Soft Tissue Abnormalities Research Articles

Multimodality imaging review of the post-amputation stump pain.

Limb amputation is one of the oldest known surgical procedures performed for a variety of indications. Little surgical technical improvements have been made since the first procedure, but perioperative and post-operative refinements have occurred over time. Post-amputation pain (PAP) of the stump is a common complication but is an extremely challenging condition to treat. Imaging allows early diagnosis of the underlying cause so that timely intervention is possible to minimize physical disability with its possible psychological and socioeconomic implications. A multidisciplinary approach should be taken involving the rehabilitation medicine team, surgeon, prosthetist, occupational therapist and social workers. Conventional radiographs demonstrate the osseous origin of PAP while high-resolution ultrasound is preferred to assess soft-tissue abnormalities. These are often the first-line investigations. MRI remains as a problem-solving tool when clinical and imaging findings are equivocal. This article aimed to raise a clear understanding of common pathologies expected in the assessment of PAP. A selection of multimodality images from our Specialist Mobility and Rehabilitation Unit are presented so that radiologists are aware of and recognize the spectrum of pathological conditions involving the amputation stump. These include but are not limited to aggressive bone spurs, heterotopic ossification, soft-tissue inflammation (stump bursitis), collection, nervosas, osteomyelitis etc. The role of the radiologist in reaching the diagnosis early is vital so that appropriate treatment can be instituted to limit long-term disability. The panel of authors hopes this article helps readers identify the spectrum of pathological conditions involving the post-amputation stump by recognizing the imaging features of the abnormalities in different imaging modalities.

Ankle impingement.

Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.

Role of MRI in assessment of patello-femoral derangement in patients with anterior knee pain

ObjectiveTo assess the diagnostic accuracy of magnetic resonance imaging (MRI) in evaluating patello-femoral instability as a cause of anterior knee pain (AKP) and its predisposing factors. Methods55 knees of 50 adult patients below 40 years complaining of AKP underwent MRI between February 2013 and February 2015. The patients were analyzed prospectively for the presence of bone, hyaline cartilage and soft-tissue abnormalities, as well as anatomic variants that may contribute to patello-femoral maltracking or impingement abnormalities. Our results were compared to those of the arthroscopic and mini open exploration procedures. ResultsIn the 55 knees analyzed for patello-femoral instability cartilaginous injuries were found in 58%, with an MRI sensitivity of 88%, disruption of the medial patello-femoral ligament (MPFL) in 31% with an MRI sensitivity 84%, joint morphology abnormalities in 74.5% of patients, bone edema in 27% of patients and Hoffa’s fat pad edema in 30 patients (55%). MRI had a sensitivity of 84% and accuracy of 81% in determining the injury site and pattern. ConclusionMRI is reliable imaging modality in identifying the risk factors that may contribute to the development of patello-femoral maltracking or impingement permitting individual tailored treatment.

Tarsal tunnel disease and talocalcaneal coalition: MRI features.

To assess, utilizing MRI, tarsal tunnel disease in patients with talocalcaneal coalitions. To the best of our knowledge, this has only anecdotally been described before. Sixty-seven ankle MRIs with talocalcaneal coalition were retrospectively reviewed for disease of tendons and nerves of the tarsal tunnel. Interobserver variability in diagnosing tendon disease was performed in 30 of the 67 cases. Tarsal tunnel nerves were also evaluated in a control group of 20 consecutive ankle MRIs. Entrapment of the flexor hallucis longus tendon (FHL) by osseous excrescences was seen in 14 of 67 cases (21%). Attenuation, split tearing, tenosynovitis, or tendinosis of the FHL was present in 26 cases (39%). Attenuation or tenosynovitis was seen in the flexor digitorum longus tendon (FDL) in 18 cases (27%). Tenosynovitis or split tearing of the posterior tibial tendon (PT) was present in nine cases (13%). Interobserver variability ranged from 100% to slight depending on the tendon and type of disease. Intense increased signal and caliber of the medial plantar nerve (MPN), indicative of neuritis, was seen in 6 of the 67 cases (9%). Mildly increased T2 signal of the MPN was seen in 15 (22%) and in 14 (70%) of the control group. Talocalcaneal coalitions may be associated with tarsal tunnel soft tissue abnormalities affecting, in decreasing order, the FHL, FDL, and PT tendons, as well as the MPN. This information should be provided to the referring physician in order to guide treatment and improve post-surgical outcome.

