Superomedial Aspect Research Articles

Anatomical Description of the Spring Ligament Articular Facet.

The spring ligament fibrocartilaginous complex (SLFC), which is essential for stabilizing the medial longitudinal arch, features a little-explored fibrocartilaginous facet within its superomedial aspect, articulating with the talar head. This research aimed to provide a detailed anatomical description of this facet, designated as the spring ligament articular facet (SLAF). Nine normally aligned cadaveric lower limbs were dissected, approaching the SLFC from a superior direction. Following talus disarticulation, high-resolution images of the ligament complex were captured and analyzed. ImageJ software was used to determine the areas and dimensions of the superomedial calcaneonavicular (SMCN) spring and SLAF. The fibrocartilage facet exhibited a trapezoid shape in all specimens. The mean area for SMCN spring was 280.39 mm², and for SLAF, it was 200 mm². The proximal-to-distal length for SLAF averaged 11.78 mm at its longest and 5.34 mm at its shortest. Attachment of the SLAF to the calcaneum and the navicular showed robust fibrous structures, with average measurements of 3.75 and 1.75 mm at the medial and lateral calcaneal margins, and 2.75 and 2.98 mm at the medial and lateral navicular margins, respectively. This study clearly delineated the individual structural components of the SLFC articulating with the talar head and detailed its dimensions, emphasizing the need for more specific anatomical terminology that respects the intricate anatomy of the SLFC. Level III, descriptive study.

Multimodal study of multilevel pulvino-temporal connections: a new piece in the puzzle of lexical retrieval networks.

Advanced methods of imaging and mapping the healthy and lesioned brain have allowed for the identification of the cortical nodes and white matter tracts supporting the dual neurofunctional organization of language networks in a dorsal phonological and a ventral semantic stream. Much less understood are the anatomical correlates of the interaction between the two streams; one hypothesis being that of a subcortically mediated interaction, through crossed cortico-striato-thalamo-cortical and cortico-thalamo-cortical loops. In this regard, the pulvinar is the thalamic subdivision that has most regularly appeared as implicated in the processing of lexical retrieval. However, descriptions of its connections with temporal (language) areas remain scarce. Here we assess this pulvino-temporal connectivity using a combination of state-of-the-art techniques: white matter stimulation in awake surgery and postoperative diffusion MRI (n = 4), virtual dissection from the Human Connectome Project 3 and 7 T datasets (n = 172) and operative microscope-assisted post-mortem fibre dissection (n = 12). We demonstrate the presence of four fundamental fibre contingents: (i) the anterior component (Arnold's bundle proper) initially described by Arnold in the 19th century and destined to the anterior temporal lobe; (ii) the optic radiations-like component, which leaves the pulvinar accompanying the optical radiations and reaches the posterior basal temporal cortices; (iii) the lateral component, which crosses the temporal stem orthogonally and reaches the middle temporal gyrus; and (iv) the auditory radiations-like component, which leaves the pulvinar accompanying the auditory radiations to the superomedial aspect of the temporal operculum, just posteriorly to Heschl's gyrus. Each of those components might correspond to a different level of information processing involved in the lexical retrieval process of picture naming.

Supraorbital artery: Anatomical variations and neurosurgical applications.

The supraorbital artery (SOA) originates from the ophthalmic artery in a superomedial aspect of the orbit, exiting through the supraorbital groove to emerge onto the forehead. The SOA has important neurosurgical considerations regarding different approaches and bypasses. The SOA is poorly described in the standard anatomical textbooks. Therefore, we present this article to describe the anatomical variations of the SOA and their implications on the neurosurgical field. We conducted a literature review in PubMed and Google Scholar databases to review the existing literature describing the SOA anatomy and its neurosurgical applications. While reading the available articles and original works regarding SOA, we identified 22 studies that discuss the SOA. We noticed the anatomical variations of the SOA in terms of origin, course, diameter, branches, depth, and distance in relation to the midline and vertical glabellar line. We also discussed certain applications of SOA and its importance in neurosurgical approaches, bypass, photoplethysmography, aneurysms, and reconstruction of cranial fossa defects. The variable anatomy of the SOA has a paramount impact on performing different neurosurgical approaches. Therefore, cadaveric studies of the SOA are important to explore potential methods for the preservation of the artery in different neurosurgical applications.

