Sutural Research Articles

Age, Sex, and Maxillary Position Are Associated with Successful Microimplant-Assisted Rapid Palatal Expansion in Adults

The purpose of this study was to investigate the possible predictors of success of microimplant-assisted rapid palatal expansion (MARPE) in skeletally mature patients. Additionally, factors associated with the amount of maxillary expansion were analyzed. Factors associated with MARPE success were analyzed in 53 adult patients (27 males, 26 females, mean age 25.8 ± 8.9 years, and range 18.0 to 56.6 years) who had a maxillary transverse deficiency greater than 2 mm and a cervical vertebral maturation stage of 6. Age at pretreatment (T1), sex, sutural bone density at T1, type of appliance, mode of microimplant fixation, and lateral cephalometric variables at T1 were considered for inclusion as predictors for MARPE success. In patients who showed successful maxillary skeletal expansion, the linear distances of maxillary widths were measured on cone-beam-computed-tomography images at T1 and after MARPE (T2), and factors associated with the amount of expansion were analyzed. In total, 41 of the 53 patients showed successful maxillary expansion. Age (p = 0.019), sex (p = 0.002), and A-N perp (p = 0.015) were significantly associated with the success of MARPE. The factors associated with the amount of maxillary skeletal expansion were SN-MP and midpalatal-suture density at T1. In conclusion, there is a greater chance of failure in male patients who are older and have maxillary retrusion. A greater amount of maxillary expansion can be expected in patients with a higher mandibular-plane angle and with lower midpalatal-suture density.

The Morphometric analysis of accessory sutural bones with an emphasis on association with parietal emissary foramina

Background: The sutural bones and fontanelle of the skull display unique morphological characters. Sutural bones are also called supernumerary bones or ossicles or Wormian bones (WB). These are irregular and develop from the independent ossification centers present along the cranial sutures. They appear on periosteal and endosteal surfaces of the skull with variations in size, number, shape, and location. In the present study, we aimed to determine the morphological characteristics of sutural bones and emphasize the significance of the same. One interesting entity of skull near the posterior fontanelle is the presence of Inca bones. Methods: The present study was done on 128 dry human skulls by a convenient sampling method. The skulls were collected from the Department of Anatomy and significant characteristic features of Inca and Wormian bones like shape, number, size and location were recorded. Results: Of the 128 dry skulls examined Wormian bones were seen in 13.2 % of skulls and Inca bones in 5.4 % of skulls. Incorporation of Wormian bones in lambdoid suture was noted in 12.5 % in sagittal suture in 0.7 % skulls respectively. The Wormian bones were found frequently on the left side (n=12) as compared to the right side (n=5). The morphometry of the accessory bones showed quadrilateral as the most common shape (n=9, 37.5 %) followed by triangular (n=4, 16.6 %). Radiological examination of all 24 skulls with accessory bones showed a zigzag pattern of accessory suture lines. Conclusions: The presence of Wormian and Inca bones can be easily confused with fractures of the related bony regions. The surgeons need to be aware of this fact in order to make a proper and accurate diagnosis. The knowledge regarding these bones is highly beneficial to the clinician, radiologist, and neurosurgeon.

Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate

BackgroundThe objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate).MethodsMaxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software.ResultsUnder corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model.ConclusionsFor UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.

Case Report: Orthotic Treatment of Cranial Asymmetry Arising from Large Wormian Bone

Wormian bones are accessory bones found within fontanelles and sutures. They are thought to be an anatomic variant, though presence of several Wormian bones may be associated with pathological conditions such as osteogenesis imperfecta. Positional deformational plagiocephaly results from external forces on the infant skull leading to brachycephaly or asymmetric flattening. Severe cases are commonly treated with a cranial orthotic helmet that guides remodeling of the growing skull into a more symmetric shape. There is little reported about the association between Wormian bones and development of plagiocephaly. We present a case of a patient with occipital cranial asymmetry (cranial asymmetry index 10.4%) who underwent CT scan to rule out lambdoidal synostosis. This demonstrated patent sutures and a large right-sided Wormian bone. He was successfully treated with helmet therapy to address the contralateral deformational plagiocephaly. Wormian bones may be an under-recognized cause of asymmetrical cranial shape, potentially coexisting with deformational plagiocephaly. This case reports a role for orthotic therapy in these situations, as in isolated deformational plagiocephaly, to minimize asymmetry exacerbated by positioning on the contralateral side.

