Parietal Bone Research Articles

Effect of Selective Serotonin Reuptake Inhibitor (Paroxetine) on Newly Formed Bone Volume: Real-Time In Vivo Micro–computed Tomographic Analysis

IntroductionSelective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression and anxiety. The purpose of this study was to assess in real time the effect of paroxetine, an SSRI, on newly formed bone volume (NFBV) in standardized calvarial defects (SCDs) in rats. MethodsFourteen Wistar albino female rats with a mean age of 7.5 months and a mean weight of 275 g were used. The animals were randomly divided into 2 groups. The experimental group was given paroxetine 8 weeks before the surgical procedure and throughout the experiment, and the control group was given a placebo 8 weeks before the surgical procedure and throughout the experiment. In each group, 14 SCDs measuring 4.6 mm in diameter were created on the parietal bone. In both groups, a Bio-Oss + collagen membrane was placed. All defects showed primary closure. The volume of the newly formed bone (NFBV) was measured using in vivo micro–computed tomographic imaging. Measurements were taken at days 0, 14, 28, 42, and 56 after surgery using real-time assessment with micro–computed tomographic imaging. ResultsThe mean NFBV was 17.12 ± 4.52 mm3 and 12.52 ± 4.78 mm3 for the control and experimental groups, respectively, at day 56. The differences between the 2 groups were statistically significant (P < .05) at all time intervals. ConclusionsParoxetine intake significantly reduced the amount of regenerated NFBV and the rate of new bone formation.

Prevalence and Characterization of Dental and Skull-Bone Pathologies of the Raccoon Dog (Nyctereutes procyonoides) in Lithuania.

The present investigation endeavours to discern dental and non-dental pathologies affecting cranial structures of raccoon dogs, while focusing on cases of periodontitis. Furthermore, the study aims to conduct a comparative analysis based on sex and the nature of the pathologies encountered. The number of investigated skulls amounted to 126, including 76 males and 50 females. The predominant pathology identified was hypodontia, which accounted for 26.7% of males and 20% of females. Notably, the majority of hypodontia cases involved the absence of the mandibular third molar. Another noteworthy pathology was various stages of periodontitis, with rates ranging from 21.3% in males to 8% in females. Other pathologies, like tooth fractures and abrasion, were significantly less encountered. Excessive bone formation was relatively abundant and localized in specific areas-the parietal bone and the occipital regions. This tendency was observed in 8% of male cases and 6% of females. We found that the total number of dental and skull-bone pathologies is significantly more common in males than in females (p = 0.003). Additionally, the total number of various cases of periodontitis is more common in males too (p = 0.04).

Pediatric Nasoorbitoethmoid Fractures: A Single Institution's 15-Year Experience.

Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study describes characteristics, management, and outcomes of NOE fractures in children seen at a single institution. A retrospective review of patients under 18 years who presented to our institution from 2006 to 2021 with facial fractures was conducted; patients with NOE fractures were included. Data collected included demographics, mechanism of injury, fracture type, management, and outcomes. Fifty-eight patients met inclusion criteria; 77.6% presented with Manson-Marcowitz Type I fractures, 17.2% with Type II, and 5.2% with Type III. The most common cause of injury was motor vehicle accidents (MVAs, 39.7%) and sports (31%). Glasgow Coma Scale and injury mechanism were not predictive of injury severity in the pediatric population ( P =0.353, P =0.493). Orbital fractures were the most common associated fractures (n=55, 94.8%); parietal bone fractures were more likely in Type III fractures ( P =0.047). LeFort III fractures were more likely in type II fractures ( P =0.011). Soft tissue and neurological injuries were the most common associated injuries regardless of NOE fracture type (81% and 58.6%, respectively). There was no significant difference in type of operative management or in the rates of adverse outcomes between types of NOE fractures. These findings suggest that pediatric NOE fractures, although rare, present differently from adult NOE fractures and that revisiting predictive heuristics and treatment strategies is warranted in this population.

A study of the influence of genetic variance and sex on the density and thickness of the calvarial bone in collaborative cross mice.

