TRANSECTION OF INFERIOR ALVEOLAR NERVE IN THE RAT - NEUROANATOMICAL STUDY AND EXPERIMENTAL MODEL.

OBJECTIVE: Experimental lesions in the inferior alveolar nerve (IAN) are used for the study of peripheral and central alterations. The objective of our study was to contribute to a more precise description of the approach to the IAN and creating a lesion. MATERIAL AND METHODS: Twenty-six males of Wistar laboratory rats were used for the study. The animals were divided into three groups: control group (6 rats), experimental group (12 rats - a part of the bone above the mandibular canal was removed under general anaesthesia using extraoral approach, after exposing a part of the IAN, the nerve was excised in a length of 3 mm), and a sham group (8 rats - the nerve was only dissected but not transected). Persisting denervation was verified using surgical revision and histological and immunohistochemical analysis after the observation period (4 weeks). RESULTS: No evidence of re-innervation after 4 weeks. We found no statistically significant differences in mean weight gains between individual groups during the observation period. CONCLUSION: The described technique used in the study is one of the possible ways to create a nerve lesion at the site of the main trunk of the nerve. At the same time, the study provides a more precise description of the anatomical situation and approach to the IAN in the mandibular canal.

Multielemental Chemical Analysis of Elements in Mandibular Bone and Teeth in the Rat.

The purpose of the study was to test the hypothesis of different distribution spaces of elements in the rat mandibular bone and teeth. We used six adult males of Wistar laboratory rats for the study. After killing the animals, we extracted the molars and removed incisor crowns. The mandibular bone was divided into four parts (mesial-central-distal-ridge). Inductively coupled plasma mass spectrometry was used to determine the presence of 41 elements in the bone and tooth. Evidence of 14 elements was found in all samples (incisors-molarsbone). Generally, significant differences between the left and right side were found for K and Rb in the bone locations. As regards statistically significant differences in incisors-molars-bone locations, the elements for which these differences were found for all comparisons are listed as incisors versus individual molars, incisors versus bone locations, and individual molars versus bone locations: a) incisors-molars: Ba, Mn, Mo, Sr, Zn, K, Mg and Rb; b) incisors-bone: Fe, K, Mg, Mn, Na, Zn and Ba; c) molars-bone: Mn, Mo, Na and Mg. Statistically significant differences were also found between molars for Fe, Mg, Mn, and Sr and between bone locations for Ba, Ca, Mn, Sr, K, Rb, Zn, Mo, Mg, and Na. The elements Cu, Ni and Co were without pronounced differences. Twenty-seven elements were below the detection limit. Our results indicate different distributions of some elements in the rat mandibular incisors-molars-bone. We assume that the knowledge of chemical element contents in the laboratory rat bone and teeth will prove useful in experimental research of both these hard tissues.

Multielemental Chemical Analysis of Elements in Mandibular Bone and Teeth in the Rat.

The original article was published in Folia Biologica (Praha) Volume 64, No. 3 (2018), 84-96.

Children's cranial lesions from Neolithic.

In skeletal material from the neolithic settlement at Makotrasy, county Kladno, were analysed two children's craniums (identification numbers Ao 8218 and Ao 4184) with pathological cases. Case 1 (Object 127, Ao 8218) is the individual about 4 to 5 years old. There is oval aperture with the diameter 25 x 20 mm in the area of anthropometrical point bregma, with vertical, multiple knurled edges. Bevelled and rounded segment in the left frontal part of the aperture with diameter 10 mm is imitating healing process. We suggest this case is the trephination with the marks of the healing process in the period of 1 to 2 weeks after the surgery took over. Case 2 (Pit 25, Ao 4184) is child with age determined about 4 years old. Cranium was found buried separately. There is oval defect located at os occipitale and os parietale sin and goes through sutura lambdoidea. Caudal part of defect is missing. The edge of the defect is sharp and inward bevelled with exposed diploe. Traces of any vital reaction were not identified. Diameter is around 50 mm. Perimortal trephination leading to death, or postmortal taking of the trephinational amulet must be considered. There were several pathological lesions on the same skull. Defect of oval shape sized 8 x 12 mm is located at the os parietale dex. Defect interferes mostly with lamina externa and less with lamina interna. Exposed diploe is without any vital reaction.