Role of Ultrasonography in Knee Osteoarthritis.

Ultrasound has become popular among rheumatologists as the first-choice imaging investigation for the evaluation and monitoring of osteoarthritis (OA). Because of recent improvement in technology, ultrasound has the ability to demonstrate and assess the minimal structural abnormalities, which involve the pathophysiology and progression of OA, such as articular cartilage, synovial tissue, bony cortex, and other soft tissue. Nowadays, ultrasonography is a promising technique for assessing soft tissue abnormalities such as joint effusion, synovial hypertrophy, Baker cyst, and other structural changes including the decrease in cartilage thickness, meniscus bulging, and formation of osteophyte. Ultrasonography not only possesses diagnostic potential in knee OA but also reveals long-term predictability for disease progress as imaging biomarker. Ultrasonography has also been proven as a useful tool in guiding therapeutic interventions and monitoring treatment effectiveness. This review addresses the utility, reliability, and potential utilization of ultrasonography as an imaging technique in knee OA.

Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: A retrospective study

The present study examined the histopathological and magnetic resonance imaging (MRI) features of pyogenic, brucella and tuberculous spondylitis (PS, BS and TS, respectively). A total of 22 PS, 20 BS and 20 TS patients were included in the study. Histopathological examination was used to assess the lesion structure and composition, and the MRI observation identified the lesion location and signal features. The following histopathological and MRI features were identified significantly more in patients with PS than in patients with BS and TS: Predominant neutrophil infiltration, abnormal intervertebral disk signal, lesions on the ventral and lateral sides of the vertebral bodies, and thick and irregular abscess walls. The following histopathological and MRI features were identified significantly more in patients with BS than in patients with PS and TS: Predominant lymphocyte infiltration, new bone formation, epithelioid granuloma, lesions on the ventral sides of the vertebral bodies, no, or very mild, vertebral body deformation, no abnormal paraspinal soft tissue signal, no intraosseous or paraspinal abscesses, and thin and irregular abscess walls. The following histopathological and MRI features were identified significantly more in patients with TS than in patients with BS and PS: Sequestrum, Langerhans giant cells, caseous necrosis, lesions primarily in the thoracic region and on the lateral sides of the vertebral bodies, no obvious intervertebral disk damage, obvious vertebral body deformation, abnormal paraspinal soft tissue signal, intraosseous or paraspinal abscesses, and thin and smooth abscess walls. In conclusion, it can be suggested that these significant differences in histopathological and MRI features between the three different types of spondylitis may contribute towards the differential diagnosis of the diseases.

Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor.

Objectives/Hypotheses Functioning pituitary adenomas may produce endocrinopathies such as acromegaly and Cushing syndrome. Both conditions lead to characteristic anatomic variations as a result of hormonally induced abnormal soft tissue deposition. We evaluate the anatomic differences between acromegalics and Cushing disease patients and compare these dimensions to controls. Design Radiographic review of preoperative magnetic resonance images (MRI) of the pituitary gland. Setting Tertiary academic medical center. Participants Patients who underwent transnasal, transsphenoidal surgery for pituitary adenomas found to have acromegaly or pituitary Cushing between January 1, 2007 and September 1, 2015. A total of 15 patients with similar MRIs and no history of pituitary or sinonasal disease were selected as controls. Main Outcome Measures Dimensions assessed were intercarotid distance; carotid canal width; piriform aperture width; distance from the piriform aperture to the anterior face of the sphenoid; sphenoid sinus height, width, and length; angle from anterior nasal spine to anteroinferior face of sphenoid sinus; choanal height; and nasal cavity height at the level of the vertical segment of the middle turbinate. Sphenoid sinus pneumatization patterns were recorded. Results There were 30 acromegalics and 31 Cushing disease patients. When compared with controls, both acromegalics and Cushing disease patients had significantly wider piriform apertures and a longer distance from the piriform aperture to the anterior face of the sphenoid sinus (p < 0.05). Acromegalics had a significantly less acute angle (19 ± 3 degrees) from the anterior nasal spine to the sphenoid (p < 0.05). Cushing disease patients had significantly lower sphenoid sinus length and shorter nasal cavity height (p < 0.05). There were no differences in intercarotid distance or carotid canal width. Conclusions As acromegalics and Cushing disease patients have known anatomic variations, the skull base surgeon should be aware of these differences and adapt their techniques and approaches as needed.