Poster 143: Patella Fixation Using All-Suture Versus Knotted and Knotless Solid Suture Anchors in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Analysis

Objectives: Patients with recurrent patellofemoral instability are indicated for medial patellofemoral ligament (MPFL) reconstruction. Multiple different patellar graft fixation methods exist in MPFL reconstruction surgery, namely bone tunnels, interference screws, and suture anchors. Meta analysis has shown suture patellar fixation to have superior patient reported outcomes with no statistical difference in failure rates when compared to transpatellar tunnel fixation clinically. Amongst suture anchor designs, all-soft-suture anchors occupy a smaller volume than solid suture anchors, requiring a smaller diameter tunnel during placement and thus theoretically can reduce the risk of patella fracture and articular surface violation. However, there is concern that all-soft-suture anchors may be biomechanically inferior to their hard-bodied anchor counterparts. Additionally, there is a paucity of research comparing different anchor designs (knotted vs knotless) amongst hard-bodied anchors in the setting of MPFL reconstruction. The purpose of this study is to perform a biomechanical comparison of newer generation soft-bodied anchors and hard-bodied suture anchors with different fixation methods when performing an osseous-based MPFL reconstruction in a cadaveric model. Methods: Fourteen patellae were randomized into three groups: PEEK hard-body knotless (HB-knotless), PEEK hard-body knotted (HB-knotted), and soft-body knotless (SB-knotless) anchors placed at the anatomic MPFL insertions in the direct medial position and at the superomedial aspect of each patella. Prior to anchor placement, bone density at the sites of anatomic MPFL insertions was measured on standard radiographs. After anchor placement, patellae were potted, and anchors were tested in a materials test system in a cyclic regimen (10-30 N, 100 cycles) immediately followed by load-to-failure (6mm/sec). All testing was performed in line with the anchor alignment (Figure 1). Outcome measures included maximum load and cyclic creep, defined as the difference in segment length from the peak load of the first cycle to the peak load of the 100th cycle of testing. One-way ANOVA and Fisher exact tests were used to evaluate outcomes between groups. Statistical significance was set at p < 0.05. Results: Analysis included 6 SB-knotless, 14 HB-knotted, and 8 HB-knotless anchors. The groups were equivalent in age (range 30 years – 70 years; p = 0.657) and bone density (p = 0.134) in a 4:3 male-to- female ratio. There was no significant difference in cyclic creep detected between SB-knotless (3.00 ± 0.79 mm), HB- knotless (2.80 ± 0.42 mm), and HB-knotted (3.25mm ± 0.70 mm) groups (p = 0.301). HB-knotted exhibited a lower maximum load (111.30 ± 43.71 N) than HB-knotless (180.01 ± 58.87 N) (p = 0.017), but no significant difference to SB-knotless (149.34 ± 61.38 N) (p = 0.310) (Figure 2). HB- knotless and SB-knotless did not have a significant difference in maximum load (p = 0.529). When evaluating the influence of patellar anchor site on performance, there was no significant difference in cyclic creep or maximum load between direct medial and superomedial anchor positioning in SB-Knotless (p = 0.800, p = 0.800), HB-Knotted (p = 0.719, p = 0.219), or HB-Knotless (p = 0.886, p = 0.057) groups, respectively. There were 6 SB-knotless, 12 HB-knotted, and 7 HB-knotless anchors that failed by anchor pull-out, with 2 HB-knotted and 1 HB-knotless which failed either by the suture breaking within the anchor or the knot failing (Figure 3). This difference between failure mechanisms was not significant. Conclusions: Hard-body knotless anchors provide superior load to failure than traditional hardbody knotted anchors. Additionally, all-soft-suture anchors performed as well as their counterparts in both load to failure and resistance to cyclic creep. This work suggests surgeons should be comfortable using either hard-body or all-soft-suture anchors when performing osseous-based MPFL reconstructions and may consider opting for a knotless mechanism when utilizing a PEEK hard-bodied anchor for this purpose. A clinical study should take place next to validate these cadaveric findings.

