Occlusal Patterns Research Articles

Occlusal deviations in adolescents with idiopathic and congenital scoliosis.

ObjectiveThis cross-sectional study aimed to investigate the characteristics of malocclusions in scoliotic patients through clinical examinations.MethodsFifty-eight patients with idiopathic scoliosis (IS) and 48 patients with congenital scoliosis (CS) participated in the study. A randomly selected group of 152 orthopedically healthy children served as the control group. Standardized orthodontic and orthopedic examination protocols were used to record the occlusal patterns and type of scoliosis. Assessments were made by three experienced orthodontists and a spinal surgery team. The differences in the frequency distribution of occlusal patterns were evaluated by the chi-squared test.ResultsIn comparison with patients showing IS, patients with CS showed a higher incidence of Cobb angle ≥ 45° (p = 0.020) and included a higher proportion of patients receiving surgical treatments (p < 0.001). The distribution of the Angle Class II subgroup was significantly higher in the IS (p < 0.001) and CS (p = 0.031) groups than in the control group. In comparison with the healthy controls, the CS and IS groups showed significantly higher (p < 0.05) frequencies of asymmetric molar and asymmetric canine relationships, upper and lower middle line deviations, anterior deep overbite, unilateral posterior crossbite, and canted occlusal plane, with the frequencies being especially higher in CS patients and to a lesser extent in IS patients.ConclusionsPatients with scoliosis showed a high frequency of malocclusions, which were most obvious in patients with CS.

Clinical features of prosthetic treatment in edentuluos patients

BACKGROUND: Social adaptation of patients with complete absence of teeth is associated with fixation and stabilization of prostheses during chewing and speech. It is necessary to take into account the somatic status of the patient, the causes of tooth loss, pay attention to the clinical stages of orthopedic treatment.&#x0D; AIM: Of the study is to increase the efficiency of the orthopedic dentist with full removable prosthetics.&#x0D; MATERIAL AND METHODS: The conditions for obtaining a compression impression are a rigid spoon, silicone impression material of medium viscosity, constant pressure at the time of impression removal. The indication for removing the compression impression is the mucous membrane of the 1st type according to the Supple. The conditions for removing decompression impressions are a perforated individual spoon, liquid-flowing impression material, no pressure on the oral mucosa. The indication for the use of decompression impressions is a thin, atrophied mucous membrane of the oral cavity of the 2nd type according to Supple. It is necessary to use functional impressions combined according to the degree of pressure on the oral mucosa. This implies the peculiarities of manufacturing a rigid base with wax rollers. After determining the central ratio of the jaws and packing the template basis with bite rollers, the doctor applies the impression material differentially to its inner surface. Both templates with bite rollers are inserted into the oral cavity, the doctor controls the central position of the lower jaw, while functional impressions are taken from the upper and lower jaws, taking into account the functional pressure of the patients chewing muscles. This will allow you to evenly distribute the chewing pressure on the oral mucosa. The value of functional rest is determined by measuring two marked points at the base of the nose and on the chin and always exceeds the amount of separation in the state of the central ratio of the jaws by the amount of the interclusal space. Having determined the amount of functional rest, they begin to design the maxillary occlusion pattern, then note the anatomical landmarks. Often, the removal of impressions with a corrective silicone mass is performed in the position of the central ratio.&#x0D; The value of functional rest is determined by a set of anatomical landmarks in a state of maximum possible muscle relaxation in combination with phonetic tests when closing the lips without tension.&#x0D; RESULTS: The determination of the central ratio on rigid bases makes it possible to accurately fix the interalveolar distance. Patients adapt to prosthetic structures faster.&#x0D; The use of a facial arch with an articulator significantly improves the quality of the prosthetic structure, allows you to individualize the anatomical parameters of the patient.&#x0D; When determining the central ratio of the jaws, checking the design of the future prosthesis, cone-beam computed tomography of the temporomandibular joint was used to control the position of the heads of the lower jaw, confirming the correctness of the actions. At the stage of checking the design of the removable prosthesis, phonetic tests were used.&#x0D; CONCLUSION: The use of combined impressions with simultaneous determination of the central ratio of the jaws and control of the position of the heads of the lower jaw can accelerate the process of orthopedic treatment (combining two stages) and adaptation to removable prostheses. To improve speech during treatment, it is necessary to use special phonetic tests that allow you to restore the correct ratio between the jaws, find the optimal position of artificial teeth, determine the boundaries and shape of the basis of the prosthesis and design the optimal prosthesis for each patient.