Dorsal Lumbar Disc Migrations with Lateral and Ventral Epidural Extension on Axial MRI: A Case Series and Review of the Literature.

Dorsal epidural migration of lumbar disc extrusion is rare and commonly misdiagnosed. Our purpose was to retrospectively analyze soft-tissue abnormalities on axial MR imaging in both the ventral and lateral epidural space in such dorsal epidural migrations. The presence of each component required complete concordance by 3 independent neuroradiologist readers. In a case series (n = 6) of surgically proved dorsal lumbar disc migrations, in which the radiologist's favored prospective diagnosis had not been correct, each case demonstrated epidural soft-tissue abnormality that had components both laterally and ventrally, abutting the parent disc. Similarly, in previously published cases for which axial MR imaging was available, the lateral component was demonstrated in 23/24 cases (96%). Ventral abutment of the parent disc was evident, in addition, in 17/18 cases (94%) with available disc-level axial images. Both ventral and lateral epidural soft-tissue abnormalities are typically present in dorsal lumbar disc herniations and may help radiologists suggest this rare diagnosis in appropriate cases.

Musculoskeletal ultrasound on the hand and wrist in systemic Sclerosis

Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disorder. Musculoskeletal involvement represents a major cause of disability in SSc, which is localized especially at the level of the hands and feet. Musculoskeletal ultrasound (MSUS) had become a reference imaging tool in the evaluation of joint and softtissue abnormalities in rheumatic diseases. This study aimed to characterize ultrasonographic changes of the hand and wrist in patients with SSc as compared with patients with rheumatoid arthritis (RA), as well as determine the relation of these changes with clinical, laboratory, and radiographic findings in SSc. Twenty SSc patients and 20 control RA patients were included in this study. All patients underwent history taking, clinical examination, hand/wrist plain radiography, and MSUS performed on both hand and wrist joints. MSUS was more sensitive than radiographies in detecting soft-tissue calcifications in SSc patients and also in detecting erosions with no statistically significant difference (P>0.05). In SSc patients, the prevalence of synovitis and tenosynovitis detected by ultrasound was found to be statistically significantly higher than that found by clinical examination (P=0.025 and 0.011, respectively). Patients with higher values of erythrocyte sedimentation rate and C-reactive protein were more likely to have synovitis and/or tenosynovitis and inflammatory activity on power Doppler assessment. Ultrasound was more accurate than clinical examination and conventional radiography in the detection of subclinical synovitis, tenosynovitis, and the underlying fibrotic changes of tendon friction rub. In SSc patients, on using MSUS, articular involvement was found to be less frequent compared with that in RA patients, with specific appearance of sclerosing tenosynovitis in SSc patients.

Elbow Imaging in Sport: Sports Imaging Series.

