Current approach in the management of patients with foreign bodies in the maxillofacial region.

The aim of the present study was to describe and discuss the gamut of current diagnostic and therapeutic modalities regarding impacted foreign bodies in the head and neck region, addressing xeroradiography, magnetic resonance imaging, computed tomography, and ultrasonography as diagnostic aids and stressing the importance of a multidisciplinary team in the treatment of such injuries. Considerations are also offered on the different types and forms of presentation of foreign bodies that may be impacted in the maxillofacial region and specific treatment methods.

[Imaging of the painful cervical spine]. / Imagerie du rachis cervical douloureux.

Neck pain can occur in several circumstances: traumatic, spontaneous, associated or not with motion, with or without head or upper limb irradiations. Each case requires appropriate clinical examination and radiographs. CT and MRI can be used to obtain additional information. Myelography and arteriography are exceptionally used. Cervical discography and facet joint arthrography are used therapeutically. After a brief anatomical review, normal and pathological patterns will be reviewed using radiographs. Each circumstance is studied: traumatic, degenerative, inflammatory and tumoral. It is emphasized that discogenic cervico-brachial neuralgia usually has a favorable spontaneous outcome. A special chapter is dedicated to calcifying and ossifying diseases of the cervical spine. Cervico-occipital neuralgia is also discussed.

Femoral neck fracture--the cause of death of Emperor Charles IV.

We present the oldest documented case of femoral neck fracture of a particular person in the history of orthopaedic surgery. Examination of the skeleton of Charles IV, the King of Bohemia and Roman Emperor living in XIVth century has revealed a fracture of the left femoral neck. This fracture was most probably an indirect cause of his death as it resulted in pneumonia, the immediate cause of death. This fact has been confirmed by contemporary chronicles.

Periosteal new bone formation in a canine neuropathic model of osteoarthritis.

OBJECTIVE: To characterize, for the first time, periosteal new bone formation in a well-established canine model of accelerated osteoarthritis (OA) with features of neuropathic arthropathy. METHODS: Seven dogs underwent left L4-S1 dorsal root ganglionectomy (DRG), followed 3 weeks later by transection of the anterior cruciate ligament of the ipsilateral knee (ACLT). Eight weeks thereafter, a postmortem examination was performed to assess the severity of cartilage changes of OA and the formation of new bone on the distal femur and proximal tibia in the cruciate-deficient limb. RESULTS: As described previously, extensive full-thickness ulceration of the articular cartilage was present in the unstable knee of every dog. The femoral shaft immediately proximal to the condyles in the unstable limb was consistently wider (mean +/- SD diameter 22.4 +/- 2.2 mm) than that in the contralateral limb (19.9 +/- 1.3 mm; P = 0.01). Xeroradiography and histologic examination of the distal femur revealed extensive formation of woven bone on the periosteal surfaces of the medial, lateral, and anterior aspects of the femoral shaft in the OA limb of every dog. These bony changes were not seen in radiographs of dogs that underwent DRG with the cruciate ligament left intact (n = 8) or of neurologically intact dogs that underwent ACLT (n = 7) and were examined 24 weeks after surgery. CONCLUSION: Formation of new periosteal bone on the distal femur and tibia is a feature of this model of accelerated OA that is not seen in the conventional ACLT model of OA in the neurologically intact dog. This observation suggests that interruption of sensory input from the limb may affect the regulation of osteogenesis in the mechanically unstable joint.

Estenosis subglótica adquirida: experiencia en 80 casos: Hospital Niños "J. M. de los Ríos" / Adquire subglotic stenosis: experience in cases: Hospital of Niños \"J. M.\" of the Rios

La Estenosis Subglótica Adquirida es una entidad que afecta a tejidos blandos y estructuras cartilaginosas del espacio subglótico. Desde enero de 1987 hasta agosto de 1995, ingresaron al servicio de ORL del Hospital de Niños "J.M de Los Ríos" 80 pacientes con esta patología. El 87 por ciento (70) ameritaron traqueotomía y el 13 por ciento (10) no necesito tratamiento alguno. De los 70 pacientes traqueotomisados el 77 por ciento (60), se les realizó dilatación más infiltración de esteroides. al 10 por ciento (8), se les practicó laringotraqueoplastia, 2 pacientes fallecieron. El 75 por ciento (45) de los traqueotomisados fueron decanulados y dados de alta. El 25 por ciento (15) de los pacientes se mantienen en tratamiento. Fueron decanulados el 75 por ciento (6) de los 8 pacientes a los cuales se les realizó laringotraqueoplastia; y el 25 por ciento (2) no han podido ser decanulados por regresión de la estenosis.

