A case of giant ameloblastoma: destructive effect on the facial skeleton and soft tissues of the head and neck.

Ameloblastoma is a benign odontogenic tumor characterized by slow growth causing painless facial swelling. The tumor can behave locally aggressively, and may have direct destructive effects on the surrounding soft and hard tissues. This paper reports the unique case of a female patient with giant ameloblastoma of the mandible. Computed tomography (CT) revealed an enormous swelling of the left side of the face, resorption of the affected hemi-mandible, left maxilla, and tissues of the temporal, infratemporal, and pterygopalatine fossae. Pressure from the tumor resulted in displacement and destruction of the facial skeleton, upper aero-digestive tract structures, and some structures of the neck. The patient was treated by radical hemimandibulectomy with removal of the tumorous mass. Precise knowledge of the anatomical structures, and their locations and topographical relationships is required in the diagnosis and treatment plan for each surgical procedure in cases of giant ameloblastoma. CT imaging can be used to determine the extent and exact location of the lesion, revealing other important details that may help in selecting appropriate treatment.

Three-dimensional CAD/CAM imaging of the maxillary sinus in ageing process.

OBJECTIVES: During the physiological ageing process atrophy of the alveolar bone appears in vertical direction. This bone resorption causes pushing the limits of the maxillary sinus at the expense of a degraded bone. The sinus volume increases due to the facial development in children and adolescents or during the ageing process due to the loss of teeth and bone mass. The main aim of this study is to determine the sinus shape and sinus floor morphology related to age. MATERIALS AND METHODS: Human adult male and female cadaveric heads (aged 37 to 83 years) with different dental status were used. The three-dimensional CAD/CAM software was used to scan the solid impressions of the maxillary sinus to visualize the real sinus shape and sinus floor. Subsequently, other findings are shown in tables and evaluated graphically. RESULTS: The maxillary sinus morphology, its relationship to the nasal cavity, the sub sinus alveolar bone height, displacement of the lowest and highest points of sinus, and the sinus relationship to the roots of the upper teeth were studied and evaluated. Some septa, crests, and the prominent infraorbital canal were also found in the area of the sinus floor. CONCLUSIONS: This paper provides a unique view on the maxillary sinus and its changes during the ageing process with preserved topographical relations in a representative sample of the Slovak population. The visualization of the maxillary sinus anatomy is necessary in the diagnosis and treatment plans for dental implants and during current surgical procedures.

Unilateral occurrence of five different thyroid arteries-a need of terminological systematization: a case report.

This article highlights an unusual and unilateral variation in the blood supply to the inferior portion of the thyroid gland observed on the right lobe during anatomy dissection course. The rare variation of the occurrence of two anomalous arteries: the middle thyroid artery and the aberrant accessory inferior thyroid artery, and one uncommon variant, the thyroid ima artery, was detected in an adult female cadaver. The two generally constant arteries, the superior thyroid artery and the inferior thyroid artery, have been found in their usual anatomical location. Both the middle thyroid artery and aberrant accessory inferior thyroid artery arose from the right common carotid artery. The middle thyroid artery coursed as a very short branch ventromedially to enter the inferior lateral portion of the right lobe of the thyroid gland. It was at the same level, in which the inferior thyroid artery reached the lateral border of the thyroid gland. The aberrant accessory inferior thyroid artery originated similarly, from the ventromedial surface of the right common carotid artery and passed to supply the inferior pole of the right lobe. The thyroid ima artery was found to arise from the brachiocephalic trunk, entering the isthmus of the thyroid gland. Information about the embryological background might be helpful to clarify why such a type of variation occurs. It is necessary to understand the possible existence of this anomaly, to carry out successful radical neck dissection and to minimize the risk of postoperative complications in patients.

Anatomical study of the roots of cranial parasympathetic ganglia: a contribution to medical education.

