respectively. Nearly 30% of the mandibular incisors had two root canals. Root canal merging and splitting appeared more often in mandibular teeth. Merging was more common in the middle third of the root canal in the maxillary teeth and in the middle and apical thirds in mandibular teeth. Root canal splitting did not exhibit a tendency, and their position along the length of the root canal varied from tooth to tooth. Clinicians must be aware that each tooth may display several types of root canal configuration. However, a greater variability in root canal configuration was found in maxillary second premolars and in the mesiobuccal roots of maxillary molars. Main root canal merging and splitting may also be expected to occur at any level of the root canal.

Lumbosacral Transitional Vertebrae Cause Spinal Level Misconception in Surgeries for Degenerative Lumbar Spine Disorders.

Human lumbar spine usually consists of five vertebrae; however, some individuals have vertebral anomalies with four or six lumbar vertebrae because of sacralized fifth lumbar vertebra (L5 sacralization) or lumbarized first sacral vertebra (S1 lumbarization), respectively. These vertebral anomalies are called lumbosacral transitional vertebra (LSTV). Although LSTV is an asymptomatic anomaly, it is known to cause misconception in spinal counts and in spinal level at lumbar spinal surgery. The purpose of this study is to evaluate how LSTV affects the diagnosis and surgeries in lumbar spine disorders. In 550 consecutive patients who underwent lumbar spinal surgeries, a whole-spine X-ray was taken on admission to assess the true number of lumbar vertebrae. We assessed the coherence between the neurological level diagnosis and the level of spinal canal stenosis on imaging studies before and after the recognition of LSTV to clarify how recognition of LSTV affected pre-operative surgical planning. Out of 550 patients, LSTV was found in 71 (12.9%) patients: 37 cases with L5 sacralization and 34 cases with S1 lumbarization. The number of vertebrae was miscounted at the outpatient department (OPD) in 38 cases (54%): 10 L5-sacralization cases and 28 S1-lumbarization cases. Moreover, surgical spinal levels were altered from the original surgical plans at OPD in 11 cases (15%; 3 L5-sacralization and 8 S1-lumbarization cases), after recognizing the true spinal counts by the whole spine X-ray. To avoid errors in spinal level diagnosis, we should recognize the possibility of LSTV that could be assessed by a whole spine X-ray.

Sacrotuberous Ligament Healing following Surgical Division during Transgluteal Pudendal Nerve Decompression: A 3-Tesla MR Neurography Study.

Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the sacrotuberous ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9–55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2–3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock’s canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4–5 mm) in the group of prior STL division without repair and 8 mm (range, 8–9 mm) in the group with the STL reconstructed with grafts (p<0.05). The group of healed STLs were significantly thicker than the normal STL (p<0.05). We conclude that a surgically divided STL will heal spontaneously and will be significantly thicker after healing.

Prospective Randomized Trial Comparing Titanium Clips to Bipolar Coagulation in Sealing Lymphatic Vessels During Pelvic Lymph Node Dissection at the Time of Robot-assisted Radical Prostatectomy

Lymphocele is the most common complication after pelvic lymph node dissection (PLND). Over the years, various techniques have been introduced to prevent lymphocele, but no final conclusion can be drawn regarding the superiority of one technique over another. In this prospective study, 220 patients undergoing robot-assisted radical prostatectomy between 2012 and 2015 were randomized to receive titanium clips (group A, n=110) or bipolar coagulation (group B, n=110) to seal lymphatic vessels at the level of the femoral canal during extended PLND (ePLND). Ultrasound examination was used to detect lymphoceles at 10 and 90 d after surgery. Lymphocele was defined as any clearly definable fluid collection and was considered clinically significant when requiring treatment. There were no statistically significant differences between groups A and B regarding overall lymphocele incidence (47% vs 48%; difference −0.91%, 95% confidence interval [CI] −2.6 to 0.7; p=0.9) and the rate of clinically significant lymphocele [5% vs 4%; difference 0.75%, 95% CI, 0.1–3.2; p=0.7]. The two groups were comparable regarding mean (±SD) lymphocele volume (30±32 vs 35±39ml; p=0.6), lymphocele location (unilateral, 37% vs 35%, p=0.7; bilateral, 13% vs 14%, p=0.9), and time to lymphocele diagnosis (95% vs 98% on postoperative day 10; p=0.5). In conclusion, this trial failed to identify a difference in lymphocele occurrence between clipping and coagulation of the lymphatic vessels at the level of the femoral canal during robot-assisted ePLND for prostate cancer. Patient summaryIn this study we compared the frequency of postoperative complications after sealing lymphatic vessels from the leg to the abdomen using metallic clips or electrical coagulation during robot-assisted surgery for prostate cancer. We found no difference in postoperative complications between the two methods.

