Mastoid Research Articles

An Analysis of Hearing Outcomes in Children with Hutchinson-Gilford Progeria Syndrome

Aims/Background Few hearing loss studies have been conducted in patients with progeria, and only the possibility of low-frequency conductive hearing loss has been mentioned. The primary objective of this study is to perform a comprehensive analysis of the clinical audiological characteristics of children with Hutchinson-Gilford progeria syndrome (HGPS), and the secondary objective is to analyse the causes of their hearing loss and what can be done to enable them to hear as well as possible. Methods Ten children with HGPS underwent impedance audiometry (tympanogram), otoacoustic emissions, and pure-tone audiometry tests. Otoscopic examination and imaging were also performed in the patients with abnormal hearing. Results Five patients had normal hearing, while the other five had varying degrees of hearing impairment manifesting as mild to moderate low-frequency or full-frequency conductive hearing loss. Otoscopic examination of those patients with abnormal hearing showed a narrowing of the external auditory canal, a thinning of the tympanic membrane, and a distorted cone of light. Further, computed tomography of one patient showed a poorly defined temporal bone morphology with scant pneumatization of the mastoid process. Conclusion Patients with HGPS differ from normally aging individuals with a predominant conductive pattern of hearing loss as opposed to sensorineural deafness, with more lower-frequency hearing impairment due to poor pneumatization of the mastoid process and the possible formation of osteophytes in the temporal bone.

Finds of skulls of juvenile <I>Kurdalagonus maicopicus</I> (Сetacea, Cetotheriidae) in the upper Miocene of the Republic of Adygea

Fragments of two skulls of young cetotherium baleen whales have been described from the Fortep’yanka 2 locality (Russia, Republic of Adygea, Maikop district, Fortep’yanka river valley, Upper Miocene, Upper Sarmatian, Blinovskaya Formation). Based on the morphology of the posterior (mastoid) process of the petrous bone, the structure of the posterior edge of the temporal fenestra, and the S-shaped shape of the superoccipital ridges, the finds were attributed to Kurdalagonus maicopicus (Spasskii, 1951). The proportions of the skull and the degree of closure of the sutures of the skull made it possible to determine the individual age of these whales within a year. New findings significantly complement the data on the structure of the sutures of the lateral wall of the skull and age-related variability of cranial morphology in representatives of the genus Kurdalagonus.

The Sternocleidomastoid Muscle Reverse Pad: A “Safety Net” in Catastrophic Tracheal Surgery Situation

Background: This paper presents the outcomes of employing the inferiorly based rotated sternocleidomastoid muscle flap in complex tracheal reconstruction/repair scenarios, focusing on the key objectives of ensuring stable airway, functional digestive tract and patient survival. Methods: A retrospective analysis was performed for patients treated at two medical centers (A.O. San Camillo Forlanini, Rome, and A.O.U. Careggi, Florence) from 2011 to 2023, in which the sternocleidomastoid muscle (SCM) flap, detached from the mastoid and basicranium, was rotated on the lower pivot directly onto the repair site and pedicled to the sternal origin to ensure the continuity of the airway. Average postoperative hospital stay, follow-up period and patient survival were analyzed. Follow-up assessments encompassed bronchoscopies and CT scans conducted at intervals of 15 and 28 days, and subsequently at 3 and 9 months. Results: A total of five patients were enrolled in this study. These cases included one patient with anterior tracheal wall lesions with abundant tissue loss, one patient with an anterior wall necrosis due to descending cervical mediastinitis and three patients with extra-long tracheoesophageal fistulas (TEFs) (greater than 4.5 cm or >30% of the total tracheal length). In the case of the direct repair of a TEF with a proximal tracheal stenosis, the sternocleidomastoid muscle was used to reconstruct the tissue deficit caused by extensive loss of substance in the left lateral side of the tracheal wall. In case of repair through exclusion of the TEF, the sternocleidomastoid muscle was interposed between the visceral sutures after exclusion of the TEF by an endomechanical device, in one case even substituting the membranous part of the tracheal wall. Our technique allows rotation on the sternal head of the sternocleidomastoid muscle with the lowest rotation radius, pedicled to the sternal origin, detached from the mastoid process and superior nuchal line, thus providing optimal vascularization from the superior thyroid artery/external carotid artery and accessory vasculature from the suprascapular artery. Patients exhibited uneventful postoperative recovery concerning airway and digestive patency. The mean postoperative hospitalization duration was 41 days. The follow-up assessments were negative for postoperative complications. Conclusions: The use of sternocleidomastoid muscle flap was proposed to ensure repair and protection of the suture margin or to constitute a portion, as a scaffold, of the wall by leveraging the muscle’s vascularization and thickness. This technique may be considered a leading component in managing complex situations in tracheal surgery.