Diagnostico por imagem: aplicações na terapêutica endodôntica / Image diagnosis: applications on endodontic therapy

O diagnóstico na clínica odontológica está embasado em grande parte nos exames complementares que coadjuvados ao exame clínico fornecem dados capazes de trazer o máximo de informações da área a ser estudada, sendo o exame radiográfico o procedimento para diagnóstico por imagem mais corriqueiramente utilizado. Através dos avanços tecnológicos capazes de fornecer imagens mais apuradas das estruturas dento-alveolares como os novos métodos de radiação ionizante, xerorradiografia, digitalização, manipulação das imagens, tomografia computadorizada, fica a Odontologia enquadrada nos chamados novos métodos de diagnóstico por imagem largamente utilizados na Medicina

Radiographic diagnosis of breast implant rupture: current status and comparison of techniques.

Rupture of a breast implant is a recognized complication of augmentation mammaplasty and reconstructive breast surgery. Due to concerns over the extravasation of silicone gel within adjacent tissue and distant body sites, considerable attention has been given to the radiographic detection of mammary implant rupture. A metaanalysis comparing the accuracy of various currently available imaging modalities was conducted and an algorithm suggested to guide clinicians in the detection of breast implant rupture. Advantages and limitations of mammography, xeromammography, ultrasonography, MRI, and CT are outlined as well as some of the most specific radiographic signs of each with illustrative examples from patients evaluated at our institution. Results of our retrospective analysis corroborated by a review of the most recent literature reveal that mammography supplemented with ultrasonography constitutes the most cost-effective initial study, followed by MRI if these are equivocal. MRI is the most sensitive and specific study to evaluate breast implant rupture.

Postoperative evaluation of the surgical treatment of accessory teat and gland cistern complexes in dairy cows.

The purpose of this study was the long-term evaluation of a method of surgically repairing the abnormal condition of accessory teat and gland cistern complexes in dairy cattle. A prospective evaluation of three cows that had undergone the procedure was done. These cows were evaluated from four months to one year, postoperatively. A thorough history, physical examination, contrast radiography, and ultrasonic examination were done on each cow. A retrospective evaluation of an additional 13 cows that had also undergone the procedure was obtained four months to three years following the surgery, via owner communication. The prospective portion of this study demonstrated patency of the communication between main and accessory teat cisterns. Postoperative complications included initial slow milking and mild swelling of the involved teat. These problems resolved in all cows one to two months postoperatively. None of the 16 cows that had undergone the surgery either developed or was treated for mastitis. Likewise, none of these cows was sold or slaughtered as a result of postoperative teat problems or unsatisfactory milk production. Our study demonstrated that this particular method of surgical correction of accessory teat and gland cistern complexes is effective, is esthetically acceptable, produces minimal associated complications, and preserves the milk production capacity of the gland.

[Value of hyomandibulopexia in the surgical treatment of snoring in patients with sleep apnea]. / Intérêt de la hyomandibulopexie dans le traitement chirurgical des ronfleurs apnéiques.

The authors report their experience with hyomandibulopexia for lingual repositioning in patients with the sleep apnea syndrome. The technique was used 12 times in 11 men and 1 woman and a maximum follow-up of 3.4 years. Hypomandibulopexia was performed as first intention therapy 7 times with or without uvulo-palato-pharyngoplasty. Video-fibroscopy of the pharynx and cephalic magnetic resonance imagery revealed retrobasilingual narrowing in all 7 of these cases. Hyomandibulopexia was performed 5 times for recurrent sleep apnoea syndrome after prior surgery. In two cases, pre-operative evaluation did not reveal any topographic abnormality. Polysomnography studies showed clear improvement with a decreased apneic index and desaturation values. A second fixation of the hyoid was success fully in one case. Hyomandibulopexia is a simple and reliable technique which is useful in patients with sleep apnea syndrome with good to excellent medium term results.

Comparação entre os métodos radiográfico e xerorradiográfico / Comparison between radiographic and xerorradiographic methods

O presente estudo em sua parte II, procurou fazer uma análise comparativa das imagens apresentadas pelos métodos radiográfico e xerorradiográfico, em diferentes técnicas radiográficas. Na obtenção das duas imagens, radiográfica e xerorradiográfica, os pacientes foram submetidos às incidências lateral, transfacial da articulação temporomandibular e transcranial da articulação temporomandibular, onde os fatores utilizados foram de acordo com o tipo físico de cada paciente. Os exames obtidos, pelos dois métodos, receberam parecer quanto a qualidade das imagens, por cinco profissionais radiologistas da área de saúde. A análise dos resultados mostrou que o método xerorradiográfico foi superior ao método radiográfico quanto a qualidade da imagem, mas foi necessário maior exposição aos raios X para a obtenção

Comparison of radiologic imaging techniques for diagnosis of fragmented medial coronoid process of the cubital joint in dogs.

