Bilateral Maxillary Duplication in Tessier No. 7 Cleft: An Uncommon Congenital Deformity with a Challenging Radiological Diagnosis.

Tessier No. 7 cleft, known as lateral facial cleft, is a rare and understudied entity with an incidence of 1/80,000-1/300,000 live births. Besides perioral tissue abnormalities manifesting as macrostomia, Tessier 7 cleft also involves anomalies of the underlying bony structures. It can appear as part of a syndrome, such as Treacher-Collins syndrome or Goldenhar/Orbito-Auriculo-Vestibular Spectrum, or as an isolated form (unilateral or bilateral) with variable expressions. Bilateral maxillary duplication in Tessier 7 cleft is considered extremely rare, accounting for only two previously presented cases. Given that the cases presented in the literature mainly focus on clinical appearance and surgical treatment, without providing sufficient imaging, we aim to present key radiological features of Tessier 7 cleft in terms of evaluating the involved structures, which is essential for the therapeutic approach and final outcome. A 17-year-old male with incompetent lips and orthodontic abnormalities was referred to our Radiology Department for orthopantomography (OPG) and CT examinations. Hetero-anamnestic data revealed a history of surgical treatment of the commissural cleft conducted 2 months after the birth to enable feeding. Intraoral examination showed a maxillary cleft and supernumerary teeth. Since the given clinical presentation was inconclusive, radiological diagnostics took precedence in elucidating this complex entity.

Chondrosarcoma of the Alveolar Process of the Mandible Initially Suspected to Be a Periodontal Lesion.

Chondrosarcoma (CS) initially suspected to be a periodontal lesion is atypical and rare. To the best of our knowledge, only six similar cases have been reported so far. A 47-year-old woman presented with a discreet swelling of the alveolar process of the mandible, while adjacent mucosa appeared normal. Upon initial intraoral radiography, a periodontal lesion was suspected by the ordinating dentist. Further radiological evaluations included CBCT, CT, and MRI, which showed a thickening of the supporting bone with ground-glass foci but without visible calcifications. The periodontal space of the affected teeth appeared to be uniformly widened. The destruction of the vestibular and lingual cortex was observed, as well as a discreet periosteal reaction, implying the secondary involvement of these teeth and not the odontogenic nature of the lesion. The lesion was restricted to the alveolar process of the mandible, and the bone marrow was not affected. Upon biopsy, a preliminary histopathology report suggested chondrosarcoma, and the patient underwent surgery. It is important to emphasize the possible malignant nature of atypical lesions in the alveolar bone, especially in cases with the expansion of vestibular and lingual cortical plates. Additionally, postoperative "watch and see" follow-ups may be considered in cases of CS in the jaws.

Feasibility of using cross-sectional area of masticatory muscles to predict sarcopenia in healthy aging subjects.

Determination of sarcopenia is crucial in identifying patients at high risk of adverse health outcomes. Recent studies reported a significant decline in masticatory muscle (MM) function in patients with sarcopenia. This study aimed to analyze the cross-sectional area (CSA) of MMs on computed tomography (CT) images and to explore their potential to predict sarcopenia. The study included 149 adult subjects retrospectively (59 males, 90 females, mean age 57.4 ± 14.8 years) who underwent head and neck CT examination for diagnostic purposes. Sarcopenia was diagnosed on CT by measuring CSA of neck muscles at the C3 vertebral level and estimating skeletal muscle index. CSA of MMs (temporal, masseter, medial pterygoid, and lateral pterygoid) were measured bilaterally on reference CT slices. Sarcopenia was diagnosed in 67 (45%) patients. Univariate logistic regression analysis demonstrated a significant association between CSA of all MMs and sarcopenia. In the multivariate logistic regression model, only masseter CSA, lateral pterygoid CSA, age, and gender were marked as predictors of sarcopenia. These parameters were combined in a regression equation, which showed excellent sensitivity and specificity in predicting sarcopenia. The masseter and lateral pterygoid CSA can be used to predict sarcopenia in healthy aging subjects with a high accuracy.

Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study.

BACKGROUND: The mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis. METHODS: We retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests. RESULTS: The mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%. CONCLUSION: Our findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis.

Predictors of complications associated with unerupted maxillary canines: a cone beam computed tomography study.

To detect predictive factors for the occurrence of complications associated with unerupted maxillary canines (C). A total of 83 cone beam computed tomograms (CBCT), made from November 1, 2021 to October 31, 2022, have met the inclusion criteria, whereby 110 unerupted C were detected. Independent variables were: gender, age, and C position. Outcome variables were detected complications: external root resorption (ERR) and dilaceration of adjacent tooth, ERR and dilaceration of C, dentigerous cyst, canine ankylosis, and adjacent teeth malposition. Chi-square test and logistic regression analysis were used to examine the relationship between income variables and detected complications. Vertical position of unerupted C showed as predictor for adjacent tooth dilacerations and malposition. Chance for dilaceration increases 5.5-fold with C position at the middle third of lateral incisor (LI) root, while chance of malposition increases 23.4-fold with its supra-apical position to the LI root, in comparison to the C position occlusal to the LI cemento-enamel junction. Age is a predictive factor for dentigerous cysts, with decreasing the chance of their occurrence 1.5-fold with each additional year of age. Early evaluation of the vertical position and timely treatment of C are decisive steps in preventing complications.

