Perforation Of Cortex Research Articles

Management of early and late presenting tibial stress fracture with advanced osteoarthritis of the knee: A dilemma among arthroplasty surgeons in developing countries

BackgroundSingle-stage total knee arthroplasty (TKA) with long-stem is a viable option to treat proximal tibial stress fracture in advance knee osteoarthritis. However, in patients with old mal-united or non-united tibial fractures, treatment becomes complicated. Therefore, our aim in this study was to monitor clinical and radiological outcome in patients presenting early or late managed by single-stage long-stem TKA. MethodsThis retrospective study included 24 consecutive patients; all were female. Patients with recent and mobile stress fracture (Group A) were treated with close reduction and long-stem tibial component. However, in patients with old, sclerotic or mal-united fractures (Group B), open reduction, partial fibulectomy and plating with bone grafting was also performed. Outcome was monitored by tibiofemoral angle, functional Knee Society score and time taken for union. ResultsThe mean age of patients was 62.34 years. There were 13 patients in Group A and 11 in Group B. The mean follow up was 42.79 months (range, 18–72 months). Knee Society score improved from 29.83 ± 6.10 to 91.57 ± 4.89 in Group A and from 27.21 ± 3.32 to 89.87 ± 3.89 in Group B. Tibiofemoral angle improved from 20.57 ± 3.00° to 0.80 ± 0.46° in 21 varus knees, whereas it improved from 22.33 ± 4.61° to 0.83 ± 0.28° in three valgus knees. Iatrogenic perforation of tibial cortex occurred in one case. Union of stress fracture was achieved in all cases with a mean duration of 4.70 months. ConclusionExcellent results were obtained in both groups but were slightly lower in patients presenting late, therefore all efforts must be made to treat such cases as early as possible.

The occurrence of dental implant malpositioning and related factors: A cross-sectional cone-beam computed tomography survey.

PurposeDental implants are widely used for the rehabilitation of edentulous sites. This study investigated the occurrence of dental implant malpositioning as shown on post-implantation cone-beam computed tomography (CBCT) and to identify related factors.Materials and MethodsSamples with at least 1 malpositioned dental implant were collected from a central radiology clinic in Tehran, Iran from January 2017 to January 2019. Variables such as demographic characteristics, length and diameter of implants, type of implant, sites of implant insertion, different types of implant malpositioning problems (cortical plate perforation, interference with anatomical structures), angulation of the implant, and the severity of malpositioning were assessed. In addition, the incidence of implant fracture and over-drilling was evaluated. Data were statistically analyzed using the chi-square test, 1-sample t-test, and Spearman correlation coefficients.ResultsIn total, 252 patients referred for implant postoperative CBCT evaluations were assessed. The cases of implant malpositioning included perforation of the buccal cortical plate (19.4%), perforation of the lingual cortical plate (14.3%), implant proximity to an adjacent implant (19.0%), implant proximity to an adjacent tooth (3.2%), interference with anatomical structures (maxillary sinus: 18.3%, mandibular canal: 11.1%, nasal cavity: 6.3%, mental foramen: 5.6%, and incisive canal: 0.4%). Implant fracture and over-drilling were found in 1.6% and 0.8% of cases, respectively. Severity was categorized as mild (9.5%), moderate (35.7%), severe (37.7%), and extreme (17.1%), and 52.4% of implants had inappropriate angulation.ConclusionCBCT imaging is recommended for detecting dental implant malpositioning. The most common and severe type of malpositioning was buccal cortex perforation.

Pre –treatment implant CBCT Analysis of Anterior Mental Loop Length, Lingual Concavity and Inclination of Alveolar Ridge in the Mandible – A UAE Study

