Thin Bone Research Articles

Augmented corticotomy-assisted presurgical orthodontic treatment to prevent alveolar bone loss in patients with skeletal Class III malocclusion

The objective of this study was to explore the effect of augmented corticotomy (AC) on anterior alveolar bone morphology in presurgical orthodontic treatment for skeletal Class III malocclusion. Thirty-six surgical patients with skeletal Class III malocclusion with high-angle were included: 18 (AC group) accepted AC surgery during presurgical orthodontic treatment, and 18 (control group) accepted traditional presurgical orthodontic treatment. Cone-beam computed tomography scans were obtained before treatment (T0) and after presurgical orthodontic treatment (T1). The alveolar bone morphology, root length, dehiscence, and movement of mandibular central incisors were measured by cone-beam computed tomography using Dolphin software. Statistical analyses were performed with independent-sample t tests, paired t tests, and multiple linear regression. After presurgical orthodontic treatment, the whole alveolar bone thickness at each level, alveolar bone area, and alveolar bone height decreased significantly in the control group but increased or remained unchanged in the AC group. In the AC group, the lower the labial alveolar bone height at T0 was, the greater the increase after T1; the change in alveolar bone thickness was related to ΔL1-MP and sex. At T0, the incidences of dehiscence were similar in the 2 groups, ranging from 11.11% to 16.67%. At T1, the labial and lingual incidences of dehiscence in the AC group were 0% and 27.78%, compared with 55.56% and 66.67% in the control group. During presurgical orthodontic treatment, AC is effective in preventing alveolar bone resorption and dehiscence without additional root resorption. AC can be recommended for high-angle skeletal Class III patients with thin alveolar bone around anterior teeth during presurgical orthodontic treatment.

Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-orbital Advancement

OBJECTIVE: Fronto orbital advancement (FOA) requires the removal of the fronto-orbital bandeau via an anatomically challenging osteotomy that passes from the anterior cranial fossa to the middle fossa. During the intracranial portion of the osteotomy, visualization of the saw blade is lost as it passes through the fronto-orbito-sphenoid junction, prior to entering the middle cranial fossa. This places the temporal lobe dura and parenchyma at risk of injury. The aim of this study is to provide a 3-dimensional analysis of the space surrounding this osteotomy, and determine differences amongst different types of craniosynostosis. METHOD: 18 head CT scans of patients from ages 2 to 24 months with craniosynostosis (6 Metopic, 6 nonsyndromic Bicoronal, and 6 Unicoronal) were reconstructed to 3D skulls using Mimics 24.0 (Materialise NV, Lueven, Belgium). Unicoronal skulls were mirrored as necessary to be right sided. These skulls were landmarked with 47 cephalometric points. Measurents and volumetric analysis was performed to determine differences in sphenoid anatomy between the 3 craniosynostoses. RESULTS: For the 3 craniosynostosis groups, metopic, bicoronal and unicoronal, the average distance from the lateral orbital rim to temporal lobe tip was significantly different (17.37mm, 10.15mm, 14.76mm, respectively (p<0.05)). The mean depth of the temporal lobe tip from the edge of the sphenoid was also significantly different (16.23mm, 27.5mm, 22.8 mm respectively, p<0.05). The thickness of the fronto-orbito-sphenoid junction at the level of the supraorbital rim was significantly different between the three groups as well (7.75mm, 3.60mm, 8.04mm; p=0.01). Distances from the cornea to the lateral orbital rim, anteroposterior depth of the lateral orbit, and overhang of the lesser sphenoid wing over the middle cranial fossa were not significant between groups. CONCLUSION: Sphenoid shape and the zone of the fronto-orbital-sphenoid junction differs between types of craniosynostosis. Bicoronal craniosynostosis has the most unfavorable anatomy in this area, with minimal distance between the orbit and the anterior portion of the temporal lobe, a vertically deep middle cranial fossa, and thin bone at the fronto-orbital sphenoid junction, all of which make retraction and protection of the temporal lobe more challenging. Careful understanding of the patient’s specific anatomy is necessary to perform this osteotomy safely.