Role of High-Resolution Computed Tomography in Classifying Pneumatization of the Temporal Bone: Typical Patterns, Prevalence, and Implications

Introduction: Pneumatization patterns in the temporal bone have been implicated in the prognostic outcomes of various pathological conditions, such as cholesterol granulomas, otitis media, and cholesteatomas. This study investigated how high-resolution computed tomography (HRCT) helps to classify pneumatization patterns in the temporal bone, exploring its impact on the pathogenesis, surgical outcomes of temporal bone diseases, and its association with age and gender. Methods: HRCT of temporal bone of fifty patients of age 13 years and more with normal findings were included. The petrous apex, mastoid, and infra-labyrinthine regions’ pneumatization patterns were categorized using previously published grading methods. Results: The dominant pattern of pneumatization in the petrous apex was classified as group 2, indicating that less than 50% of the pneumatization was located medially in the labyrinth. Conversely, in the mastoid, the prevailing pattern was group 4, which signifies hyper-pneumatization. In the infra-labyrinthine region, the prevailing pattern was categorized as type B, indicating limited pneumatization. It was found that patients who exhibited augmented pneumatization in one compartment of the temporal bone tended to display similar changes on the opposite side and in other compartments on the same side (P < 0.05). Importantly, it was observed that younger age (P < 0.001) and male gender (P = 0.001) were associated with increased pneumatization in the petrous apex and infra-labyrinthine compartments. Conclusion: Different compartments of temporal bone show varying degrees of pneumatization. The level of pneumatization of the temporal bone is highly associated with age and sex.

Clinical outcomes after post-operative radiotherapy for breast cancer patients presenting with ipsilateral supraclavicular metastasis: considerations on the cranial border of irradiation field.

Disease recurrence at lower neck adjacent to ipsilateral supraclavicular (SCV) region represents a concern in locally advanced breast cancer patients presenting with SCV metastasis at diagnosis. This study aims to report the outcomes following post-operative radical radiation therapy and discuss the reasonable cranial border of the irradiation field for N3c patients. Between July 2016 and January 2022, a total of 268 patients were eligible for analysis. The endpoints included in-field and out-field cervical failures, local-regional recurrence-free survival (LRRFS), SCV recurrence-free survival (SRFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS). During a median follow-up of 37months (range 3-89months), 17 patients (6.3%) developed local-regional recurrence as the first recurrence event, with 13 having concomitant distant-metastasis (DM); 56 patients (20.9%) had DM alone. The 3-year rates of LRRFS, SRF, DMFS, RFS, and OS were 92.3%, 94.5%, 74.5%, 73.0%, and 90.0%, respectively. 89.2% of patients received RT with the cranial border at the top of hyoid bone, and 95.1% of patients received a boost not exceeding the level of cricoid cartilage. A total of 11 patients (4.1%) developed ipsilateral SCV failure, and 3 patients (1.1%) experienced cervical failure, including 2 in-field failures and 1 out-field failure. Neoadjuvant systemic therapy (NST) was administered to 234 patients (87.3%). In the multivariate analysis, non-ypN0, triple-negative subtype and cT4 at diagnosis were predictors of worse SRFS and RFS in NST subgroup. Our findings suggest that radical RT with cranial border of irradiation field at the hyoid bone level lead to excellent local-regional control, and out-field cervical failure was rare. The irradiation field might not extend to mastoid process.

