Correlation between Tomography Scan Findings and Clinical Presentation and Treatment Outcomes in Patients with Orbital Floor Fractures.

Background: Orbital floor fractures involve damage to the orbital floor but not the infraorbital margin. Despite intensive research, they remain a controversial topic. The aim of this study was to investigate the relationship between parameters gathered by means of computed tomography (CT), the clinical presentation, and treatment outcomes, in patients suffering from orbital floor fractures. Methods: Forty patients with orbital floor fractures were included in this study. Information regarding diplopia, impaired ocular mobility, asymmetric eyeball placement, and infraorbital paresis was gathered from the medical records. Nine CT-based parameters were assessed. Two parameters were calculated, based on them. The follow-up data of 30 patients were analyzed. The results were statistically evaluated. The significance level was p < 0.05. Results: Statistical evaluation revealed multiple correlations between CT-based findings, symptoms, and treatment results. Among others, the hernia into the maxillary sinus was significantly larger in patients without improvement in infraorbital paresis (p = 0.0031) and without improvement in assymetric eyeball placement (p = 0.0037). There was no correlation between the entrapment of the rectus inferior muscle and impaired ocular mobility (p = 0.664431; p = 0.420289) and between the direct fracture of the infraorbital canal and infraorbital paresis (p = 0.371102). Conclusions: The widely assumed thesis that impaired ocular mobility in orbital fractures is caused by entrapment of the rectus inferior muscle is disproved by CT-based data. CT-based findings, symptoms, and treatment results in patients with orbital floor fractures were significantly correlated. A large hernia may be a negative prognostic factor.

Large intradiploic arachnoid cyst of the skull in child-a case report and new terminology proposition.

We present a rare finding of the arachnoid matter invaginating into the base of middle cranial fossa and creating an abnormal space. Presented entity was incidentally found in head CT scan of 12-year-old male. Based on the radiological characteristics in CT scans and MR images, the diagnosis of intradiploic arachnoid cyst (AC) was suggested. After surgical intervention and histopathological analysis of the specimen, the diagnosis was confirmed. We assume this is the first description of large intrasphenoid AC without any traumatic or iatrogenic cause. The literature provides many different terms for the phenomenon. We are proposing the term intradiploic arachnoid diverticulum as the more accurate for capturing the essence of the phenomenon. It provides clear differentiation of the entities from classical arachnoid cysts since they are of different anatomical localization (intradural vs. extradural) and etiopathogenesis. Management with arachnoid diverticulum is not yet established, but observation with serial imaging studies should be recommended as primary management in case of asymptomatic cyst. When cyst is symptomatic, surgical treatment may be required.

State of the Art in Temporomandibular Joint Arthrocentesis-A Systematic Review.

Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject.

RAGE and HMGB1 Expression in Orbital Tissue Microenvironment in Graves' Ophthalmopathy.

Graves' ophthalmopathy (GO) is a chronic autoimmune inflammatory disorder involving orbital tissues. A receptor for advanced glycation end products (RAGE) and its ligand high mobility group box 1 (HMGB1) protein trigger inflammation and cell proliferation and are involved in the pathogenesis of various chronic inflammatory diseases. This study was aimed to evaluate RAGE and HMGB1 expression in GO to determine its potential clinical significance. To the best of our knowledge, this is the first study showing RAGE and HMGB1 expression in orbital tissue using immunohistochemistry. Sections of orbital adipose tissue obtained from patients diagnosed with GO (23 patients; 36 orbits) and normal controls (NC) (15 patients; 15 orbits) were analyzed by immunohistochemistry for RAGE and HMGB1 expression. Expression profiles were then correlated with clinical data of the study group. RAGE and HMGB1 expression were elevated in GO patients in comparison with NC (p = 0.001 and p = 0.02, respectively). We observed a correlation between RAGE expression and occurrence of dysthyroid optic neuropathy (DON) (p = 0.05) and levels of TSH Receptor Antibodies (TRAb) (p = 0.01). Overexpression of RAGE and HMGB1 might be associated with GO pathogenesis. In addition, RAGE and HMGB1 proteins may be considered as promising therapeutic targets, but this requires further research.