Bone microarchitecture is affected by multiple genes, each having a small effect on the external appearance. It is thus challenging to characterize the genes and their specific effect on bone thickness and porosity. The purpose of this study was to assess the heritability and the genetic variation effect, as well as the sex effect on the calvarial bone thickness (Ca.Th) and calvarial porosity (%PoV) using the Collaborative Cross (CC) mouse population. In the study we examined the parietal bones of 56 mice from 9 lines of CC mice. Morphometric parameters were evaluated using microcomputed tomography (μCT) and included Ca.Th and %PoV. We then evaluated heritability, genetic versus environmental variance and the sex effect for these parameters. Our morphometric analysis showed that Ca.Th and %PoV are both significantly different among the CC lines with a broad sense heritability of 0.78 and 0.90, respectively. The sex effect within the lines was significant in line IL111 and showed higher values of Ca.Th and %PoV in females compared to males. In line IL19 there was a borderline sex effect in Ca.Th in which males showed higher values than females. These results stress the complexity of sex and genotype interactions controlling Ca.Th and %PoV, as the skeletal sexual dimorphism was dependent on the genetic background. This study also shows that the CC population is a powerful tool for establishing the genetic effect on these traits.

Investigation of injuries sustained from falls down stairs

Interpretation of injuries sustained from fatal falls involving stairs is a challenge encountered by death investigation teams regularly. The high incidence of this occurrence is because stairs are a common entity in society. Without a medical evaluation of an individual's injuries, it is difficult to determine whether a fall from stairs contributed to how the individual died. The purpose of this study is to characterize the injuries of individuals that were sustained from a confirmed fatal fall involving stairs within our jurisdiction (Ontario, Canada) during 2014–2020. In a retrospective cross-sectional observation study, we examined 159 cases using both postmortem imaging and routine autopsy approaches. Our findings showed the head was the most common anatomical region injured. The most common injuries observed in the head included skull fracture(s) (most commonly the temporal, parietal and occipital bones), subarachnoid hemorrhages, and brain contusions. Anatomical regions less commonly injured included the extremities, thorax, and pelvis. This study identified an association between the presence of intracranial hemorrhage and those 65-years-old and younger; brain injury in the absence of pre-existing medical conditions; and brain injury for individuals that had a blood alcohol concentration between 0 and 80mg/100 mL. Extracranial skeletal trauma, as defined by skeletal trauma apart from the head region, was observed in 62% of cases. Extracranial skeletal trauma was also found to be strongly associated with individuals over 65-years-old. Overall, our study affirms that traumatic head injury is the primary cause of death from falls down stairs. Also, we provide information on rare injuries from falls down stairs, and indirectly, identify which body locations appear protected from injury during falls. These findings may aid in the interpretation of whether injuries in this setting are compatible with accidental or non-accidental trauma.

Bone structure and composition in a hyperglycemic, obese, and leptin receptor-deficient rat: Microscale characterization of femur and calvarium.

Metabolic abnormalities, such as diabetes mellitus and obesity, can impact bone quantity and/or bone quality. In this work, we characterize bone material properties, in terms of structure and composition, in a novel rat model with congenic leptin receptor (LepR) deficiency, severe obesity, and hyperglycemia (type 2 diabetes-like condition). Femurs and calvaria (parietal region) from 20-week-old male rats are examined to probe bones formed both by endochondral and intramembranous ossification. Compared to the healthy controls, the LepR-deficient animals display significant alterations in femur microarchitecture and in calvarium morphology when analyzed by micro-computed X-ray tomography (micro-CT). In particular, shorter femurs with reduced bone volume, combined with thinner parietal bones and shorter sagittal suture, point towards a delay in the skeletal development of the LepR-deficient rodents. On the other hand, LepR-deficient animals and healthy controls display analogous bone matrix composition, which is assessed in terms of tissue mineral density by micro-CT, degree of mineralization by quantitative backscattered electron imaging, and various metrics extrapolated from Raman hyperspectral images. Some specific microstructural features, i.e., mineralized cartilage islands in the femurs and hyper-mineralized areas in the parietal bones, also show comparable distribution and characteristics in both groups. Overall, the altered bone microarchitecture in the LepR-deficient animals indicates compromised bone quality, despite the normal bone matrix composition. The delayed development is also consistent with observations in humans with congenic Lep/LepR deficiency, making this animal model a suitable candidate for translational research.