Transoral Approach to Parapharyngeal Space Tumours: Preliminary Reports from a Single-Centre Retrospective Analysis

The aim of this study is to identify certain parapharyngeal space tumours with specific characteristics that can be treated successfully through an endoscopically assisted transoral approach (EATA). Nine patients with PPS tumours underwent surgery through an EATA between 2003 and 2021. All patients underwent clinical examination and fibrolaryngoscopy. Preoperative CT and/or MRI was performed on all patients. All the patients were successfully treated through an endoscopically assisted transoral approach. Histological examination revealed five pleomorphic adenomas, two schwannomas, one ectopic thyroid gland and one lipoma. The only long-term sequelae observed was Horner syndrome in the two schwannomas arising from the carotid space. The mean hospitalisation time was 2.6 days, while the mean follow-up time was of 9.7 years. An endoscopically assisted transoral approach (EATA) is a valid technique for treating benign capsulated tumours of the true PPS and some benign capsulated tumours of the superomedial aspect of the carotid space.

Unprecedented emergencies during radiofrequency ablation procedure: a case series

Radiofrequency ablation (RFA) of nerves is an upcoming intervention for relieving chronic musculoskeletal pain. However, being relatively new not much publications are available on emergencies during the procedure. 66 years old male, a case of Osteoarthritis knee, underwent RFA genicular nerve of right knee. Conventional RFA of Superolateral, Inferomedial, Superomedial genicular nerves were done under C- arm guidance. Thirty minutes after the procedure, we found a boggy swelling developing over his right knee. It was a hematoma developing on the superomedial aspect of the right kneecap most likely due to injury to Superomedial genicular vessels accompanying the nerve. 67 years old female planned for RFA genicular nerves of both knees under C arm guidance. During the intervention, she complained of numbness around face, and suddenly went into disoriented state with muscle twitching and bluish discoloration of lips. Medicine consultation diagnosed the incident as LA associated systemic toxicity. 57 years old female with chief complaints of pain in left hemiplegic shoulder pain for 6 months duration admitted for suprascapular nerve block. During the procedure patient goes into hypotensive bradycardic episode. 65 years old female admitted for Medial calcaneal block for right heel pain. 24 hours after the procedure she has aggravated pain of foot. RFA is considered as a non-invasive, OPD based procedure for effective pain relief but it is also important to understand such unprecedented emergencies that can happen.

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Middle Fossa Approaches and Anterior Petrosectomy, Surgical Principles, and Illustrative Cases.

Introduction The middle fossa (MF) approaches encompass a group of versatile surgical accesses to pathologies in the MF, internal auditory canal (IAC), and superomedial aspect of the posterior fossa. Although many descriptions of the MF approaches have been published, a practical surgical guide that allows an easy understanding for Skull Base trainees is needed. Methods Three formalin-fixed, colored-injected specimens were dissected under microscopic magnification (six sides). A MF craniotomy followed by IAC drilling was performed on three sides, and anterior petrosectomy (AP) was performed in the remaining three sides. The anatomical dissection was documented in stepwise three-dimensional photographic images. Following dissection, representative case applications were reviewed. Results The MF approach provides direct access to the MF structures and IAC. The AP provides excellent access to the superomedial aspect of the posterior fossa. Key common steps include: positioning and skin incision; scalp and muscle flaps; burr holes; craniotomy flap elevation; dural dissection along the petrous ridge; division of the middle meningeal artery; and exposure of the greater superficial petrosal nerve, tegmen tympani, and V3. Then, to approach the IAC: superior IAC drilling, and longitudinal dura opening. The area drilled in the AP approach forms a pentagon limited by the petrous internal carotid artery, cochlea, IAC, petrous ridge, and lateral border of V3. Conclusion The MF approaches are challenging. Operatively oriented skull base dissections provide a crucial foundation for learning these techniques. We describe comprehensive step-by-step approaches intended to develop familiarity in the cadaver laboratory and facilitate understanding of their potential for skull base disorders. Basic surgical principles are described to help in the operating room as well as illustrative cases.