[Anterior skull base reconstruction]. / Plastika báze prední jámy lební.

The reasons for transcranial operative revision of anterior cranial fossa are cerebrospinal fluid (CSF) leakage, pneumocephalus, recurrent meningitis and eventually other causes. The trauma is the most common etiology of previously mentioned pathologic statuses, rarely it can also be long-lasting intracranial hypertension. We retrospectively analyzed our 61 patients, operatively treated at Department of Neurosurgery in Brno-Bohunice between 1997 and 2005, at whom the cranionasal communication must have been treated by means of transcranial neurosurgical repair of anterior fossa skull base. Each year approximately 10-15 operations of this kind were performed. The main goal of operative solution was the water-tight closure of dural defect and cranial base by means of direct dural suture duroplasty with periostal flap, fascial flap or other graft. Each case solution was dependent on actual operative appearance of the operative field. The majority of transcranial repairs of frontal cerebral fossas were performed acutely as a part of frontobasal injury operation with haematoma, calvar impressive fractures and open cerebral injury. The minority of repairs is formed by elective operations for posttraumatic rhinnorhea and meningitis. In our announcement we also mention possible conservative treatment.

Rosai-Dorfman disease: successful long-term results by combination chemotherapy with prednisone, 6-mercaptopurine, methotrexate, and vinblastine: a case report.

Sinus histiocytosis with massive lymphadenopathy (SHML), also known as Rosai-Dorfman disease (RDD), is a rare clinicopathologic entity of unknown etiology. The majority of patients do not require treatment, demonstrating spontaneous resolution or stable disease. However, in some cases the disorder runs a progressive course and/or threatens vital structures and functions, which dictates some form of intervention. It is not clear what constitutes the best approach for those cases. We report on a girl with an extensive and progressive form of the disease who was cured with combination chemotherapy, showing no evidence of recurrence after a follow-up of 5.5 years.

The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury.

Aim of this study was to examine the hypothesis that only a subgroup of patients with lesser primary brain damage after severe head injury may benefit from therapeutic hypothermia. We prospectively analysed 72 patients with severe head injury, randomized into groups with (n = 37) and without (n = 35) hypothermia of 34 degrees C maintained for 72 hours. The influence of hypothermia on ICP, CPP and neurological outcome was analysed in the context of the extent of primary brain damage. Patients with normothermia and primary lesions (n = 17) values: GCS on admission 5 (median), ICP 18.9 (mean), CPP 73 (mean), GOS 4 (median). Patients with normothermia and extracerebral hematomas (n = 20): GCS 4, ICP 16, CPP 71, GOS 3. Patients with hypothermia and primary lesions (n = 21): GCS 4,62, ICP 10, 81, CPP 78,1, GOS 4. Patients with hypothermia and extracerebral hematomas (n = 14): GCS 5, ICP 13.2, CPP 78, GOS 5. Hypothermia decreased ICP and increased CPP regardless of the type of brain injury. Hypothermia was not able to improve outcome in patients with primary brain lesions but this pilot study suggests that it significantly improves outcome in patients with extracerebral hematomas.

Problem of double vegetative innervation of rabbit cornea.

The coagulation of the sensitive part of the Gasserian ganglion in rabbits did not cause the disappearance of acetylcholinesterase-positive nerve fibres in the corneal epithelium. Most of them were very well detectable 6 to 8 days after operation. The autors cannot exclude the possibility that the interval between the coagulation and the killing the animals could be too short for disappearance of acetylcholinesterase reaction, but they express the view, that another source of corneal innervation by cholinesterase positive nerve fibres is to be taken into consideration.

Cerebral perfusion pressure and spect in patients after craniocerebral injury with transtentorial herniation.