THICKNESS MAPPING OF NEPALESE CALVARIA USING COMPUTERIZED TOMOGRAPHY

Background: The bony skeleton of the head is termed skull. Skull composed of cranial vault and base. Cranial vault is known as Calvaria. Cranial vault (Calvaria) is the superior view of skull (Norma Verticalis). Calvarium consists of frontal, parietal, temporal and occipital bones. Total thickness of calvarial bones includes outer table, diploe and inner table. Diploe is made up of spongy bone. Outer and inner table made up of compact bone. This study aims to measure the image assisted measurement of thickness of Calvaria and to observe the variation in thickness with age, gender and ethnicity. Methods: This was a descriptive cross-sectional study conducted at Department of Radiology, Chitwan Medical College Teaching Hospital Bharatpur-13, Chitwan. Patient of age 15 to 50 years with normal CT finding were included in the study. Using the axial view of brain CT, the thickness of Calvaria was measured and recorded in millimeter. Results: Hundred calvarial thickness was measured using computerized tomography scan. Thickness of frontal bone; parietal bone and occipital bone ranges from 0.37 mm to 0.97mm with mean value 0.6991±0.311mm;0.36mm to 0.99 with mean 0.6772±0.15058 mm and 0.30 to 0.95mm with mean 0.68±0.15236 respectively. No significant correlation between thickness of frontal, parietal and occipital bone is observed using Pearson coefficient. Conclusions: There is slight variation of calvarial thickness of frontal, parietal and occipital bone. The frontal, parietal and occipital bone thickness are not significantly correlated with each other.

Osteological material and the population state of the speckled ground squirrel (Spermophilus suslicus) on the periphery of the species’ distribution (Belarus)

The studies were carried out in 2021 near the village of Yushevichi, Nesvizh Raion, Minsk Oblast (Belarus). The content of pellets of three bird species were analysed: Buteo buteo, Buteo lagopus, and Corvus corax. In total, 129 intact and about 30 destructed pellets were processed. Skeletal elements of five small mammal species belonging to five genera of two orders (Rodentia and Eulipotyphla) were found, including remains of nine speckled ground squirrels. The remains of seven of the nine ground squirrel individuals found in the pellets were found in raven pellets, however, the authors believe that this fact does not yet prove a greater influence of the raven on the local ground squirrel population. The pellets analysis and observations of feeding behaviour of the three bird species prove that the speckled ground squirrel is constantly included in the diet of both diurnal birds of prey (genus Buteo) and of atypical predators with a mixed nutrition (raven). Finding of intact skulls of Spermophilus suslicus in pellets of the mentioned bird species is unlikely, which is determined by its considerable size. This circumstance does not allow obtaining most of the craniometric characters, but does not prevent the detection of pathomorphological changes. To compare the craniological characters, we used the skulls of dead ground squirrels (n = 5) found in the field near the village of Yushevichi. These individuals had visible injuries (lacerated wounds, etc.) presumably left both by predators and fights between ground squirrels. The most striking pathomorphological changes were revealed: osteoporosis and osteolysis of dental alveoli of the upper and lower jaws and initial osteomyelitis of the cranial vault (in the parietal and frontal bones). We believe that the speckled ground squirrel’s conservation status should be raised to at least Category II (according to the system of categories adopted in Belarus) for the following reasons: over the past six years, out of 12 known colonies, only four colonies have survived, two of which are practically unviable; stable for 10 years reduction in the number; and range fragmentation (single localities). According to the IUCN classification, it corresponds to category CR (critically endangered).