HomeRadiologyVol. 280, No. 1 PreviousNext CommunicationsFree AccessErrataElbow Imaging in Sport: Sports Imaging SeriesMatthew D. Bucknor, Kathryn J. Stevens, Lynne S. SteinbachMatthew D. Bucknor, Kathryn J. Stevens, Lynne S. SteinbachMatthew D. BucknorKathryn J. StevensLynne S. SteinbachPublished Online:Jun 20 2016https://doi.org/10.1148/radiol.2016164015MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:Radiology 2016;279(1):12–28 DOI: 10.1148/radiol.2016150501Erratum in:Radiology 2016;280(1):328 DOI:10.1148/radiol.2016164015The institutional affiliation for Kathryn J. Stevens should be as follows: Department of Radiology, Stanford University School of Medicine, Stanford, Calif.Article HistoryPublished online: June 20 2016Published in print: July 2016 FiguresReferencesRelatedDetailsCited ByMRI of the Upper ExtremityEira S.Roth, LuluHe2022Ossification of the posterior capitellum: description of a new pathology and its radiological appearanceM. M.Schneider, B.Hollinger, A.Zimmerer, R.Nietschke, H.Michaely, F.Migliorini, N.Maffulli, K. J.Burkhart2022 | Archives of Orthopaedic and Trauma SurgeryMRI of the Elbow: Interpretation of Common Orthopaedic InjuriesRupert O.Stanborough, Daniel E.Wessell, Bassem T.Elhassan, Bradley S.Schoch2022 | Journal of the American Academy of Orthopaedic Surgeons, Vol. 30, No. 6Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injuryLuigiTarallo, GiovanniMerolla, GiuseppePorcellini, Maria GraziaAmorico, GianmarioMicheloni, MicheleNovi, EttoreDi Giovine, FabioCatani2021 | International Orthopaedics, Vol. 45, No. 1Pediatric Musculoskeletal Trauma: Special ConsiderationsJessica RLeschied, Steven BSoliman2021 | Seminars in Roentgenology, Vol. 56, No. 1Sports-related Fractures, Dislocations and TraumaJackSpittler, AdamSeidl2020Sports-related Fractures, Dislocations and TraumaJordan S.Gold, Adam C.Zoga, John C.Hill2020Postoperative Imaging of Sports InjuriesDavid A.Rubin2020Magnetic resonance imaging of elbow injuries in childrenNancy A.Chauvin, Cristy N.Gustas-French2019 | Pediatric Radiology, Vol. 49, No. 12Overuse Injuries of the ElbowArvin B.Kheterpal, Miriam A.Bredella2019 | Radiologic Clinics of North America, Vol. 57, No. 5Was erwarten Orthopäden und Unfallchirurgen vom Radiologen bei der Beurteilung der Bildgebung des Ellenbogens?R.Lenz, J.Bonacker, W.Mittelmeier, M.Ellenrieder, T.Tischer2018 | Der Radiologe, Vol. 58, No. 11Accompanying This ArticleElbow Imaging in Sport: Sports Imaging SeriesMar 18 2016RadiologyRecommended Articles MRI of the Normal Elbow and Common Pathologic ConditionsRadioGraphics2020Volume: 40Issue: 2pp. 468-469The Ulnar Nerve at Elbow Extension and Flexion: Assessment of Position and Signal Intensity on MR ImagesRadiology2016Volume: 280Issue: 2pp. 483-492Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball PlayersRadiology2016Volume: 280Issue: 1pp. 328MRI-Arthroscopy Correlations: A Case-Based Atlas of the Knee, Shoulder, Elbow and HipRadiology2017Volume: 285Issue: 1pp. 34Histotopographic Anatomy of the Cubital TunnelRadiology2016Volume: 280Issue: 3pp. 979-980See More RSNA Education Exhibits A Useful Guide for Traumatic Elbow Injuries at Your ElbowDigital Posters2020High Resolution Ultrasonography (US) of the Elbow Demonstrating Standard Technique and Its Variations with Emphasis on Detailed Evaluation of Ligaments, Tendons, and NervesDigital Posters2019Dynamic Ultrasound and Guided Intervention in Cubital Tunnel Ulnar Nerve Subluxation - A Diagnosis Often OverlookedDigital Posters2018 RSNA Case Collection Medial epicondylar fracture with internal joint entrapmentRSNA Case Collection2022Supracondylar FractureRSNA Case Collection2020Radial Head FractureRSNA Case Collection2021 Vol. 280, No. 1 Metrics Altmetric Score PDF download

A randomized controlled trial evaluating the efficacy of a 67% sodium bicarbonate toothpaste on gingivitis.