We present a group of 29 consecutive head injured comatose patients with the syndrome of transtentorial herniation. All patients had urgent surgery and then continuous monitoring of ICP, CPP, blood pressure and jugular bulb oximetry was instituted. Two postoperative CT and SPECT examinations were performed in each patient. 15 patients had a normal CPP (> 70 mmHg) throughout the postoperative period, 80% of them had a favourable outcome. On the other hand 14 patients had decreased CPP lasting at least one hour and only 36% of them had a favourable outcome (p < 0.05). Similar relationships were found comparing GOS in patients with normal and increased ICP (> 20 mmHg) and normal and decreased SjO2 (< 55%). All but 3 patients had ischaemia on SPECT. Ischaemia improved on the 2nd SPECT in 11 patients and 10 (91%) of them had a favourable outcome. GOS (mean follow up 9 months) is: 12 patients good, 5 moderately disabled, 2 vegetative, 10 died. We conclude that SPECT is able to disclose even reversible ischaemic changes. In these patients all effort has to be made to keep CPP on normal levels. Improvement in cerebral perfusion is related to a better outcome.

Treatment of congenital swan neck deformity with dynamic tenodesis of proximal interphalangeal joint.

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.

Rehabilitation in plastic surgery. Splinting and positioning of flexor tendons of the hand.

The paper describes a method of conservative therapy for damaged flexor apparatus of the hand using splinting. It describes splinting of the thumb and three-phalangeal fingers in acute injuries and reconstructive operations. It shows techniques of splint preparation and application designed to improve the flexor function and contracture removal.

Replantation by arterialization of the venous system of amputated parts.

Only in four cases out of 800 replantations and revascularizations as the last resort it was necessary to anastomose an artery of the stump to a vein of the amputated part. Three of these cases were very distal finger amputations in zone II and III and one was an auricle amputation with so severely damaged arteries of the amputated part that it was not possible to perform their anastomosis. All of these four clinical cases were successful and they confirm the possibility of arterialization of the venous system which was proved in experiments with rabbit auricle replantation by Mundy and Pajn (1994) and by Farrior and Baker (1988).

Congenital contracture of the superficial flexor of the hand.

The authors describe a case of an inborn contracture of the superficial flexors of the three-phalangeal fingers in a 15-year-old girl and treatment of the condition. For clinical purposes a classification on congenital deformities in the proximal part of the flexor complex was proposed in which the described case is included. The classification was derived from the ontogenetic development of flexor tendons. There are three types of deformities: S1--the muscular belly of the superficial flexor of the fingers is only in the palm; S2--the muscle is attached to the area between the wrist and medial epicondyle; S3--the palmaris longus of the fingers is on the medial epicondyle, however the m. palmaris longus is lacking; Pl-1 the superficial flexor exists only in the form of a proximal muscular belly of varying length; Pl-2--the palmaris longus is on the wrist and the insertion tendon may be thinner than on the contralateral side. The described contracture deformity was classified as type S2.

Environmental pollution and the occurrence of congenital defects in a 15-year period in a south Moravian district.

We have made a simple 15-year retrospective epidemiological study of a part of South Moravia, district Breclav, on the basis of genetic documentation of 245 congenital defects and 28 spontaneous abortions. The whole area was worked up by computer-geographical methods, and the occurrence of congenital defects was compared both in areas of severe chronic air pollution and in less contamined areas. There were three municipal areas, Mikulov, Breclav-Postorná, Velké Bilovice and their surroundings, in which an increased number of congenital defects was recorded. In the municipal area of Breclav-Postorná there was also a greater occurrence of organic solvents and phosphoric acid and a significantly higher occurrence of spontaneous abortions and at the same time a higher occurrence of heart defects.

Reconstruction of paralyzed biceps brachii muscle by transposition of pedicled latissimus dorsi muscle: report of two cases.