Dystocia due to faulty disposition caused by a monocephalus diprosopus monauchenos monster fetus in a buffalo

A 5 years old buffalo in her second lactation was presented with the history of complete gestation at village Bajuri situated in district Hamirpur of Himachal Pradesh, India. Per vaginal examination showed fetus in posterior longitudinal presentation with dorso-sacral position and bilateral hip flexion. Per vaginal traction of fetus was tried by mutations and was removed manually. Fetus was congenitally defected with the presence of two heads. It was a rare case of ‘monocephalus diprosopus monauchenos’ with two pairs of nostrils, four eyes (tetraophthalmus), two mouths, each with a tongue and two ears. The two faces were fused caudally by a single parietal bone. Both faces were joined ventrally by the medial rhami of the mandible.

A rare case of intracranial Castleman disease

Introduction. Castleman disease (CD) is a rare lymphoproliferative disorder also known as angiofollicular lymph node hyperplasia or giant lymphoid hyperplasia. CD is considered unicentric in the presence of a single focus and if the clinical picture is represented by multiple lymphadenopathy and systemic manifestations, it is considered multicentric. Manifestation of the disease by the occurrence of a focus that mimics a tumor of the meninges or brain is extremely rare, only 20 cases are known including the one presented in our article. The main treatment for localized forms is surgical resection. Our observation is devoted to a rare variant of intracranial CD. Description of the clinical case. Woman, 35 years old, was admitted to the clinic with complaints of recurrent headache of moderate intensity of a diffuse nature and difficulty in counting and writing. A month before hospitalization a single generalized epileptic seizure occurred. In the clinical picture at the time of admission, Gerstmann-Schilder syndrome was noted which topically corresponded to the lesion of the right parietal lobe. MRI of the brain with contrast enhancement showed pathological infiltration in the structure of the right parietal bone, the presence of a massive paraosseous component that spread intracranially with compression of the right parietal lobe, and moderately pronounced perifocal edema. The neoplasm was removed totally with a fragment of the dura mater (DM). The plastic of DM was performed with a vascularized periosteal flap and one-stage plastic of the skull defect with a titanium implant. According to histological and immunochemical studies, as well as additional examinations, a diagnosis of unicentric CD was established. According to the results of the control MRI of the brain with contrast enhancement after 3, 6 and 12 months, data for relapse were not revealed. The patient currently does not report any symptoms of the disease. Conclusion. Intracranial unicentric CD is a benign disease amenable to radical surgical treatment and does not require further adjuvant therapy. Despite the complexity of differential diagnosis between CD and meningiomas, the primary treatment strategy remains the same in all cases: total surgical removal.

Morphological features of the human dura mater in elderly and senile age

A fairly common trauma in the population of developed and developing countries is traumatic brain injury, with a significant proportion of patients of the elderly and senile age due to objective reasons. However, anatomical and morphological features of the dura mater (DM) are extremely poorly covered in the scientific medical literature. The aim of the study was to investigate the age-related features of the structure and thickness of the dura mater of a person in the elderly and senile age.Material and methods. The work was based on the analysis of the results of a comprehensive morphological examination of the DM of 127 deceased (65 men and 62 women) of adolescent, elderly and senile age. Autopsy material was taken from the parietal bones in the projection of the sagittal suture. Hematoxylin and eosin and van Gieson staining was used. The thickness of the DM was determined.Results. The age morphometric features of DM consist in its statistically significant increase in its thickness in both sexes (p &lt; 0.01). The most pronounced changes are in senile age compared to adolescent: men have 60.7 % more thickness (p &lt; 0.01) and women 63.5 % (p &lt; 0.01). There are no statistically significant differences in the thickness of the DM between men and women in each age period studied (p &gt; 0.05).Conclusions. The results of the study can serve as a foundation for the future study of age-related changes in the human DM, as well as for use by physicians of such clinical specialties as forensic medicine, neurosurgery, trauma and rehabilitation, gerontology.