PETAL – LIKE OTOPLASTY IN THE TREATMENT OF PROTRUDING EARS

Introduction. Approximately 5% of humanity suffers from inborn protruding ears, and usually this condition causes marked psychosomatic disorders. Despite years of experience gained in aesthetic surgery, optimal technique of otoplasty is yet to be elaborated. The Aim of the Research. To develop a method of surgical correction of congenital bulging ears in order to optimize the immediate and long-term results of otoplasty. Material and methods. We have analysed the outcomes of 120 patients operated for congenital protruding ears at Lviv City Cosmetologic Hospital between 2020 and 2023. Distance between mastoid process and the concha exceeding 20 mm, and auriculo-cephalic angle over 30° were used as objective criteria of protruding ears. Surgical improvement of tall concha and increased auriculo-cephalic angle were identified as key vectors in elaboration of the original otoplasty technique. Results of the Research. With local anaesthesia, an S-shaped incision is made to the depth of perichondrium of posterior surface of the cartilage of the ear. Once subcutaneous dissection is completed, preoperative markup is transferred with injection needles from anterior surface to posterior surface of the conchal cartilage. A full depth arch-shaped incision of conchal cartilage is made. Perichondrium and skin of anterior surface of the concha are mobilized with a raspatory, from the chondral «petal» to the margin of external meatus. Basis of the chondral «petal» is dissected by 2/3 of its depth along the vertical axis between the pedicle of the helix, and the antitragus. In order to reliably fix the auricula, the cartilage is stitched to the mastoid process with three mattress sutures on the ventral surface of the «petal». Finally, excessive skin is carefully resected, and the wound is closed with continuous suture, with dead space elimination for hematoma prevention. Our technique has the following significant advantages: Unique conchal cartilage is kept entirely, therefore it can be used as auto-transplant in the future. The technique does not significantly affect the rheology of auricula. With this technique correction and modification of antihelical curve and radius is possible; if necessary, width of auricula can be corrected, and auricular height to width ratio can be modified. The proposed «petal» technique significantly reduces the rate of postoperative complications, such as recurrent protruding ears. Postoperatively, the size of external meatus is not reduced, hence no hearing deterioration. The outcomes of the technique we have developed were assessed 6 months after otoplasty as good, satisfactory and unsatisfactory. Good outcome: preservation of symmetry and anatomical «standard» of both auriculas, no recurrence throughout follow-up, and no impairment of sensation in the external ear. Satisfactory outcome: anatomical «standard» of the organ is preserved, with permissible error of up to 3 mm in the symmetrical points on the right and left auriculas, not requiring additional correction. Conclusions. 98 (81,3%) patients operated by the proposed «petal» technique assessed their otoplasty outcome as good, 17 (14,3%) of patients assessed the outcome of surgery as satisfactory. 5 (4,3%) patients were not satisfied with the outcome of surgery. These patients were operated during the early period of development of the technique.

Enhanced Understanding of Facial Nerve Anatomy and Arborization in the Indian Population: Implications for Surgical Procedures.

The anatomy and arborization patterns of the extraparotid facial nerve show considerable variation among different populations, impacting surgical approaches in plastic, head and neck, and ENT surgeries. This study focuses on the Indian population to provide a detailed understanding of these variations, specifically highlighting the Davis type IV arborization pattern's prevalence and its clinical relevance. We conducted a comprehensive dissection of 16 formalin-preserved Indian cadaveric hemifaces. The study meticulously mapped the facial nerve trunk (FNT), its furcation points, and branches. Key anatomical landmarks for locating these nerve structures were identified, including the tip of the mastoid process, the angle of the mandible, and a novel line between the lateral palpebral fissure and otobasion superioris. The most common arborization pattern observed was Davis type IV (31.3%). The study provided precise measurements for locating the FNT and its branches, using identifiable landmarks. These findings facilitate more accurate surgical planning, crucial for procedures involving nerve repair or grafting. This research offers vital insights into the facial nerve anatomy specific to the Indian population, with significant implications for surgical precision and patient outcomes. By establishing reliable anatomical landmarks and elucidating the predominant arborization pattern, the study enhances the understanding of facial nerve behavior during surgical interventions, particularly in the context of facial paralysis treatment and reconstructive surgeries. Due to the small sample size, however, this study only acts as a pilot for further research.

