Size Of Foramen Research Articles

Study of Nutrient Foramina in Human Typical Long Bones of Lower Limb

Abstract Background and Aim Nutrient foramina form important landmarks on human bones as they form portal of entry for nutrient artery. Nutrient artery is an important source of blood supply for a growing bone. Different parameters of nutrient foramina are important in various procedures such as vascularized bone grafting, tumor resections, fracture repair, and other surgical procedures in orthopedics. The objective of the present study was to report the number, position, direction, size, and foraminal index of nutrient foramen in the femur, tibia, and fibula. Materials and Methods The present study analyzed the location, direction, size, and the number of nutrient foramina in the diaphysis of 180 long bones of the lower limbs of adults: 60 femurs, 60 tibiae, and 60 fibulae. Result The location of the nutrient foramina is predominant on the posterior aspect of the lower limb long bones. Single nutrient foramen found in the tibia (100%), femur (48.3%), and fibula (60%) may represent as a single source of blood supply. The majority of the femur (50%) and few fibulae (5%) had a double nutrient foramen. The mean foraminal index for the lower limb bones was 40.5% for the left and 38.2% for the right side of the femur, 31.69% for the left and 32.3% for the right side of the tibia, and 32.7% for the left and 31.7% for the right side of the fibula. Conclusion The present study provides information on the number, size, position, and direction of nutrient foramina of the femur, tibia, and fibula bones.

Preoperative Clinical and Radiographic Variables Predict Postoperative C5 Palsy

Postoperative C5 palsy affects 8% of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000. All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course. We sought to identify those variables predictive of postoperative C5 palsy. Of 221 included patients (mean age, 63 years; 54% male), 12.2% experienced C5 palsy. On univariate analysis, C5 palsy was associated with foraminal diameter (P= 0.0005), spinal cord cross-sectional area (P= 0.11), number of levels undergoing laminectomy (P= 0.14), and clinical presentation of dropping objects (P= 0.07), hand clumsiness (P= 0.13), or paresthesias in the upper extremities (P= 0.08). Foraminal diameter (odds ratio, 0.31 per mm increase; 95% confidence interval, 0.16-0.60; P < 0.001) and patient report of gait disturbance (odds ratio, 0.53; 95% confidence interval, 0.33-0.85; P= 0.008) were the only significant predictors on multivariate analysis. A foraminal diameter <2 mm had 2-fold greater odds of postoperative C5 palsy. A receiver operating curve for the multivariate logistic model had an associated C-statistic of 0.7818. The absolute error of this model was 9.3% on internal validation. Foraminal stenosis most strongly predicted postoperative C5 palsy. A proof-of-concept model incorporating foramen size, as well as clinical complaints of paresthesias, hand clumsiness, and gait abnormality, successfully predicts the occurrence of postoperative palsy with an overall accuracy of 78%.

Carotid foramen size in the human skull tracks developmental changes in cerebral blood flow and brain metabolism.

In humans, neuronal processes related to brain development elevate the metabolic rate of brain tissue relative to the body during early childhood. This phenomenon has been hypothesized to contribute to slow somatic growth in preadolescent Homo sapiens. The uncoupling of the brain's metabolic rate from brain size during development complicates the study of the evolutionary emergence of these traits in the fossil record. Here, we extend a method previously developed to predict interspecific differences in cerebral blood flow (a correlate of cerebral glucose use) to predict ontogenetic changes in human brain metabolism. Radii of the carotid foramen from an ontogenetic series of modern human crania were used to predict blood flow rates through the internal carotid arteries (ICA), which were compared to empirically measured ICA flow and brain metabolism values. Predictions of both absolute ICA blood flow rates and perfusion (ICA blood flow rates relative to brain size) generally match measured values in infancy and childhood. Maximum predicted ICA blood flow rates and perfusion were found to occur between ages 5 and 8, which roughly correspond to the age of maximum measured ICA blood flow rate and absolute and brain mass-specific rate of whole brain glucose uptake. These findings suggest that, during human growth and development, the size of the carotid foramen corresponds well to blood flow requirements through the ICA, and the method tested here may provide new opportunities for studying developmental changes in brain metabolism using osteological samples, including fossil hominins.