Aims: This study aims to use 3D imaging (CBCT) in order to identify the presence of anterior mental loop,know its dimensions and variation in anatomy, lingual concavity and the angle of tilt in the mandibular ridgeaiding in better treatment planning for surgical approaches.Method: Forty CBCT images of patients scanned by Planmeca Romexis for different diagnostic purposes,were analyzed using the Romexis software.Results: The study results showed that mental loop was present in 62.5% of patients on the right side and 70%of patients on the left side, with a mean length ranging from 0.30 mm to 3.12 mm. The presence of anteriorcanal was observed in 5 patients (2 Females and 3 Males) 12.5% of the cases examined. As mentioned inmethodology lingual concavity was classified based on its morphology into three classifications: A (Acuteundercut) B (stream line) C (Kidney shape), with class C (Kidney shape) amounting up to 42.5% of the caseswhile the least common was class B (stream line). In 40% of the cases, deepest lingual concavity was in theregion of the second molar.Conclusions: Placement of implants in the molar region of the mandible may result in perforation of thelingual cortex due to severely inclined ridge or deep lingual concavity. Presence of mental loop and anteriormandibular canal in the region of mandibular region needs careful evaluation using different tomographicslices.

Outcomes of Patients Undergoing Anterior Screw Fixation for Odontoid Fracture and Analysis of the Predictive Factors for Surgical Failure.

ObjectiveAnterior odontoid screw fixation (AOSF) is a safe and effective treatment for type II and rostral type III odontoid fracture. This study aimed to report the outcomes of the AOSF surgery and evaluate the potential risk factors of surgical failure. MethodsWe enrolled 63 patients who underwent AOSF. Follow-up computed tomography was performed 6 months after the surgery and once a year thereafter to evaluate the union. Clinical data including the age, sex, presenting symptoms, cause of injury, fracture gaps, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were collected. ResultsSuccessful fusion was achieved in 55 patients (87.3%) and surgical failure occurred in 8 patients (12.7%). Variables such as age, sex, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were not significantly associated with the surgical failure. However, surgical failure was statistically significantly associated with the fracture gap. The overall mean fracture gap at the time of injury was 1.29 mm (range, 0–3.11 mm), and the incidence of surgical failure was 8.3 times higher when the fracture gap at the time of injury was > 2 mm (p=0.019). ConclusionWhen performing AOSF in patients with type II or rostral shallow type III odontoid fractures, the displacement of the odontoid fracture fragment should be appropriately reduced to the aligning position before screw insertion and downward reduction should be achieved by perforation of the apical cortex of the odontoid during screw fixation, even if the surgery is delayed.

Potential risk of medial cortex perforation due to peg position of morphometric tibial component in unicompartmental knee arthroplasty: a computer simulation study.

The purpose of this study is to evaluate the risk of medial tibial cortical perforation in unicompartmental knee arthroplasty (UKA) due to peg positions on the tibial tray of the Persona Partial Knee (PPK). Preoperative CT images of 60 patients and 60 osteoarthritic knees (30 male and 30 female patients) were used. A tibial multiplanar reconstruction (MPR) image was reconstructed in preoperative planning software, and the implant was placed in a virtual osteotomy plane. In addition to PPK, Zimmer Unicompartmental Knee (ZUK) and TRIBRID (TBD) were used for evaluation. The horizontal distances from the medial tibial cortex to the anterior and posterior pegs (APCD/PPCD, respectively) were measured under neutral, 3-degree varus, 3-degree valgus and 2mm distal positions. The differences between implants under the same positions and between positions using the same implants were compared. The percentage of total cases with APCD/PPCD of less than 3mm and the perforation risk rate were calculated. The APCD of PPK was significantly shorter at all positions except for the varus position of TBD. The PPCD of PPK was significantly shorter at all positions compared to ZUK and TBD. There were no cases with an APCD of less than 3mm. Except for varus positions, the perforation risk rate of PPCD was significantly higher for PPK than the other two implants. The posterior pegs of the PPK are located more medially than the other two implants, which may result in perforation of the medial tibial cortex during implantation. Surgeons should consider the risk involved in the type of implant used.

