A radiological and anatomic examination of intralaminar screws in the thoracic spine-a theoretical feasibility study.

BACKGROUND: Failure of pedicle screws and anatomical variations which prevent pedicle screw implantation make the search for an alternative to pedicle screws in thoracic spine surgery necessary. To date, published data have shown that intralaminar screws could be a possible way of fixation. Object of this study is a systematic examination of the feasibility of lamina screws in the whole thoracic spine. METHODS: Fifty females and 50 males (age 20 to 60 years) who underwent a polytrauma CT from 2010 to 2012 were randomly selected. Patients with injury of the thoracic spine, trauma-independent deformity, or dysplasia of the thoracic spine were excluded. A three-dimensional reconstruction of the thoracic spine was performed from the data set. The anatomical data of the lamina were measured under consideration of the potential trajectory of a laminar screw. The caliber of the corresponding pedicle was measured as well. RESULTS: The diameters of the lamina show a decline in superior-inferior direction (0.66 cm in T1 to 0.60 cm in T12 in males, 0.62 to 0.56 cm in females). Diameters of pedicle and lamina show no correlation. Twenty percent of the pedicles have a hypoplasia with a diameter of less than 0.5 cm. However, in these vertebrae, 62.3% of the laminae would be suitable for 0.4-cm lamina screws. Only in 2.75% of the vertebral bodies, there was no possibility for intralaminar or pedicle screws. CONCLUSIONS: This study shows that it is possible to use intralaminar screws in the thoracic spine in most of patients.

Functional anatomy of the nose.

The human nose is a very complex entity with a great amount of variation among and within different human populations. Even though the morphology of the nasal pyramid and its soft tissue coverage is principally known, a standardized nomenclature does not yet exist. The past two decades have witnessed a considerable increase of new studies on the functional morphology of the external nasal anatomy. Detailed anatomic and clinical knowledge about the external nose is a prerequisite for successful rhinosurgery, thus this report deals with the basic structures necessary for functional and aesthetic rhinoplasty.

Cartilaginous septum deviation in children with cleft lip, alveolus and palate--an MRI analysis.

INTRODUCTION: This study aimed to investigate by MRI examination the degree of deviation of the cartilaginous septum in relation to cleft size in patients with cleft lip, alveolus and palate. MATERIAL AND METHODS: Six children with cleft lip, alveolus and palate at age 5-20 days were examined with a 1.0 Tesla scanner using a head coil. The following parameters were evaluated: maximal cleft size (millimeter) and degree of the nasal septum deviation from the median-sagittal plane (degrees). RESULTS: Two children with bilateral clefts had no deviation; 3 children with unilateral (left-sided) cleft had a deviation to the right and 1 patient with a unilateral right-sided cleft a deviation to the left side. In all 4 patients, the degree of the nasal septum deviation increased with cleft size. CONCLUSION: Cartilaginous nasal septum deviation was noticed only in patients with unilateral cleft lip and palate toward the non-cleft side and was greater with increasing cleft sizes.

Maxillary sinus pneumatization of an adult skull with an untreated bilateral cleft palate.

INTRODUCTION: Patients with clefts of lip, alveolus and palate show a high incidence of maxillary sinusitis. In order to evaluate sinus size as a factor in sinusitis, this study investigates maxillary sinus morphology in an adult skull with an untreated bilateral cleft. MATERIAL AND METHODS: The maxillary sinus volume (MSV) of a mixed-sex sample of 140 adult skulls from three different populations was assessed and compared with the MSV of a skull of a 25 year old man showing an untreated complete bilateral cleft. A least squares regression analysis was used to investigate the relationship between MSV and different external cranial dimensions. RESULTS: The cleft skull shows a well-developed set of paranasal sinuses. There are close, significant relationships between MSV and the cranial measurements. The cleft skull had a MSV that does not deviate substantially from that predicted from the size of its facial skeleton. CONCLUSION: This study indicates a close link between the size of the facial skeleton and the MSV in humans, even in case of an untreated bilateral cleft. This, in conjunction with the existing literature, makes it extremely unlikely that the sizes of the paranasal sinuses are a factor for sinusitis in patients with cleft lip, alveolus and palate.