Effect of Simvastatin and Low-Level Laser Therapy on Sutural Bone Formation After Expansion in Rats: Biomechanical, Computed Tomography and Immunohistochemical Assessment.

Introduction: The application of low-level laser therapy (LLLT) and some medications have been shown to accelerate bone formation in rapid palatal expansion (RPE). A combination of these two therapeutic modalities may reduce the time required for the retention period. This study sought to assess the effects of simvastatin and LLLT, alone and combined, on sutural bone formation in rats. Methods: Sixty male Wistar rats averagely weighing 150 g were divided into five groups (n=12) of control (group 1), 5 mg simvastatin (group 2), 10 mg simvastatin (group 3), LLLT (group 4), and LLLT plus 10 mg simvastatin (group 5). The expansion appliance was placed in the parietal bone in all groups. One week after placing the appliance, the spring was fixed with Duralay acrylic resin to serve as a retainer during the rest of the experiment. The rats were sacrificed after 30 (for biomechanical and computed tomography [CT] assessments) or 60 days (for biomechanical, CT and immunohistochemical [IHC] assessments). Results: Groups 3 and 4 showed a significant improvement in osteogenesis (confirmed by CT findings, histological analysis and biomechanical test) compared to the control group. Group 5 was significantly superior to all other groups in terms of all parameters (P < 0.001). Group 2 and the control group were not significantly different (P>0.05). Conclusion: Although LLLT, simvastatin treatment and the combination of both significantly improved sutural bone formation in rats compared to the control group, the combined treatment showed significantly superior clinical results compared to other interventions.

Wormian bones and nonsyndromic craniosynostosis: A comparative study using computed tomography

Introduction: Wormian bones (WB) are accessory bones positioned within the sutures or fontanelles. Although several studies have associated them with genetic disorders, ethnicity, and skull deformations, their relationship with nonsyndromic craniosynostosis (CS) has not been established, especially among Brazilians. Therefore, this study was conducted to analyze the incidence and association of WB with nonsyndromic CS in Brazilian children.&#x0D; Methods: An observational and retrospective study was conducted using computed tomography with 3D reconstruction in Brazilian children aged &lt;3 years to compare the incidence and number of WB between regular children (group 1) and those with nonsyndromic CS (group 2).&#x0D; Results: A total of 140 children, comprising 62.9% boys (p &lt; 0.001) with a mean age of 8.78 months, were included in this study. The most common types of CS were trigonocephaly (34; 48.6%), scaphocephaly (25; 35.7%), anterior plagiocephaly (5; 7.1%), posterior plagiocephaly (3; 4.2%), and brachycephaly (3; 4.2%). WB were more common in regular children (41; 58.6%) than in children with CS (28; 40.0%) (p = 0.028). Regular children had an average of 2.12 WB versus 1.32 WB in children with nonsyndromic CS (p = 0.024).&#x0D; Conclusion: The significantly less incidence of WB in Brazilian children with nonsyndromic CS was quite different from that reported in other studies and could indicate the tendency of this disease to have disturbance in ossification of the cranial vault, the impact of ethnicity, and probably the lack of additional compensatory skull growth.&#x0D; &#x0D;

Prevalence of Wormian (Sutural) Bones in the Paris Catacombs Ossuary

Wormian, or sutural bones, vary in number, size, and arrangement in humans and other vertebrates. While their occurrence has been noted in some genetic bone development disorders, Wormian bones are also found in the general population. Currently, there are not reliable data to estimate the frequency at which they are found in humans with no underlying disorder. Some anthropologists have attempted to assess Wormian bone frequency in different human populations hoping to find whether there are differences among peoples of different genetic lineage. However, the sample sizes in these studies are too small to be able to compare such highly variable structures. The data presented here examining 500 skulls in the ossuary within les catacombes de Paris has revealed that Wormian bone occur in about 85% of skulls examined. This contrasts with most published studies that report incidences in the 10‐20% range. Les catacombes de Parisare believed to contain remains mostly from the late 18th and early 19th centuries. While there may be bones from earlier times, it is likely that these are fragile and fragmentary, and thus almost certainly do not contribute to the accessible visible walls of bones. These results are compared to surveys of skulls in three Italian collections: Museo di Anatomia umanaat Luigi Rolando dell'Università di Torino, Museo di Antropologiaat Università degli Studi di Padova,and Museo di Storia Naturale Sezione di Antropologia e Etnologia di Firenze, and in the only two known medieval English church ossuaries, in Hythe and Rothwell. The Italian collections represent Europeans, most if not all from late 19th and early 20th centuries, and the English skulls are presumed to be from the 13th and14th centuries. Wormian bones were found slightly more frequently in les catacombes de Paris than the other sites, but in each as well as all taken together, the incidence is significantly higher than is commonly reported for skulls from other parts of the world. The sample size of each of these studies individually, as well as in composite, is a very large. This large sample size further increases the credibility of these data. These findings expand the data set for comparison of Wormian bones from different parts of Europe and to peoples from other regions of the world, thus serving the greater community by providing a large baseline against which smaller sample groups may be compared. Additionally, the photographic evidence collected in this project may be used to support further research in human anatomical variation.