Ap-2β regulates cranial osteogenic potential via the activation of Wnt/β-catenin signaling pathway

The skull is a fundamental bone that protects the development of brain and consists of several bony elements, such as the frontal and parietal bones. Frontal bone exhibited superior in osteogenic potential and regeneration of cranial defects compared to parietal bone. However, how this regional difference is regulated remains largely unknown. In this study, we identified an Ap-2β transcriptional factor with a higher expression in frontal bone, but its molecular function in osteoblasts needs to be elucidated. We found that Ap-2β knockdown in preosteoblasts leads to reduced proliferation, increased cell death and impaired differentiation. Through RNA-seq analysis, we found that Ap-2β influences multiple signaling pathways including the Wnt pathway, and overexpression of Ap-2β showed increased nuclear β-catenin and its target genes expressions in osteoblasts. Pharmacological activation of Wnt/β-catenin signaling using LiCl treatment cannot rescue the reduced luciferase activities of the β-catenin/TCF/LEF reporter in Ap-2β knockdown preosteoblasts. Besides, transient expression of Ap-2β via the lentivirus system could sufficiently rescue the inferior osteogenic potential in parietal osteoblasts, while Ap-2β knockdown in frontal osteoblasts resulted in reduced osteoblast activity, reduced active β-catenin and target genes expressions. Taken together, our data demonstrated that Ap-2β modulates osteoblast proliferation and differentiation through the regulation of Wnt/β-catenin signaling pathway and plays an important role in regulating regional osteogenic potential in frontal and parietal bone.

Case Report: Management Penetrating Brain Injury Across Middle Third of Superior Sagittal Sinus

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Penetrating cranial injuries are rarely reported on thick parietal bone. Goal of its management include removal of the foreign object while minimizing furher damage to the brain and associated neurovascular structures, also prevent further complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case &lt;/strong&gt;&lt;strong&gt;Description&lt;/strong&gt;: We report a case of a 22-year-old male presented with machete stucked in his head following an accidentally fell down of the weapon from a coconut tree. The cranial location affected were midparietal. He was disoriented on admission, with neither neurological focal signs nor seizure. Computed tomography (CT) revealed that the object penetrate middle superior sagittal sinus. After emergency craniotomy to remove the objects, debridement, dural sinus repair were performed. Recovery was complete without sequelae.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Laceration of the middle thirds of the superior sagittal sinus require special handling and care during surgery. Operative approach and treatment strategies are among the most important considerations to achieve the best patient outcomes. &lt;/p&gt;

Apparent diffusion coefficient (ADC) measurements and morphometric evaluation of the cranium in age-matched children with central precocious puberty.

Central precocious puberty (CPP) is one of the common reasons for referral to pediatric endocrinology. Magnetic resonance imaging (MRI) is used to rule out intracranial pathologies. However, there is insufficient information in the literature about bone marrow abnormalities on MRI in CPP cases. The aim of this study was to evaluate the apparent diffusion coefficient (ADC) values obtained from bone marrow diffusion weight images (DWI) of cranial bone structures and the status of sphenooccipital synchondrosis (SOS) in CPP. MRI data from 6-to 9-year-old girls with CPP and a healthy control group were evaluated. Anthropometric data, FSH, LH, and oestradiol tests were recorded, and the relationship between SOS status, DWI-ADC values of the clivus, parietal bone, and occipital protuberance were compared. The study included 146 girls, 79 CPP, and 67 healthy aged 6-9 years (median: 8 (2)). The diagnosis age was 8.30 ± 0.8 years. The ADC values were significantly lower on CPP than normal controls (p=<0.05). In the CPP group, pattern 1 was found at 2 % (n=2), pattern 2 at 3.5 % (n=3), and pattern 3 at 3.5 % (n=3) in clivus sphenooccipital synchondrosis. There was no correlation between the mean parietal, occipital, and clivus ADC values and any variable (p>0.05). DWI-MRI ADC analysis can be used as a quantitative radiological marker for early detection of CPP, even before changes in sphenooccipital synchondrosis.