Thirty cubital joints from 16 dogs suspected of having a fragmented medial coronoid process were examined. Four breeds accounted for 87.5% of the cases: German Shepherd Dog (25%), Labrador Retriever (25%), Rottweiler (18.75%), and Golden Retriever (18.75%). Seventy-five percent of the dogs were male. Mean age of affected dogs was 13.6 months. Plain-film radiography, xeroradiography, linear tomography, arthrography, and computed tomography were performed on each cubital joint prior to surgical exploration of the joint. Three reviewers evaluated each diagnostic study and independently determined whether a fragment from the medial coronoid process could be seen. The consensus opinion was compared with the finding at surgery. Abnormalities of the medial coronoid process were detected in 25 of 30 joints at surgery. Fragmented coronoid process was found in 17 of 30 joints, and wear lesions were observed in 8 of 30 joints. Computed tomography had the highest accuracy (86.7%), sensitivity (88.2%), and negative-predictive value (84.6%) of the 5 imaging modalities evaluated (P < 0.05). Specificity and positive-predictive value of all imaging techniques were high. There was no significant difference between the diagnostic ability of plain-film radiography, xeroradiography, or linear tomography of the cubital joint. The combination of plain-film radiography and linear tomography provided an improvement in accuracy, approaching that of computed tomography.

[Integrated diagnostic imaging in the study of tumors of the periskeletal soft tissues]. / Iter diagnostico integrato nello studio dei tumori dei tessuti molli perischeletrici.

Integrated diagnostic imaging is nowadays an extremely valuable tool in the study of periskeletal soft tissue tumors, relative to their diagnosis, prognosis and treatment. In the past, difficulties arose from the complex embryogenetic factors causing the tumors, from the different growth patterns and courses of the lesions themselves, and finally from poor development of technology specifically designed to study the soft tissues. Today, such new imaging methods as CT and MRI exhibit special features allowing the accurate study of the soft tissues and their conditions. The basic method to investigate the relationship of soft tissues to skeleton is still conventional radiology--or xeroradiography--with the soft-ray technique. However, its limitations are well known. US, with the appropriate probes and the correct technique, with comparative and dynamic studies, yields precise information, especially relative to benign tumors. CT allows not only lesion but also tumor staging, together with the study of adjacent structures; moreover, CT angiography provides accurate information as to tumor vascularization. The role of MRI, though still debated, looks extremely promising. Finally, as for angiography, the method has been replaced by newer technologies and thus limited to preoperative vascular mapping.

Skeletal histopathology in fetuses with chondroectodermal dysplasia (Ellis-van Creveld syndrome).

Chondroectodermal dysplasia (CED) is an uncommon autosomal recessive disorder and one of the short rib polydactyly syndromes (SRPS). It is characterized by acromelic and mesomelic shortness of limbs, postaxial polydactyly, small chest, ectodermal dysplasia, and in many cases, congenital heart defects. Controversy exists over possible changes in the growth plate. With the advent of ultrasonographic examination, increasing numbers of fetuses with osteochondrodysplasias are examined by pathologists. Since histopathologic examination of the skeletal system is useful in defining various osteochondrodysplasias and it has not been described in the fetus with CED, we herein describe 3 cases of fetal CED with emphasis on skeletal histopathology. All 3 pregnancies were terminated at 22-23 weeks because of ultrasonographic demonstration of short limbs and growth retardation. Radiologically, each fetus had acromelic and mesomelic shortness of long bones with smooth round metaphyses, vertically short iliac bones, short ribs and normal vertebrae. These findings are similar to those described in the larger newborn infant with CED. Histopathologically, the cartilage of the long bones showed chondrocytic disorganization in the physeal growth zone. The findings are dissimilar to those of larger infants and older children in whom chondrocytic columnization has been seen in the central physis and disorganization in peripheral physis. Furthermore, a variable degree of chondrocytic disorganization was also seen in the central physeal growth zone of vertebrae in these fetuses. Other findings noted at fetopsy were: polydactyly in all 3 cases, congenital heart defect in 2 and an abnormal frenulum in one case. The foregoing phenotypic and radiographic manifestations and skeletal histopathology help separate CED from other SRPS.

Circumscribed myositis ossificans. Report of nine cases without history of injury.

The clinical features of 9 patients with circumscribed myositis ossificans (CMO) are described and the effects of treatment with surgical removal of ectopic bone are assessed. The average age of these patients was 24.4 years, and the average follow-up period was 7.4 years. Early correct diagnosis remains unusual, mainly because myositis may be mistaken for bruising, sarcoma or mumps. Once histological diagnosis was established in biopsy, surgical resection of the mass was found in these series. Although spontaneous recurrence was found in this series. Although spontaneous regression of the clinical findings has been reported, we consider surgery to be necessary in CMO in order to establish the diagnosis; furthermore, when the clinical and radiological diagnosis is uncertain or when the lesion causes pain or mechanical blocking of a joint, the removal of the mass is mandatory.