A STUDY ON PTERION IN ADULT DRY HUMAN SKULL BONES IN RAYALASEEMA POPULATION

Introduction: The knowledge of the variations of pterion &amp; its surgical anatomy are important for surgeons in operating the elds. This study also contribute additional information as skull bone fractures in infancy &amp; early childhood which may be associated with large inter sutural bones giving false appearance of fracture radiologically. 100 dry human skulls Materials &amp; Methods: which were obtained from the Departments of Anatomy, SVIMS - SPMCW; SV Medical college, Department of Anthropology, SV University, Tirupati; RIMS Medical college, Kadapa. Results: The sphenoparietal type of variety is seen in 71%, Frontotemporal - 20 %, Epipteric - 6 %, Stellate - 3%. The knowledge of location of pterion and its types in relation to important internal Conclusion &amp; Key Message: landmarks are really very essential for the neurosurgeon in their routine surgical approach.

Effect of Low-Level Laser Therapy on Bone Formation in Rapid Palatal Expansion: A Systematic Review.

Introduction: Crossbite is a common malocclusion with a 7-23% prevalence rate. Treatment is based on the expansion of the mid-palatal suture (MPS) with Rapid Palatal Expansion(RPE) followed by a retention period to reach new bone maturation, enough to maintain the results stable. This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in increasing bone formation in MPS. Methods: This article was written by the PRISMA checklist. Electronically, 3 databases, namely PubMed, Scopus, and Embase, were searched with the keywords selected based on PICO. Time (2010-2021) and language restrictions were performed. Results: 528 articles, out of which 374 studies were screened, were found, and 9 full-text articles were subsequently included considering these inclusion criteria: randomized clinical trial (RCT) that examines the efficacy of LLLT in rapid palatal expansion (RPE), age under 15 years, non-surgical RPE with a tooth-supported appliance, and low-intensity laser application. Finally, 4 articles were appraised by Cochrane version 5.2.0 with 7 domains. 3 of 4 articles showed LLLT has a significant impact on bone formation. One of them showed no significant difference in pain perception and bone density between the laser and non-laser groups. Conclusion: While many studies have assessed the effect of LLLT on bone formation in animal models, high-quality clinical trials are missing in this regard. The available clinical trials suggest a positive effect of LLLT on sutural bone formation after RPE.

Application of Deep Learning Techniques for Automated Diagnosis of Non-Syndromic Craniosynostosis Using Skull.

Non-syndromic craniosynostosis (NSCS) is a disease, in which a single cranial bone suture is prematurely fused. The early intervention of the disease is associated with a favorable outcome at a later age, so appropriate screening of NSCS is essential for its clinical management. The present study aims to develop a classification and detection system of NSCS using skull X-ray images and a convolutional neural network (CNN) deep learning framework. A total of 56 NSCS cases (scaphocephaly [ n = 17], trigonocephaly [n = 28], anterior plagiocephaly [n = 8], and posterior plagiocephaly [n = 3]) and 25 healthy control infants were included in the study. All the cases underwent skull X-rays and computed tomography scan for diagnosis in our institution. The lateral views obtained from the patients were retrospectively examined using a CNN framework. Our CNN model classified the 4 NSCS types and control with high accuracy (100%). All the cases were correctly classified. The proposed CNN model may offer a safe and high-sensitivity screening of NSCS and facilitate early diagnosis of the disease and better neurocognitive outcome for patients.