In previous studies, toothpastes with high levels of sodium bicarbonate (>50%) have reduced gingival inflammation and oral malodour. This study compared the effects of brushing for 6 weeks with 67% (test group) or 0% (control group) sodium bicarbonate toothpaste on gingival health. This was a single-centre, single examiner-blind, randomized, controlled, two-treatment, parallel-group study. Eligible subjects (≥18 years) had ≥20 gradable teeth, mild-to-moderate gingivitis, a positive response to bleeding on brushing and ≥20 bleeding sites. The primary objective was to compare the number of bleeding sites following twice-daily use of 67% sodium bicarbonate toothpaste or 0% sodium bicarbonate toothpaste after 6 weeks. Secondary endpoints included Modified Gingival Index (MGI), Bleeding Index (BI) and volatile sulphur compounds (VSC), assessed after 6 weeks. Safety was assessed by treatment-emergent oral soft tissue abnormalities and adverse events. Of 148 patients randomized (74 to each treatment), 66 (89.2%) completed the study in the test group, compared with 69 (93.2%) in the control group. Compared with the control group, the test group had a significant reduction in the number of bleeding sites at Week 6 (absolute difference - 11.0 [-14.0, -8.0], P < 0.0001; relative difference - 25.4%), together with significant reductions in MGI and BI (both P < 0.0001). Although the median reductions from baseline for VSC were numerically greater in the test group, the difference did not reach statistical significance (P = 0.9701). This 67% sodium bicarbonate toothpaste provided statistically significant improvements in gingival health and bleeding after 6 weeks of use.

Clinical and surgical correlation of hip MR arthrographic findings in adolescents

ObjectiveThe purpose of this study was to analyze the utility of MRA-H in adolescents by comparing the results of imaging with surgical findings and/or clinical outcome. Material and methodsAfter obtaining appropriate IRB approval, the Radiologic Information System database was queried for all patients 13–18 years of age who underwent MRA-H from 2004 through 2013. The electronic medical record was reviewed for clinical history, clinical examination findings, and operative notes. MRA-H images were reviewed for soft tissue abnormalities (labral tear, paralabral ganglion, articular cartilage loss, synovitis, ligament tears) and bony abnormalities (cam-type femoroacetabular impingement (FAI), pincer-type FAI, hip dysplasia). MRA-H findings were correlated with surgical findings and with clinical outcomes. ResultsTwenty-six patients with labral tears by MRA-H were included in study and grouped as follows: Group I) patients who underwent surgical management (n=10); group II) patients managed non-surgically (medication, intra-articular injection, physical therapy) (n=9); group III) patients lost to follow up after being advised to have surgery (n=7). With regard to presenting symptomatology, 87.5% of patients with labral tear had groin pain. Of those patients who were diagnosed with a labral tear, 52% were categorized as idiopathic labral tears, 26% as secondary tears (secondary to abnormal bony morphology), and 22% as traumatic labral tears. The labral tears were found to be anterior in 61% and posterior in 22%. Associated articular cartilage lesions were found in 29% of patients. In group I (surgical patients), MRA-H labral findings were confirmed at surgery in 9/10. Seventy percent of labral tears in our study had some form of abnormal bony morphology. Nine of the 12 patients with bone abnormalities were derived from group I patients. Six out of 7 patients with cam-type FAI had a labral tear. ConclusionLabral tears diagnosed by MRA-H in the adolescent population correlated well with clinical examination and surgical findings. Also, MRA-H contributed by defining bony morphology that was directly applied to surgical management. Non-surgical management of labral tears diagnosed on MRA-H had a generally favorable outcome.

High resolution ultrasonography and magnetic resonance imaging in the evaluation of tendino-ligamentous injuries around ankle joint

PurposeThe aim of this study was to rule out the diagnostic accuracy of both ultrasonography (US) and magnetic resonance imaging (MRI) for the assessment of tendino-ligamentous pain around the ankle joint. Patients and methodsThis study included 35 patients (25 females and 10 males) complaining of unilateral ankle pain (acute or chronic), and they were subjected to plain X-ray (to exclude osseous pathology), US and MRI examinations. ResultsThe study included 35 patients where 20 patients showed tendon pathology that was diagnosed into 21 pathological entities by both US and MRI imaging modalities with no difference in interpretation between them. 21 patients had pathological ligaments which were diagnosed by both ultrasound and MRI. However, two ligamentous lesions were diagnosed as partial tear by US, while MRI diagnosed them as complete tear. Associated findings were also diagnosed as retrocalcaneal bursitis in two patients, joint effusion in four patients and joint synovitis in three patients. ConclusionUS is an excellent tool for imaging soft tissue abnormalities, as it allows rapid, in-expensive detailed examination of the structures of the ankle joint. US and MRI are two complementary tools of investigation with the former being used as primary effective tool of investigation and the latter is done to confirm the diagnosis.