Morphological and Morphometric Analysis of Carotid Canal Apertures in the Nigerian Population

Background: The external opening of the carotid canal (EOCC), the entry point of the internal carotid artery into the skull, varies across populations. This study characterized the EOCC with the mastoid process (shortest distance from the EOCC to the tip of the mastoid process [SDTCC]), the foramen magnum (shortest distance from the EOCC to the foramen magnum [SDFM]), and the midline of the skull base (shortest distance from the EOCC to the midline of the base of the skull [SDMCC]) in the Nigerian population. Materials and Methods: Fifty skull base pictures were taken in the plumed position with a digital camera. Measurements were taken using Image J software, and Euclidean distances were calculated. The shapes of the EOCC were noted. Paleontological Statistics (PAST 3.0) was used to perform descriptive statistics. Paired ttest and Pearson correlation were used to compare bilateral values and the relationship between the parameters, respectively. Results: The length (right, 0.53 [standard deviation (SD)=2.5] mm; left, 10.99 [SD=2.84] mm) and width (right, 13.96 [SD=2.43] mm; left, 14.16 [SD=2.09] mm) of the EOCC were recorded. In contrast to the populations in South Africa, Serbia, and India, the length of the EOCC obtained from this study is shorter than the breadth. The length of SDFM (right, 41.04 mm; left, 44.13 mm), SDMCC (right, 58.4 mm; left, 57.97 mm), and SDTCC (right, 57.29 mm; left, 55.61 mm) was established among Nigerians. Conclusion: The Nigerian population showed EOCC of shorter length than the breadth compared to other populations, and the size of the skull is independent of the foramina size. These dimensions may provide information for procedures that affect the skull base.

Symptoms of post COVID-19 condition and diseases/conditions diagnosed after COVID-19 in Japanese patients: A real-world study using a claims database

BackgroundMore than 200 symptoms of post coronavirus disease (COVID-19) condition (PCC) impacting patients’ quality of life have been reported. This study describes the symptoms of well-known PCC and diseases/conditions diagnosed after COVID-19 and analyzes the trends in well-known PCC according to the epidemic waves in the Japanese population. MethodsPatients with a COVID-19 diagnosis in the JMDC claims database were matched 1:1 with individuals without COVID-19 diagnosis (controls) based on sex, year and month of birth, and risk factors for aggravation. The first month of COVID-19 diagnosis from January 2020–March 2022 was the index month, and the observation period was from July 2019 to 6 months from the index month (patients) and July 2019–September 2022 (controls). ResultsOf 263,456 each of patients and controls after matching, 51.8 % were aged 18–49 years, 56.3 % were male, and 24.5 % had risk factors for aggravation. One in 18 patients experienced well-known PCC 2–3 months after severe acute respiratory syndrome cornonavirus 2 infection, with the highest odds ratio (OR) being for pulmonary thromboembolism (29.37), followed by smell/taste disorder (13.34) and respiratory failure (8.28). Some of the common diseases/conditions diagnosed after COVID-19 comprised those of the genitourinary system, eye and adnexa, and ear and mastoid process and certain infectious and parasitic diseases. Overall, the risk difference decreased from the first to the sixth wave, but the OR was >1.00 for most symptoms even during the sixth wave. ConclusionsPCC symptoms showed a declining trend over time but persisted. Physicians and patients need to recognize PCC symptoms.

Research on performance optimization of electrolytic cell: Non-parameter topology and parameter optimization

The technology of water electrolysis for hydrogen production converts renewable energy into hydrogen, enabling efficient storage and utilization of clean energy. The key to enabling the large-scale development of water electrolysis technology lies in enhancing the performance of electrolytic cells and minimizing energy consumption. The mastoid process structure obviously influences the electrolytic cell's flow and electrochemical performance. Therefore, this paper studied the sensitivity of the mastoid process structure to the optimization target, designed the shape topology and the parameter optimization structure, and further analyzed the influence of the two optimization methods on the flow and electrochemical performance of the electrolytic cell based on the multi-physics coupling model. The results show that under the same deformation area, the pressure drop of the topology and the parameter optimization structure is reduced by 17.17 % and 11.89 % compared with that of the original structure. The electrochemical properties were almost unaffected, and the change value was less than 0.1 %. Topology optimization design can achieve optimal performance within limited deformation constraints, and parameter optimization design is more conducive to industrial processing.