Supracerebellar Infratentorial Infratrochlear Trans-Quadrangular Lobule Approach to Pontine Cavernous Malformations.

Brainstem cavernous malformations with symptomatic hemorrhage have a poor natural history. Those without a pial or ependymal presentation are often observed given the morbidity of resection. Surgical removal is considered only in patients with accessible lesions that have repeated symptomatic hemorrhagic. To describe a novel supracerebellar infratentorial infratrochlear trans-quadrangular lobule approach to safely resect lesions in the upper pons. We use a hybrid paramedian/lateral suboccipital craniotomy in the gravity-dependent supine position. Opening the cerebellomesencephalic fissure over the tentorial surface of the cerebellum brings the trochlear nerve, branches of the superior cerebellar artery, and the quadrangular lobule of the cerebellum into view. Removal of small a portion of the quadrangular lobule defines an entry point on the superomedial aspect of the middle cerebellar peduncle, and a surgical trajectory aimed superior to inferior. A total of 6 patients underwent this approach. All presented with symptomatic hemorrhage and all cavernous malformations were completely resected. Five patients were improved or unchanged with modified Rankin scale scores of 1 or 2. The trans-quadrangular lobule approach allows safe resection of upper pontine cavernous malformations along a superior to inferior trajectory.

A mysterious case of transient proptosis

A 42-year-old Indian woman presented with a slowly progressive and painless swelling in the superomedial aspect of right orbit over past 5 years. She succumbed to homeopathic treatment which controlled the swelling for some time, but eventually recurred. The swelling led to protrusion of her right eye down and out. The patient's vision in her right eye was reduced, with restricted movement on elevation and adduction. The right eye pupil was sluggishly reacting to light. The fundus examination of the right eye revealed hyperemic disc with disc edema and retinal folds. Whereas, left ocular examination was normal. The computed tomography and magnetic resonance imaging scans of the right orbit revealed an intraconal, multiloculated lesion in the superomedial aspect of the orbit, adhering to the optic nerve, giving us an array of differential diagnosis. She underwent right anterolateral orbitotomy under general anesthesia; the masses excised were sent for histopathological examination, which gave the definitive diagnosis of a schwannoma.

Mini Fronto-Orbital Approach: "Window Opening" Towards the Superomedial Orbit - A Virtual Reality-Planned Anatomic Study.

Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the "window-opening" cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.

An anatomical investigation into the blood supply of the proximal humerus: surgical considerations for rotator cuff repair

BackgroundThe purpose of this study was to investigate the blood supply of the humeral head (HH) originating from the anterior (ACHA) and posterior circumflex humeral arteries (PCHA).MethodsFormalin preserved specimens were used to measure ACHA length, ACHA length in the bicipital groove (BG), the length of the ascending branch of the ACHA, the penetration point of the ascending branch of the ACHA at the greater tuberosity (GT), and the penetration point of the ascending branch PCHA at the GT. Fresh specimens were used to identify the intraosseous vascular network by both the ACHA and PCHA by injecting a contrast medium using a high-resolution microfocus computed tomography. Specimens were then dissected to expose where the branches of the ACHA and PCHA penetrate the bone, and a small section of the medial head was removed to visualize dye penetration of the cancellous bone.ResultsSeven variations for the course of the ACHA were observed. In 36%, the ACHA runs posterior to the BG and posterior to the long head of biceps tendon, and splits into the anterolateral ascending and descending branch. The ascending branch enters the medial wall of the GT. Microfocus computed tomography demonstrated that the intraosseous branch of the ascending branch of the ACHA runs within the GT in a medial direction from its penetration point just along the lateral edge of the BG. Intraosseous accumulation of contrast within the GT supply occurs more toward the inferior aspect of the HH, and the anterior-superior and superior-medial aspect of the HH is not perfused. This region is a high-risk zone for avascular necrosis.ConclusionThe results of this study suggest that 7 variations for the course of the ACHA exist. These variations and the interruption of the intraosseous arterial network in the GT with surgery and suture anchor placement result in a high-risk zone in the superomedial aspect of the humeral head overlapping with the area where early aseptic necrosis is identified.