Changes of the subchondral bone microchannel network in early osteoarthritis

We have identified a 3D network of subchondral microchannels that connects the deep zone of cartilage to the bone marrow (i.e., cartilage-bone marrow microchannel connectors; CMMC). However, the pathological significance of CMMC is largely unknown. Here, we quantitatively evaluated how the CMMC microarchitecture is related to cartilage condition, as well as regional differences in early idiopathic osteoarthritis (OA). Two groups of cadaveric female human femoral heads (intact cartilage vs early cartilage lesions) were identified, and a biopsy-based high-resolution micro-CT imaging was employed. Subchondral bone (SB) thickness, CMMC number, maximum and minimum CMMC size, and the CMMC morphology were quantified and compared between the two groups. The effect of joint's region and cartilage condition was examined on each dependent variable. The CMMC number and morphology were affected by region of the joint, but not by cartilage condition. On the other hand, the minimum and maximum CMMC size was changed by both the location on the joint, as well as the cartilage condition. The smallest CMMC were consistently detected at the load-bearing region (LBR) of the joint. Compared to non-pathological subjects, the size of the microchannels was enlarged in early OA, most noticeably at the non-load-bearing region (NLBR) and the peripheral rim (PR) of the femoral head. Furthermore, subchondral bone thinning was observed in early OA as a localized occurrence linked with areas of partial chondral defect. Our data point to an enlargement of the SB microchannel network, and a collective structural deterioration of SB in early idiopathic OA.

Cortical thickness mapping at segmented regions in the distal radius using HR-pQCT.

An advanced method of analyzing the cortical bone microarchitecture of the distal radius using high-resolution peripheral quantitative computed tomography (HR-pQCT) was developed. The subjects were 60 women (20: aged 30-49, 20: aged 50-69, and 20: aged 70-89years). The distal radius was scanned by HR-pQCT, and its cortical volumetric bone mineral density (Ct.vBMD), cortical porosity (Ct.Po), and cortical thickness (Ct.Th) were measured. The cortical bone was also divided into three areas according to whether its thickness was < 0.5mm, 0.5-1.0mm, or > 1.0mm, and the percentage of each surface area in the total surface area of cortical bone was calculated(Ct.Th(<0.5), Ct.Th(0.5-1.0), Ct.Th (>1.0), respectively). The cortical bone at the distal radius was further segmented into dorsal, palmar, radial, and ulnar sides, and the above-described parameters were measured in these regions. Integral analysis showed that Ct.vBMD and Ct.Th decreased and Ct.Po increased with age (R = -0.62, -0.55, and 0.54). Ct.Th (< 0.5) expanded with age (R = 0.49), with the rate of change between those aged 30-49years and those aged 50-69years being 106.7%. On regional analysis, the expansion of Ct.Th (< 0.5) with age was particularly marked on the dorsal and palmar side (R = 0.51 and 0.49), where the rate of change between those aged 30-49years and those aged 50-69years was the highest, at 196.1 and 149.6%. The method to identify areas of cortical bone thinning in the segmented regions of the dorsal, palmar, radial, and ulnar sides of the distal radius using HR-pQCT may offer a sensitive assessment of age-related deterioration of cortical bone.