A neglected case of chronic suppurative otitis media presented with a chest wall abscess

The objective of the study was to present a neglected case of chronic suppurative otitis media presented to us with a chest wall abscess. We encountered a case of complicated chronic suppurative otitis media in a 16-year-old male, who presented with abscess extending from the mastoid region up to the ipsilateral chest. Incision and drainage of the chest wall and mastoid abscess was under local anesthesia and approximately 250 ml pus was collected. The patient was given intravenous injections of meropenem and regular dressings. Right modified radical mastoidectomy with type 3 tympanoplasty was performed under general anesthesia after four weeks. The patient was discharged on postoperative day 6. The case is an eye-opener as having several complications at the time of presentation that reflects inattention at the community level health provider and patient. Through this article, we emphasis on early diagnosis and proper management of disease so as to avoid life-threatening complications. High index of suspicion and timely intervention is needed for any patient presenting with neck or chest swelling as it may be a complication of COM.

Unveiling the Giants: A Descriptive Study of Giant External Auditory Canal Osteomas – An Uncommon Clinical Odyssey

Abstract Background: External auditory canal (EAC) osteoma, an uncommon manifestation within the mastoid bone, emerges as a particularly intriguing subject of study. Despite its low prevalence, the emergence of giant variants of these osteomas presents unique clinical and therapeutic challenges. Aim and Objectives: The study focuses on five patients presenting with giant bony osteomas, aiming to elucidate the prevalence, clinical features, radiological aspects, and optimal management strategies of these lesions. Material and Methods: Patients were selected from those presenting to the ear, nose, and throat outpatient department at a tertiary hospital between June 2022 and June 2023. Diagnosis was established through clinical examination and high-resolution computed tomography scans of the temporal bone. The diagnostic process underscored the importance of imaging studies in confirming osteoma characteristics, differentiating them from other conditions like exostosis. Management primarily involved surgical excision using a novel “eggshell thinning” technique to ensure minimal damage to the EAC skin and preserve natural canal contours. Results: The patients, predominantly young males, presented with symptoms ranging from hearing loss to ear pain and aural fullness. The outcomes across the cases were optimal, with surgical interventions resulting in symptom resolution. Notably, the innovative eggshell thinning technique facilitated complete removal while preserving skin flap integrity in 80% of cases. The contour of canal was well maintained. Conclusion: This research highlights the importance of recognizing and addressing the distinctive features of giant osteomas in the EAC. The findings emphasize the effectiveness of the surgical approach utilized, characterized by minimal trauma and successful preservation of skin flap integrity. The study calls for continued research and documentation to refine strategies for managing such rare entities, underscoring the necessity for a patient-centered, multidisciplinary approach in otologic surgery.

Efficacy of Mastoid Morphometry in Sex Determination Using Cone-beam Computed Tomography: A Retrospective Analysis in Dakshina Kannada Population.

To evaluate the morphology of the mastoid process and its role in sex determination with the help of cone-beam computed tomography (CBCT). A retrospective study was conducted on 200 adults who were subjected to full FOV CBCT scans (100 males and 100 females). Eight parameters of the mastoid process were assessed for sex determination. The study measured eight parameters of the mastoid process, including mastoid length (ML), mastoid width, mastoid height (MH), intermastoidale distance (IMD), intermastoidale lateral surface distance (IMLSD), mastoid medial convergence angle, mastoid size (MS), and mastoid surface area (MSA). Data were recorded and statistically analyzed. Statistics revealed a significant value for MH (p < 0.001), IMD (p < 0.001), IMLSD (p < 0.001), MSA (p < 0.001), MS (p < 0.001), and ML (p = 0.032). A highly significant value was noted for MH (p < 0.001), IMD (p < 0.001), IMLSD (p < 0.001), MSA (p < 0.001), MS (p < 0.001), followed by ML, all of which were found to be greater in males. Out of the eight parameters, IMD was found to be the best sex determinant among all the eight parameters, with an accuracy of 70%. The study showed a significant difference between the mastoid process morphometric measurements for males and females. It can be concluded from the present study that IMD can be used as a good index for sex determination. The combined parameters that were found to be the most accurate were right MH, left ML, and IMLSD, with an accuracy of 75%. The three-dimensional imaging techniques can contribute significantly towards disaster victim identification and sex determination in the fields of forensic odontology and anthropology. For the recognition of victims, sex determination becomes one of the most difficult parameters to assess. In such events, the mastoid process can become an important anatomical landmark for the estimation of sex. This is due to the condensed nature of the petrous bone and its protected position in the skull. How to cite this article: Ahmed J, Saha A, Muralidharan A, et al. Efficacy of Mastoid Morphometry in Sex Determination Using Cone-beam Computed Tomography: A Retrospective Analysis in Dakshina Kannada Population. J Contemp Dent Pract 2024;25(5):453-458.

