Root Anomalies Research Articles

Anatomical variations of the brachial plexus in adult cadavers: A descriptive study and clinical significance.

Brachial plexus injury is recognized as one of the most severe clinical challenges due to the complex anatomical configuration of the brachial plexus and its propensity for variation, which complicates safe clinical interventions. This study aimed to ascertain the prevalence and characterize the types of brachial plexus variations, and to elucidate their clinical implications. We conducted meticulous dissections of 60 formalin-fixed cadavers' upper arm, axilla and lower neck to reveal and assess the roots, trunks, divisions, cords, and branches of the brachial plexus. The pattern of branching was noted by groups of dissecting medical students and confirmed by the senior anatomists. The variations discovered were record and photographed using a digital camera for further analysis. Variations in the brachial plexus were identified in 40 of the 60 cadavers, yielding a prevalence rate of 66.7%. These variations were classified into root anomalies (2.1%), trunk anomalies (8.5%), division anomalies (2.1%), and cord anomalies (4.3%). Notably, anomalies in communicating branches were observed in 39 cadavers (83.0%): 14 with bilateral anomalies, 14 with anomalies on the left side, and 11 on the right side. These communicating branches formed connections between the roots and other segments, including trunks, cords, and terminal nerves, and involved the median, musculocutaneous, and ulnar nerves. The frequency and diversity of brachial plexus variations, particularly in communicating branches, are significant in cadavers. It is imperative that these variations are carefully considered during the diagnostic process, treatment planning, and prior to procedures such as supraclavicular brachial plexus blocks and nerve transfers, to mitigate the risk of iatrogenic complications.

Managing Short Root Anomalies in Pediatric Cancer Survivors: Utilizing Resin Wire Splints and Miniscrews for Skeletal Anchorage

Patients with pediatric cancer often undergo multiple therapies, such as chemotherapy, radiation therapy, and stem cell transplantation. These treatments, while essential, can result in dental developmental issues, including hypodontia, microdontia, short roots, and delayed dental development. This report presents two cases of pediatric patients diagnosed with neuroblastoma who exhibited severe tooth mobility due to short roots as a complication of cancer treatment. Moreover, we investigated the conservative management of the patients’ conditions using resin wire splints and orthodontic miniscrews for skeletal anchorage along with long-term follow-ups to evaluate their prognosis.

Conjoined Lumbosacral (L7-S1) Nerve Roots in a Dog

Vertebral and spinal cord anomalies are well known in veterinary medicine. However, nerve root anomalies are seldomly reported. In human patients, nerve root anomalies can cause back pain and radicular pain. In human medicine, nerve root anomalies are more often found in cadaveric studies than in imaging studies, representing the lack of advanced imaging in the past and the unawareness about these pathologies. Additionally, nerve root anomalies can mimic other pathologies in imaging studies. It is important to know about the anatomy of the individual patient not only for correctly localizing the pathology but also for surgical planning and to prevent iatrogenic trauma to the patient. Conjoined nerve roots are a type of nerve root anomaly described in human medicine and are defined as two nerve roots that either share a common dural envelope at some point during their course from the dural sac or that have their origin very close together in the dural sac. In humans, lumbosacral nerve roots are most commonly conjoined, and signs of pain may be associated with this anomaly. We report the magnetic resonance imaging finding of right-sided conjoined L7 and S1 nerve roots in a dog that presented with lumbosacral hyperesthesia. We postulate that it is possible that the conjoined nerve roots played a role in the clinical signs of this dog. This is an anomaly that has not been reported before in veterinary medicine.

BMP signaling in the development and regeneration of tooth roots: from mechanisms to applications.

Short root anomaly (SRA), along with caries, periodontitis, and trauma, can cause tooth loss, affecting the physical and mental health of patients. Dental implants have become widely utilized for tooth restoration; however, they exhibit certain limitations compared to natural tooth roots. Tissue engineering-mediated root regeneration offers a strategy to sustain a tooth with a physiologically more natural function by regenerating the bioengineered tooth root (bio-root) based on the bionic principle. While the process of tooth root development has been reported in previous studies, the specific molecular mechanisms remain unclear. The Bone Morphogenetic Proteins (BMPs) family is an essential factor regulating cellular activities and is involved in almost all tissue development. Recent studies have focused on exploring the mechanism of BMP signaling in tooth root development by using transgenic animal models and developing better tissue engineering strategies for bio-root regeneration. This article reviews the unique roles of BMP signaling in tooth root development and regeneration.