Primary cutaneous anaplastic large-cell lymphoma: A case report.

RATIONALE: Primary cutaneous anaplastic large-cell lymphoma (C-ALCL) is a rare cancer belonging to the group of primary T-cell lymphoproliferative diseases. C-ALCL is characterized by the presence of single or multiple ulcerated lesions on the skin's surface. PATIENT CONCERNS: This is the case of a 73-year-old man who reported to the Clinic of Cranio-Maxillofacial and Oral Surgery and Implantology, Medical University of Warsaw, owing to a skin tumor in the right parotideomasseteric region, initially diagnosed as discoid lupus erythematosus. During treatment for discoid lupus erythematosus, biopsy was repeated because of significant disease progression and dynamic tumor growth. Histopathological examination revealed the presence of pilomatrix carcinoma (trichilemmal carcinoma). Because of the discrepancy between clinical and histopathological findings, the tumor specimen was submitted to another facility, wherein lymphoma infiltration by anaplastic large cells was found in the dermis and subcutaneous tissue. DIAGNOSIS: C-ALCL. INTERVENTIONS: The patient was transferred to the Lymphoid Tumours Clinic of the Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, where chemotherapy was initiated. OUTCOMES: After 4 cycles of chemotherapy, a complete remission of skin lesions was achieved. During the 5-year follow-up, no recurrence occurred. LESSONS: C-ALCL is a rare type of cancer. Misdiagnosis can lead to inappropriate therapy and result in disease progression or unnecessary harm to the patient.

Relapsing polychondritis in a liver transplant recipient: A case report.

RATIONALE: Relapsing polychondritis (RP) is a multisystemic, progressive disease of unknown etiology characterized by recurrent inflammation and progressive cartilage destruction. It can involve all types of cartilage including ears and nose, tracheobronchial tree, joints, and any other tissue rich in proteoglycans such as heart, eyes, and blood vessels. Recurrent chondritis can be life-threatening if the respiratory tract, heart valves, or blood vessels are affected. To date there is no data in the literature on the post solid organ transplantation RP. PATIENT CONCERNS: We present a 59-year-old male liver transplant recipient with primary sclerosing cholangitis who developed RP of the earlobes and nose despite post-transplant immunosuppression. DIAGNOSES: Based on the clinical criteria, scintigraphy and biopsy from the left auricle his condition was diagnosed as RP. INTERVENTIONS: Pulses of methylprednisolone followed by high-dose oral steroids along with azathioprine were administered. OUTCOMES: Such therapy diminished local cartilage inflammation, improved patient's general condition and the laboratory results. Significant loss of ear cartilage and characteristic "saddlenose" were observed after remission of acute symptoms. The control scintigraphy proved very good treatment response. LESSONS: To the best of our knowledge this is the first report on the RP in liver transplant recipient. Based on our patient presentation, we suggest that RP should be suspected in any transplant recipient with cartilage inflammation, and that the Michet's clinical criteria and scintigraphy seem to be the best diagnostic tools for solid organ transplant recipients suspected of RP.

Three-layered osteodural plasty for severe anterior skull base and facial injuries. Report of eleven cases.

BACKGROUND AND PURPOSE: The upper cranial trauma of high force and wide area of application leads to fractures of calvaria, the skull base, and the viscerocranium. The aim of the study was to present eleven patients treated for severe anterior skull base and facial defects by means of three-layered osteodural plasty. MATERIALS AND METHODS: The operative tactics consisted of bicoronal incision, bifrontal craniotomy, closure of the dura mater damage with a pericranium, reconstruction of bone defects with autologous bone grafts and plasty with anteriorly pedicled pericranial flap on the supratrochlear and supraorbital vessels. RESULTS: During follow-up, which lasted 2-7 years, none of the patients developed any early or late postoperative complications. CONCLUSIONS: The three-layer osteodural plasty of severe anterior skull base injuries with the use of autologous bone grafts for the reconstruction of craniofacial skeleton resulted in a good final functional, morphological and aesthetic outcome in all patients.