Bezold Abscess in a Case of Eosinophilic Otitis Media.

A 57-year-old man with a history of bronchial asthma and eosinophilic sinusitis presented to the emergency department with an exacerbation of otitis media. His primary complaints were otopyorrhea, headache, and neck pain with redness. Contrast-enhanced computed tomography revealed a posterior neck abscess contiguous with the mastoid process. The patient underwent mastoidectomy and received antimicrobial therapy. Eosinophilic granulation tissue in the middle ear obstructed the middle ear aditus and directed the inflammatory process toward the mastoid tip. Bezold abscess is a rare extracranial complication of acute mastoiditis. Therefore, clinicians should consider neck pain with redness as an important physical sign that suggests Bezold abscess in patients with otitis media.

FORENSIC EVALUATION OF SELF-INFLICTED SUICIDES WITH MULTIPLE GUNSHOT WOUNDS

Suicide is a common cause of premature death and a serious social problem. The use of firearms for suicide is quite common. The infliction of multiple self-inflicted wounds, including a fatal one, is rare among suicides, but it is possible and requires careful investigation. Aim To provide a forensic assessment of the possibility of suicide by multiple gunshot wounds. Methods. Archival material from the Kyiv City Clinical Bureau of Forensic Medicine and the Zhytomyr Regional Bureau of Forensic Medicine (2 "medical examination reports") was used. The objects of the study were: gunshot wounds on the head (wounds, wound channels), elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov", shot products, pistol "Makarov-MP 79" converted to shoot elastic bullets. Their characteristics were examined visually and under the stereo microscope. The detection of shot soot layers on skin flaps and gunsmith's grease was carried out in infrared and ultraviolet rays. The study of the elemental composition of shot products in objects of biological and non-biological origin was carried out using the X-ray fluorescence spectrometer "M4 TORNADO". Standard methods of variational statistics were used in the study. Results. The forensic examination of the entry and exit wounds and wounds on the head of the corpses of persons who died as a result of self-inflicted gunshot wounds, as well as of the bullets and weapons that caused bodily injuries, confirmed the possibility of committing suicide by firing double shots from pistols to shoot bullets of the so-called "non-lethal type": elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov". It was established that in case No 1 the first injury was non-fatal and the second was fatal, accompanied by damage to the skull and brain. In case No. 2, the first wound was fatal and the second was non-fatal, as it damaged only the soft tissues of the head without damaging the bones of the skull and brain. The wounds were caused by automatic shots due to the poor technical condition of the weapon, i.e. partial damage and wear of the trigger mechanism and the pistol sear. This was facilitated by a one-time partial self-destruction of the weapon, followed by the wedging of the next cartridge with an elastic bullet in the lower part of the barrel. Conclusion. Thus, the cases of double head injuries caused by shots from firearms (pistols) for shooting bullets of the so-called "non-lethal type" (elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov") serve as evidence of suicide. In case No. 1, one of the wounds was not fatal, as the wound channel began with an entrance hole in the lower half of the right temporal region, continued on the right through the right mastoid process and the soft tissues of the neck, and ended in the middle with an exit wound in the back of the neck. This wound was the first inflicted. The second wound was final and fatal, as there was damage to the skull and brain, as evidenced by the wound channel which passed through the right temporal cyst, the brain and its membranes, the left occipital bone, and ended with the exit wound in the left occipital region. It was the second in order of entry. In case 2, the first wound was fatal, resulting in damage to the bones of the skull and brain and the presence of an elastic ball in the substance of the brain. The second wound was non-fatal and tangential, injuring only the soft tissues of the head without damaging the bones of the skull and brain. It occurred as a result of automatic (independent) shots due to the poor technical condition of the weapon, namely partial damage and wear of the trigger mechanism and the pistol sear. This was facilitated by a one-time partial self-destruction of the weapon, followed by the wedging of the next cartridge with an elastic bullet in the lower part of the barrel.