86 Multiple dysostosis in Hurler’s disease: a report of three cases

IntroductionHurler syndrome is the most severe form of mucopolysaccharidosis type I (MPS I), It is a hereditary, metabolic disorder due to an enzymatic deficiency in alpha-Liduronidase with tissue accumulation of glycosaminoglycans (GAGs) leading gradually to chronic multiple visceral dysfunction.We report three cases of multiple dysostosis in Hurler's disease.Case 1:Mr S.O, 26 years old man, presenting a dysmorphic syndrome associating short stature, facial dysmorphism, dental staining, gingival retractions, recurrent bronchial infections, mitral valve disease and joint deformities with a tunnel syndrome. Alpha L iduronidase dosage was performed confirming the diagnosis of Hurler's disease. The radiological assessment showed thickening of the cranial vault with poorly developed paranasal sinuses. Vertebral bodies collapse with oval shape, thoracolumbar kyphosis, hypoplasia of the iliac bones and the superior acetabular region, coxa-valga, with dysplastic femoral heads; cortical thinning of the long bones with a tapered appearance of the distal portions of the radius and ulna, small and deformed carpal bones, thin metacarpal bones, and dysplastic interphalangeal joints.Case 2:Patient B.M 17 years old girl, born of a consanguineous marriage, presenting with a malformation syndrome with short stature, facial dysmorphism, umbilical hernia, valvular heart disease, hepatomegaly, joint stiffness and deformity. Standard x-rays revealed macrocephaly with thickening of the cranial vault, flattened mandibular condyles, with hypertrophy of the clinoid processes; pectus excavatum, platyspondyly with thoracolumbar kyphoscoliosis, small and narrowed pelvis, enlarged and obliquus cotyles, coxa-valga with dysplastic femoral heads; long curved bones with metaphyseal and diaphyseal enlargement, short and enlarged proximal and intermediate phalanx and hypoplastic distal phalanx.Case 3:Patient D.W, 31-year-old female, born of a consanguineous marriage. The patient’s physical examination shows a dysmorphic syndrome with short stature, facial dysmorphism, corneal opacity, recurrent otorhinolaryngological and bronchial infections, joint deformities with carpal tunnel syndrome. An alpha L iduronidase assay was performed confirming the diagnosis. The radiological assessment revealed macrocephaly, thickening of the cranial vault, an elongated J-shaped sella turcica, a short thorax, short and thick clavicles, widened, oar-shaped ribs tapering at their vertebral insertion, “spur” vertebrae, thoracolumbar kyphoscoliosis, narrowed pelvis with coxa-valga and genu valgum, small and deformed carpal and tarsal bones with cortical thinning of long bones.DiscussionThe term dysostosis multiplex is used to describe skeletal abnormalities seen in MPS I that are often early and prominent. The progressive accumulation of GAGs led to an increase in chondrocyte apoptosis favoring the production of pro-inflammatory cytokines (TNFα, IL-1), chemokines and metalloproteases. This results in a degradation of the cartilaginous matrix, increased by the mechanical stresses, the disturbance of endochondral ossification, particularly in the sites subjected to articular mechanical stresses. That could explain the focal defect of the ossification of certain cartilaginous sites leading to this multiple dysplasia. At the axial level, the vertebrae can be oval shaped and flattened (platyspondyly). In the lower limbs, coxo-femoral abnormalities (coxa valga, splayed or flattened acetabulum), epiphyseal alterations, genu valgum, and hypoplasia of the iliac bones can be found. The metacarpal bones take on a tapered appearance like sucked candy cane and the interphalangeal joints of the hands and feet are dysplastic. Hypoplasia of the odontoid process leads to potentially serious cervical instability. Regular monitoring by MRI is necessary to avoid the risk of spinal cord section. The early introduction of enzyme replacement therapy led to a slower progression of symptoms, with improved growth, joint mobility and physical capacity, and stability over time, especially when associated with an appropriate rehabilitation care.ConclusionEven if Hurler syndrome is rare, it is still underdiagnosed, it can give various and varied clinico-radiographic features and potentially severe disabilities. Early diagnosis is essential since enzyme replacement therapy could stop or slow down the evolution to irreversible tissue damage.

29 Juvenile idiopathic arthritis and osteogenesis imperfecta: an exceptional association

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. Osteogenesis imperfecta (OI) is an autosomal dominant inherited disease defined by bone fragility due to abnormal collagen synthesis. It affects the entire skeleton, predisposing the patient to fractures.We report an uncommon association between osteogenesis imperfecta and juvenile idiopathic arthritis.Case presentationA 15-year-old child presented to our rheumatology department with medical history of recurrent bone fractures due to low-energy trauma since the age of five years. The patient was born from a consanguineous marriage. He has been diagnosed with a polyarticular JIA since the age of eight years-old. The initial clinical presentation was a symmetric, cumulative, large and small joint polyarthritis. The rheumatoid factor was negative. No other autoantibodies were detected.The patient was treated initially with methotrexate which was inefficient. He developed joint deformities. Then, biologic therapy was associated with a good response.Clinical examination on entry showed severe joint deformities touching elbows, wrists and interphalangeal joints. Arms and thighs were curved and an unequal leg length was noted. There was no arthritis. The patient has bluish sclera. Neurological and dental examination was normal. There was no hearing loss. Laboratory findings showed a normal C-reactive protein. Calcium and phosphate serum levels were within normal ranges. On radiological investigations, radiographs showed excessive trabecular bone transparency, cortical bone thinning and incomplete bone fractures. Bone densitometry revealed a Z-score of the lumbar spine of -4.2 SD.According to clinical, biological, and radiological investigations, the diagnosis of JIA associated with OI was confirmed clinically. Treatment with Pamidronate was initiated intravenously.ConclusionWe reported an exceptional association between JIA and OI which occurred in a young Tunisian patient. We emphasize that this association should be considered when severe joints and extremities deformities occur.Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this abstract.Acknowledgements: declared none.