A Case of Common Carotid Artery Occlusion: A Unique Pattern of Occlusion and Lessons Learned.

Common carotid artery occlusion (CCAO) is a rare cause of cerebrovascular events. For patients with neurological deficits due to emboli from an occluded common carotid artery, ligation of the ipsilateral internal carotid may appear as a simple therapeutic option, provided there is adequate collateral circulation. Here, we describe a patient with an unusual pattern of CCAO, who underwent ligation of the internal carotid artery after a successful test occlusion with a hypotensive challenge. He suffered a delayed stroke. This case report aims to highlight the unique pattern of CCAO in this patient and our experience with his management.

Clinical characteristics and outcomes of acute ischemic stroke in patients with COVID-19: A systematic review and meta-analysis of global data

Objective. There is increased concern regarding acute ischemic stroke (AIS) in patients with coronavirus disease 2019 (COVID-19). The aim of this study was to depict the manifestations and outcomes of COVID-19-associated AIS. Methods. We systematically searched for eligible studies describing AIS in patients with COVID-19 using PubMed, Embase, and Web of Science up to November 29, 2021. We complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Newcastle&amp;ndash;Ottawa Scale to assess data quality. The data were pooled using fixed- and random-effects models. Results. Thirty-eight eligible studies involving 76,894 participants were included in this meta-analysis. Compared with AIS patients who did not have COVID-19, patients with COVID-19 were more likely to have anterior circulation stroke (odds ratio [OR]: 2.29, 95% confidence interval [CI]: 1.03 &amp;ndash; 5.10; I2: 37%), particularly involving the internal carotid artery (OR: 1.85, 95% CI: 1.19 &amp;ndash; 2.88; I2: 0); more severe neurological deficit (National Institutes of Health Stroke Scale [NIHSS]) (weighted mean difference [WMD]: 3.21, 95% CI: 2.13 &amp;ndash; 4.29; I2: 64%); higher proportion of cryptogenic stroke (OR: 1.83, 95% CI: 1.24 &amp;ndash; 2.70; I2: 62%), large vessel occlusion (OR: 1.68, 95% CI: 1.10 &amp;ndash; 2.57; I2: 75%), and multi-territory involvement (OR: 2.64, 95% CI: 1.62 &amp;ndash; 4.29; I2: 0%); higher C-reactive protein levels (WMD: 55.90, 95% CI: 33.32 &amp;ndash; 78.49; I2: 67%), and D-dimer levels (standardized mean difference: 0.81, 95% CI: 0.52 &amp;ndash; 1.10; I2: 59%). The proportion of poor outcomes were higher among patients with COVID-19, including increased risk of in-hospital death (OR: 3.70, 95% CI: 2.73 &amp;ndash; 5.02; I2: 64%) and lower possibility of favorable discharge (OR: 0.49, 95% CI: 0.39 &amp;ndash; 0.61; I2: 0). However, COVID-19 did not increase the risk of hemorrhagic transformation (OR: 1.34, 95% CI: 0.91 &amp;ndash; 1.98; I2: 39%) and symptomatic intracerebral hemorrhage (OR: 1.46, 95% CI: 0.81 &amp;ndash; 2.62; I2: 0). Conclusion. AIS patients with COVID-19 seem to display a pattern of large vessel occlusion and multi-territory infarcts. These patients have high inflammatory marker levels and increased D-dimer levels, which implies that thrombosis and/or thromboembolism might be the underlying mechanism. These patients tend to have worse prognosis regardless of whether they receive reperfusion treatment.

Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke

BackgroundA thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular...

Systematic revision of Gyriabrus (Rodentia, Caviomorpha), a large dinomyid from the Neogene of South America