The biceps brachii muscle was reconstructed in two patients with inveterate injuries of the brachial plexus. The latissimus dorsi muscle was transferred on the thoracodorsal neurovascular bundle into the regio brachii anterior and sutured to the long head of the m. biceps brachii. The distal part of the latissimus dorsi muscle was sutured above the tuberositas radii along with the insertion tendon of the biceps brachii muscle. Both patients achieved very satisfactory restoration of flexion in the elbow joint 12 and 16 months after surgery.

Inveterate lesions of the collateral ligaments of the thumb joints.

Inveterate lesions 2-18 months following injury to the collateral ligaments of the metacarpophalangeal (MP) joint of the thumb and pollicised proximal interphalangeal (PIP) joint were replaced by a tendinous transplant from the palmaris longus muscle. The group comprised three patients, 34-46 years old, with a post-traumatic injury of the ulnar collateral ligament of the MP joint of the thumb and a seven-year-old child with an congenital defect of the radial collateral ligament. Lateral 30-degree instability indicates injury of the collateral ligament. On examination the range of instability in the investigated group was between 45 and 90 degrees. The authors recommend comparison with the contralateral thumb.

Long time follow-up of flexor tendons of the hand after reconstructive operations. Part 1. Monitoring method.

Monitoring method for patients who undertook the reconstructive operation of flexor tendons of the hand is described. Pre-operative condition, operation finding, surgery execution, post-operative condition, rehabilitation as well as the situation during the graduated checks up after 6 and 9 months; 2, 6 and 10 years were noted down into standard forms.

Microsurgical reconstruction of a stiff jointless thumb after an avulsion injury.

We demonstrate three types of reconstruction of a stiff jointless thumb after an avulsion injury. In the first type, the skeleton of the thumb was harvested from the iliac crest or from a rib, the cutaneous cover was formed from a forearm flap on the a. radialis. In the second type, the preserved skeleton of the thumb from crushed tissues was transferred to the forearm and from there subsequently used for reconstruction together with the forearm flap. These two types of reconstruction were carried out if the amputation line reached the metacarpophalangeal (MP) joint of the thumb. In an amputation proximally from the MP joint, the skeleton of the thumb was reconstructed with a graft from the fibula on a vascular pedicle. The fibula with the vascular pedicle was transferred to the forearm and sutured in an Y-shape suture to the a. radialis. The tissue block of the forearm flap together with the fibula were subsequently transferred for the reconstruction of the thumb. The fundamental prerequisite for the reconstruction of a stiff jointless thumb were freely mobile three-phalangeal digits which could form a functional unit with the stiff thumb. The reconstructions were performed in 7 patients. The advantages and disadvantages of these particular operation schemes are discussed postoperatively after 2 years.

Precision grip with congenital hypoplasty or hypofunction of the thumb.

We tested the grip in four patients with congenital defects of the hand and either a hypoplastic thumb or a thumb with impaired inervation. Small objects were taken by a scissors grip between the fingers. In a hand with radial duction in the manus vara congenita, during strengthening of the wrist, the grip from the ulnar side between the fourth and fifth fingers was changed to the radial side between the second and third fingers. Large objects were gripped by all the three-phalanx fingers into the palm in a horizontal position. In case 4 with hypoplasia of the thumb grade IIIC by the classification of Blauth and Buck-Gramcko, we describe a transposition of the index finger to the site of the thumb and the hypoplastic thumb to the site of the index finger. It is obvious that the precision grip is affected by the thumb length and strengthening of the ulnar side of the wrist. We assume that the scissors grip is the earliest precision grip in the evolution of the primate hand.

Treatment of a maxillary defect following resection of carcinoma.

A group of 37 oncological patients with tumours of the head and neck where extensive resection of the face, maxilla or mandible or calva was necessary, comprised five patients with a typical defect after resection of part of the maxilla including half of the palate and exenteration of the orbit. This extensive defect causes discomfort to the patient and his environment--functional i.e. impaired speech, and cosmetic. A satisfactory solution during reconstruction of the maxilla without the need of skeletal reconstruction is microsurgical transplantation of a narrow flap of the latissimus dorsi, usually with two cutaneous islands--one to close the palate and the other to close the orbit and face.