Incidence of Pre-Existing Lingual Cortex Perforation Before Removal of Mandibular Third Molars

The objective of this study was to determine the relationship between the mandibular third molar tooth (Md3) and the adjacent lingual cortical bone and determine the incidence of lingual cortex perforation by Md3s. This retrospective study was designed and implemented from 100 cone-beam computed tomographic scans (CBCTs) of patients with age ranging from 18 to 65years old. The primary outcome was to assess the incidence of mandibular third molars (Md3s) with existing lingual cortex perforation by their roots. Perforation was assessed at the level of root apex and the most lingual portion on the apical half of the root. Other outcome variables included average thickness of covering lingual bone in the nonperforation group, lingual cortex morphology, impaction, and demographics. Descriptive statistics were computed. More than half the radiographs showed lingual cortex perforation at the level of root apex and most lingual portion on the apical one half of the root (51.2% and 52.8%, respectively). The average thickness of the covering lingual bone was 1.25mm around the root apex and 0.93mm around the most lingual portion on the apical half of the root. The most common lingual cortex morphology was the undercut shape. There was statistically significant association between the presence of Md3 impaction and perforation at both root levels [(P value<.001, Effect size=0.378) and (P value<.001, Effect size=0.445)]. Perforation of the lingual cortex by Md3s, whether erupted or impacted, was found in >50% of patients as determined by a preoperative CBCT scan. Therefore, the finding of lingual cortex perforation after removal of Md3s is likely to be evidence of a pre-existing condition rather than a result of surgery.

Determination of Anatomical Sacral Dysmorphism Criteria based on CT scan Findings for Iliosacral Screw Fixation in a Sample of Iranian Population without Pelvic Ring Fracture

Background: The pelvic ring, sacral fractures and sacroiliac dislocations are managed with different methods. The preferred treatment in sacral fractures or SIjoint dislocations is iliosacral screw fixation. The upper sacral segment dysplasia increases the risk of perforation of the osseous cortex during Iliosacral fixation with a screw. The dysmorphic sacra have a narrow and angular osseous corridor. Objectives: To date, no study has been conducted on the sacral dysmorphism and quantitative and qualitative criteria for fixation with iliosacral screw in sacral dysmorphism among the Iranian population. Methods: We analyzed 100 CT scan and Outlet CT reformation forms of traumatic patients without pelvic trauma to determine 5 qualitative criteria of sacral dysmorphism (i.e., mammillary bodies, misshapen sacral foramen, upper sacral segment not recessed in the pelvis, residual disc between S1 and S2 vertebra and acute alar slope). Upper sacral surface area and angulation were determined based on the CT scan reformatted. Results: Five qualitative criteria from the 3D pelvic CT outlet view and sixth characteristic (tongue-in-groove) from the axial pelvic CT section were obtained by an orthopedic surgeon. Coronal reconstruction was used to divide the patients into dysmorphic and non-dysmorphic groups by drawing a line along the axis of the osseous corridor from one side of iliosacral to its other side. The results showed that 37% of the patients were in the dysmorphic group and 63% in non-dysmorphic. Qualitative criteria were in the range 24% -71% in the dysmorphic group and 14%-34% in the non-dysmorphic group. The sacral dysmorphism score was calculated in all patients. The sacral dysmorphism score = (first sacral segment coronal angle) + 2(first sacral segment axial angle). The obtained mean angle in the dysmorphic and non-dysmorphic group was 84° and 72°, respectively. As the score increased, the safety of the osseous corridor decreased. The dysmorphic score ranged between 70 and 84 in one-third of the patients and none of them was less than 70°. Conclusion: In this study, sacral dysmorphism was detected in 37% of the patients. Axial angulation and coronal angulation were the most important quantitative criteria for determining the sacral dysmorphism. Detecting sacral dysmorphism can be useful for preoperative planning of iliosacral screw placement.

Correlation of panoramic high-risk markers with the cone beam CT findings in the preoperative assessment of the mandibular third molars

Background/purposePreoperative radiographic examination of mandibular third molars (MTM) is essential to prevent inferior alveolar nerve (IAN) injury. The aim of this study was to assess the panoramic radiography (PAN) signs considered as indicators of increased risk of IAN injury and to correlate them with the cone beam CT (CBCT) findings. Materials and methods58 patients who had MTMs extraction between January 2012 and January 2018. OPG were evaluated for the following signs: interruption of the roof of the canal, root darkening, roots deflection and narrowing, canal deviation, superimposition between the MTM roots and mandibular canal. Loss of canal cortication, root grooving, thinning and perforation of lingual cortex were assessed in CBCT images. Chi-square test and multivariate logistic regression tests were used to test the relationship between PAN signs and CBCT findings. ResultsA total of 79 MTMs were examined. Loss of canal cortication in CBCT was seen in 22 (27.8%) of the cases. Root darkening in PAN images was the most frequent radiographic sign. Canal deviation and interruption of white line in PAN demonstrated a statistically significant correlation with the loss of canal cortication between the MTM and the mandibular canal on CBCT images (p = 0.004 and p = 0.012, respectively). No statistically significant association was observed for the other PAN signs and CBCT findings. ConclusionCanal deviation and interruption of white lines were associated with loss of canal cortication on CBCT, indicating a direct contact between the roots and the mandibular canal which required a further assessment prior to the extraction.