Root Anomalies after Combined Chemotherapy Treatment for Acute Lymphoblastic Leukemia during Childhood: A Case Report‬‬‬‬‬‬‬‬‬‬‬‬‬

Dental abnormalities have been sporadically reported in patients treated as children for acute lymphoblastic leukemia (ALL) with multi-agent chemotherapy, with and without radiation. Reports included delayed dental development, microdontia, hypoplasia, agenesis, V-shaped roots, shortened roots, and cervical root resorption. These anomalies in pediatric patients require regular dental follow-up and sometimes highly complex treatment. We describe a well-documented case of a 19-year-old male who presented with such anomalies 12 years after treatment with several chemotherapy agents for ALL, and discuss the resultant disruption of normal tooth development that led to the ensuing abnormalities.

Conjoined nerve root in a patient with lumbar disc herniation accompanied by a lumbosacral spine anomaly: a case report

BackgroundA nerve root anomaly, typified by a conjoined nerve root, is a rare finding. Conjoined nerve root anomalies are easily missed even in preoperative advanced imaging modalities, which can be potentially troublesome during and after surgery. In this report, we present a case of conjoined right L5–S1 nerve root in a patient with lumbar disc herniation, accompanied by spina bifida occulta, which was undiagnosed on preoperative imaging studies.Case reportA 55-year-old Asian (Japanese) woman presented with low back pain and right leg radiating pain due to lumbar disc herniation at the right L5/S1. Physical examination revealed a positive Lasègue sign and the range of the straight leg raising test was 20° on the right side. The right patellar tendon reflex was normal; however, the right ankle jerk reflex disappeared. Although no obvious hypoesthesia was noted, mild muscle weakness (4/5) was observed in the right leg on the manual muscle test. We planned the lumbar discectomy under a microscope. During surgery, the conjoined right L5–S1 nerve root, which was compressed by herniated nucleus pulposus, was encountered. Although it was very thick and less mobile, some pieces of herniated nucleus pulposus could be removed piece by piece from the axillary part. After sequential decompressive procedures, the tightness of the conjoined right L5–S1 nerve root decreased but its mobility did not improve much. The laterality of the thickness and exit angle of the conjoined right L5–S1 nerve root was retrospectively confirmed on T2 coronal magnetic resonance images and magnetic resonance neurography. Postoperatively, right leg pain was immediately alleviated and complete improvement of muscle weakness was achieved 1 week later (5/5).ConclusionsMagnetic resonance neurography is extremely useful for the accurate diagnosis of anomalous nerve roots because of clear visualization of the neural tissue. Discectomy under a microscope, which enables magnified three-dimensional observation of the surgical field, must provide a valid and safe procedure to achieve not only secure resection of herniated discs but also adequate exposure of anomalous nerve roots.

Effective management of mandibular second premolar with root anomalies

The enigma of successful treatment of mandibular second premolars with taurodontism has been explored for very long due to its rarity of occurrence. This case report aimed to enumerate the successful nonsurgical endodontic management of left mandibular second premolar #35 with three roots and taurodontism. A 34-year-old Saudi male patient with a noncontributory medical history was referred from the prosthodontic department for nonsurgical root canal treatment of tooth #35. Clinical examination revealed rotated clinical crown with caries related to tooth #35. Pulp sensibility cold test of the tooth showed no response, with the absence of pain on percussion and/or visible pocket depth. Radiographic examination showed long and deep pulp chamber and rotated and curved roots with broken apical lamina dura. The tooth was diagnosed with necrotic pulp and asymptomatic apical periodontitis. After making an access to the pulp chamber, two orifices were easily detected while the third one was found by the aid of surgical microscope. The canals were cleaned and shaped using ProTaper Gold file and then obturated with BioCeram Sealer and Gutta-Percha points, using hydraulic bonded obturation technique. Tooth immediately received the final crown. Clinical and radiographical examination after a 3-month follow-up revealed successful peri-apical healing with no symptoms. A literature search was organized to review the past publications about management of mandibular second premolar with taurodontism or anomalies in the root canal system. The search was focused on cases reported in Medline, Scopus, and Google Scholar databases. The conclusion of the seven selected studies and reported cases revealed that proper visualization with advanced microscopes or computer imaging radiographs, negotiation of the root canals, and efficient instrumentation and obturation enhance endodontic success.