Identification a novel de novo RUNX2 frameshift mutation associated with cleidocranial dysplasia

BackgroundCleidocranial dysplasia (CCD) is a rare genetic disorder affecting bone and cartilage development. Clinical features of CCD comprise short stature, delayed ossification of craniofacial structures with numerous Wormian bones, underdeveloped or aplastic clavicles and multiple dental anomalies. Several studies have revealed that CCD development is strongly linked with different mutations in runt-related transcription factor 2 (RUNX2) gene.ObjectiveIdentification and functional characterization of RUNX2 mutation associated with CCD.MethodsWe performed genetic testing of a patient with CCD using whole exome sequencing and found a novel RUNX2 frameshift mutation: c.1550delT in a sporadic case. We also compared the functional activity of the mutant and wild-type RUNX2 through immunofluorescence microscopy and osteocalcin promoter luciferase assay.ResultsWe found a novel RUNX2 frameshift mutation, c.1550delT (p.Trp518Glyfs*60). Both mutant RUNX2 and wild-type RUNX2 protein were similarly confined in the nuclei. The novel mutation caused abrogative transactivation activity of RUNX2 on osteocalcin promoter.ConclusionsWe explored a novel RUNX2 deletion/frameshift mutation in a sporadic CCD patient. This finding suggests that the VWRPY domain may play a key role in RUNX2 transactivation ability.

Isolated avulsion fracture of the tibia at the insertion to the posterior cruciate ligament

Three cases of evulsion tibia fractures at the posterior cruciate ligament attachment are presented. The bone fragment displacement was more than 1 cm. All patients were treated surgically. In 1 patient reduction offracture was completed by bone suture, in 2 patients by fixation with screw inserted retrogradely. Follow up from 6 months to 4 years showed no complications, the joint was stable and full volume of motion was noted.

Paediatric skull growth models: A systematic review of applications to normal skulls and craniosynostoses

Craniosynostoses affect 1/2000 births and their incidence is currently increasing. Without surgery, craniosynostosis can lead to neurological issues due to restrained brain growth and social stigma due to abnormal head shapes. Understanding growth patterns is essential to develop surgical planning approaches and predict short- and long-term post-operative results. Here we provide a systematic review of normal and pathological cranial vault growth models. The systematic review of the literature identified descriptive and comprehensive skull growth models with the following criteria: full text articles dedicated to the skull vault of children under 2 years of age, without focus on molecular and cellular mechanisms. Models were analysed based on initial geometry, numerical method, age determination method and validation process. A total of 14 articles including 17 models was reviewed. Four descriptive models were assessed, including 3 models using statistical analyses and 1 based on deformational methods. Thirteen comprehensive models were assessed including 7 finite element models and 6 diffusion models. Results from the current literature showed that successful models combined analyses of cranial vault shape and suture bone formation. Growth modelling is central when assessing craniofacial architecture in young patients and will be a key factor in the development of future customized treatment strategies. Recurrent technical difficulties were encountered by most authors when generalizing a specific craniosynostosis model to all types of craniosynostoses, when assessing the role of the brain and when attempting to relate the age with different stages of growth.

Monitoring Skull Base Abnormalities in Children with Osteogenesis Imperfecta - Review of Current Practice and a Suggested Clinical Pathway.

In the context of a lack of national consensus on the benefits of skull base imaging in children with osteogenesis imperfecta (OI), this study aims to analyse and correlate the clinical symptoms and radiological images of children with severe OI. A retrospective case notes and image analysis was carried out on children with complex OI between 2012 and 2018 at a specialist tertiary centre. Data were collected on patient demographic factors, clinical data, imaging findings (presence of Wormian bones, platybasia, basilar impression (McGregor's technique) and basilar invagination (McRae's technique)), and clinical features at the time of imaging. Of the 127 patients in the OI database, 94 were included. A total of 321 radiographs, 21 CT scans and 39 MRI scans were analysed. Average frequency of radiographs was 8 per 10years. Of the 94 patients, 58 (62%), 10 (11%), 1 (1%) demonstrated platybasia, basilar impression, and basilar invagination, respectively. Of the radiographs analysed, platybasia, basilar impression, basilar invagination, and the presence of Wormian bones, could not be evaluated in 71 (22.3%), 48 (15.2%), 61 (19.5%) and 28 (9.4%) radiographs respectively (due to poor positioning, anatomical abnormalities, and poor image quality). Of the 140 radiographs with platybasia, 17 (12%) also demonstrated basilar impression compared to only 3 (2.9%) out of the 99 without platybasia (p=0.03). No significant associations were seen between the presence of Wormian bones and basilar impression. Of the 39 MRIs, additional information on CSF flow rate, spinal cord signal and cerebellar morphology was reported in 14 (36%). There was a lack of concordance between MRI and matched radiographs in 7.1% (1/14) and 36% (5/14) for platybasia and basilar impression respectively, with full concordance for basilar invagination. Fewer than 5% had positive clinical symptoms/signs at the time of imaging; 2% (7/321) had macrocephaly, 0.6% (2/321) headache, all other neurological features were absent). Clinical features were not documented in >85% of patients. The apparent low prevalence of clinical symptoms and signs and of radiologically identified cranio-cervical abnormalities, suggests that current levels of serial imaging may be excessive. Until larger prospective studies clarify these issues, we suggest a clinical pathway for base of skull imaging which proposes a risk stratification approach to radiographic frequency and suggests parameters for proceeding to MRI.