2213 Spinal Rod Migration and Pelvic Perforation in a Patient with Severe Cerebral Palsy and Scoliosis

Video Objective To describe a rare occurrence of spinal hardware migration and perforation into the pelvic peritoneum. To describe the evaluation of the pelvic organs with perforating trauma. Setting Academic university affiliated tertiary care center. Interventions Cerebral palsy refers to a heterogeneous group of conditions involving permanent nonprogressive central motor dysfunction that affect muscle tone, posture, and movement. It can be associated with neuromuscular scoliosis which can cause large curves in the spine and pelvic obliquity necessitating spinal and pelvic fusion and fixation. Hardware failures from these surgeries are rare however do occur with increased incidence in patients with risk factors such as ongoing severe contractures of the spine. Specifically, the Luque rod has been associated with complications and even pelvic cortex perforation. This video describes a rare occurrence of a Luque rod perforation from the spine and bony pelvis into the retroperitoneum and perforation into the pelvis. We show an evaluation of the potential trauma sites and highlight the location of this rod in relation to the surrounding vital pelvic structures. Conclusion We report a rare occurrence of spinal hardware migration and perforation into the pelvic peritoneal cavity. Multispecialty surgical planning and coordination is extremely important. Many contingent surgical plans are necessary prior to the operating room for optimal outcomes.

Acetabular Subchondral and Cortical Breach During Labral Repair with Suture Anchors: Influence of Portal Location, Curved vs Straight Drill Guides, and Drill Starting Point

Objectives: Acetabular labral tears are commonly treated with arthroscopic repair using suture anchors. Iatrogenic chondral injury has been cited as one of the more common complications during hip arthroscopy, and can occur while pre-drilling for suture anchors. Proposed factors contributing to penetration of the articular subchondral bone or the far cortex of the acetabulum include the portal utilized for drilling; the position of the drill guide relative to the acetabular rim (on rim, ON; off rim, OFF); and the use of straight (ST) versus curved (CU) drill guides. The purpose of this study was to evaluate the relative impact of these variables on drill penetration of the acetabular subchondral bone or the far cortex of the acetabulum. Methods: Sixty sawbone acetabula models were marked at the 3, 2, 1, 12, and 11 o’clock position. A Simulated anterior (AP), anterolateral (AL), and distal anterolateral accessory (DALA) portals were created. Twelve groups of five acetabula were drilled at each clock face position: ST/AP/ON; ST/AL/ON; CU/AP/ON; CU/AL/ON; ST/AP/OFF; ST/AL/OFF; CU/AP/OFF; CU/AL/OFF; ST/DALA/ON; ST/DALA/OFF; CU/DALA/ON; CU DALA/OFF. Perforations of the articular subchondral bone and far cortex of the acetabulum were recorded. Results were tabulated and analyzed to assess the relative impact of each variable both in aggregate and at each position on the clock face. Results: A total of 300 acetabular suture anchor drill holes were created on 60 acetabula 12 combinations of portal utilized (anterior, anterolateral, distal anterolateral accessory), drill guide type (curved or straight), and rim position (on rim, off rim). A total of 38/300(12.7%) drillings perforated the subchondral bone, and 45/300(15%) breach the far cortex. Drilling from the AP, AL, and DALA portal breached the articular subchondral bone 21/100 (21%), 17/100(17%), and 0/100(0%) respectively; and breached the far acetabular cortex 36/100(36%), 1/100(1%), and 8/100(8%) respectively. Drillings using a curved drill guide penetrated the subchondral bone on 14/150(9.3%) attempts and drillings using a straight drill guide penetrated the subchondral bone 33/150(22%) attempts (p=0.0025). Drillings with an “On Rim” start point breached the articular subchondral bone 29/150(19.3%) versus 9/150(6%) for drillings with an “Off Rim” start point; and breached the far acetabular cortex 21/150(14%) times versus 24/150(16%) times. Articular surface penetrations were most frequent at the 2 and 3 o’clock positons, and far cortex perforations were most frequent at the 11 and 12 o’clock positions. Conclusion: This study quantifies the relative impact of portal location, drill guide, and starting point on the acetabular rim on acetabular subchondral bone and far cortex penetration. Portal location had the highest impact, with the DALA portal noted to be the safest. Curved drill guides also reduced the number of acetabular subchondral bone penetrations. These findings can be used to influence arthroscopic technique during acetabular labral repair.