Evaluation of Size and Location of a Mental Foramen in the Polish Population Using Cone-Beam Computed Tomography.

Introduction The mental foramen (MF) is a bilateral opening localized on an anterior surface of the mandible. A precise location as well as well-defined shape, size, and number of the MF is crucial for different clinical dental procedures. The aim of this study was to determine a size and location of the MF in relation to the lower teeth using the cone-beam computed tomography (CBCT) study. Material and Methods In a group of 201 patients (106 males and 95 females) the CBCT images were performed using the GX CB-500 device (Gendex, USA). Results No significant differences in values of the horizontal (H) and vertical (V) diameters as well as the H:V ratio on both sides in relation to the age of participants were found. In males both average values of a horizontal diameter (p=0.031) and vertical diameter (p=0.001) were significantly higher on the right side than in the female subgroup, whereas on the left side only an average value of a vertical diameter was significantly higher in men (p=0.006) in comparison to women. Moreover, the H:V ratio was significantly lower in males on the left side (p=0.032). There were no significant relationships between age and gender of the patients (p>0.05) and the type of mental foramen on the right and left sides. Conclusions The application of the CBCT study enabled a precise determination of the shape, size, and position of the mental foramen in relation to the neighboring anatomical structures on a representative group of the Polish patients. The results obtained may contribute to guidelines for dental procedures including anesthesia of the mental nerve and endodontic, implantology, and dental surgery with regard to the location of mental foramen depending on the sex and age of patients.

Comparison between conventional radiograph and 3D volumetric radiograph for determining the morphology and morphometry of mental foramen

Objective: Mental foramen is a vital anatomical structure in human mandible as they are important for dental surgeons for extraction, implant placement, osteotomy procedures, anesthetists in nerve block, and surgical procedures to avoid injury to neurovascular bundle in mental foramen area. The aim of this study was to compare the position, shape, size, and distinctness of mental foramen using orthopantomogram (OPG) and digitalized volumetric tomography (DVT). Materials and Method: This study was conducted on 25 individuals for both the genders. Position, shape, size, and distinctness of mental foramen were compared using OPG and DVT and were evaluated by Expert three-dimensional (3D) software in DVT and Annotation software in OPG. Results: Mental foramen was found to be on the vicinity of the second premolar region with respect to apices of premolars and molars and was more common in the middle third region of the jaw bone with respect to superoinferior cortex of the mandible in vertical plane. There was no significant difference in the position of the mental foramen using OPG and DVT. The commonest shape of mental foramen was found to be oval and was better defined in DVT. The size of the mental foramen was observed to be 0.49 ± 0.05 and 0.51 ± 0.06 cm in OPG and DVT, respectively, and more distinctly visible in DVT. There was no significant difference in the position, shape, size, and distinctness of the mental foramen among genders. Conclusion: Conventional radiography can be initially done for the position of the mental foramen but the details must be confirmed using 3D volumetric radiography to avoid any kind of procedural complications.

Multidetector computed tomography (MDCT) estimation of prevalence and anatomic characteristics of the sternal body foramen in the population of central Serbia

Background/Aim. The most frequent form of sternal defects is a single foramen, usually located at the distal half of the sternal body, with prevalence that varies among different ethnic populations. Clinical importance of these defects arises from various diagnostic and therapeutic sternal treatments and close location of heart, lungs and other vital organs of the chest cavity. The aim of this study was to determine the prevalence and morphometric characteristics of the sternal midline foramen in the population of central Serbia. Methods. The multidetector computed tomography (MDCT) chest images of 422 patients of both genders were analyzed. The radiological imaging was performed on 64- slice MDCT scanner (Aquilion 64, Toshiba, Japan). All scans were performed in the axial plane, with subsequent multiplanar reconstruction (MPR). Due to the angulation of the sternal body coronal curved-planar, the images were obtained in order to show the whole length of the sternum and the vertical diameter of the sternal foramen. The measurements were done using the commercially available software (Imaging Software ver. 4.1.14.0, Vital-Images). Results. The solitary foramen, located in the distal segment of the sternal body, was detected in 24 patients, representing 5.9% of the observed population with slightly higher prevalence in males. The average size of foramen was 3.9 ? 4.2 mm. The mean distance from the skin was 12.7 ? 3.3 mm, the distance from skin to pericardium was on average 37.3 ? 8.2 mm, while the average distance from skin to pleura was 25 ? 5.9 mm. The average depth of foramen 8.7 ? 2 mm, while the mean distance from the posterior surface of foramen to pericardium was 12.7 ? 9.1 mm. Conclusion. The results presented in this paper confirmed the prevalence of 5.9% regarding the midline sternal foramen in the observed population. Serious complications of the sternal puncture could be prevented by prior MDCT imaging.