Short Root Anomaly (SRA)/Rhyzomicroly-Report of an Unusual Radicular Anomaly with Comprehensive Literature Review

Short Root Anomaly (SRA)/Rhyzomicroly-Report of an Unusual Radicular Anomaly with Comprehensive Literature Review

Seedling Biometry of nud Knockout and win1 Knockout Barley Lines under Ionizing Radiation.

The genes NUD and WIN1 play a regulatory role in cuticle organization in barley. A knockout (KO) of each gene may alter plant mechanisms of adaptation to adverse environmental conditions. A putative pleiotropic effect of NUD or WIN1 gene mutations in barley can be assessed in a series of experiments in the presence or absence of a provoking factor. Ionizing radiation is widely used in research as a provoking factor for quantifying adaptive potential of living organisms. Our aim was to evaluate initial stages of growth and development of barley lines with a KO of NUD or WIN1 under radiation stress. Air-dried barley grains with different KOs and wild-type control (WT) were exposed to γ-radiation at 50, 100, or 200 Gy at a dose rate of 0.74 R/min. Approximately 30 physiological parameters were evaluated, combined into groups: (1) viability, (2) radiosensitivity, and (3) mutability of barley seed progeny. Seed germination, seedling survival, and shoot length were similar among all barley lines. Naked nud KO lines showed lower weights of seeds, roots, and seedlings and shorter root length as compared to win1 KO lines. The shoot-to-root length ratio of nud KO lines’ seedlings exceeded that of win1 KO and WT lines. In terms of the number of seedlings with leaves, all the KO lines were more sensitive to pre-sowing γ-irradiation. Meanwhile, the radioresistance of nud KO lines (50% growth reduction dose [RD50] = 318–356 Gy) and WT plants (RD50 = 414 Gy) judging by seedling weight was higher than that of win1 KO lines (RD50 = 201–300 Gy). Resistance of nud KO lines to radiation was also demonstrated by means of root length (RD50 = 202–254 Gy) and the shoot-to-root length ratio. WT seedlings had the fewest morphological anomalies. In nud KO lines, mainly alterations of root shape were found, whereas in win1 KO lines, changes in the color and shape of leaves were noted. Thus, seedlings of nud KO lines are characterized mainly by changes in the root system (root length, root number, and root anomalies). For win1 KO lines, other parameters are sensitive (shoot length and alterations of leaf shape and color). These data may indicate a pleiotropic effect of genes NUD and WIN1 in barley.

MDCT EVALUATION OF AORTIC ROOT AND ASCENDING AORTIC PATHOLOGIES: PICTORIAL ESSAY

Objective; The purpose of this pictorial essay is to review the MDCT appearance of aortic root and ascending aortic pathologies. Familiarity with atypical anatomy and pathologies of the aortic root, ascending aorta and their clinical presentation may facilitate appropriate diagnosis and management.This can be of immense help to the clinician planning interventional procedures such as stenting, balloon dilatation, or graft surgery. Conclusion; Increasing use of MDCT for cardiac imaging has helped in the detection of many benign aortic root anomalies, but a small number are associated with myocardial ischemia and sudden death. Increasing the use of MDCT in cardiac imaging may yield diagnostic information on pathologies of the aortic root and ascending aorta not obtained with invasive coronary angiography. Axial sections, multiplanar reconstructions, virtual angioscopy, and 3D volume-rendered images should aid in the detection and improve the interpretation of such pathologies.

Dental Anomalies in Parry-Romberg Syndrome: A 40-Year Retrospective Review.