Finite element method for analysis of stresses arising in the skull after external loading in cranio-orbital fractures.

BACKGROUND AND PURPOSE: The craniofacial skeleton remains not fully recognised as far as its mechanical resistance properties are concerned. Heretofore, the only available information on the mechanism of cranial bone fractures came from clinical observations, since the clinical evaluation in a living individual is practically impossible. It seems crucial to implement computer methods of virtual research into clinical practice. Such methods, which have long been used in the technical sciences, may either confirm or disprove previous observations. The aim of the study was to identify the areas of stress concentrations caused by external loads, which can lead to cranio-orbital fractures (COF), by the finite element method (FEM). MATERIAL AND METHODS: For numerical analysis, a three-dimensional commercially available geometrical model of the skull was used which was imported into software of FEM. Computations were performed with ANSYS 12.1 Static Structural module. The loads were applied laterally to the frontal squama, the zygomatic process and partly to the upper orbital rim to locate dangerous concentration of stresses potentially resulting in COF. RESULTS: Changes in the area of force application revealed differences in values, quality and the extent of the stress distribution. Depending on the area of force application the following parameters would change: the value and area of stresses characteristic of COF. CONCLUSION: The distribution of stresses obtained in this study allowed definition of both the locations most vulnerable to fracture and sites from which fractures may originate or propagate.

Salivary gland calculi - contemporary methods of imaging.

Sialolithiasis is the most common disorder of major salivary glands. The main site of salivary stones' formation is submandibular gland, followed by parotid and sublingual gland. The aim of this article was to present current diagnostic imaging modalities carried out in patients suspected with salivary stones on the basis of own material and review of literature.Current diagnostic imaging tools used in the imaging of salivary stones were described and illustrated in this paper. These are: conventional radiography, sialography, ultrasonography, computed tomography, magnetic resonance sialography and sialoendoscopy.Digital subtraction sialography and ultrasonography are the methods of choice in the imaging of salivary gland calculi. Although sialography is a very old diagnostic method, still it is the best diagnostic tool in the imaging of subtle anatomy of salivary gland duct system. Digital subtraction sialography can show the exact location of salivary stone and enables imaging of salivary ducts' pathology (e.g. stenoses), which is especially important when sialoendoscopy is planned. Sialography is also used as the treatment method, i.e. interventional sialography. Nonenhanced computed tomography is recommended when multiple and tiny salivary stones are suspected. Magnetic resonance imaging is the evolving alternative diagnostic method. In this diagnostic modality there is no need for salivary ducts' cannulation and administration of contrast material. Thus magnetic resonance sialography can also be carried out in the acute sialoadenitis. In the future, sialoendoscopy may become one of the main diagnostic and treatment procedures for salivary duct disorders, especially in salivary stone cases.

Treatment of osteomas located between the anterior cranial base and the face.

OBJECTIVE: Osteomas located on the border between the anterior cranial base and the facial region are benign, often asymptomatic and usually slow growing. They may cause different complications depending on the part of the central nervous or visual systems which they affect. MATERIAL AND METHODS: Between 1997 and 2002, four patients were treated at the 1st Department of Maxillofacial Surgery of the Medical University of Warsaw for osteomas located at the border of the anterior cranial base. In all patients a radical surgical removal of the tumour was performed via bifrontal craniotomy, with an extradural approach to the anterior cranial fossa. The resulting defects were repaired with autologous bone grafts. RESULTS: The post-operative results were good regarding morphological, functional and aesthetic outcome. Two of the four patients are described to illustrate the surgical treatment.