A major key to increasing the safety of cranial surgery is a thorough understanding of anatomy. The anatomy of the head is of fundamental interest to dental and medical students early in their studies. Clinically, it is mostly relevant to surgeons who are performing interventions and reconstruction in the maxillofacial region, skull base, and the orbit. However, the level of appropriate anatomical knowledge necessary for general and special medical and surgical practice is still under discussion. This study maps the significant areas and structures of the head that are not normally accessible during dissection courses because of time and difficulties involved in the preparation. The detailed photodocumentation enriched by diagrams provides a view of structures until now only partially documented. Three parasympathetic ganglia are located in hardly accessible areas of the head - inside the orbit, infratemporal fossa, and in the pterygopalatine fossa. No detailed photographs have been found in current anatomical textbooks and atlases in relation to the morphology of fibers (roots) connected to the ciliary, otic, and pterygopalatine ganglia. Therefore, this study focused on the detailed display of sensory, sympathetic, and parasympathetic roots of ganglia to provide relevant photodocumentation and an improvement in human anatomy teaching. This study also confirms that cadaver dissection provides an excellent opportunity for the integration of anatomy and clinical medicine into the early clinical training of undergraduate dental and medical students. We believe this article, because of the details mentioned above, will be beneficial not only for the future anatomical undergraduate but also for postgraduate education.

Postnatal development of nitrergic and cholinergic structures in rat spinal cord.

Nitric oxide (NO) is known to be a freely diffusible gaseous neurotransmitter that is not requiring synaptic connection to exert its effects. Nitric oxide synthase (NOS), the enzyme responsible for NO synthesis can be visualised by nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry. Other neurotransmitter is a classical neurotransmitter acetylcholine (ACh), regulated by enzyme acetylcholinesterase (AChE) that hydrolyses the acetylcholine after its releasing. This work is presenting results of histochemical study of the NADPH-d and AChE expression (nitrergic and cholinergic neurons) in the spinal cord (SC) during various periods in its development. Specimens from Wistar rat pups in the age ranging from 1st to 21st postnatal days (P1-P21) have been compared with those of adult rats (P90). Transverse sections of the SC were evaluated by light microscope. In adults, the NADPH-d positivity was detectable in the neurons of superficial and deep layers of the dorsal horn, pericentral area and in the area of preganglionic autonomic nuclei. AChE positive structures were seen in the same locations as previous ones with the exception of two locations: in superficial layers of the dorsal horn AChE staining was absent, while in the ventral horn the groups of AChE positive motoneurons were found. At the perinatal period both NADPH-d and AChE positive neurons were stained from slight to moderate intensity only. During later developmental periods the staining gradually increased and achieved adult level of intensity on the day P21. Our results confirmed the presence of nitrergic and cholinergic neurons in investigated areas of the SC and indicated their fully functioning of NADPH-d and AChE positive structures in SC from the third postnatal week.

The effect of long-term reduction of aortic blood flow on spinal cord gray matter in the rabbit. Histochemical study of NADPH-diaphorase.

1. The aim of this work was to study the influence of reduced aortic blood flow on NADPH-diaphorase (NADPH-d) staining in the gray matter of L4-S3 spinal cord segments. 2. Surgery was performed on the abdominal aorta of the rabbit. Spinal cord ischemia was introduced by infrarenal aortic constriction to 30% from the normal blood flow. Animals were allowed to survive 1 week, 1 month and 3 months after surgery. Neurological outcome was studied in relation to the duration of aortic occlusion. The NADPH-d histochemistry was used for the visualisation of spinal cord sections. 3. The most affected area of the spinal cord was pericentral region, and slight changes were seen in the NADPH-d activities of both dorsal and ventral horns. One week after surgery, NADPH-d positive pericentral neurons were almost unchanged in their shape and intensity of staining, the only difference was seen in slightly increased staining of the background around the central canal. One month following surgery neurons exhibited shrinkage or were swollen, NADPH-d staining was less intensive in the pericentral zone and positively stained vessels were present. 4. Three months of ischemia influenced the NADPH-d activity: (a) In the pericentral region were seen intensively NADPH-d stained neurons almost normal in shape of their bodies but with shortened processes or without them; (b) NADPH-d staining of neuropil was greatly enhanced mostly around the central canal and in the dorsal commissure; (c) Numerous vessels were present in the pericentral zone and in the location of the ventral horn. 5. It can be concluded that the reduction of blood flow in the abdominal aorta makes most changes in the pericentral region of the rabbit spinal cord. Increased NADPH-d staining of neuropil and the presence of positively stained vessels reflect increased NADPH-d/NOS production in the spinal cord gray matter after long-term incomplete aortic occlusion.