Synovial Sarcoma Arising in the Retromolar Trigone: A Rare Presentation

Synovial sarcoma is a rare malignant neoplasm of young adults with poor survival. These usually arise from large joints and articular tendons. We describe an unusual case of synovial sarcoma arising from the left retromolar trigone upon initial presentation. To the best of our knowledge, this case is the only patient with left retromolar trigone involvement recorded in the literature. A 33-year-old female presented to us with complaints of a lesion in the left retromolar trigone. An ulcerated lesion with irregular margins and a smooth base was noted at the left retromolar trigone. CT scan demonstrated a soft tissue mass predominantly involving the left buccal space measuring 5.0 × 4.2 × 2.8 cm superiorly extending into the left infratemporal region, closely abutting posterior lateral of the left maxillary sinus with gross bone thinning. Biopsy was taken from the temporal and infratemporal region, which was positive for synovial Sarcoma. She received 2 cycles of neoadjuvant chemotherapy AIM protocol followed by wide local excision, however, the margin status could not be ascertained. Subsequently, treatment with a total of 60 Gy adjuvant radiotherapy was given. Patient tolerated the treatment well and remained disease-free for 4.5 years. She then developed biopsy-proven recurrence at the primary site; her metastatic workup was negative. Unfortunately, the patient was lost to follow-up for 2 years and then presented with a very large lobulated mass in the left infratemporal fossa, now measuring 6.2 × 7.6 × 6.3 cm, encasing ramus of mandible, temporomandibular joint and muscle of mastication with intra-orbital extension. She received 2 cycles of chemotherapy with gemcitabine and docetaxel. However, she did not tolerate the chemotherapy well. Subsequently, she developed tumor bleeding and received palliative radiation for bleeding and pain control. Patient is now on the best supportive care, her general condition deteriorating rapidly with the passage of time. Synovial sarcoma of the retromolar trigone is a rare malignant tumor with a poor prognosis. As there is no standard treatment protocol for synovial sarcomas of the head and neck, optimal antineoplastic treatment remains unclear. Mainstay of treatment is surgical resection with high relapse rates. Radiation therapy, with or without chemotherapy, appears to improve survival.

How teeth moved and alveolar bone changed after mandibular incisor retraction with intrusion: A retrospective cephalometric and CBCT study

ABSTRACT Purpose To investigate the changes of mandibular incisors in position and alveolar bone thickness and height after retraction with intrusion in adults. Materials and Methods Cephalometric radiograph tracings were evaluated before and after retraction and divided into two groups: pure retraction (PR) and retraction with intrusion (RI). Distances of tooth movements and alveolar bone changes were recorded in cephalograms. Tooth movements in anteroposterior and vertical directions were measured at the incisal edge (IE) and root apex(AXE). Changes of labial bone thickness (LaBT), lingual bone thickness (LiBT) and bone height (BH) were assessed at crestal (S1), mid-root (S2), and apical (S3) levels from 86 Cephalograms (46PR/40RI) and 33 CBCT (17PR/16RI). T-tests were applied for cephalometric group (Ceph-M) and non-parametric tests for CBCT groups (CBCT-M). Results Retraction distances at IE were not different between PR and RI but significant intrusion was observed in RI. Amount of retraction and intrusion at AXE was greater in RI. In PR, LaBT was maintained at S1 and S2 in Ceph-M but only S2 in CBCT-M, whereas S3 exhibited significant bone gain. In RI, LaBT was maintained at S1 in Ceph-M but at S2 in CBCT-M, significant bone gain occurred at S2 and S3 in Ceph-M but at only S3 in CBCT-M. LiBT in both groups showed significant bone thinning at all three levels. LaBH and LiBH in both groups exhibited BH loss. RI showed significantly greater bone gain in LaBT at S3. Conclusions RI provided more lingual and apical movement at AXE with comparable labial and lingual bone response to PR with more apical labial bone gain in RI.