This study investigates crown and root anomalies in patients with Parry-Romberg Syndrome. This is a retrospective review of patients with Parry-Romberg Syndrome who were evaluated at a tertiary care center from 1980-2020. Patients seen in the dental unit from 1980-2020. Seventeen patients with documented Parry-Romberg Syndrome were referred for dental evaluation. All dental anomalies were documented. Root anomalies were assessed using panoramic radiographs and cone beam CT (CBCT) scans to evaluate buccal-lingual, mesio-distal, and axial measurements of hypoplastic teeth, which were compared to those of contralateral teeth. Findings included agenesis (29%, n = 5), hypoplastic teeth (29%, n = 5), delayed canine eruption (24%, n = 4), and mulberry molars (12%, n = 2). Of the five patients with tooth hypoplasia, four had CBCT records and the fifth had panoramic radiographs available for assessment. Axial length was always shorter in hypoplastic teeth relative to contralateral teeth, with differences ranging from 1.2-9.2 mm. Differences in crown size of hypoplastic versus contralateral teeth were unpredictable but always present. Patients with Parry-Romberg Syndrome can have hypoplastic roots with atypical crown morphology. A patient's specific dental anomaly will influence planning and treatment.

GENETICS OF SHORT ROOT ANOMALIES

GENETICS OF SHORT ROOT ANOMALIES

Rare Case of Lumbosacral Conjoint Root Diagnosed as Sequestered Disc by MRI: A Case Report

Introduction: Conjoint nerve root is embryological nerve root abnormality mainly affecting lumbosacral region. The atypical roots present primarily as a bifid, conjoined structure originating from a wide area of the dura. The conjoint roots are highly liable to trauma due to their size and attachment to surrounding structures. The effects of compression and entrapment are augmented in the case of having stenosis of the lateral recesses where developmental changes and disc herniations deplete the available reserve space. Conjoined nerve roots are a relatively uncommon finding but are frequently left undiagnosed on preoperative imaging studies. Misinterpretation as sequestered disc can lead to devastating results especially during limited spine approach.
 Case Report: A 43-year-old male patient presented with low back pain gradually progressing over the last three years. Pain was radiating to his left leg associated with tingling sensation and a mild weakness in his left foot. Clinical examination revealed normal muscle bulk and tone. Strength was full bilaterally except the mild weakness 3/5 on toe dorsiflexion of the left foot. Deep tendon reflexes were 3+ at the left knee and ankle. Plantar responses were flexor. Sensation was intact, and there was no loss of sphincters control or bladder dysfunction. A standard plain lumbosacral MRI was performed. The patient was admitted for L5/S1 discectomy. Surgical intervention was recommended, during the surgery we recognized the huge conjoint root. Adhesiolysis and discectomy was done carefully without causing any serious neural injury to the conjoint root. Clinical surgical outcome was good. Pain and tingling sensation disappeared only paresthesia over the S1 dermatome. Postoperative course was uneventful, and the patient was discharged after his neurological improvement on day 7, post operation. However, the patient complained of recurrent pain on follow-up visit and continues being followed-up.
 Conclusion: The conjoined nerve root anomaly diagnosis is not easy and has several points of significance. If misdiagnosed, it could be incorrectly treated as a case for a herniated disc. Neurosurgeons should consider these anomalies in their differential diagnosis. Cases of conjoined nerve root anomaly may be wrongly managed and result in wrong level of surgery with a poor outcome. Researchers conclude that the correct diagnosis of root anomalies is vital for the patient, any misinterpretation could lead to catastrophic consequences.

Association between Smoking during Pregnancy and Short Root Anomaly in Offspring.