Bipartite parietal bone

This study reports the first case of the bipartite parietal bone in the Croatian modern and archaeological population. We have examined 458 skulls from Multi-Slice Computed Tomography (MSCT) images and found only one case of this trait (0.22%; 95%CI 0.01%-1.21%). The bone exhibiting an additional suture was the left parietal; the type of the trait was complete, horizontal, and asymmetrical. Some additional sutural bones were observed, including asterion and lambda ossicle and two lambdoid ossicles. Among the other epigenetic variants, parietal, zygofacial, oval, and mastoid foramina, frontal grooves, supratrochlear notch, and condylar canal were visible. The principal components analysis (PCA) of features extracted from the frontal, lateral, and posterior view of 110 female crania using a convolutional neural network (CNN) for image analysis demonstrated that the skull deviated from the average female skull in the population. The visual and metric examination of the skull showed ultrabrachycephaly, mild lateral deformational plagiocephaly, and depression on the posterior part of the skull. The rarity of this case in the Croatian population indicated that this variant could be interesting for both clinicians and forensic anthropologists, as it can be used as means of comparative identification. Further studies will show its importance in assessing population affinities and relations inside the graveyards.

Effects of teriparatide on bone formation in rats with experimentally induced premaxillary expansion.

ABSTRACTObjective: This study aimed to evaluate the effects of systemic teriparatide on sutural bone formation after premaxillary suture expansion in rats.Material and Methods: Twenty Wistar male rats (8-10 weeks old) were randomly divided into two groups, namely, control (C, n=10) and teriparatide (T, n=10). An expansion force was applied to the maxillary incisors using helical spring for a seven-day expansion period, for both groups. On the eighth day, the rats were kept for a seven-day consolidation period, and then 60 µg/kg teriparatide (once a day) was administered to group T subcutaneously for seven days. Then, all the rats were sacrificed, and histological sections were stained with hemotoxylin-eosin for examination. Anti-osteonectin, anti-osteocalcin, anti-Vascular endothelial growth factor (VEGF) and anti-transforming growth factor beta (TGF-β) were evaluated by immunohistochemical analysis in the midpalatal suture area. Results: Histologically, the newly formed bone tissue was observed to be larger in group T than in group C. The number of immunoreactive osteoblasts for osteonectin, osteocalcin and VEGF antibodies was significantly higher in group T than in group C (p = 0.0001). The TGF-β antibody showed a mild reaction in group T, but did not reach significance in comparison with group C (p ˃ 0.05).Conclusion: Systemic teriparatide application following the premaxillary expansion of the suture area may stimulate bone formation and add to the consolidation of the expansion in rats by regulating osteonectin, osteocalcin and VEGF.

Morphometric Analysis and Variation of Pterion, Asterion and Lambda in Dry Human Skulls and Its Sexual Dimorphism

Introduction: Pterion is a H- shaped sutural junction of the frontal, parietal, squamous part of the temporal and greater wing of sphenoid bone. Asterion is a sutural junction of lambdoid, parietomastoid and occipitomastoid sutures. Lambda is the junction where lambdoid sutures and sagittal sutures meet. These sutures play an important role in infants' brain development. Flexibility of these allows the bones to overlap and hence it can pass through the brain canal easily without any damage to the brain.&#x0D; Aim: To analyse pterion asterion and lambda of dry human skulls morphologically and morphometrically and determine its sexual dimorphism.&#x0D; Materials and Methods: 40 dry human skulls were collected from the department of Anatomy of Saveetha dental college and hospitals. By excluding abnormal and damaged skulls, 20 skulls were studied. Out of 20 skulls, 11 were male skulls and 9 were female skulls. On investigation, Pterion was classified into four types: Sphenoparietal, stellate, Epipteric and Frontotemporal. Asterion was classified into types: Type-1 and Type-2 based on the presence and absence of wormian bones respectively. Lamda was classified into two types: Normal and Abnormal. Statistical analysis was done by SPSS software. Paired Sample T test was used to analyse the data.&#x0D; Results: Percentage of occurrence of different types of pterion in males and females: Sphenoparietal (59.09 % of males and 59.09 % of females), Stellate (27.7% of males and 22.2% of females), Epipteric (99% of males and 16.6% of females) and Frontotemporal (45.5% of males and 5.5% of females). Different types of Asterion: Type-1 (13.63% of males and 16.66 % of females and Type -2 (86.63% of males and 83.33% of females). Different types of Lambda: Normal (90.9% of males and 94.4% of females), Abnormal (9% of males and 5.55% of females).&#x0D; Conclusion: In the present study, there was no correlation between the male and female skulls in the presence of Pterion, Asterion and Lambda. Therefore these cannot be used as reliable parameters for determining sexual dimorphism.