Ultrasound Examination of Pediatric Musculoskeletal Diseases and Neonatal Spine.

Ultrasound (US) is a simple, non-invasive imaging modality which allows high-resolution imaging of the musculoskeletal (MSK) system. Its increasing popularity in pediatrics is due to the fact that it does not involve radiation, has an ability to visualize non-ossified cartilaginous and vascular structures, allows dynamic imaging and quick contralateral comparison. US is the primary imaging modality in some pediatric MSK conditions like infant hip in developmental dysplasia (DDH), hip joint effusion, epiphyseal trauma and evaluation of the neonatal spine. US is the modality of choice in infants with DDH, both in the initial evaluation and post-treatment follow-up. US has a sensitivity equivalent to MRI in evaluation of the neonatal spine in experienced hands and is a good screening modality in neonates with suspected occult neural tube defects. In other MSK applications, it is often used for the initial diagnosis or in addition to other imaging modalities. In trauma and infections, US can often detect early and subtle soft tissue abnormalities and a quick comparison with the contralateral side aids in diagnoses. Dynamic imaging is crucial in evaluating congenital instabilities and dislocations, soft tissue and ligamentous injuries, epiphyseal injuries and fracture separations. High-resolution imaging along with color Doppler (CD) is useful in the characterization of soft tissue masses. This article reviews the applications of US in pediatric MSK with emphasis on conditions where it is a primary modality. Limitations of US include inability to penetrate bone, hence, limited diagnosis of intraosseous pathology and operator dependency.

The prevalence of malocclusion and orthodontic treatment needs in school going children of Nalagarh, Himachal Pradesh, India.

The aim of this study was to determine the prevalence of malocclusion and orthodontic treatment need in 13-18-year-old schoolchildren of Nalagarh, Himachal Pradesh, India using the Index of Orthodontic Treatment need (IOTN) and to analyze the treatment needs between males and females and correlation between the esthetic component (AC) and dental health component (DHC) of IOTN. The sample comprised 2000 school children (1125 females and 875 males) who had not undergone orthodontic treatment. No radiographs, study casts, were used; IOTN was calculated from clinical examination. DHC results showed that little need for orthodontic treatment was found in 31.6% and moderate need in 30.85%. A great need was estimated at 37.55%. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by increased overjet, impeded eruption of teeth, and anterior or posterior cross bite. AC results showed that little need for orthodontic treatment was in 86.15%, moderate need in 8.90%, and great need in 4.95%. Index does not consider midline discrepancy, soft tissue abnormalities, and AC does not include Class III and Class II div 2 malocclusion photographs. There seems a discrepancy in the proportion of children needing orthodontic treatment on esthetic and dental health grounds. This study provides baseline data on the need and demand for orthodontic treatment among the sample which is important for planning public orthodontic and dental services.

An Unexpected Airway Complication in a Male Patient with Goltz Syndrome.

Goltz syndrome, also known as focal dermal hypoplasia, is a rare X-linked dominant multisystem syndrome presenting with cutaneous, skeletal, dental ocular, central nervous system and soft tissue abnormalities. This case report discusses an adult male patient with Goltz syndrome that was noted to have large, papillomatous, hypopharyngeal lesions upon induction of general anesthesia. We highlight challenges with airway management intraoperatively and postoperatively in patients with Goltz syndrome. Our aim is to increase awareness of the potential airway complications associated with this genetic disorder and to provide suggestions for optimal perioperative management for patients afflicted with Goltz syndrome.