Short root anomaly (SRA) is a dental anomaly with short dental roots and its pathogenesis is poorly understood. This study investigated the association between maternal smoking during pregnancy and SRA in offspring. A survey was conducted on 558 children aged 8–16 years from two public schools in Ulaanbaatar, Mongolia. SRA was diagnosed using cases with a root-crown ratio of maxillary central incisors of ≤1.0. A questionnaire survey was conducted to assess maternal lifestyle habits. Multiple logistic regression was used to analyse the association between maternal smoking during pregnancy and SRA in offspring after adjusting for possible confounders. The prevalence of SRA in these children was 14.2%. Children whose mothers smoked from pregnancy to date were found to be 4.95 times (95% confidence interval [CI]: 1.65–14.79) more likely to have SRA than those whose mothers never smoked, after adjusting for possible confounders. Additionally, children whose mothers had been exposed to passive smoking during pregnancy were found to be 1.86 times (95% CI: 1.02–3.40) more likely to have SRA than those whose mothers had not been exposed to passive smoke. Our population-based study suggests that maternal and passive smoking exposure during pregnancy can affect tooth root formation in children.

Incidence of various dental anomalies in population of Taxilla, Pakistan

Background: There are different types of teeth anomalies that effects the people of different regional populations. Aim: To determine the occurrence of dental anomalies in patients of Taxila that visit our college for routine dental procedures. Methods: The study was retrospective and was conducted on periapical intraoral radiographs of patients between the ages of 15 to 35 years, with no gender discrimination at Dental College HITEC-IMS. Results: We collected data from 450 periapical intraoral radiographs that were taken in last six months (i.e. 15th January 2021 till 15th July 2021) in dental radiology department. Conclusion: The dental anomalies that were found in the population of taxila were impacted teeth, missing teeth, rotated tooth, supernumerary teeth (mesiodens), root dilacerations, peg lateral, taurodontism and hypercementosis. Keywords: Root anomalies, dental anomalies, periapical radiograph

Features of TLIF/PLIF in lumbar spine nerve root anomalies. The literature review and own experience

Introduction. Anomalies of the roots of the lumbar spine are often not diagnosed at the preoperative stage and may cause technical difficulties during performing decompression‑stabilization surgeries of spine.Purpose of the study. To study the clinical features of patients with anomalies of the lumbar roots on the background of de‑ generative diseases of the spine, to develop techniques to protect abnormal nerve roots from damage during TLIF/PLIF.Materials and methods. Performed retrospective analysis of the results of treatment of 9 patients whom were done TLIF/PLIF for degenerative‑dystrophic diseases of the lumbar spine in the period from 2018–2019 was. The distribution of changes detected in the spine was carried out according to the classification of Schizas, Meyerding and Neidre & Macnab.Results. The study group of patients was 0.63 % of all operated patients using the TLIF/PLIF technique (n = 1432). Developmental anomalies of the nerve roots were not identified during routine MRI in all patients. In six patients (66.7 %), radicular pain manifested in two dermatomes; intraoperatively, these patients had conjoint roots (Ia). Three pa‑ tients (33.3 %) had radicular pain in several (>2) dermatomes. The root tension sign (Lasegue sign) was negative in eight (88.9 %) patients. The intensity of the preoperative pain syndrome in the leg averaged 6.44 (VAS), in the back 6.11, and in the postoperative period it decreased to 0.7 and 2.1, respectively.Conclusion. Clinical preoperative markers for the presence of root anomalies can be two‑dermatomal radicular mani‑ festations in the presence of a single‑level process, as well as the absence of a Lasegue sign in severe radiculopathy. Intraoperative detection of anomalies requires a balanced approach to the choice of the method of surgical intervention from the surgeon. To prevent iatrogenic damage of anomaly roots at the stage of surgical treatment, it is necessary to change the preoperative planning strategy in favor of choosing the contralateral side for interbody fusion. In addition, root traction and interbody distraction should be minimal.

Epithelial Bone Morphogenic Protein 2 and 4 Are Indispensable for Tooth Development.