Morphological and Morphometric Study of the Pterion &amp;ndash; A Cadaveric Study in Sri Lanka

Introduction: Pterion is an important landmark as its relation to the anterior branch of middle meningeal artery, Broca’s motor speech area on the left side, and surgical interventions relating to pathologies of the sphenoid ridge and optic canal as it provides access to vital structures such as sylvian fissure, circle of Willis, optic nerve, para-sellar regions, middle meningeal vessels and cavernous sinus. Approach through pterion is mostly used to treat lesions of anterior and middle cranial fossa. Pterion ossicle or Epipteric bone are sometimes mistaken as a fracture at this point.Objective: The aim is to study the types of pterions and measure the distance from various bony landmarks on skull to the midpoint of pterion.Methods: Specific measurements were taken, and type of the pterion recorded by two independent investigators in the Frankfurt plane on both sides of 37 adult dry skulls of unknown age, gender and race, without calvaria which were prepared for academic purposes, none of which showed any obvious pathology or trauma. The skulls with broken lateral walls were excluded. The linear distance from the center of the pterion to four anatomical landmarks were measured using a Vernier caliper with an accuracy of 0.1 mm.Results: The sphenoparietal type of pterion was the most common (83.8% left, 81.1% right), followed by the frontotemporal (8.1% left, 13.5% right), and epipteric (8.1% left, 2.7% right) types and the stellate type was the least commonly observed (2.7% left side only). The distances on the left and right sides respectively from the center of the pterion to the frontozygomatic suture were 3.60 ± 0.57 cm and 3.68 ± 0.50 cm, to the zygomatic arch 3.76 ± 0.39 cm and 4.03 ± 0.40 cm, to the tip of the mastoid process 7.96 ± 0.58 cm and 8.16 ± 0.61 cm, and to the topmost part of the external auditory meatus 5.42 ± 0.34 cm and 5.53 ± 0.35 cm.Conclusions: This knowledge is essential in surgical approaches and interventions via the pterion, especially for neurosurgeons while drilling a burr hole at the pterion to prevent orbital penetration due to an anterior drilling and an ineffective access for instrumentation due to a posterior drilling. It will also be helpful for surgeons, radiologists, anthropologists, forensic pathologists in their diagnosis and treatment.

Программный комплекс для дифференциальной оценки риска здоровью населения от воздействия шума железнодорожного и автомобильного транспорта

Objective: in the modern world, the number of vehicles on the roads is growing exponentially, and the infrastructure either remains unchanged or is changing, but it is not happening as fast as we would like [1]. Long-term effects of noise exposure, such as disorders of the cardiovascular system (high blood pressure, myocardial infarction, coronary heart disease, etc.), the nervous system (sleep disorder, cognitive impairment, vegetative vascular dystonia), diseases of the ear and mastoid process (conductive and sensorineural hearing loss), depression and other mental disorders [2, 3, 4], are more related to indicators that sum up the noise exposure over a long time. Both when conducting tests by accredited specialists and when choosing housing for buyers, you have to rely on an analytical or practical way to assess the noise pollution of a room. In order to provide a person with a simple and objective way to assess noise pollution, a software package has been developed that allows assessing the impact of noise pollution from transport on public health. Methods: quantitative risk assessment was carried out in accordance with the methodological recommendations of MP 2.1.10.0059-12 “Assessment of public health risk from exposure to traffic noise”. Results: in order to automate calculations, unify the evaluation of results and reduce time costs, the authors propose a software package for differential assessment of public health risks from exposure to rail and road transport. The end product is a user-friendly, cross-platform application for operational risk assessment in the field for employees of test centers who measure noise from known sources of automobile, railway or combined traf fic flows. Practical importance: convenience and optimization of risk processing by noise measurements by employees of noise measurement laboratories using the application.

3-Dimensional Printed Model of the Temporal Bone for Neurosurgical Training.