A diabetic woman with soft tissue complex pathology

Introduction: Despite the fact that the diabetic patients can frequently develop some soft tissue abnormalities, these entities are rarely described in aggregation. case report: this clinical case of a 50-year-old insulin-treated female, presented with plantar and palmar fibromatosis (Ledderhose disease and Dupuytren disease), cheiroarthropathy, knuckle pads (Garrod's pads), Huntley's papules, acanthosis nigricans and large dorsal cutaneous scleredema. Diagnosis has engaged clinical and imaging correlation. Planning the therapeutic approach has been adapted accordingly. conclusion: In this case, the soft tissue's abnormalities have challenged our clinical and imaging skills as well. Long-term follow-up is claimed due to the diabetic condition and the potential aggressiveness of lesions.

Treatment of Obstructive Sleep Apnea Syndrome through Orthodontics and Orthognathic Surgery: A Case Report with a Five Year Follow-Up

Introduction: Obstructive sleep apnea (OSA) results from the presence of abnormal soft and hard tissues in the upper airway, which cause the collapse of the oropharynx in the deeper stages of sleep. Different treatment modalities have been proposed for OSA, aiming to offer a better quality of life for the patients. Orthognathic surgery via maxillary-mandibular advancement (MMA) decreases the collapse of soft and hard tissue structures during sleep and has a high success rate. The facial and occlusal improvement, the enhancement on respiratory function and the less morbid postoperative period are some advantages responsible for the growing acceptance of this technique. Case report: This case reports a combination of orthodontic treatment and orthognathic surgery via MMA in a 51 year old man with OSA. The initial polysomnography showed an apnea-hypopnea index of 49.2 and arousal index of 21.7. Follow-up polysomnography performed 15 months after surgery revealed significant improvement. The apneahypopnea index decreased to 2.9 and the arousal index to 12.3. The patient reported significant improvements in life quality, sleep quality, and nasal breathing capacity, as well as a decrease in daytime sleepiness and snoring. Thus far, the patient has been under postoperative follow-up for 5 years and 6 months, without any complaints of breathing difficulties during the day or night. Conclusion: The combination of orthodontic and surgical treatment via MMA may be a favorable alternative treatment for improving the respiratory symptoms of patients with OSA and is highly indicated for patients with maxillary-mandibular discrepancies.

EFFECT OF L-CARNITINE ON THE LINGUAL MUCOSA OF STREPTOZOTOCIN-INDUCED DIABETIC ALBINO RATS

Background: Diabetes mellitus (DM) is a significant healthcare problem concern worldwide that has different pathological effects on the body tissues and organs. A number of oral soft tissue abnormalities have been associated with DM by various reports. L-carnitine (LC) is an essential nutrient that is present in almost all animal species, microorganisms and plants.The scope of this study is two-fold: 1) to investigate degenerative changes in the epithelium of the diabetic rat tongue, and 2) to test the hypothesis that (LC) attenuates epithelial cell degeneration. Materials and methods: Thirty adult male albino rats were divided into 3 equal groups: group I; (control group), group II; (diabetic group): diabetes was induced by a single intraperitoneal injection of streptozotocin in a dose of 35 mg/kg and group III; (LC) rats were treated as in diabetic group and injected intraperitoneally by (LC) at a dose of 300mg/kg b.w/day for 4 weeks. By the end of the experimental periods all animals were sacrificed and the tongue of all rats were dissected and processed for light and immunohistochemical examinations. Results: Examination of dorsal surface of diabetic rats’ tongues revealed numerous filliform papillae with evidently disturbed orientation and inclination. Some of them appear notched; others were destructed with desquamation of its epithelial covering. Dorsal surface of rats’ tongues of (LC) group revealed almost normal direction, distribution and structure of the papillae and taste buds. Immunohistochemical examination of Ki67 expression of the control group showed significant decrease in Ki67 positive immunoreactivity, indicating less proliferative changes. While (LC) treated group revealed expression of Ki67, that statistically having no significant difference with control group

Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors

QuestionWhat (risk) factors are associated with plantar fasciopathy (PF)?DesignSystematic review with meta-analyses.ParticipantsPatients with PF.FactorsAll factors described in prospective, case–control or cross-sectional observational studies.Results51 included studies (1 prospective, 46 case–control and...