Diagnosis and management of spermatic cord tumors.

Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics, diagnosis, and management of SCT. Although the majority of SCT are benign, when malignant almost all SCT are sarcomas. Liposarcomas are the most common; whereas rhabdomyosarcomas recorded the highest tendency of develop distant metastases. The clinical presentation is usually a unilateral solid slow-growing mass at the level of the inguinal canal and of the scrotum. Surgical excision represents the most common used treatment, and considering the risk in developing local recurrence, radical inguinal orchiectomy and resection of the tumor with negative microscopic surgical margins is mandatory. Adjuvant therapies such as radiotherapy and chemotherapy have been suggested in selected patients, but clear data to demonstrate any improvement in survival are not available. SCT are rare tumors with high risk of misdiagnosis or mistreatment. The majority are benign, but when malignant almost all are sarcomas. A surgical excision is the treatment of choice; however, no clear data exists documenting the efficacy of a multimodal treatment in reducing high local recurrence rates after surgery.

Comparison Between Different Endodontic Irrigating Protocols In Smear Layer Removal From Radicular Dentin

The aim of our study was to measure the cleaning efficiency of irrigating solutions used during endodontic treatment regarding smear layer removal from the root canal dentin walls. Ethylenediaminotetraacetic acid (EDTA) 17%, citric acid (CA) 10% and sodium hypochlorite (NaOCl) 2,5 % solutions were tested as final irrigating solutions. The study was conducted on extracted teeth, divided in four groups according to the irrigation protocol used. The specimens were analyzed by scanning electron microscopy and the amount of smear layer present at apical, middle and coronal level was recorded, based on a scoring system. Data were statistically analyzed using Kruskal-Wallis and Friedman test and the level of significance was set at p&lt;0.05. In the coronal and middle segments of dental roots we noticed no statistically significant difference between EDTA and CA in smear layer removing capacity. Final irrigation with 17% EDTA proved to be more efficient than 10% CA and 2,5% NaOCl in smear layer removal at apical level of the root canal, with p&lt;0.05 (p=0.042), which is an important area for disinfection in endodontic treatment.

LIGHT TRANSMISSION THROUGH POSTS TO SIMULATED REGIONAL ROOT CANAL USING DIFFERENT CURING SOURCES

Statement of problem: Light-activated luting agents have become an indispensable material for clinical dental use. However, it remains debatable as to which level, the light curing unit pro­vides sufficient intensity of light to achieve polymerization. Purpose: The purpose of this study was to assess quantitatively the light intensity transmitted from three different light sources through translucent glass fiber posts with sequential cuts at depths of 15 mm, 10 mm, 5.0 mm Materials and Methods: A 15 x 30 mm hollow Teflon ring was used. 60 specimens were prepared and assigned randomly into three groups (n=20 per each) according to the curing source. Within each group, 15 specimens were used for the experimental and 5 for the control group. For the experimental ones, a self-cure acrylic resin with black pigment was poured into the ring. A translucent glass fiber post was placed in the center of each ring and held in position till com­plete polymerization was occurred. For the control groups, the black resin blocks were filled with a lubricated dowel for its later removal. Therefore, the resin blocks with internal hollow orifices were obtained without the dowel. After preparing the blocks, readings for the passage of light will be made at the apical, middle , and cervical third level, involving dowel lengths of 15, 10, 5 mm respectively. A 40-second light exposure was used for each specimen and curing unit combina­tion .The output of light intensity was recorded. Mean light intensities were analyzed with 2-way ANOVA test followed by Kruskal-Wallis tests at α = 0.05. Results: Two-way ANOVA results of light intensities for the experimental and control groups demonstrated significant differences between the light curing units (P<0.001) and the root level (P<0.001). Moreover, their interaction was also significantly different (P<0.001). For the experi­mental groups, Kruskal Wallis test revealed the highest quantity of light intensity was recorded for the high power LED curing unit at the cervical level of the root canal. For the control groups, the highest quantity of light intensity was displayed for the HPLED curing unit at the cervical level of the root canal. Conclusions: The quantity of the light intensity transmitted from three different light sourc­es are significant different through translucent glass fiber posts with sequential cuts at depths of 15 mm, 10 mm , 5.0 mm

The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation.