Craniofacial, dental, and molecular features of Pyle disease in a South African child

IntroductionPyle Disease (PD), or familial metaphyseal dysplasia [OMIM 265900], is a rare autosomal recessive condition leading to widened metaphyses of long bones and cortical bone thinning and genu valgum. We detail the oro-dental and molecular findings in a South African patient with PD.MethodsThe patient underwent clinical, radiographic and molecular examinations. An exfoliated tooth was analysed using scanning electron microscopy and was compared to a control tooth.ResultsThe patient presented with marked Erlenmeyer-flask deformity (EFD) of the long bones and several Wormian bones. His dental development was delayed by approximately three years. The permanent molars were mesotaurodontic. The bones, including the jaws and cervical vertebrae, showed osteoporotic changes. The lamina dura was absent, and the neck of the condyle lacked normal constrictions. Ionic component analysis of the primary incisors found an absence of magnesium. Sanger sequencing revealed a novel putative pathogenic variant in intron 5 of SFRP4 (c.855+4delAGTA) in a homozygous state.ConclusionThis study has reported for the first time the implication of a mutation in the SFRP4 gene in an African patient presenting with PD and highlights the need for dental practitioners to be made aware of the features and management implications of PD.

Surgical Bone Adhesives with Potential Maxillofacial Applications A Systematic Review

The reduction and stabilisation of fractured bone fragments have always been a challenging task for thesurgeon. A micro-platesystem for maxillofacial fracture treatment provides excellent results. However, plates and screws are difficult toadapt to the thin bone, and small fragments often lead to the weakening of bone causing secondary fractures. Surgical bone adhesives promise as a viable alternative for issues with micro-plates, but a lotremains desired for successful usefor clinical application. The present systematic review aims to identify the bone adhesive materials available at various stages in animal or human models in the last decade and enumerate their characteristics for potential use in non-load bearing maxillofacial fractures. PubMed electronic database searched using a combination of keywords to identify English language articles between January 2011 and December 2020 yielded a total of 1204 records, of which 15 were included for final review after applying PRISMA guidelines. Cyanoacrylate was the commonly used adhesive material followed by fibrin glue and calcium phosphate-based materials. Although encouraging, results with each material still lack human randomised control trials thus presenting inconclusive evidence. Studies on these lines are suggested along with the development of newer materials to overcome the shortcomings in the currently available systems.

Combined Regenerative and Mucogingival Treatment of Intraosseous Defects with Buccal Gingival Recession: A Case Series

&lt;p&gt;Abstract: Regenerative surgery is an effective treatment of intraosseous defects, however, subject with thin gingival tissue phenotype and bone dehiscence defect tends to have more post-surgery gingival recession. The gingival recession is considered as soft tissue loss, which may affect the result of periodontal regeneration. Therefore, this case series aimed to describe a periodontal regenerative surgery combined with subepithelial connective tissue graft (SCTG) in intraosseous defects associated with buccal gingival recession would make periodontal regeneration more predictable. Materials and Methods: The case series describes a surgical approach to improve regenerative parameters in deep intraosseous defects associated with buccal gingival recession. Teeth with buccal bone dehiscence or furcation involvement were included. The surgical technique consisted of an SCTG placed on the buccal dehiscence defect or furcation area to thicken the soft tissue wall, then treated with enamel matrix derivative and biomaterials as regenerative scaffolds inside the intraosseous component of the defect. Results: In all cases, there were buccal gingival margin thickness increased, significant clinical attachment level gain, bone level gain, reduced probing pocket depth, and partial root coverage at least one year after the surgery. The radiographs demonstrated increased bone density of the deep intraosseous defects associated with buccal gingival recession in both single root and furcation-involved teeth. Conclusion: The combination of regenerative treatment and SCTG in intraosseous defects associated with buccal gingival recession in a single root or furcation-involved molar supports the stability of the gingival profile and improves root coverage outcome as well as periodontal regeneration.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Novel management of sizeable calcaneal UBC with autograft and allograft amalgamation: a case report and review of literature