The Bmp2 and Bmp4 expressed in root mesenchyme were essential for the patterning and cellular differentiation of tooth root. The role of the epithelium-derived Bmps in tooth root development, however, had not been reported. In this study, we found that the double abrogation of Bmp2 and Bmp4 from mouse epithelium caused short root anomaly (SRA). The K14-cre;Bmp2f/f;Bmp4f/f mice exhibited a persistent Hertwig’s Epithelial Root Sheath (HERS) with the reduced cell death, and the down-regulated BMP-Smad4 and Erk signaling pathways. Moreover, the Shh expression in the HERS, the Shh-Gli1 signaling, and Nfic expression in the root mesenchyme of the K14-cre;Bmp2f/f;Bmp4f/f mice were also decreased, indicating a disrupted epithelium- mesenchyme interaction between HERS and root mesenchyme. Such disruption suppressed the Osx and Dspp expression in the root mesenchyme, indicating an impairment on the differentiation and maturation of root odontoblasts. The impaired differentiation and maturation of root odontoblasts could be rescued partially by transgenic Dspp. Therefore, although required in a low dosage and with a functional redundancy, the epithelial Bmp2 and Bmp4 were indispensable for the HERS degeneration, as well as the differentiation and maturation of root mesenchyme.

Hyperphosphatemic Familial Tumoral Calcinosis Hidden in Plain Sight for 73 Years: A Case Report

While dental pulp calcifications and root anomalies may be inconsequential incidental findings in dental radiographs, they can, especially in combination, represent a clue, hidden in plain sight, for the diagnosis of hyperphosphatemic familial tumoral calcinosis (HFTC). HFTC is an autosomal recessive disease of mineral metabolism characterized by sometimes massive, painful calcification around large joints, systemic inflammation, dental pulp calcification, and thistle-shaped roots. This paper describes a woman with HFTC who endured not only the symptoms of HFTC for decades, but also the frustration of not knowing the cause. The diagnosis was finally made at the age of 73 years, when the connection between a large right shoulder calcification and hyperphosphatemia was made. The dental findings were likely present on her initial radiographs taken in childhood. Increased awareness of the association between characteristic dental findings and HFTC may allow for earlier diagnosis and interventions to improve the care of patients with this rare condition.

Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult Male Football Player: Case Report

Interbody fusion is preferred surgical treatment for various symptomatic pathologies of lumbar spine and spondylolisthesis is one of the commonest indication. Goal is to achieve adequate bony and neural decompression, disc height restoration, deformity correction and good interbody fusion. Numerous techniques and approaches have been designed, minimal invasive tubular transforminal interbody fusion is widely accepted among them. In any case pre-operative planning and identifying any anatomical variation is prerequisite before surgery. In this article, we report, 22-year male football player, presenting with worsening low back pain, left radicular pain with neurogenic claudication. Radiographs revealed a L5-S1 Meyerding grade I isthmic spondylolisthesis with L5-S1 left sub articular disc protrusion with narrowing of lateral recess on left side and no evidence of lumbosacral nerve root anomalies on magnetic resonance imaging. Patient was planned for minimal invasive L5-S1 transforaminal interbody fusion, intraoperatively, Type 3 Neidre and Macnab root anomaly was identified, patient successful underwent interbody fusion with no acute intraoperative or postoperative complications. In follow up period, patient had no radicular pain. In our article, we summarize the incidence, classification of nerve root anomaly along with intra operative strategy for interbody fusion in presence of root anomaly and report this rare twin anomaly. Keywords: Isthmic spondylolisthesis, nerve root anomaly, MIS TLIF, young football player.

Generalized Short Root Anomaly with Various Dental Anomalies : A Case Report with a 5 - Year Follow - up

Short root anomaly (SRA) is a rare dental condition with abnormally short and blunt root morphology. It mostly affects maxillary central incisors symmetrically and only has been observed in permanent teeth. A 9-year-old girl was referred from a local dental clinic for short root development in mixed dentition with no symptoms. Radiographic and intraoral examinations revealed SRA on upper and lower incisors and mandibular first molars along with other dental anomalies such as enamel hypoplasia and dens invaginatus. During long - term follow - up for 5 years, her mixed dentition has changed to permanent dentition and generalized SRA was observed in all permanent teeth. Cephalometric radiograph also revealed the calcification between the anterior and posterior clinoid processes described as a sella turcica bridge which was reported associating with dental anomalies. Early diagnosis of SRA is emphasized for successful management and prevention of root resorption and tooth loss. This report aimed to present a rare case of generalized SRA along with other dental anomalies and sella turcica bridging in a female patient through long - term follow - up.