Mental Foramen Size, Position and Symmetry in a Multi-Ethnic, Urban Black Population: Radiographic Evidence.

ABSTRACTObjectivesTo determine the approximate location, shape and dimensions of the mental foramen in African subjects using panoramic radiographs.Material and MethodsThis study analysed 320 orthopantomograms of subjects from two centres. The analysis was done using the radiographic software tools (SIDEXIS, Bensheim, Germany) which allowed for determination of the position, shape and dimensions of the foramen. Furthermore, the right and left mental foramina were compared to ascertain both shape and positional symmetry.ResultsMost of the foramina analysed were horizontally positioned between the mandibular first and second premolars (65.9%) and vertically positioned greater than 2 mm below the apex of the second mandibular premolars. The average vertical dimension and horizontal dimension of the foramen is 2.87 (SD 1) mm and 3.56 (SD 1.23) mm respectively with 55.2% of the foramen analysed being ovoid in shape. Asymmetrical mental foramina were seen in 164 subjects (51.3%) while 156 subjects had symmetrical mental foramina (48.7%). ConclusionsThe mental foramen is most commonly located between the mandibular premolars, greater than 2 mm below the apex of the second mandibular premolars. They are usually ovoid in shape with an almost equal distribution of asymmetry and symmetry.

Mandibular first premolar apical morphology: A stereomicroscopic study.

The aim of this study was to investigate the size, shape and position of the physiological foramen and the relationship between the age and gender to the location and size of the apical foramen of mandibular first premolars. One hundred and one extracted human mandibular first premolar teeth were examined; age and gender of the patients were recorded. Apices of teeth were examined stereomicroscopically for number, size and shape of apical foramina; frequency and deviation of accessory foramina from the apex and the relation with age and gender. Sixty-four of the premolars had one foramen and 23% had two. The distances from the foramina openings to the apices ranged from 0.07 to 2.18mm. In younger range irregular shape was dominant (41%), whilst in older range, round shape was dominant (45%). The shape of the apical foramen changed with age and the distance from the foramen to the anatomical apex increased with age.

The mental foramen: A cone beam CT study of the horizontal location, size and sexual dimorphism amongst living Jordanians

Accurate information regarding the horizontal location and size of mental foramen (MF) has a well-known clinical importance. In addition, these variables have been reported to exhibit inter-population variation. The aims of the present study were to study the horizontal position and size of MF, as seen on cone beam CT (CBCT) images, and to assess sexual dimorphism in these variables. Total of 139 CBCT images of a random Jordanian sample (50 males, 89 females, average age = 43.5, SD = 13.0, range = 23–69 years) were included. The most frequent horizontal locations of MF were found to be: between the two lower premolars (50%), and in line with lower second premolar (40%). The average long diameter of MF was 3.08 mm, SD = 0.65 mm in males (n = 50, range = 1.5–4.8 mm) and 2.46 mm, SD = 0.58 mm in females (n = 89, range = 1.2–4.0 mm), and the difference was statistically significant. Very weak positive correlation was found between age and MF diameter in females (r = 0.161) and the correlation was approaching statistical significance (p-value = 0.066), while a weak negative correlation was found between these two variables in males (r = −0.276) and the correlation was statistically significant (p-value = 0.038). It could be inferred from the results of the present study that about 95% success rate for mental nerve block anesthesia is expected when the anesthetic solution is administered between the two premolars; however this needs to be tested experimentally. It appears that there is a tendency for an increase in MF size with age in females as opposed to a tendency for size reduction with age in males; this might suggest a role for sexual hormones in influencing MF size.