An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL.

A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone. Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface. A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region. An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.

A novel technique to prevent distal anterior femoral cortical perforation

Background: Anterograde femoral intramedullary nailing is a commonly used operative technique in orthopaedic surgery. Of its related complications, distal femoral anterior cortical breach is of special concern. Methods: We describe the steps of an anterograde femoral intramedullary nailing surgical technique performed on three patients to mitigate their risk of developing an anterior distal perforation of the femoral cortex. Results: All patients presented with a proximal intertrochanteric femoral fracture and underwent an intramedullary femoral nail placement. They all had an anatomic reduction radiographically. No complications intraoperatively or at last follow-up were recorded. Conclusions: By surgically redirecting the guidewire posteriorly before placing the nail in its desired position, our surgical technique prevents the anterior intramedullary nail abutment against the femoral cortex and the risk of anterior femoral cortical perforation. Level of Evidence: V.

Atypical diaphyseal femoral fractures: Considerations on surgical technique

In the last two decades bisphosphonates (BP) has become the mainstream therapy for osteoporosis and the benefit in reducing the incidence of fractures has been well demonstrated in several studies, together with the drug long term (5–10 years) efficacy and safety.A complication of the long-term use of bisphosphonates is a low-energy stress fractures located in the sub-trochanteric region and the femoral shaft called atypical femur fracture (AFF).These stress fractures can be seen on plain radiographs as simple transverse patterns, with unicortical beaking and hypertrophy of the diaphyseal lateral cortex. Usually a localized thigh pain in the prodromal phase may precede the fracture by months. The current surgical treatment of choice for AFFs is intramedullary nailing (IMN). However, the treatment of AFFs is associated with a higher rate of intra-operative and post-surgical complications. This is related to anatomical e biomechanical reasons. Iatrogenic fractures, deformities, medial gap opening, eccentric position of the distal nail tip with anterior cortex perforation, delayed or non-union are frequent complications of this procedure and healing rate of AFFs. The average healing time of almost 8 months for AFFs appeared to be longer than that for typical femoral fractures, which heal at an average of 3–6 months.The purpose of this study is to analyze the different surgical devices and techniques and to advance some considerations that can be useful to diminish the rate of failure and/or complications in the treatment of AFFs in both oncologic and osteoporotic patients.

Displasia Óssea Florida Expansiva: relatos de dois casos incomuns

Osseous dysplasia generally is a radiographic finding because, for themost part, it does not cause clinical changes. However, a new subtype ofdysplasia that affects primarily middle-aged black women and promotesexpansion of the involved cortical bone has been reported as ExpansiveOsseous Dysplasia. The aim of this article is to report two cases ofFlorida Osseous Dysplasia with expressive expansion and perforationof the osseous cortex involved. The first case reports a 46-year-oldblack female patient whom was attended at the Naval Dental Centerrequiring indirect restoration in one tooth. Clinical examination showeda hard and increased volume at lingual portion of alveolar ridge in theregion of the lower incisors. In the panoramic radiography two mixeddensity images were observed with predominance of radiopaque areasin the apical region of the anterior inferior teeth and in the first lowerleft molar. The computed tomography showed the buccal cortex thinningand the expansion and perforation of the lingual cortex in the incisorregion. The second case presents a middle-aged brown skin patient whosought dental care to monitor a mixed lesion in the apical region of theanterior inferior teeth, lower premolars on both sides and in the thirdright lower third molar. In cone beam computed tomography, expansionand thinning of the vestibular cortex in the anterior inferior teeth wereobserved. Based on the current literature and the characteristics of bothlesions, the diagnostic hypothesis was Florida Osseous Dysplasia withexpansive aspect. The patients were advised on the importance of oralhygiene and the need for an annual follow-up of these lesions.