Calcaneal unicameral bone cyst (UBC) is uncommon benign tumor that can be managed either conservatively or with different surgical interventions described in the literature. However, surgical intervention is usually preferred when the lesion is an active UBC significant in size, as there is the risk of pathological fracture due to thin bone, especially in load-bearing bones like the calcaneus. We report a case of calcaneal UBC considerable in size managed by open curettage and graft reconstruction using a combination of autograft and allograft in a 30-year-old male at two-years follow-up. Level of Evidence IV; Therapeutic Studies; Case Report.

Rib cortical bone thickness variation in adults by age and sex.

Rib fractures are a common and serious outcome of blunt thoracic trauma and their likelihood is greater in older individuals. Osteoporotic bone loss is a well-documented aging phenomenon with sex-specific characteristics, but within rib bones, neither baseline maps of regional thickness nor the rates of bone thinning with age have been quantified across whole ribs. This study presents such data from 4014 ribs of 240 adult subjects aged 20-90. A validated cortical bone mapping technique was applied to clinical computed tomography scans to obtain local rib cortical bone thickness measurements over the surfaces of ribs 2 through 11. Regression models to age and sex gave rates of cortex thinning in local zones and aggregated across whole ribs. The statistical parametric mapping provided these relationships regionally as a function of rib surface location. All models showed significant reductions in bone thickness with age (p < 0.01). Average whole-rib thinning occurred at between 0.011 to 0.032 mm/decade (males) and 0.035 to 0.043 mm/decade (females), with sex and age accounting for up to 37% of population variability (R2 ). Rates of thinning differed regionally and by rib, with the highest bone loss of up to 0.074 mm/decade occurring in mid-rib cutaneous and superior regions of ribs 2-6. Rates were consistently higher in females than males (significantly so across whole ribs but not all local regions) and were more pronounced in cutaneous, superior, and inferior rib aspects (average 0.025 mm/decade difference in ribs 4-8) compared to pleural aspects which had the thickest cortices but saw only minor differences in thinning rates by sex (0.045 mm/decade for females and 0.040 mm/decade for males). Regional analysis showed male and female bone thickness differences that were not statistically significant at 20 years of age (p > 0.05 across practically all regions) but subsequent cortex thinning meant that substantial pleural and cutaneous regions were thinner (p < 0.05) in females than males by 55 years of age. The techniques and results from this study can be applied to assess rib bone content loss in clinical settings across wide populations. Additionally, average cortex thickness results can be mapped directly to finite element models of the thorax, and regression results are used to modify such models to represent the ribs of men and women across their full adult lifespan.

Inter-Slice Resolution Improvement Using Convolutional Neural Network with Orbital Bone Edge-Aware in Facial CT Images.

The 3D modeling of orbital bones in facial CT images is essential to provide a customized implant for reconstructions of orbit and related structures during surgery. However, 3D models of the orbital bone show an aliasing effect and disconnected thin bone in the inter-slice direction because the slice thickness is two to three times larger than the pixel spacing. To improve the inter-slice resolution of facial CT images, we propose a method based on a 2D convolutional neural network (CNN) that uses the spatial information on the sagittal and axial planes and the orbital bone edge-aware (OBE) loss. First, intermediate slices are generated on the sagittal plane. Second, the generated intermediate slices are transformed to an axial image, which is then compared with the original axial image. To generate intermediate slices with an accurate orbital bone structure, the OBE loss considering the orbital bone structure on the sagittal and axial planes is used. To improve the perceptual quality of the generated intermediate slices, the feature map difference loss is additionally used on the axial plane. In the experiment, the proposed method showed the best performance among bilinear and bicubic interpolations, 3D SRGAN, and a 2D CNN-based method. Experimental results confirmed that the proposed method can generate intermediate slices with clear edges of thin bones as well as cortical bones on both the sagittal and the axial plane.