Variasi Foramen Mentale pada Tulang Mandibula Tengkorak Manusia Koleksi Laboratorium Anatomi Fakultas Kedokteran Universitas Cenderawasih

Knowledge of the position of the mental foramen is important both when administering regional anaesthesia,performing periapical surgery and dental implant surgery and endodontic treatments in the mandible. This study was to investigate the variation of the mental foramen in human skull. The study sample included eleven skulls taken in Anatomy Laboratory, Faculty of Medicine, Cenderawasih University. The mental foramen was symetrical in 100% of skulls. The most common size of foramen is 2.6 mm (46%) and the most common position of the mental foramen was between the first premolar and the second premolar (64%).Key words:  mental foramen, variation , mandible, human skull

A Morphologic and Morphometric Study of the jugular foramen of the adult human skulls: an osteological study in Upper Egypt

Background:Jugular foramen is one of the foramen at the base of skull lies between the occipital bone and the petrosal portion of the temporal bone. It allows passage of important nervous and vascular elements, such as the glossopharyngeal, vagus accessory nerves, and the internal jugular vein. Glomic tumors, schwannomas, metastatic lesions and infiltrating inflammatory processes are associated with this foramen, which can account for injuries of related structures. Variability in anatomical aspect of jugular foramen has been studied by many workers in different part of the world. Aims & Objective:Tostudy the variability in shape and size of jugular foramen which has clear cut relationshipwith size of internal jugular vein and presence or absence of dome. Materials andMethods: Present study has been designed to study on 100 skulls (100×2=200 foramen). Result: In the study Bilateral presence of dome has been found in 98% of cases. Both unilateral and bilateral completeseptation have been observed. The mean diameters on the right side were more than the left. Conclusion:The clinical significance of jugular foramen is very important during surgeries. Therefore, the dimensions of jugular foramen is very much necessary.

Mental foramen and accessory mental foramen: a dry human mandibles study in South Indian population

Abstract Introduction and aim: Mandible usually has a bilateral oval or circular mental foramen [MF] situated on the anterolateral aspect of the body of mandible. Variations of the MF are often encountered ranging from difference in incidence, shape, size, position and supernumerary [accessory MF] to even complete absence. So, the aim of the present study was to evaluate the incidence and the anatomical features of the mental foramen and the accessory mental foramen. Materials &amp; method: 61 dry human mandibles of unknown sex were examined. Size and distance of mental foramen and accessory mental foramen from symphysis menti [Mandibular midline], inferior border of the mandible, posterior border of ramus and superior border of body of mandible were measured using vernier calliper and statistically analyzed by mean and standard deviation. Results: Bilateral mental foramina [MF] were present in all 61 [100%] mandibles. Out of 122 mental foramina [MF], 86 [70.5%] were round and 36 [29.5%] were oval in shape. Approximately half [47.54%] of MF were present below the apex of 2nd premolar tooth. MF was located approximately half way between alveolar crest and mandibular body. Bilateral AMF were present in 1.64% mandibles. All 5 AMFs were round in shape. AMF was separated from MF by a median distance of 2mm. Conclusion: The knowledge about incidence and variability in position of mental foramen and accessory mental foramen is important in order to avoid nerve damage in connection with surgical procedure and to achieve complete effect of anaesthesia after mental nerve block

Study of position, shape and size of mental foramen in dry adult human mandibles at S.M.S. Medical College, Jaipur

Study of position, shape and size of mental foramen in dry adult human mandibles at S.M.S. Medical College, Jaipur