Comprehensive Anatomic Assessment of Ipsilateral Pterional Versus Contralateral Subfrontal Approaches to the Internal Carotid Ophthalmic Segment: A Cadaveric Study and Three-Dimensional Simulation

Medially pointing aneurysms of the ophthalmic segment of the internal carotid artery (oICA) represent a neurosurgical challenge. Conventional ipsilateral approaches require internal carotid artery and optic nerve (ON) mobilization as well as anterior clinoidectomy (AC), all associated with increased surgical risk. Contralateral approaches could provide a better exposure of the superomedial aspect of the oICA, ophthalmic artery, and superior hypophyseal artery, sparing AC and internal carotid artery or ON mobilization. However, the microsurgical anatomy of this approach has not been systematically studied. In the present work, we exhaustibly analyzed the anatomic and morphometric characteristics of contralateral approaches to the oICA and compared them with those from ipsilateral approaches. We assessed 36 ipsilateral and contralateral approaches to the oICAs in cadaveric specimens and live patients, using for the latter a three-dimensional virtual reality (VR) system. Contralateral approaches spared sylvian fissure dissection and required only minimal frontal lobe retraction. The ipsilateral and contralateral oICA were found at a depth of 49.2 ± 1.8 mm (VR, 50.1 ± 2.92 mm) and65.1 ± 1.5 mm (VR, 66.05 ± 3.364 mm) respectively. Theexposure of the superomedial aspect of oICA was 7.25± 0.86 mm (VR: 6 ± 1 mm) contralaterally without ON mobilization and 2.44 ± 0.51 mm (VR, 2 ± 1 mm) ipsilaterally even after AC. Statistical analysis showed that, for nonprefixed chiasm, contralateral approaches achieved a significantly higher exposure of the ophthalmic artery, superior hypophyseal artery, and the superomedial aspect of the oICA with its perforating branches (all P < 0.01). Contralateral approaches may enable successful exposure of the oICA and related vascular structures, reducing the need for AC or ON mobilization. Systematic clinical/surgical studies are needed to further determine the effectiveness and safety of the approach.

Anatomical assessment of the digastric branch of the facial nerve as a landmark to localize the extratemporal facial nerve trunk.

Localization of the facial nerve trunk (FNT) [i.e., the portion of the facial nerve between the stylomastoid foramen (SMF) and pes anserinus] may be required during various surgical interventions such as parotidectomy and hypoglossal-facial anastomosis. Several landmarks have been proposed for efficient identification of the FNT. We sought to assess the anatomical features of the digastric branch of the facial nerve (DBFN) and its potential as a landmark to identify FNT. Fifteen sides of eight cadaveric heads were dissected to find the DBFN. Anatomic features of DBFN including its point of origin relative to SMF, length, and important relationships, as well as the distance between the insertion point on the digastric muscle and mastoid tip were recorded. DBFN was found in all specimens originating from the FNT outside the SMF with an average length (± standard deviation) of 15.4 ± 3.4mm. In all specimens, the DBFN inserted on the superomedial aspect of the posterior belly of the digastric muscle (PBD). In 8/15 specimens, DBFN was accompanied by the stylomastoid artery on its anteromedial side. Average distance (± standard deviation) between the mastoid tip and the nerve insertion point on PBD was 13.6 ± 2.0mm (range 10-17). The DBFN is a reliable landmark for identifying the FNT. It could be consistently identified within 15-20mm of the mastoid tip on the superomedial aspect of the PBD. The DBFN may be used as a supplementary landmark for efficient localization of the FNT. Not applicable (anatomic study).

Anatomic Nuances of the Ophthalmic Artery Origin from a Ventral Viewpoint: Considerations and Implications for Endoscopic Endonasal Surgery.

The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 "normal" angiographic studies. On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90±standard deviation of 0.74 mm). Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

Large intra-articular true lipoma of the knee

BackgroundIntra-articular lipomas are rare and very few cases have been reported in the knee. To the best of our knowledge, here we report the largest lipoma to have ever been observed in the knee. It is crucial to avoid the misdiagnose of lipoma arborescens, which is associated with degenerative joint disease. Lipoma is a homogeneous, ovoid, adipose tissue tumor that is contained within a fibrous capsule and not associated with previous disease.Case presentationA 48-year-old male, with a soft-tissue tumor on the superomedial aspect of the right knee. Magnetic resonance imaging (MRI) revealed an intra-articular lipoma. The mass was resected by means of a limited arthrotomy.ConclusionsKnee lipoma is an extremely rare disease that must be diagnosed by MRI. Where possible, it should be resolved by arthroscopic resection.