ObjectiveThis study analyzed retrospectively the bladder function of patients after early surgery for cauda equina syndrome (CES) performed within 24 or 48 hours, or after 48 hours of the onset of autonomic symptoms.MethodsWe retrospectively reviewed the clinical data of 31 patients after decompression surgery for lumbar disc herniation (LDH) who had been diagnosed with CES between January 2001 and December 2014 at Inha University Hospital. The following factors were assessed to evaluate the influence of time to surgery: bladder function, rectal incontinence, sexual dysfunction, LDH level, and degree of spinal canal compression.ResultsAfter decompression, the outcome group was categorized into normal bladder function and abnormal bladder function. The patients operated on within 48 hours showed an improved postoperative outcome. Among 16 patients operated on within 48 hours, 13 (81%) recovered normal bladder function. In contrast, among 15 patients with decompression after 48 hours, 6 (40%) recovered normal bladder function. Among 21 patients with mild bladder dysfunction at admission, 16 (76%) recovered normal bladder function after decompression.ConclusionOur study suggests that patients who have decompression surgery within 48 hours of the onset of bladder dysfunction, improve their chances of recovering bladder function than those who have a late operation (>48 hours). Also, patients with mild bladder dysfunction are more likely to recover bladder function after decompression, than patients with severe bladder dysfunction.

The Facial Nerve Palsy in Skull Base Lesions

Facial nerve paralysis may ensue after the removal of a CPA tumor or a petroclival meningioma encroaching at the level of the internal auditory canal.

Assessment of the Nonoperated Root after Apical Surgery of the Other Root in Mandibular Molars: A 5-year Follow-up Study

IntroductionIf a surgical approach is chosen to treat a multirooted tooth affected by persistent periapical pathosis, usually only the affected roots are operated on. The present study assessed the periapical status of the nonoperated root 5 years after apical surgery of the other root in mandibular molars. MethodsPatients treated with apical surgery of mandibular molars with a follow-up of 5 years were selected. Patient-related and clinical parameters (sex, age, smoking, symptoms, and signs of infection) before surgery were recorded. Preoperative intraoral periapical radiographs and radiographs 5 years after surgery were examined. The following data were collected: tooth, operated root, type and quality of the coronal restoration, marginal bone level, length and homogeneity of the root canal filling, presence of a post/screw, periapical index (PAI) of each root, and radiographic healing of the operated root. The presence of apical pathosis of the nonoperated root was analyzed statistically in relation to the recorded variables. ResultsThirty-seven patients fulfilled the inclusion criteria. Signs of periapical pathosis in the nonoperated root 5 years after surgery (PAI ≥ 3) could be observed in only 3 cases (8.1%). Therefore, statistical analysis in relation to the variables was not possible. The PAI of the nonoperated root before surgery had a weak correlation with signs of apical pathosis 5 years after surgery. ConclusionsNonoperated roots rarely developed signs of new apical pathosis 5 years after apical surgery of the other root in mandibular molars. It appears reasonable to resect and fill only roots with a radiographically evident periapical lesion.

Thickened internal anal sphincter has been reported to be a typical finding in solitary rectal ulcer syndrome.