REVASCULARIZATION IN MATURE PERMANENT TEETH WITH NECROTIC PULP AND APICAL PERIODONTITIS: CASE SERIES

INTRODUCTION: Revascularization procedures have been limited to immature teeth but application to mature teeth should be clinically investigated as an alternative to conventional root canal treatment. The translation of regenerative endodontic procedures into treating mature teeth is challenging and depends on efficient root canal disinfection, proper size of the apical foramen, the availability and delivery of stem cells into the root canal system. OBJECTIVES: Evaluation of revascularization in mature teeth after enlargement of the apical foramen to size 35 K-file. MATERIALS AND METHODS: Three necrotic incisors with mature roots and apical periodontitis in three patients ranging from 20–30 years old were treated by revascularization procedures. Access opening was performed. The canal was mechanically instrumented to the radiographic apex. The apical foramen was enlarged with a size 35 K-file. Triple antibiotic paste (0.1 mg/ml) was applied in the canal using a syringe. After three weeks, the medication was removed with 20 ml of 1.5% sodium hypochlorite followed by final irrigation with 20 ml of 17% EDTA. Bleeding was induced in the root canal and mineral trioxide aggregate (MTA) was placed approximately 3-4 mm below the CEJ. The tooth was restored with a layer of glass ionomer followed by composite resin. The patient was scheduled for follow up and evaluation of healing after 3 months, 6 months and 9 months. Resolution of apical periodontitis and regression of clinical signs and symptoms were observed during the follow up periods. RESULTS: After a follow-up period of 9 months, the three teeth demonstrated radiographic evidence of periapical healing with absence of clinical signs and symptoms. CONCLUSIONS: The present cases demonstrated a favorable outcome of the revascularization procedure in mature necrotic incisors with chronic apical periodontitis

Low Back Pain - Recreational Soccer Player

HISTORY: A 21-year-old female recreational soccer player presented with intermittent right-sided low back pain for two years. She denied any trauma or inciting event. Pain was localized to the right lumbosacral region without radiating leg pain and was described as dull and aching. It was rated on average 5/10 on a numerical rating scale and associated with nausea when pain worsened. Symptoms were worse with prolonged sitting, and several times in the last month she reported worsening of typical pain with alcohol intake. She denied leg weakness, numbness, or bowel/bladder dysfunction. She participated in six weeks of physical therapy, which helped with nausea and pain with sitting, but she continued to have pain with alcohol consumption. PHYSICAL EXAM: Full and symmetric strength, sensation, and reflexes. Mild lumbar dextroscoliosis. No palpable step-offs. Tenderness over right lumbar paraspinals and above right iliac crest. No tenderness over PSIS. Full, non-painful range of motion with lumbar flexion and extension. No pain with facet loading. Full, non-painful hip range of motion. Negative FABER, FADIR, and straight leg raise test bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Discogenic pain 2. Facet-mediated pain 3. Disc herniation 4. Muscular strain 5. Sacroiliac joint dysfunction 6. Intrabdominal/ intrapelvic etiology 7. Neoplasm TESTS AND RESULTS: 1. Lumbar spine X-rays: -Normal alignment, normal vertebral body and disc space height -Partial lumbarization of S1 vertebral body -Five degrees of lumbar dextroscoliosis 2. MRI lumbar spine: -Lumbarization of S1 vertebral body -Normal disc heights and signal -Normal central canal and neural foramen size throughout lumbar spine -T1/T2 hyperintensity within S2 vertebral body, likely lipoma -Increased T2 signal medial to right kidney suggestive of hydronephrosis 3. Renal ultrasound: -Moderate right hydronephrosis with extrarenal pelvis. No nephrolithiasis. 4. Renogram with furosemide: - Right kidney with blunted flow and delayed clearance improved slightly with furosemide, consistent with partial obstruction at right ureteropelvic junction FINAL/WORKING DIAGNOSIS: Ureteropelvic junction obstruction causing Dietl’s crisis TREATMENT AND OUTCOMES: 1. Referral to urology 2. Resolution of pain and improvement in renal function after pyeloplasty