Safe Margin beyond Dens Tips to Ventral Dura in Anterior Odontoid Screw Fixation : Analysis of Three-Dimensional Computed Tomography Scan of Odontoid Process.

ObjectiveAnterior odontoid screw fixation is a safe and effective method for the treatment of odontoid fractures. The surgical technique is recommended for perforation of the apical cortex of the dens by the lag screw. However, overpenetration of the apical cortex may lead to potentially serious complications such as damages of adjacent vascular and neural structures. The purpose of this study was to assess the role of three-dimensional computed tomography (CT) scan to evaluate the safe margin beyond dens tip to ventral dura for anterior odontoid screw fixation.MethodsWe retrospectively analyzed the three-dimensional CT scans of the cervical spines in 55 consecutive patients at our trauma center. The patients included 38 males and 17 females aged between 22 and 73 years (mean age±standard deviation, 45.8±14.2 years). Using sagittal images of 3-dimensional CT scan, the safe margins beyond dens tip to ventral dura as well as the appropriate screw length were measured.ResultsThe mean width of the apical dens tip was 9.6±1.1 mm. The mean lengths from the screw entry point to the apical dens tip and posterior end of dens tip were 39.2±2.6 mm and 36.6±2.4 mm. The safe margin beyond apical dens tip to ventral dura was 7.7±1.7 mm. However, the safe margin beyond the posterior end of dens tip to ventral dura was decreased to 2.1±3.2 mm, which was statistically significant (p<0.01). There were no significant differences of safe margins beyond dens tip to ventral dura with patient gender and age.ConclusionExtension by several millimeters beyond the dens tip is safe, if the trajectory of anterior odontoid screw is targeted at the apical dens tip. However, if the trajectory of the screw is targeted to the posterior end of dens tip, extension beyond dens tip may lead to damage immediately adjacent to the vental dura mater.

Therapeutic outcome of various treatment modalities for the management of 34 cases of mandibular unicystic ameloblastoma

Background &amp; Objectives: Unicystic ameloblastoma is a challenge, as conservative modalities have high recurrence chances whereas radical modalities have high morbidity for defects and deformity. Enucleation with peripheral ostectomy and Carnoy’s solution is an intermediate treatment with less risk of recurrence and good outcome. The objectives of the study was to determine the therapeutic outcome for various treatment modalities for the management of mandibular unicystic ameloblastoma.Materials &amp; Methods:Retrospective analysis of 34 cases from 2005 to 2014 was done and were analysed in terms of demographic profiles, treatment modalities and its efficacy (recurrence) in 6 years’ follow up time.Results: The total number of patients was 34. The age ranged from 12 years to 28 years with a mean age of 18.82 years. Gender distribution was 21 males (61.8%) and 13 females (38.2%). The location found was 26 (76.5%) cases in posterior mandibular region and 8 (23.5%) cases in the anterior mandibular region. Size of the lesions was small in 10 (29.4%) cases, medium in 18 (52.9%) cases and large in 6 (17.6%) cases. Perforation of buccal or lingual cortex was present in 6 (17.6%) and no preforation in 28 (82.4%). Treatment modalities done was marsupilisation in 6 (17.6%) cases, enucleation with peripheral ostectomy with caroney solution in 22 (64.7%) cases and resection with safe margin in 6 (17.6%) cases. Recurrence occurred in 8 (23.5%) cases and no recurrence in 26 (76.5%) cases.Conclusion:Enucleation with peripheral ostectomy and Carnoy’s solution is one of the good treatment modality for unicystic ameloblastoma of the mandible whereas complete resection of the mandible with safe margin has low risk of recurrence in long term follow up.