Anatomical study of the innervation of posterior knee joint capsule: implication for image-guided intervention

Background and objectivesPeripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve block supplying the posterior knee joint capsule...

A rare and unusual case of cycle pedal in the orbit

A 58-year-old male presented with injury in the left eye by falling over a cycle pedal. On presentation to the casualty, the cycle pedal was found penetrating onto the superomedial aspect of the left orbit. The cycle pedal was removed in toto, and computed tomography brain with orbital cuts revealed fracture in the orbital floor, maxilla, and nasal bone. Upper-lid tear was sutured, and visual acuity was 20/30 no improvement in glass, no improvement in pinhole (NIG, NIP). Thus, immediate extraction of the foreign body resulted in better visual and cosmetic outcome.

Clinical profile of patients with intertrochanteric fractures of hip attending tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The hip joint is ball and socket joint. In weight bearing the pressure forces are transmitted to the head and neck of the femur at an angle of 165 degrees to 170 degrees regardless of position of pelvis. The plane of the force coincides with strongly developed trabeculae that lie in the medial portion of the femoral neck and extend upwards through the supero-medial aspect of the femoral head. These trabeculae are in line with similar pressure trabeculae that start at acetabulum and run upwards and medial to sacro-iliac joint.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; After the patient with intertrochanteric fracture was admitted to our hospital, all the necessary clinical details were recorded in the proforma prepared for this study. After the completion of the hospital treatment patients were discharged and called for follow-up to outpatient department at regular intervals (6 weeks, 12 weeks, 6 months, 12 months) for clinical and radiological evaluation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The most common age group was in the range of 60 to 70 yrs. Most common mode of injury was trivial fall in this series. 56% of the patients having type II BOYD and GRIFFIN fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most common mode of injury in young patients is the road traffic accident while most common mode of injury in older patients is the simple fall (domestic fall). &lt;/p&gt;

Analysis of Craniofacial Remodeling in the Aging Midface Using Reconstructed Three-Dimensional Models in Paired Individuals.

Aging leads to a panoply of changes of facial morphology. The present study was conducted to analyze modifications of the facial skeleton with aging, using high-resolution imaging and comparing the same individuals at two time points. The electronic medical record system was reviewed since its inception in 2001 for patients for whom two computed tomographic scans of the midface were obtained at least 9 years apart. The computed tomographic scans were converted into three-dimensional craniofacial models for each patient, using the initial and the follow-up computed tomographic scan data. The models were used to highlight areas of bone growth and bone resorption using a color scale and to perform a cephalometric analysis. Seven patients with a mean age of 61 years and computed tomographic scans on average 10.3 years apart were included. Bone resorption was consistently present (100 percent) at the pyriform aperture and the anterior wall of the maxilla. Resorption was noted at the superocentral (71 percent), inferolateral (57 percent), and superomedial (57 percent) aspects of the orbital rim. Resorption occurred earlier at the inferolateral orbital rim followed by the superomedial orbital rim in later decades of life. Paired-analysis of change in the orbital rim height and width demonstrated a mean decrease over time but was not significant. Bone remodeling in the same individual, over a period of 10 years, was characterized by resorption at the pyriform aperture; anterior wall of the maxilla; and superocentral, superomedial, and inferolateral aspects of the orbital rims.

An unusual radiological presentation of optic nerve sheath meningioma

Our report describes an unusual radiological presentation of optic nerve sheath meningioma. The classic radiological appearance of optic nerve thickening with enhancement and calcification within the tumor was not seen; instead, an elongating gadolinium enhancing band-like area adjacent to the superomedial aspect of the left optic nerve sheath was identified. The diagnosis was confirmed on histopathology. Our report adds to the spectrum of presentations of this relatively common clinical entity.