tion disorder among patients with solitary rectal ulcer syndrome (SRUS). The study showed that SRUS patients with abnormal balloon expulsion test had thicker internal anal sphincter (IAS), compared to those with normal tests. In fact, thickened IAS has been reported to be a typical endoanal sonographic finding in SRUS. 2,3 This finding could be associated with hypertrophy, possibly resulting from chronically increased work demand. A thickened IAS in patients with SRUS also is reported to be highly predictive of high-grade rectal intussusception. 4 Therefore, the result of Sharma et al’s study is not a novel finding but adds to the body of evidence demonstrating thickened anal sphincter as a typical endoanal feature in SRUS. As far as we know, several measuring points are required for the assessment of IAS thickness, since the thickness of IAS is not uniform. However, we could not find detailed methods for the measurement of IAS thickness in their article. We present typical endoscopic and sonographic findings of SRUS in a 59-year-old woman. She was referred to our constipation clinic for refractory constipation. Colonoscopy showed large ulcer with fold convergence (Figure A). The thickness of the IAS was measured at 4 different circumferential points. Endoanal sonography demonstrated thickened IAS irrespective of the level of anal canal (Figures B and C). Pathology showed fibrous obliteration and extension of smooth muscle fibers into the lamina propria. The confirmatory diagnosis of SRUS was made based on clinical presentation, endoscopic appearance and characteristic histologic features.

In vitro correlation of the level of inferior alveolar canal with CBCT imaging.

The aim was to correlate the level of the inferior alveolar canal on cadaver specimens and as evaluated with three-dimensional radiographic cone-beam computed tomography (CBCT) imaging. Twenty-one skulls with intact mandibles (42 inferior alveolar canals) were imaged with an I-CAT Cone-Beam 3D Imaging System and multi-planar reformatted images obtained were scored to assess the level of the canal (Level I, Level II, and Level III). The mandibles were later dissected and level of the canal was directly visualized, scored, and further correlated with results from CBCT imaging. There was no difference in the level of the inferior alveolar canal between the dissected cadaver specimen and CBCT images. Also, there was no statistically significant difference in the level of the canal among the gender assigned to the specimens and corresponding CBCT images. There were no statistical differences in the level of the canal (cadaver specimen vs. CBCT) between the left and right sides of the specimens, as studied individually. Our study indicates that there is close correlation of the level of the inferior alveolar canal between cadaver specimens and CBCT images. Well-designed studies would be required to further validate the findings in this study.

Radiographic observation of nasolacrimal canal in congenital nasolacrimal canal agenesis

To explore the radiographic characteristics of nasolacrimal canals in congenital nasolacrimal canal agenesis. Retrospective case series study. The images of Computed Tomography of 18 children with unilateral congenital nasolacrimal canal agenesis who were treated in Beijing Children's Hospital from January 2009 to June 2013 were studied. The common features of abnormal lacrimal canals were analyzed. The heights of bilateral lacrimal canals, anterioposterior and transverse diameters at the original level of lacrimal canal were measured. The traverse diameters, anteroposterior diameters, heights of bony nasolacrimal duct between affected side and normal side were compared using paired t tests. The initial segment of abnormal nasolacrimal canal showed no obvious abnormalities, but it became significant stenosis or even atresia at the middle and terminal segments. The transverse (4.72 ± 0.79) mm and anterioposterior diameters (5.45 ± 1.07) mm of affected sides were larger than the values of normal sides (3.42 ± 0.67) mm, (4.35 ± 1.01) mm at the original level of nasolacrimal canal with statistically significance (t = 5.665, P = 0.000; t = 6.610, P = 0.000). However, the height of nasolacrimal canal of normal sides were larger than the affected sides (t = 5.931, P = 0.000). Atresia position of congenital nasolacrimal canal agenesis always located in the terminal segment. High pressure in the nasolacrimal duct caused by bony obstruction leaded to the enlargement of nasolacrimal canal in affected side.

The correlation between ossification of the nuchal ligament and pathological changes of the cervical spine in patients with cervical spondylosis.