Floor of Mouth Haematoma following Dental Implant: A Case Report

Introduction: Airway-compromising haematoma in the floor of the mouth (FOM) following insertion of dental implants has been reported, with accidental perforation of the lingual cortex being the most common cause. We report a case with an extensive FOM haematoma following placement of a dental implant with no perforation of lingual cortex of the mandible.

The characteristics of adjacent anatomy of mandibular third molar germs: a CBCT study to assess the risk of extraction

This study aims to investigate the characteristics of adjacent anatomy of mandibular third molar germs (MTMGs). Three hundred Chinese patients aged 12 to 17 years old who received cone-beam computed tomography (CBCT) were enrolled. The continuity of cortical outline of inferior alveolar canals (IACs) in the region of MTMGs, the integrity of lingual bone cortex and the relationship between hard tissue part of MTMGs and IACs were investigated by observing CBCT data via the NNT viewer software. The age, degree of dental development, gender and location were recorded as variables. The associations between different variables and the observed data were analysed. The possibilities of disrupted cortical outline of IACs or the hard tissue part of MTMGs contacting IACs were significantly lower in 12 or 13 age groups, lower in Nolla stage ≤ 6. Males were significantly less than females in the incidence of disrupted cortical outline of IACs. As to the perforation of lingual bone cortex, no significant differences were observed in gender, ages, location or development stages. According to the CBCT images, anatomical factors contributed the lest to the risk of inferior alveolar nerve and lingual nerve injury in the 12 to 13 age group during removing the MTMG removal.

The Azygos Vein Is at Potential Risk of Injury From Malpositioning of Left Thoracic Pedicle Screw in Thoracic Adolescent Idiopathic Scoliosis Patients.

A computed tomography study. To evaluate the changed position of azygos vein in patients with thoracic adolescent idiopathic scoliosis (AIS) and to analyze the potential risk of injury of azygos vein from thoracic pedicle screw placement in these patients. It has been widely recognized that the anatomic positions of structures adjacent to the vertebrae may change in patients with AIS. To date, no study had evaluated such change of azygos vein in patients with AIS. Twenty-five patients with thoracic AIS and 17 age-matched normal teenagers were included in the present study. Axial computed tomography images from T7 to T10 level were obtained to evaluate azygos vein-vertebral angle (defined as 0° when the azygos vein was located directly laterally to the left and 180° when directly laterally to the right). The percentage of azygos vein located in the direction of left screw passage was calculated to analyze the potential risk of injury from left pedicle screw placement. The azygos vein-vertebral angles were significantly smaller in patients with AIS when compared with normal teenagers from T7 to T10 level (P < 0.001). The percentage of azygos vein at high risk of injury from left pedicle screw placement was 80% (20/25) at T7 level, 84% (21/25) at T8 level, 76% (19/25) at T9 level, and 72% (18/25) at T10 level in patients with AIS. No azygos vein was found to be at risk of injury from right pedicle screw placement in patients with AIS. The azygos vein was safe from pedicle screw placement on both sides in normal teenagers. The changed relative anatomic position of azygos vein in patients with thoracic AIS places the azygos vein at high potential risk of injury from excessively long left pedicle screw placement. Spine surgeons should choose appropriate screw length to avoid anterior cortex perforation. 3.

Clinical protocol levels are required in laboratory animal surgery when using medical devices: experiences with ureteral replacement surgery in goats.

It is common to test medical devices in large animal studies that are or could also be used in humans. In this short report we describe the use of a ureteral J-stent for the evaluation of biodegradable tubular constructs for tissue reconstruction, and the regeneration of ureters in Saanen goats. Similarly to a previous study in pigs, the ureteral J-stent was blindly inserted until some resistance was met. During evaluation of the goats after three months, perforation of the renal cortex by the stent was observed in four out of seven animals. These results indicated that blind stent placement was not possible in goats. In four new goats, clinical protocols were followed using X-ray and iodinated contrast fluids to visualize the kidney and stent during stent placement. With this adaptation the stents were successfully placed in the kidneys of these four new goats with minimal additional effort. It is likely that other groups in other fields ran into similar problems that could have been avoided by following clinical protocols. Therefore, we would like to stress the importance of following clinical protocols when using medical devices in animals to prevent unnecessary suffering and to reduce the number of animals needed.