Low Back Pain - Recreational Soccer Player

HISTORY: A 21-year-old female recreational soccer player presented with intermittent right-sided low back pain for two years. She denied any trauma or inciting event. Pain was localized to the right lumbosacral region without radiating leg pain and was described as dull and aching. It was rated on average 5/10 on a numerical rating scale and associated with nausea when pain worsened. Symptoms were worse with prolonged sitting, and several times in the last month she reported worsening of typical pain with alcohol intake. She denied leg weakness, numbness, or bowel/bladder dysfunction. She participated in six weeks of physical therapy, which helped with nausea and pain with sitting, but she continued to have pain with alcohol consumption. PHYSICAL EXAM: Full and symmetric strength, sensation, and reflexes. Mild lumbar dextroscoliosis. No palpable step-offs. Tenderness over right lumbar paraspinals and above right iliac crest. No tenderness over PSIS. Full, non-painful range of motion with lumbar flexion and extension. No pain with facet loading. Full, non-painful hip range of motion. Negative FABER, FADIR, and straight leg raise test bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Discogenic pain 2. Facet-mediated pain 3. Disc herniation 4. Muscular strain 5. Sacroiliac joint dysfunction 6. Intrabdominal/ intrapelvic etiology 7. Neoplasm TESTS AND RESULTS: 1. Lumbar spine X-rays: -Normal alignment, normal vertebral body and disc space height -Partial lumbarization of S1 vertebral body -Five degrees of lumbar dextroscoliosis 2. MRI lumbar spine: -Lumbarization of S1 vertebral body -Normal disc heights and signal -Normal central canal and neural foramen size throughout lumbar spine -T1/T2 hyperintensity within S2 vertebral body, likely lipoma -Increased T2 signal medial to right kidney suggestive of hydronephrosis 3. Renal ultrasound:-Moderate right hydronephrosis with extrarenal pelvis. No nephrolithiasis. 4. Renogram with furosemide: - Right kidney with blunted flow and delayed clearance improved slightly with furosemide, consistent with partial obstruction at right ureteropelvic junction FINAL/WORKING DIAGNOSIS: Ureteropelvic junction obstruction causing Dietl’s crisis TREATMENT AND OUTCOMES: 1. Referral to urology 2. Resolution of pain and improvement in renal function after pyeloplasty

Computerized tomographic evaluation of supraorbital notches and foramen in patients with frontal migraine headaches and correlation with clinical symptoms

To correlate the location and size of supraorbital notches (SON) and foramen (SOF) with migraine headache symptoms in a migraine patient population. A retrospective review was performed on consecutive patients who were candidates for frontal migraine surgery with available preoperative computed tomography (CT) images of the face/perinasal sinuses. The supraorbital anatomy from CT images was analyzed and correlated with presenting migraine headache symptoms. To assess for anatomic variations associated with migraine headaches, normative anatomic data were obtained by performing a meta-analysis. Fifty-six patients were included, 95% were female, aged 17-80 (mean = 47) years. Bilateral SON were present in 58.9% patients, combination of SON/SOF in 25%, and bilateral SOF in 16.1%. SOF mean diameter (1.22 mm) was 45% smaller than SON (2.20 mm, p < 0.0001). The mean lateral distance from midline for SOF (2.74 cm) was ~0.5 cm farther than SON (2.25 cm, p < 0.0001). Migraine patients with SOF had 178.6% longer mean migraine headache duration (p = 0.0020), 9.8% higher intensity (p = 0.0052), and 91.4% greater migraine headache index (p = 0.0498) compared to those without SOF. Compared to normative patient data, migraine patients are more likely to have SON/SOF (100% vs. 83%, p = 0.0047) and have mean SON and SOF diameters that are 34.3-41.5% smaller (p < 0.0001). Nerve compression at SON and especially SOF contributes significantly to migraine headache symptoms, and these structures (if present) should be released during frontal migraine surgery. Given the variable presence and location of SON/SOF, analysis of available face/perinasal sinus CT images helps preoperative planning for foraminotomy and band release.

Anatomic analysis of the equine mental foramen and rostral mandibular canal using computed tomography