A retrospective clinical data analysis. This study was conducted to investigate the correlation between ossification of the nuchal ligament (ONL) and pathological changes of the cervical spine in patients with cervical spondylosis. ONL can usually be found in cervical spondylosis. Thus, it is important to find the correlation between ONL and pathological changes of the cervical spine in patients with cervical spondylosis. The medical records of 100 patients with cervical spondylosis with the local type of ONL (ONL group) and 50 patients with cervical spondylosis only (control group) were reviewed. Data analysis included patients' sex, age, location of ONL, maximum cord compression level, osteophyte height ratio, and grade of cervical intervertebral disc degeneration. Radiological features were evaluated by lateral plain radiography and magnetic resonance imaging. In total, 69.0% of subjects in the ONL group had ONL located at the maximum cord compression level; there was no difference based on sex (P = 0.248). The value of the osteophyte height ratio was higher at the ONL level than at its superior and inferior adjacent segments (P < 0.001). The osteophyte height ratio was also significantly different at the C4-C5 (P < 0.001) and C5-C6 (P = 0.008) levels between the ONL group and the control group. There was a significant difference in distribution of intervertebral disc degeneration grading between the ONL level and superior adjacent segments (P = 0.028), as well as inferior adjacent segments (P = 0.049). The distribution of intervertebral disc degeneration grading at the C5-C6 level between patients whose location of ONL and maximum cord compression level were both at C5-C6 and patients whose maximum cord compression level was at C5-C6 in the control group was also significantly different (P = 0.035). The location of ONL commonly corresponds to the most stenotic level of the spinal canal. The location of ONL also correlates with the level of osteophyte formation and intervertebral disc degeneration, indicating that ONL has correspondence to instability-related cervical pathological changes in cervical spondylosis.

Surgical Treatment of Complicated Sacrum Fractures in Unstable Pelvic Injuries. Treatment Experience

The majority of unstable pelvic injuries are accompanied by sacrum fractures of different localization. Experience in treatment of 8 patients with multiple concomitant injuries and sacrum fractures at the level of sacrum canal (Denis 3) is presented. All patients with acute condition were admitted into intensive care unit and underwent complex examination. At this step of intensive care the complexity of sacrum fractures and nerve injuries diagnosis is conditioned by the severity of patient’s condition. Patients with pelvic injuries require careful examination for detection of sacrum and nerve injuries in this region. However taking into account the multiplicity of injuries the emergency operation for nerve roots revision is not expedient. At rendering care to such patients the basic principles should be the conception of injuries control with preference given to stable and functional methods of fracture fixation. In our opinion all Denis 3 fractures with neurologic disorders require decompression-stabilizing operations that enable to mobilize patients, to determine and probably to improve the prognosis of neurologic pathology.

A Guyon’s canal ganglion presenting as occupational overuse syndrome: A case report

BackgroundOccupational overuse syndrome (OOS) can present as Guyon's canal syndrome in computer keyboard users. We report a case of Guyon's canal syndrome caused by a ganglion in a computer user that was misdiagnosed as OOS.Case presentationA 54-year-old female secretary was referred with a six-month history of right little finger weakness and difficulty with adduction. Prior to her referral, she was diagnosed by her general practitioner and physiotherapist with a right ulnar nerve neuropraxia at the level of the Guyon's canal. This was thought to be secondary to computer keyboard use and direct pressure exerted on a wrist support. There was obvious atrophy of the hypothenar eminence and the first dorsal interosseous muscle. Both Froment's and Wartenberg's signs were positive. A nerve conduction study revealed that both the abductor digiti minimi and the first dorsal interosseus muscles showed prolonged motor latency. Ulnar conduction across the right elbow was normal. Ulnar sensory amplitude across the right wrist to the fifth digit was reduced while the dorsal cutaneous nerve response was normal. Magnetic resonance imaging of the right wrist showed a ganglion in Guyon's canal. Decompression of the Guyon's canal was performed and histological examination confirmed a ganglion. The patient's symptoms and signs resolved completely at four-month follow-up.ConclusionClinical history, occupational history and examination alone could potentially lead to misdiagnosis of OOS when a computer user presents with these symptoms and we recommend that nerve conduction or imaging studies be performed.

Surgical Treatment of Complicated Sacrum Fractures in Unstable Pelvic Injuries. Treatment Experience

The majority of unstable pelvic injuries are accompanied by sacrum fractures of different localization. Experience in treatment of 8 patients with multiple concomitant injuries and sacrum fractures at the level of sacrum canal (Denis 3) is presented. All patients with acute condition were admitted into intensive care unit and underwent complex examination. At this step of intensive care the complexity of sacrum fractures and nerve injuries diagnosis is conditioned by the severity of patient’s condition. Patients with pelvic injuries require careful examination for detection of sacrum and nerve injuries in this region. However taking into account the multiplicity of injuries the emergency operation for nerve roots revision is not expedient. At rendering care to such patients the basic principles should be the conception of injuries control with preference given to stable and functional methods of fracture fixation. In our opinion all Denis 3 fractures with neurologic disorders require decompression-stabilizing operations that enable to mobilize patients, to determine and probably to improve the prognosis of neurologic pathology.