ABSTRACT Dinomyidae is a family of rodents including one extant species, Dinomys branickii, but with a high past diversity. Gyriabrus is a large dinomyid with euhypsodont cheek teeth and an occlusal pattern that changes throughout the ontogeny of the animal. Eight species of Gyriabrus have been described in the late Miocene to Pliocene of Argentina, Uruguay, Colombia and Brazil. The taxonomic status of Gyriabrus has been questioned, being considered as juvenile forms of other euhypsodont dinomyids. According to this study, Gyriabrus has a unique dental anatomy among euhypsodont dinomyids and is a valid genus. A study of the cheek teeth permitted to propose an ontogenetic series. All the species described from the late Miocene of Argentina (Ituzaingó Formation) and Uruguay (Camacho Formation) belong to Gyriabrus holmbergi (including G. glutinatus, G. rebagliattii, G. indivisus and G. teisseirei), representing different wear stages. ?Gyriabrus quadratus, G. latidens (late Pliocene? of Argentina) and ?G. royoi (late Miocene-Pliocene of Colombia), all based on isolated teeth, are considered as valid species, pending future findings that allow a deeper comparison. This study contributes to the knowledge of the systematics, taxonomy and anatomy of extinct Dinomyidae, which are essential for future studies of the evolutionary history of the group.

Masquerade presentation of acute type B aortic dissection as isolated acute limb ischaemia treated with endovascular fenestration with angioplasty: A case report.

Introduction and importanceMasquerade presentation of acute type B aortic dissections (TBAD) as acute limb ischaemia (ALI) is rare. Holistic clinical assessment, preferably with the help of scoring systems and timely computer tomographic angiogram (CTA), is needed for early diagnosis. Acute TBAD and its complications are increasingly treated with endovascular therapies.Case presentationA 21-year-old male with poorly controlled essential hypertension was admitted with prominent clinical features of ALI. No clinical pointers of a TBAD were present. Doppler ultrasound revealed an arterial occlusive pattern, and an urgent surgical embolectomy was performed. On failure to retrieve any thrombi, a CTA was performed, and diagnosis of TBAD complicated with ALI was made. The limb was revascularised with guidewire directed aortic fenestration with angioplasty. TBAD was managed conservatively.Clinical discussionWe report a case of acute TBAD presented as isolated ALI, which was initially diagnosed and treated as an ALI unrelated to aortic dissection. TBAD with typical or atypical clinical features presented with ALI as a malperfusion syndrome is not uncommon. However, masquerade presentations of TBAD as ALI are rare in the literature. Endovascular fenestration with or without stenting has fewer neurological complications and long-term mortality than thoracic endovascular aortic repair (TEVAR). Moreover, they become convenient in resource-poor settings without dedicated aortic centres.ConclusionMasquerade presentation of TBAD should be recognised in the differential diagnosis of ALI. Timely CTA would prevent unnecessary interventions and help diagnose TBAD complicated with ALI. Despite their availability, outcomes will depend on proper patient selection for endovascular, surgical, and TEVAR options.

Mechanical thrombectomy of acute occlusions of individual distal anterior cerebral artery branches

To describe our experience with mechanical thrombectomy (MT) in distal anterior cerebral artery (ACA) occlusions regarding recanalization rates, MT techniques and procedural safety. From a prospectively maintained thrombectomy database all patients with distal ACA occlusions treated with MT between April 2013 and February 2021 were retrospectively identified. Imaging data and angiographic features as well as clinical data were collected. 41 patients were included in the study, including 23 patients (56.1%) with distal main stem occlusions (occlusions distal to the anterior communicating artery but proximal to the origin of the pericallosal and callosomarginal arteries) and 18 patients (46.3%) with distal individual branch occlusions (occlusions of the pericallosal or callosomarginal arteries and their ramifications). A stent retriever mediated technique was applied in 34 patients (82.9%), the ADAPT technique in 7 patients (17.1%). Successful (mTICI 2b/3) and complete recanalization (mTICI 3) rates did not differ for the distal ACA main stem occlusion group (82.6%/56.5%), and the individual branch occlusion group (83.3%/55.6%) (p ≫ 0.05). No severe complications specific to distal MT maneuvers were noted. MT for acute distal individual ACA branch occlusions beyond the common A2/3 trunk appears safe and technically effective in different clinical settings and occlusion patterns with high recanalization rates. However, further studies are required to determine the clinical effectiveness.