ObjectivesTo characterize the anatomy of the mental foramen and determine associations with age, weight, sex and breed. Study designRetrospective descriptive study. AnimalsForty-one horses, 0.6–25.2 years and weighing 136–820 kg. MethodsComputed tomography (CT) studies of equine heads performed over 5 years were evaluated in multiplanar and three-dimensional reconstruction. Measurements obtained were positioning of the foramen along the mandible, foramen height and width, foramen–canal angulation and rostral canal mineralization. Exploratory statistical analyses investigated associations between measurements and age, weight, sex and breed. ResultsEvaluation of 41 CT studies revealed foramen positioning was one-third of the horizontal distance of the incisor–premolar space from the second premolar and one-third of the vertical distance in the mandible from the dorsal surface of interproximal space at the level of the foramen. Age was negatively correlated to horizontal positioning [r = –0.42; 95% confidence intervals (CI), –0.64 to –0.13]. Mean foramen width was 6.4 (range, 2.3–17.1) mm and height 5.6 (range, 2.1–10.3) mm. Age and foramen height (r = 0.32; 95% CI, 0.01 to 0.57) and width (r = 0.30; 95% CI, –0.01 to 0.30) were positively correlated. Thoroughbred and Warmblood/Draft horses had increased foramina heights compared with Quarter horses [analysis of variance (anova)p = 0.02]. Males had wider foramina (95% CI, –2.66 to 0.07). Angulation of the foramen–canal was mean ± standard deviation 68.3 ± 12.8° (range, 37.9–105.6°) transverse plane, 28.3 ± 4.1° (range, 18.2–39.0°) saggital plane and 41.4 ± 8.45° (range, 22.2–58.6°) dorsal plane. Older horses had decreased mineralization of the rostral canal (anova, left p = 0.015, right p = 0.025). ConclusionsThe size, shape, positioning and angulation of the mental foramen varies. Mineralization of the canal is decreased in older horses. Clinical relevanceThis study improves understanding of mental foramen anatomy and complications with needle placement.

The Use of Fluoroscopy During Direct Anterior Hip Arthroplasty: Powerful or Misleading?

BackgroundDirect anterior approach total hip arthroplasty (THA) with fluoroscopic assistance is growing in popularity. Variables such as pelvic tilt, c-arm technique, and patient positioning can affect the perceived fluoroscopic view. This study evaluates the effect of these variables on the position of the acetabular component. MethodsForty-one hips in 40 patients undergoing direct anterior arthroplasty THA with fluoroscopic assistance underwent routine postoperative radiographs and postoperative pelvic computed tomography scan. The acetabular component position as defined by a 3-dimensional reconstruction was compared to the surgeon's intraoperative perception of the component's position and compared to routine postoperative plain radiograph measurements. ResultsAlthough fluoroscopy was used to create an anteroposterior pelvic radiograph utilizing the coccyx to pubis symphysis distance, a 3D reconstruction created in the same pelvic orientation as the fluoroscopic images confirmed that 39/41 hips were placed with unrecognized excess of anteversion and inclination secondary to imaging the pelvis in extension. ConclusionIntraoperative imaging during supine direct anterior arthroplasty THA confirms appropriate component placement. Pelvic tilt can greatly affect the perceived position of the acetabular component and cannot be accurately compensated for by assessing the relationship between the coccyx and pubic symphysis due to morphologic variation and orientation. We recommend positioning the c-arm so that the size and shape of the obturator foramen matches the standing preoperative anteroposterior pelvis image. This technique allows for the native standing pelvic tilt to be accounted for intraoperatively and will result in the least variation in intraoperative and postoperative standing acetabular component orientation.

Influences of different lower cervical bone graft heights on the size of the intervertebral foramen: multiple planar dynamic measurements with laser scanning.

The aim of this study is to evaluate the influences of different bone graft heights on the size of the intervertebral foramen, which will help determine the optimal graft height in clinical practice. Six fresh adult cadavers were used, with the C5-C6 vertebral column segment defined as the functional spinal unit (FSU). After discectomy, the C5/6 intervertebral height was set as the baseline height (normal disc height). We initially used spiral computed tomography (CT) to scan and measure the middle area of the intervertebral foramen when at the baseline height. Data regarding the spatial relationship of C5-C6 were subsequently collected with a laser scanner. Grafting with four different sized grafts, namely, grafts of 100, 130, 160, and 190% of the baseline height, was implanted. Moreover, we scanned to display the FSU in the four different states using Geomagic8.0 studio software. Multiple planar dynamic measurements (MPDM) were adopted to measure the intervertebral foramen volume, middle area, and areas of internal and external opening. MPDM with a laser scanner precisely measured the middle area of the intervertebral foramen as spiral CT, and it is easy to simulate the different grafts implanted. With the increase of the bone graft height, the size of the intervertebral foramen began to decrease after it increased to a certain point, when grafts of 160% of the baseline height implanted. MPDM of the intervertebral foramens with laser scanning three-dimensional (3D) reconstitution are relatively objective and accurate. The recommended optimal graft height of cervical spondylosis is 160% of the mean height of adjacent normal intervertebral spaces.