Fracture of the Petrous Carotid Canal

A 23-year-old male motorcyclist experienced blunt head trauma with loss of consciousness, headache and vomiting, epistaxis and right otorrhagia after a collision with a motor vehicle. Fractures involving the right parietal and temporal bones, as well as acute subdural and subarachnoid hemorrhage were identified on a cranial and facial CT scan. On independent evaluation of the imaging study, a subtle but distinct fracture line in the skull base involving the petrous carotid canal was identified. (Figure 1) The patient subsequently underwent CT angiography to evaluate for any injury to the internal carotid artery. In this examination, good opacification of the internal carotid arteries and their branches was noted, with no evident aneurysm, arteriovenous malformation or arteriovenous fistula formation.&#x0D; In patients with temporal bone fractures, the most commonly encountered complications are: tympano-ossicular injury causing conductive hearing loss, cochlear or vestibular injury causing sensorineural hearing loss or vertigo, facial nerve trauma causing facial paralysis, and fractures of the tegmen or posterior cranial fossa plate causing cerebrospinal fluid leaks.1 On the other hand, injury to the intratemporal portion of the internal carotid artery has been described as a rare complication and as such may be overlooked.1 However, its potentially devastating and life-threatening sequelae necessitates a purposeful and intentional evaluation for its presence. These sequelae include brain ischemia from arterial dissection or complete vascular occlusion, exsanguinating epistaxis or otorrhagia from carotid pseudoaneurysms, and the formation of carotid-cavernous fistulas.2 The incidence of involvement of the carotid canal in skull base fractures has been reported to be around 24%, with around 11% of this group developing internal carotid artery injuries.3 As such, the presence of fractures involving the petrous carotid canal is an indication for CT or MR angiography to further evaluate the internal carotid artery.4

A Calvarial Defect Model to Investigate the Osteogenic Potential of Umbilical Cord Stem Cells in Bone Regeneration.

The standard graft material for alveolar cleft repair (ACR) is autogenous iliac crest. A promising alternative potential graft adjunct-newborn human umbilical cord mesenchymal stem cells (h-UCMSCs)-has yet to be explored in vivo. Their capacity for self-renewal, multipotent differentiation, and proliferation allows h-UCMSCs to be harnessed for regenerative medicine. This study sought to evaluate the efficacy of using tissue-derived h-UCMSCs and their osteogenic capabilities to improve ACR in a murine model. Foxn1 mice were separated into three groups with the following calvarial defects: no treatment (empty defect; n = 6), poly(D,L-lactide-co-glycolide) (PLGA) scaffold ( n = 6), or h-UCMSCs with PLGA ( n = 4). Bilateral 2-mm-diameter parietal bone critical-sized defects were created using a dental drill. Microcomputed tomography (microCT) imaging was performed 1, 2, 3, and 4 weeks postoperatively. The mice were euthanized 4 weeks postoperatively for RNAScope, immunohistochemical, and histological analysis. No mice experienced complications during the follow-up period. MicroCT imaging and histological analysis demonstrated that the no-treatment and PLGA-only defects remained patent without significant defect size differences across groups. In contrast, the h-UCMSCs with PLGA group had significantly greater bone fill on microCT and histological analysis. This study demonstrates a successful calvarial defect model for the investigation of h-UCMSC-mediated osteogenesis and bone repair. Evidence reveals that PLGA alone has neither short-term effects on bone formation nor any unwanted side effects, making it an attractive scaffold. Further investigation using h-UCMSCs with PLGA in larger animals is warranted to advance future translation to patients requiring ACR. The authors' results demonstrate a successful murine calvarial defect model for the investigation of h-UCMSC-mediated osteogenesis and bone repair, and they provide preliminary evidence for the safe and efficacious use of this graft adjunct in alveolar cleft repair.

Quantitative study of the primary ossification centre of the parietal bone in the human fetus.

Detailed morphometric data concentrating on the development of primary ossification centres in human fetuses is critical for the early detection of developmental defects. Thus, an understanding of the growth and development of the parietal bone is crucial in assessing both the normal and pathological development of the calvaria. The size of the parietal primary ossification centre in 37 spontaneously aborted human fetuses of both sexes (16 males and 21 females) aged 18-30 weeks was studied by means of computed tomography, digital-image analysis and statistics. The numerical data of the parietal primary ossification centre in the human fetus displays neither sex nor laterality differences. With relation to fetal age in weeks, the parietal primary ossification centre grew in sagittal diameter according to the quadratic function: y = 16.322 + 0.0347 × (age)² ± 1.323 (R² = 0.96), in projection surface area according to the cubic function: y = 284.1895 + 0.051 × × (age)³ ± 0.490, while in both coronal diameter and volume according to the quartic functions: y = 21.746 + 0.000025 × (age)⁴ ± 1.256 and y = 296.984 + + 0.001 × (age)⁴, respectively. The obtained morphometric data of the parietal primary ossification centre may be considered age-specific references, and so may contribute to the estimation of gestational ages and be useful in the diagnostics of congenital cranial defects.