Biomechanical evaluation of the unilateral crossbite on the asymmetrical development of the craniofacial complex. A mechano-morphological approach

Background and ObjectiveThe occlusion effect on the craniofacial development is a controversial topic that has attracted the interest of many researchers but that remains unclear, mainly due to the difficulties on measure its mechanical response experimentally. This mechano-morphological relationship of the craniofacial growth is often explained by the periosteal and capsular matrices of the functional matrix hypothesis (FMH); however, its outcomes have not been analytically demonstrated yet. This computational study aims, therefore, to analytically demonstrate the mechano-morphological relationship in the craniofacial development of children with unilateral crossbite (UXB) using the finite element (FE) method. MethodsThe craniofacial complex asymmetry of ten children, five of whom exhibit UXB, was 3D-analysed and compared with the biomechanical response computed from a FE analysis of each patient's occlusion. Due to the complexity of the geometry and the multitude of contacts involved, the inherent limitations of the model were evaluated by comparing computed occlusal patterns with those recorded by an occlusal analysis on 3D printed copies. ResultsComparison's outcomes proved the reliability of our models with just a deviation error below 6% between both approaches. Out of validation process, computational results showed that the significant elongation of mandibular branch in the contralateral side could be related to the mandibular shift and increase of thickness on the crossed side, and particularly of the posterior region. These morphological changes could be associated with periodontal overpressure (>4.7 kPa) and mandibular over deformation (0.002 ε) in that side, in agreement with the periosteal matrix's principles. Furthermore, the maxilla's transversal narrowing and the elevation of the maxillary and zygomatic regions on the crossed side were statistically demonstrated and seem to be related with their respective micro displacements at occlusion, as accounted by their specific capsule matrices. Our results were consistent with those reported clinically and demonstrated analytically the mechano-morphological relationship of children's craniofacial development based on the FMH's functional matrices. ConclusionsThis study is a first step in the understanding of the occlusion's effect on the craniofacial development by computational methods. Our approach could help future engineers, researchers and clinicians to understand better the aetiology of some dental malocclusions and functional disorders improve the diagnosis or even predict the craniofacial development.

Evaluation of Relationship Between Canine Guided and Group Function Occlusion Schemes and Tooth Wear Along with Salivary Factors Such as Salivary Flow Rate and Salivary Ph- A Clinical Study

Objective: To evaluate the relationship between canine guided and group function occlusion schemes and tooth wear along with salivary factors such as salivary flow rate and salivary pH. Methodology: A cross sectional descriptive study was conducted among 50 subjects, 25 of group function and 25 of canine guided occlusion. Type of occlusion pattern and tooth wear was assessed through clinical intra-oral examination. Lateral excursive occlusion was determined with the aid of Shimstock to confirm tooth contact and the modified ordinal scale was used for evaluating tooth wear. Working side occlusal contact patterns were determined and classified into two groups: canine guided and group function. Unstimulated and stimulated whole saliva sample was collected to assess the pH and salivary flow rate. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. Descriptive data was reported for each variable. As the data was found to be normally distributed bivariate analyses was performed using Independent t test. Level of statistical significance was set at p-value less than 0.05 Results: No significant difference was seen in pH when compared between canine guided and Group function occlusion as p &gt;0.05 whereas flow rate was found to be significantly more in group function. Conclusion: Most of tooth wear in canine guidance is reported in mandibular incisor followed by mandibular molar. No wear was seen in both maxillary and mandibular canines and minimal wear was reported in maxillary incisor. Type of occlusion did not affect the salivary pH rather it affected salivary flow rate.

A Computerized Simulation of the Occlusal Surface in Equine Cheek Teeth: A Simplified Model.

Equine mastication, as well as dental wear patterns, is highly important for the development of treatments in equine dentistry. During the last decades, the stress and strain distributions of equine teeth have been successfully simulated using finite element analysis. Yet, to date, there is no simulation available for dental tooth wear in equines. In this study, we developed a simplified two-dimensional computer simulation of dental wear. It provides a first tentative explanation for the development of the marked physiological inclination of the occlusal surface and for pathological conditions such as sharp enamel points in equine cheek teeth. The mechanical properties of the dental structures as well as the movement of the mandible during the equine chewing cycle were simulated according to previously published data. The simulation setup was optimized in preliminary test runs. Further simulations were conducted varying the lateral excursion of the mandible and the presence or absence of incisor contact during the chewing cycle. The results of simulations showed clear analogies to tooth wear patterns in living equids, including the formation of wear abnormalities. Our analysis indicates that small variations in the pattern of movement during the masticatory cycle, as well as incisor contacts, are leading to marked changes in the occlusal tooth wear patterns. This opens new research avenues to better understand the development of dental wear abnormalities in equines and might have serious implications on captive animal health, welfare, and longevity.

Evaluation of palatal dimensions in different facial patterns by using digital dental casts.