Comparing operative exposures of the le fort I osteotomy and the expanded endoscopic endonasal approach to the clivus.

Objectives We compare surgical exposures to the clivus by Le Fort I osteotomy (LFO) and the expanded endoscopic endonasal approach (EEEA). Methods Ten cadaveric specimens were imaged with 1.25-mm computed tomography. After stereotactic navigation, EEEA was performed followed by LFO. Clival measurements included lateral and vertical limits to the midline lower extent of exposure (t test). Results For EEFA and LFO, respectively, maximal lateral exposure in millimeters (mean ± standard deviation) was 24.5 ± 3.7 and 24.5 ± - 3.8 (p = 0.99) at the opticocarotid recess (OCR) and 25.1 ± - 4.1 and 24.1 ± - 3.0 (p = 0.53) at the foramen lacerum level; lateral reach at the hypoglossal canals was 39.0 ± - 5.88 and 56.1 ± - 5.3 (p = 0.0004); and vertical extension was 56.0 ± - 4.1 and 56.3 ± - 3.4 (p = 0.78). Conclusions For clival exposures, LFO and EEEA were similar craniocaudally and laterally at the levels of the OCR and foramen lacerum. LFO achieved greater exposure at the level of the hypoglossal canal.

MRI anatomy of anteriorly displaced anus: what obstructs defecation?

Anteriorly displaced anus is an anomaly that is debated with regard to its nomenclature, diagnosis and management. To describe MRI anatomy of the anal canal in children with anteriorly displaced anus and its impact on the process of defecation. We prospectively examined ten children (7 girls, 3 boys; age range 7months to 8years, mean 3years) with anteriorly displaced anus between August 2009 and April 2012. Noncontrast MRI examinations were performed on a 1.5-T magnet. T1- and T2-weighted turbo spin-echo images were acquired in axial, sagittal and coronal planes of the pelvis. The anorectal angle and the relative hiatal distance were measured in mid-sagittal images, and compared with those of a control group using the Mann-Whitney test. In children with anteriorly displaced anus, no anatomical abnormality was depicted at the level of the proximal anal canal. However, the distal anal canal was displaced anteriorly, running out its external muscle cuff, which remained un-displaced at the usual site of the anus. This changes the orientation of the central axis of the anal canal by passing across instead of along the fibers of the longitudinal muscle coat. Children with anteriorly displaced anus had a more obtuse anorectal angle (mean 112.1°), which was significantly greater than that of the control group (mean 86.2°). MRI is a valuable tool in studying the anatomy of the anal canal in children with anteriorly displaced anus. The abnormal orientation of the longitudinal muscle across the anal canal can explain the obstructed defecation in these children. Based on this study, it might be of interest to use MRI in studying equivocal cases and children with unexplained constipation.

Treatment Decisions in 330 Cases Referred for Apical Surgery

IntroductionApical surgery is an important treatment option for teeth with postendodontic apical periodontitis. However, little information is available regarding treatment planning in cases referred for apical surgery. This study evaluated the decisions made in such cases and analyzed the variables influencing the decision-making process. MethodsThe study retrospectively assessed clinical and radiographic data of 330 teeth that had been referred to a specialist in apical surgery with regard to the treatment decisions made in those teeth. The clinical and radiographic variables were divided into subcategories to analyze which factors influenced the decision-making process. ResultsThe treatment decisions included apical surgery (59.1%), tooth extraction (25.8%), no treatment (9.1%), and nonsurgical endodontic retreatment (6.1%). Variables that showed statistically significant differences comparing treatment decisions among subcategories included probing depth (P = .001), clinical attachment level (P = .0001), tooth mobility (P = .012), pain (P = .014), clinical signs (P = .0001), length (P = .041) and quality (P = .026) of the root canal filling, and size (P = .0001) and location (P = .0001) of the periapical lesion. ConclusionsThis study shows that apical surgery was the most frequently made treatment decision in teeth referred to a specialist in apical surgery, but every fourth tooth was considered nonretainable and was scheduled for extraction. The data showed that the most common variables that influenced the decision to extract teeth were teeth with an increased probing depth and tooth mobility and teeth presenting with lesions not located at the apex.