The development of neurosurgical skills stands out as a paramount objective for neurosurgery residents during their formative years. Mastery of intricate and complex procedures is a time-intensive process marked by a gradually ascending learning curve. Consequently, the study and simulation on surgical models assume significant importance. One of the most intricate neuroanatomical regions includes the petrous and mastoid portions of the temporal bone. These regions host critical, highly functional, and vital neurovascular structures, including the facial nerve, cochlea, semicircular canals, internal carotid artery, and middle ear. This fully open-source 3-dimensional (3D) model of the temporal bone, created for educational purposes, should be easily and economically reproducible using a 3D printer, offering all residents the opportunity to understand the spatial location, three-dimensional anatomical structures, and fundamental intricacies of mastoidectomy. A 3D model of the temporal bone was fabricated using a computed tomography (CT) scan derived from an actual human body. The CT scan of the model was meticulously juxtaposed with the reference sample CT scan. Neurosurgical residents were recruited as participants for this study. Each participant was tasked with executing a mastoidectomy on 2 separate occasions, with a 2-week interval between attempts. Throughout these sessions, various parameters, including the time taken for task completion, the volume of bone removal, and any potential complications, were systematically registered. The mean volume of bone removed increased by 34.5%, and the mean task time and the mean number of complications decreased by 10.3% and 25%, respectively, during the training. Engaging in training with cost-effective anatomical models constitutes a valuable tool for refining technical skills during residency. We posit that this type of model training should be incorporated as part of the trainee's curriculum during the residency program because of the myriad advantages evidenced by the findings of this study.

Perioperative Evaluation and Follow-Up Analysis of Carotid Body Tumor by Color Doppler Ultrasound

The value of Color Doppler Ultrasound (CDU) for perioperative evaluation and follow-up outcomes of carotid body tumor (CBT) remains elusive. This study aimed to investigate the role of CDU in CBT in our center. From January 2015 to December 2020, 75 patients with CBT were included in the study. Computed Tomography Angiography (CTA) and CDU data of patients were collected and analyzed. The postoperative recovery and follow-up outcomes were summarized. A total of 91 CBTs in 75 patients were included in the study. 73.3% of patients had unilateral lesions, while 26.7% had bilateral lesions. Lesions were categorized as Shamblin I (4.4%), Shamblin II (52.7%), and Shamblin III (42.9%). 79.5% lesions were treated by surgical resection, 12.3% were treated by surgical resection with internal carotid artery reconstructed by artificial vessel, while 8.2% were treated by surgical resection with internal carotid artery reconstructed by autogenous great saphenous vein. Compared with CTA, the sensitivity of CDU for detection of CBT was 96.7%, the sensitivity and specificity of CDU for detection of Shamblin Ⅰ lesions were both 100%, the sensitivity and specificity for Shamblin Ⅱ were 100% and 72.1%, respectively, while the sensitivity and specificity for Shamblin Ⅲ were 69.2% and 100%, respectively. There were no statistically significant differences between CTA and CDU for detection of the maximal diameter, volume of CBT and distance between the end of the tumor and the mastoid process. 79.7% of patients were followed up with CDU. Recurrence of CBT occurred in 1 patient. CDU showed that stenosis and occlusion of artificial vessel occurred in 1 and 6 patients, respectively. Occlusion of autogenous great saphenous vein was found in 2 cases. CDU can accurately diagnose Shamblin Ⅰ CBT, have high sensitivity for Shamblin Ⅱ and high specificity for Shamblin Ⅲ CBT. It plays an important role in diagnosis, perioperative evaluation and follow-up analysis of CBT.

Weak magnetic vestibular stimulation decreases postural sway

BackgroundPerceptible galvanic vestibular stimulation (GVS) causes nystagmus and postural sway deterioration. Conversely, imperceptible GVS improves postural stability, suggesting the presence of stochastic resonance. Research questionSimilar to GVS, strong magnetic vestibular stimulation of 7 T induces nystagmus and increases body sway. Thus, a relatively small magnetic stimulation may improve postural stability. In this study, we measured the effect of a relatively small magnetic field on postural sway. MethodsPosturography was performed in eight healthy participants using a stabilometer with foam rubber on board. The center of pressure (COP) trajectories were recorded in both the anterior–posterior and medial–lateral directions for 60 s with the eye closed. Neodymium magnets (0.4 T) or aluminum disks of similar size (0 T) were placed bilaterally over the mastoid processes. ResultsBoth the trajectory length and envelopment area of the COP movement with 0.4 T were significantly smaller than those with 0 T. SignificanceThe relatively smaller magnetic vestibular stimulation decreased postural sway. This method may be useful for improving the vestibular function and related reflexes.