To analyze the variations of hard palate volume in adults with normal occlusion and different facial types and patterns, by using a three-dimensional analysis on digital casts. The dental casts of 70 Caucasian adults (28 men, 42 women), mean age of 16.4 years (SD 1.3 years), were scanned by using a tridimensional scanner (Delcam PowerSHAPE™, 2010, Birmingham, UK). Close points were selected in the gingival and cervical regions on the lingual surface of the maxillary teeth, to analyze palatal morphology. The facial patterns and types, and the measurements (width, length, height, volume) of the space on the hard palate were compared using analysis of covariance (ANCOVA), with age as the covariate, and sex as the independent variable. The significance level of 5% (p < 0.05) was adopted. This study showed that the measurements of the width and length were similar among the mesofacial, dolichofacial and brachyfacial facial types, although the height and volume of the space on the hard palate were slightly smaller in dolichofacial individuals, and both Pattern I and Pattern II individuals showed no significant changes for the four measurements. The mean values among facial patterns were: Pattern I - width 38.31±2.59 mm; length 37.44±2.42 mm; height 17.03±2.42 mm and volume 10.52±1.72 mm3; Pattern II - width 37.48±2.44 mm; length 37.48±2.44 mm; height 16.79±2.42 mm and volume 10.41±1.65 mm3 (p>0.05 for all variables). There were no significant differences for the facial patterns and facial types of the individuals compared in the analyzed sample.

Non-extraction Camouflage Treatment of Skeletal Class III Malocclusion

Class III malocclusion can be defined as a skeletal facial deformity that is characterized by a forward mandibular position with respect to the cranial base and or the maxilla. We present a case of a 15-year-old man with skeletal Class III malocclusion who was treated with non-extraction orthodontic camouflage treatment using an orthodontic conventional technique. A fixed appliance, straight wire appliance (SWA) technique was used with a non-extraction treatment plan. Treatment was accompanied by intermaxillary Class III elastics. The total duration of active treatment was 23 months. There was a significant improvement in his occlusion, smile esthetics, and soft tissue profile pattern. Orthodontic camouflage can be considered an effective therapy for correcting milder cases of skeletal Class III malocclusion.

Pattern of occlusal contacts in eccentric position of mandible in dental students

Introduction: Canine protection and group function are the two stand out occlusal schemes observed during laterotrusive movement of the mandible. The study aims to evaluate the frequency of these occlusal schemes in Nepalese dental students. Materials and methods: A cross-sectional study was conducted among dental students in People’s Dental College and Hospital, Kathmandu, Nepal after the ethical approval from PDCH-IRC. Sixty four undergraduate students aged 21-30 years, were examined for the occlusal contact patterns in lateral mandibular movements using 12μm shim stock. The data were analyzed using SPSS software (version 21) Result: On 1mm laterotrusive position on mandible, 43 subjects (67%) showed group function, 15 subjects (24%) canine guided and 6 subjects (9%) non specified occlusion. On 3mm laterotrusive movement, 31(48%) subjects showed group function and 27 subjects (42%) showed canine guided occlusal scheme. The most frequent mediotrusive contact was the second molar followed by the first molars during both 1mm and in 3mm excursion Conclusion: Majority of occlusal schemes of the study population were group function followed by canine protection and non specified occlusion. Canine protected occlusion scheme was increased on 3mm lateral excursion. Most of mediotrusive side contact seen on 2nd molar on 1mm.

Comparative Evaluation of Occlusal Bite Force in Relation to the Muscle Activity in the Mixed Dentition Children of Age Group 9-12 Years: A T-scan Analysis.

Aim and objectiveCompare and evaluate the muscle activity and the occlusal force between the mixed dentition boys and girls of 9–12 years.Materials and methodsThe study included 15 boys and 15 girls. The occlusal force and activity of the masseter and temporalis muscle were measured with a T-scan device using a sensor, a module to transmit the signals to a computer and the complete data of the bite force and muscle activity with the EMG recordings and data were collected and evaluated.ResultsRelative occlusal force in the primary and permanent molars between the boys and girls showed no significant difference on the left side compared to the right. The electromyography values of masseter and temporalis in boys and girls showed a significant difference in which (TAR and MMR), (TAR and MML), (TAL and MMR), and (TAL and MML) are significant. The overall paired sample statistics showed higher muscle activity in masseter.ConclusionT-scan analysis has proved to be a dependable method for the evaluation of occlusal bite force with the muscle activity interpretation using EMG. This study concluded that there is a difference in the occlusal pattern and muscle activity in the mixed dentition that showed the maximum force was on the permanent molars and the symmetry of EMGs activity in children was on the right masseter comparatively with higher bite values in boys compared to girls.Clinical significanceT-scan is a computerized analysis system that helps in the proper assessment of the patient's occlusion and assists in the proper treatment planning and diagnosis accurately without much effort.How to cite this articlePrabahar T, Gupta N, Chowdhary NR, et al. Comparative Evaluation of Occlusal Bite Force in Relation to the Muscle Activity in the Mixed Dentition Children of Age Group 9–12 Years: A T-scan Analysis. Int J Clin Pediatr Dent 2021;14(S-1):S29–S34.