TRABECULAR JUVENILE OSSIFYING FIBROMA OF THE MANDIBLE: A CASE REPORT

This report aims to describe an extensive fibro-osseous lesion in a 24-year-old woman with an enlargement in the left mandible. Computed tomography showed a large multiloculated hypodense area between teeth 36 and 42, with thinning and expansion of cortical bone. Under the clinical hypothesis of central giant cell lesion, preoperative exams and incisional biopsy were performed, which was conclusive for a fibro-osseous lesion. The lesion was resected, and the mandibular reconstruction was performed with a titanium plate. Histopathologic analysis of the excised specimen showed fusocellular proliferation with trabecular deposition of immature bone and osteoid, among numerous multinucleated giant cells. Additionally, cavities filled with red blood cells and supported by cellularized fibrous connective tissue were observed. The anatomopathologic conclusion of the surgical specimen was a benign fibro-osseous lesion, leading to the diagnosis of trabecular juvenile ossifying fibroma associated with aneurysmal bone cyst. The patient is in follow-up. This report aims to describe an extensive fibro-osseous lesion in a 24-year-old woman with an enlargement in the left mandible. Computed tomography showed a large multiloculated hypodense area between teeth 36 and 42, with thinning and expansion of cortical bone. Under the clinical hypothesis of central giant cell lesion, preoperative exams and incisional biopsy were performed, which was conclusive for a fibro-osseous lesion. The lesion was resected, and the mandibular reconstruction was performed with a titanium plate. Histopathologic analysis of the excised specimen showed fusocellular proliferation with trabecular deposition of immature bone and osteoid, among numerous multinucleated giant cells. Additionally, cavities filled with red blood cells and supported by cellularized fibrous connective tissue were observed. The anatomopathologic conclusion of the surgical specimen was a benign fibro-osseous lesion, leading to the diagnosis of trabecular juvenile ossifying fibroma associated with aneurysmal bone cyst. The patient is in follow-up.

SKELETAL FACIAL CHANGES IN PEOPLE WITH SICKLE CELL DISEASE: A CASE SERIES

Sickle cell disease corresponds to a group of genetic hemoglobinopathies that present as the main characteristic the presence of an altered hemoglobin, hemoglobin S, which is able to polymerize and bring several sequelae to the human organism, substantially in the osteo-articular system. The aim of this study is to report a series of 10 cases of computed tomography exams of the jaw of patients with sickle cell disease. Computed tomography scans showed several maxillary bone changes, such as osteopenia, the presence of hyperdense areas, accentuation of the bone trabeculate, maxillary protrusion, transverse maxillary enlargement, and thinning of the cortical bone. This study showed that computed tomography of the maxillary bones can be an excellent tool to diagnose bone anomalies in the facial bones of patients with SCD.

Evaluation of the surgical approach based on impacted position and direction of mesiodens

ObjectiveThis study aimed to reveal the relationship between the approach of extraction and the position of the mesiodens by systematic classification. MethodsThis retrospective study included patients with impacted mesiodens that required computed tomography for extraction. The direction, sagittal and axial position, eruption from the nasal floor, surrounding bone thickness, surgical approach, and anesthesia type for the impacted mesiodens were analyzed. Mesiodens were classified into three groups (V: vertical position, H: horizontal position, and D: direction), and each group was classified into three subgroups (V1, 2, 3; H1, 2, 3; D1, 2, 3). ResultsA total of 169 impacted mesiodens were included in this study. The palatal approach was the most common (151 teeth, 89.3%), followed by the labial approach (11 teeth, 6.5%) and nasal floor approach (6 teeth, 3.6%). The bone thickness from the mesiodens to the palatal surface were significantly shorter in palatal far region of nasopalatine duct (H3) than in palatal near region (H2) (P < 0.05). In vertical high position (V3), the percentage of the palatal approach in H3 (87.5%) was higher than that in H2 (71.4%). Additionally, 15 teeth erupting from the nasal floor wherein four were extracted by the nasal floor approach in H2 but only one tooth in H3. ConclusionsEven at higher positions, mesiodens located in the palatal far region tended to be extracted by the palatal approach because of the thin bone thickness.