Oral and Maxillofacial Radiology

Clinically (Figure 1) a unilateral swelling, proptosis and obliteration of the nasolabial fold was noted. Intraoral examination revealed normal-appearing overlying mucosa. A pantomograph (Figure 2) demonstrates a mixed diffuse expansile lesion and thinning of the cortices affecting both jaws. 3D reconstruction (Figure 3) overview the lesions' extent. CBCT interpretation (Figures 4 and 5) indicated engrossment of the frontal, parietal, temporal, sphenoid, ethmoid, maxillary, palatine, zygomatic, and mastoid bones. T1-weighted gadolinium-enhanced MRI image (Figure 6) of a patient with a similar lesion in the right maxilla demonstrates a heterogeneous appearance.

Calvarial Vault Remodeling Technique for Lambdoid Craniosynostosis.

Premature fusion of the lambdoid suture is the most uncommon single-suture synostosis. It presents with a classic "windswept" appearance, a trapezoid-shaped head, and significant skull asymmetry notable for an ipsilateral mastoid bulge and contralateral frontal bossing. Because of the rarity of lambdoid synostosis, little is known about optimal techniques for its treatment. In particular, the proximity of the lambdoid suture to critical intracranial structures such as the superior sagittal and transverse sinuses represents a potential for significant intraoperative bleeding. Prior work has shown that parietal asymmetry persists after repair in these cases. In this article, the authors present a technique for the treatment of unilateral lambdoid craniosynostosis along with two representative cases. This calvarial vault remodeling technique requires the removal of both ipsilateral and contralateral parietal bones. These are moved across hemispheres and reinset on opposite sides to help correct the parietal asymmetry. Obliquely orientated barrel stave osteotomies are performed to provide a safe mechanism for correction of occipital flattening. The authors' early results show improvement in correction of volume asymmetry 1 year postoperatively relative to patients treated with prior calvarial vault remodeling techniques. The authors believe the technique presented here corrects the windswept appearance in patients with lambdoid craniosynostosis and also reduces the potential for complications. Further work will be necessary to confirm this technique's long-term efficacy in a larger cohort.

Precursor B-cell acute lymphoblastic leukemia presenting with isolated skin relapse: a pediatric case report

BackgroundIn childhood acute lymphocytic leukemia (ALL), relapse is most commonly seen in the bone marrow (10–20%), followed by the central nervous system (3–8%). Isolated skin relapse is very rare in ALL. We report an 8-year-old child presented with isolated skin relapse.Case presentationAn eight-year-old female patient presented with swelling on the scalp 3 months after the completion of the ALLIC-BFM 2009 chemotherapy protocol administered due to the diagnosis of precursor B-cell (pre-B) ALL. Physical examination revealed a hard, painless, hyperemic, nodule-shaped lesion measuring 2 × 1 cm on the right parietal bone. Atypical hematopoietic cells with the prominent nucleolus, narrow cytoplasm, and immunohistochemically stained with CD 10, 19, 22, 79-a, and TdT were observed in the histopathological examination of the skin lesion. There was no blast in the bone marrow aspiration smear and cerebrospinal fluid. The patient was diagnosed with aleukemic leukemia cutis (LC) and pre-B ALL, presenting as an isolated relapse.ConclusionAleukemic LC is a very rare finding after leukemia treatment. It may present with various cutaneous lesions, such as a papule, macule, plaque, nodule, palpable purpura, and ulcerative lesions. Leukemia cutis should be considered in the differential diagnosis of skin lesions developing during or after treatment in children with leukemia.