Lower Incisor Positions in Different Malocclusions and Facial Pattern

Aims: The position of lower incisor has been of significant concern when seeking orthodontic treatment plan, it has been recognized as one of diagnostic key and play an important in the development of normal occlusion and facial pattern. This study was aimed at the determination of lower incisor position and its possible association with different sagittal malocclusions and facial patterns.&#x0D; Study Design: Descriptive Cross-sectional Study&#x0D; Place and Duration of Study: Department of Orthodontics Institute of Dentistry Liaquat University Medical and Health Sciences (LUMHS) Jamshoro between June 2019 to July 2020.&#x0D; Methodology: Ninety-seven pre-treatment lateral cephalometric radiographies were taken, and they were classified sagittally into skeletal class I, II and III, and vertically into normodivergent, hyperdivergent and hypodivergent facial pattern using ANB and SNMP, respectively. Lower incisor position was assessed by means of FMIA and IMPA. One way analysis of variance (ANOVA) was applied to check any association between lower incisor position and sagittal malocclusion and facial pattern. P value of 0.05 was considered statistically significant.&#x0D; Results: The study sample consisted of 97 patients. The mean age of the patients was 25.55 SD ±3.93. The mean SNMP value was 28.84 SD ±7.354 and mean ANB value 4.809 SD ±3.85. Mean Incisor position based on IMPA was 98.598 SD ± 9.413 and FMIA 54 SD ±9.995. Intra and interobserver reliability was assessed with intraclass correlation coefficient values ranging between 0.825 and 0.990 respectively. The ANOVA test results showed significant relationship between the sagittal malocclusion and incisor position with P value .036. The Bonferroni analysis indicated that statistically significant association existed in term of lower incisor position between Class II and Class III malocclusion with P value .047. Test results further indicated that there is no significant difference in the position of lower incisor in relation to facial pattern with P value .355.&#x0D; Conclusions: Statistically significant association was found between lower incisor position with respect to the sagittal malocclusion. However, no significant association was found between facial pattern and lower incisor position.

Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population

A retrospective, single-center study was performed in Berlin between January 2012 and December 2019. A total of 179 patients with atherosclerotic disease (51% with unilateral internal carotid artery [ICA] occlusion; 49% with multivessel disease) had undergone extracranial to intracranial bypass for symptoms that had occurred within the previous 4 months, including recurrent minor ischemic stroke or transient ischemic attack (TIA) in 136 patients (76%), single TIA or ischemic stroke in 36 patients (20%), and hemodynamic instability in 7 patients (4%). The overall perioperative stroke, surgical complication, and 1-year ischemic or TIA event rate was 4%, 6.5%, and 6%, respectively. Patients more recently referred for flow augmentation surgery appear to experience more severe symptoms and have more severe vessel occlusion patterns than did patients reported in the COSS (carotid occlusion surgery study). A new randomized controlled trial appears warranted, considering the poor prognosis of patients with an occluded ICA and associated severe multivessel atherosclerotic cerebrovascular disease.

Radiographic Characteristics of Mild Ischemic Stroke Patients With Visible Intracranial Occlusion: The INTERRSeCT Study.