[Chronic atrophic polychondritis. Clinical polymorphism and severity of respiratory lesions]. / Polychondrite chronique atrophiante. Polymorphisme clinique et gravité des localisations respiratoires.

The authors report the case of chronic destructive polychondritis (PCA) with extensive and predominant laryngo-tracheal involvement. The respiratory localisation of PCA is apparent in around 50% of cases. In a quarter of patients presenting with this type of localisation, the outcome is fatal. Tracheal disorders as the presenting feature is a rarity, as in the majority of cases it occurs either concomitantly or after the appearance of classic cartilagenous disease in the nose or ear. The diagnosis of the airways disease rests on the interpretation of the flow volume curve and the CT scan of the inspiration and expiration. Taking account of the absence of any correlation between the disturbed respiratory function and the laryngotracheal bronchial lesions, the authors stress the value of an endoscopic assessment with a fibroscope of reduced calibre. The narrowing of the laryngo-tracheal region is due to a thickening of the walls with oedema and inflammatory granulomas, and to collapse of the lumen caused by the destruction of cartilage and by fibrous scarring of the tracheal walls. Either general or local treatment is virtually non-existent and the prognosis of these extensive respiratory forms of the disease is very poor.

Laryngotracheal resection and reconstruction for postintubation subglottic stenosis. Lessons learned.

Between 1981 and June 1992, 26 consecutive patients with a postintubation subglottic stenosis (21 circumferential, 2 anterolateral) underwent the Pearson operation. Subglottic stenosis resulted from a complication of mechanical ventilation with endotracheal intubation with (n = 14) or without (n = 12) tracheostomy (median placement: 25 days). One patient had an associated laryngopharyngeal and tracheoesophageal fistula. Overall, the upper limit of the stenoses lay 1.8 +/- 0.3 cm below the vocal cords, falling in the range of 1 to 2 cm in 88% of patients; they measured 2.9 +/- 0.8 cm in length and the diameter at the level of the maximum stenotic process was 0.5 +/- 0.1 cm. Operations were performed without dissection of the recurrent nerves and plicature of the membranous trachea. Because of scarred mucosa at a higher level, one vertical section of the posterior cricoid plate with interposition of autogenous costal cartilage and 2 subtotal cricoid plate resections with stenting were necessary. The mean length of resection was 3.6 +/- 0.8 cm (range: 2-5 cm) and 88% of them ranged within 2.8 and 5 cm. Twelve thyrohyoid and 3 supralaryngeal releases were performed. Six patients required postoperative tracheostomy, but all were extubated within 24 h. Good results were obtained in 24 (96%) surviving patients; 1 failure and 1 postoperative death (sudden myocardial infarction) occurred. The results confirm that the Pearson operation is an adequate treatment for subglottic stenosis extending up to 1 cm below the vocal cords and measuring up to 6 cm in length. Dissection of both the recurrent nerves, plicature of the membranous trachea, postoperative decompressive tracheostomy and stenting are not necessary.

Problem neck, hyoid bone, and submental myotomy.

Despite significant attention to the cervical region over the last two decades, the hyoid bone has not received deserved recognition. In this report, the anatomy and role of the hyoid bone and suprahyoid muscles in cervicomental morphology are reviewed. From an analysis of cephaloxerograms on 54 patients, it was concluded that on a balanced neck, the most caudal border of the hyoid body is located at or above a line parallel to the Frankfort horizontal line passing through the most caudal border of the mandibular symphysis (menton). Of the muscles that control the position of the hyoid bone, the anterior belly of the diagastric, geniohyoid, and mylohyoid muscles pull the hyoid bone cephalad and anteriorly. The stylohyoid muscles, on the other hand, pull this bone cephalad and posteriorly, while the sternohyoid and omohyoid muscles pull it caudally. Transection of the first three muscles at their attachment to the posterior aspect of the mandible in patients with dysmorphic necks due to caudal and anterior hyoid position will allow posterior and cephalad relocation of this bone, which improves the neck contour. Sixteen patients, with an average follow-up of 27 months, have undergone this procedure, with cervicomental contour improvement in all cases. The degree of improvement ranged from 1 to 5 (5 being excellent): One patient was ranked 1, two patients were ranked 2, two patients were ranked 3, and the rest were ranked 4 or 5. One patient had overcorrection as a result of an aggressive concomitant submental lipectomy. Another patient had central depression in the submental area. None of the patients had difficulties with mandibular movement or swallowing.