Spatial quantitation of antibiotics in bone tissue compartments by laser-capture microdissection coupled with UHPLC-tandem mass spectrometry

Bones are the site of multiple diseases requiring chemotherapy, including cancer, arthritis, osteoporosis and infections. Yet limited methodologies are available to investigate the spatial distribution and quantitation of small molecule drugs in bone compartments, due to the difficulty of sectioning undecalcified bones and the interference of decalcification methods with spatially resolved drug quantitation. To measure drug concentrations in distinct anatomical bone regions, we have developed a workflow that enables spatial quantitation of thin undecalcified bone sections by laser-capture microdissection coupled to HPLC/tandem mass spectrometry, and spatial mapping on adjacent sections by mass spectrometry imaging. The adhesive film and staining methods were optimized to facilitate histology staining on the same sections used for mass spectrometry image acquisition, revealing drug accumulation in the underlying bone tissue architecture, for the first time. Absolute spatial concentrations of rifampicin, bedaquiline, doxycycline, vancomycin and several of their active metabolites are shown for both small rodent bones and larger rabbit bones that more closely resemble human bone density. Overlaid MALDI mass spectrometry images of drugs and histology staining enabled the generation of semi-quantitative data from regions of interest within anatomical bone compartments. These data correlated with absolute drug concentrations determined by HPLC–MS/MS in laser-capture microdissection samples. Collectively, these techniques enable semi- and fully quantitative drug distribution investigations within bone tissue compartments for the first time. Our workflow can be translated to image and quantify not only drugs but also biomarkers of disease to investigate drug penetration as well as mechanisms underlying bone disorders.Graphical abstract

Skull anatomy of the endangered Patagonian huemul deer(Hippocamelus bisulcus).

Studies of the normal skull anatomy of the Patagonian Huemul deer are scarce. Currently, the findings of bone lesions in the skull associated with metabolic imbalances are frequent in the literature. The objective of this study was to provide anatomical and morphometric data of the cranium and facies including a morphofunctional interpretation as a reference for clinical, ecomorphological and educational purposes. Five skulls were described, measured, scanned and digitally reconstructed. The presence of a caudal projection of the vomer bone, the absence of the facial tubercle and thin bones forming the cranial cavity were observed. Linear measurements allowed the skull to be classified as dolichocephalic, hyperlepten and ultra-dolichocranial. In conclusion, the Patagonian Huemul has a long head, an extremely long skull and a very narrow face. The thickness of the bones that made up the walls of the cranial cavity suggests chronic metabolic imbalances in response to mineral deficiency. The anatomical and morphometric data obtained in this study strongly emphasizes the relevance of considering the implementation of such management policies that aim at promoting an optimal nutritional context.

Total hip arthroplasty with femoral shortening osteotomy using polished cemented stem vs. modular cementless stem in patients with Crowe type IV developmental dysplasia of the hip.

There is still little information regarding the advantages of a using a polished tapered stem for Crowe Type IV developmental dysplasia of the hip (DDH). This study aimed to investigate the mid-term clinical and radiological outcomes of primary total hip arthroplasty (THA) with femoral shortening osteotomy using modular and polished tapered stems and to compare the results between the modular and polished tapered stems. This retrospective review included 32 patients (37 hips) with Crowe type IV DDH who underwent primary THA with femoral shortening osteotomy using a modular stem (cementless group, 14 hips) or a polished tapered stem (cement group, 23 hips) between 1996 and 2018. Clinical data and radiographic assessments were reviewed to analyze the differences between the two groups. The mean duration of patient follow-up of the cementless group (134.4months) was longer than that of the cement group (75.5months). There were no differences in clinical results, time of bone union, and survival rate between the two groups. However, the cementless group exhibited a higher ratio of intraoperative fracture and thinning of cortical bone including stress shielding, medullary changes, stem alignment changes, and osteolysis, compared to the cement group. The findings of this study suggest that THA with femoral shortening osteotomy using both cemented and modular stems can provide satisfactory results. However, considering the occurrence of intraoperative fracture and radiographic analysis in the current study, the cement stem may have an advantage for patients with bone fragility and deterioration in bone quality.