Early neurological deterioration occurs in one-third of mild strokes primarily due to the presence of a relevant intracranial occlusion. We studied vascular occlusive patterns, thrombus characteristics, and recanalization rates in these patients. Among patients enrolled in INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography), a multicenter prospective study of acute ischemic strokes with a visible intracranial occlusion, we compared characteristics of mild (National Institutes of Health Stroke Scale score, ≤5) to moderate/severe strokes. Among 575 patients, 12.9% had a National Institutes of Health Stroke Scale score ≤5 (median age, 70.5 [63-79]; 58% male; median National Institutes of Health Stroke Scale score, 4 [2-4]). Demographics and vascular risk factors were similar between the two groups. As compared with those with a National Institutes of Health Stroke Scale score >5, mild patients had longer symptom onset to assessment times (onset to computed tomography [240 versus 167 minutes] and computed tomography angiography [246 versus 172 minutes]), more distal occlusions (M3, anterior cerebral artery and posterior cerebral artery; 22% versus 6%), higher clot burden score (median, 9 [6-9] versus 6 [4-9]), similar favorable thrombus permeability (residual flow grades I-II, 21% versus 19%), higher collateral flow (9.1 versus 7.6), and lower intravenous alteplase treatment rates (55% versus 85%). Mild patients were more likely to recanalize (revised arterial occlusion scale score 2b/3, 45%; 49% with alteplase) compared with moderate/severe strokes (26%; 29% with alteplase). In an adjusted model for sex, alteplase, residual flow, and time between the two vessel imagings, intravenous alteplase use (odds ratio, 3.80 [95% CI, 1.11-13.00]) and residual flow grade (odds ratio, 8.70 [95% CI, 1.26-60.13]) were associated with successful recanalization among mild patients. Mild strokes with visible intracranial occlusions have different vascular occlusive patterns but similar thrombus permeability compared with moderate/severe strokes. Higher thrombus permeability and alteplase use were associated with successful recanalization, although the majority do not recanalize. Randomized controlled trials are needed to assess the efficacy of new thrombolytics and endovascular therapy in this population.

Referral Patterns of Central Retinal Artery Occlusion to an Academic Center Affiliated With a Stroke Center.

Central retinal artery occlusion (CRAO) is a medical emergency, and patients who present acutely should be immediately referred to the nearest stroke center. We evaluated practice patterns for CRAO management at one academic center over the last decade. This was a retrospective study on all adult patients diagnosed with a CRAO seen at one tertiary hospital and outpatient clinic affiliated with a comprehensive stroke center ("our institution") from 2010 to 2020. Our electronic medical records were searched for CRAO diagnoses, and patient medical records were reviewed. The exclusion criteria were incorrect diagnosis, unclear diagnosis, historical CRAO, or satellite clinic location. Demographics, distance and time to presentation to our institution, number and type of prior providers seen, diagnostic tests performed, and treatments provided were collected. Summary statistics of median, mean, and frequency were calculated and reported with measures of variance (interquartile range [IQR], ranges). F, Tukey, and Fisher exact tests were used for comparisons. We included 181 patients with a diagnosis of CRAO (80 [44.2%] women; median age 69 years [range 20-101]). The median distance from patient's home to our institution was 27.8 miles (IQR 15.5-57.4; range 2.4-930). The median time from visual loss to presentation at our institution was 144 hours (IQR 23-442 hours, range 0.5-2,920) from 2010 to 2013, 72 hours (IQR 10.5-372 hours, range 0-13,140) from 2014 to 2016, and 48 hours (IQR 7-180 hours, range 0-8,030) from 2017 to 2020 (P = 0.07). 91/181 (50%) patients presented to an outpatient provider. 73/181 (40%) presented to an emergency department. Eighty-six percent presented within 1 week of visual loss onset, and rates of comprehensive inpatient evaluation for acute CRAO improved from 44% in 2010-2013 to 82% in 2017-2020 (P < 0.01). Patients with CRAO often present late and only after evaluation by multiple outpatient providers. Improvement has occurred over the past decade, but delays underscore the barriers to performing clinical trials evaluating very acute treatments for CRAO. Educational interventions for healthcare providers and patients are necessary.

Correlation of Facial, Dental and Oral Functions of Children with Microcephaly: Clinical Case Report

This paper discusses the orofacial manifestations of children diagnosed with severe microcephaly according to the World Health Organization. Microcephaly is a clinical condition made at or after birth that characterizes a significant reduction in head circumference, which may present craniofacial, neurological, and oral alterations as a result of this malformation. As skull growth is linked to facial growth, can patients with microcephaly have structural and functional impairments? Will these possible changes be expressed before skeletal maturity? These issues are discussed through the presentation of two relevant clinical reports of children diagnosed with severe microcephaly with similar clinical facial and occlusion patterns.. Studies along these lines should be conducted with a view to future attempts to minimize possible effects of this malformation on the craniofacial complex with preventive and interceptive therapeuticals in these individuals.