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

STUDY OF ANATOMICAL VARIATION OF ASTERION IN HUMAN DRY SKULLS AND ITS SURGICAL IMPORTANCE

Asterion is the meeting point of temporal, occipital, and parietal bones on the posterolateral surface of the skull. This point is surgically important in various posterior cranial fossa surgeries since it is a smaller delicate area where many vital structures are present. The Neurosurgeons have been doubtful about its accuracy due to population-based differences in its morphology and its location with relationship to sigmoid and transverse sinuses. In this study 100 (54 male &amp; 46 female) adult skulls were measured to accurately the type of asterion, its distance from important bony landmarks, and also the nearby venous sinuses were measured. Our study revealed that type II (absence of sutural bones) is the commonest type when compared to type I (presence of sutural bones) asterion. The asterion was 4.82 ± 0.58 cm from the apex of the mastoid process on the right side and 4.70 ± 0.70 cm on the left. It was higher in males than in females, p-value being statistically significant (P = 0.00 &amp; P = 0.02 for right &amp; left sides respectively). The distance of asterion from supramastoid crest is 4.22 ± 0.73 cm on the right and 4.23+/-0.58 cm on the left. The distance in males is higher than in females. The position of the asterion in relation to transverse sinus was at the level of the transverse sinus in 74.67% of cases, and inferior to the asterion in 22.41%, and superior to the asterion in 2.92%. The measure taken reveals that the asterion is located either at the level or below the level of the transverse sinus in the majority of the cases. This information is useful to neurosurgeons to minimize the risk during posterior cranial fossa surgeries. This study is useful for anthropologists, forensic science experts for the determination of the sex of the skull along with other parameters.

МЕТОДЫ ФИКСАЦИИ КОСТНЫХ ОТЛОМКОВ ПРИ ПЕРЕЛОМАХ НИЖНЕЙ ЧЕЛЮСТИ

Thing. A review of the literature devoted to the topical problem of maxillofacial surgery and surgical dentistry – methods of treating patients with mandibular fractures was carried out.&#x0D; The aim of the study is to review the materials of publications on the methods of treatment of patients with mandibular fractures.&#x0D; Methodology. The publications of domestic and foreign authors, considering methods of fixation of bone fragments in lower jaw fractures, have been studied.&#x0D; Results. Publications indicate that there are many treatments for mandibular fractures. Research results demonstrate the importance of bone stabilization for bone fusion. A common disadvantage of conservative and surgical methods of treatment is unstable fixation of bone fragments, which is the most common cause of delayed consolidation of a mandibular fracture. The presented studies show that bone osteosynthesis with metal plates is considered the most appropriate method for treating mandibular fractures.&#x0D; Conclusions. Splinting as a method of treating fractures of the lower jaw has a large number of disadvantages. A common disadvantage of methods for splinting the lower jaw is that these structures do not always provide anatomical reduction and stability for the entire period of consolidation or require mandatory intermaxillary fixation, the lower jaw is fixed in the central occlusion position, which is not a position of physiological rest, and leads to passive muscle tension. depriving them of active function.&#x0D; The main disadvantage of the methods of osteosynthesis using a suture and using wires is that it is difficult to achieve stable fixation of fragments using these techniques.&#x0D; Combined methods of fixation of bone fragments (use of a bone suture and dental splints) provide a stronger fixation of the fragments.&#x0D; In the past two decades, in the treatment of mandibular fractures, there has been an increase in the trend towards rigid or semi-rigid osteosynthesis using plates.&#x0D; The disadvantages of compression osteosynthesis is that significant compression can lead to ischemia and slow down the formation of callus.&#x0D; A common disadvantage of conservative and surgical methods of treatment is unstable fixation of bone fragments, which is the most common reason for their delayed consolidation.&#x0D; Bone osteosynthesis with metal plates is considered a more progressive method of treating mandibular fractures.