Assessment of chronic rhinosinusitis severity indicators: radiological and clinical perspective.

INTRODUCTION: Chronic rhinosinusitis (CRS) is inflammation of the nasal cavity and paranasal sinus mucosa. The aim of this study was to examine which of the available radiological and clinical parameters is the best indicator of the CRS severity. METHODOLOGY: In order to classify CRS, we used both a subjective assessment tool such as SNOT-22 questionnaire, as well as an objective tool such as clinical examination. We introduced three forms of CRS (mild, moderate and severe). Within these groups, we evaluated the computerized tomography (CT) parameters used as an indicator of bone remodeling, the Lund-Mackay score (LMS), CT properties of the soft tissue content in the maxillary sinuses, presence of nasal polypus (NP), presence of fungal infection and parameters indicating allergic status. RESULTS: Frequencies of NP, positive eosinophil count, presence of fungi, areas of high attenuation, and duration of CRS and LMS significantly increased with the increased severity of CRS. Anterior wall thickness and density increased in the severe forms of CRS in the group assessed by SNOT-22. Positive correlation was detected between LMS and maximal density of sinus content and between duration of CRS and anterior wall thickness. CONCLUSIONS: Morphological changes of sinus wall detected in CT could be a useful indicator of CRS severity. Changes in bone morphology are more likely to occur in patients with longer-lasting CRS. The presence of fungi, allergic inflammation of any origin and nasal polypus potentiates more severe forms of CRS both clinically and subjectively.

Testing of Different Scanning Protocols Used for Precise 3D-printing of Mandibular Models.

Multidetector computed tomography (MDCT) is often necessary to manufacture 3D-printed medical models (MMs) required for mandibular restoration due to trauma or malignant tumor. Although cone-beam computed tomography (CBCT) is a preferable method of mandibular imaging, additional scanning is often unjustified. To test whether a single radiologic protocol could be used for mandibular reconstructions, the human mandible was scanned with 6 MDCT and 2 CBCT protocols and later 3D-printed using a fused-deposition modelling technique. Then, we assessed linear measures on the mandible and compared them with MDCT/CBCT digital scans and 3D-printed MMs. Our data revealed that CBCT0.25 was the most precise protocol for manufacturing 3D-printed mandibular MMs, which is expected considering its voxel size. However, we noted that CBCT0.35 and Dental2.0H60s MDCT protocols were of comparable accuracy, indicating that this MDCT protocol could be a single radiologic protocol used to scan both donor and recipient regions required for mandibular reconstruction.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study.

OBJECTIVE: This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. METHODOLOGY: A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. RESULTS: Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. CONCLUSIONS: RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.

Erythropoietin Resistance Development in Hemodialysis Patients: The Role of Oxidative Stress.

Oxidative stress (OS) is considered a significant risk factor for the development of anemia in patients treated by regular hemodialysis (HD). Moreover, OS represents a risk factor for the development of erythropoietin (EPO) resistance in these patients. The aim of this study was to examine the role of OS regarding EPO resistance development in patients treated by regular HD. 96 patients treated with standard HD and on-line hemodiafiltration were included in this study. The patients were treated with short-acting and long-acting EPOs for anemia. The concentration of superoxide anion radical, hydrogen peroxide, thiobarbituric acid reactive substances, and nitric oxide in the form of nitrites and the activity of catalase, superoxide dismutase and reduced glutathione were measured in patients' blood spectrophotometrically. Standard biochemical analysis, inflammatory markers, nutritional status, HD parameters, and erythropoietin resistance index were also determined. Patients with resistance to short-acting EPO had significantly lower concentration of hemoglobin in the blood and hematocrit value, a significantly higher serum ferritin concentration, and significantly lower catalase activity in erythrocytes than patients without EPO resistance. Patients with resistance to long-acting EPO have a significantly lower hemoglobin concentration in the blood, hematocrit values, and serum concentration of prealbumin and vitamin D, as well as significantly higher concentration of C-reactive protein, superoxide anion, and hydrogen peroxide concentration than those without resistance. OS significantly contributes to EPO resistance development. OS, higher ferritin and CRP levels, lower hemoglobin, hematocrit and prealbumin levels, and vitamin D deficiency represent significant risk factors for EPO resistance development in HD patients.

'CT and CT image-based texture image analysis in radiological diagnostics of allergic fungal rhinosinusitis'.

BACKGROUND: This prospective study is focused on evaluating radiological properties of AFRS. We analysed specific CT features related to the presence of AFRS, as well as explored the possible usefulness of the texture image analysis (TIA) as an additional diagnostical parameter. METHODS: The CT images of maxillary sinuses of 37 adult patients diagnosed with chronic rhinosinusitis were analysed for homogeneity, high-attenuation areas, density of the soft tissue mass, bony wall thickness and density. TIA included assessment of uniformity, contrast, homogeneity and entropy of sinus content. RESULTS: In the F+ group, soft tissue mass was significantly more non-homogeneous, high-attenuation areas were more prevalent, while soft tissue densities were higher. The sinus wall showed a tendency towards decreased thickness and significantly higher density in the F+ group. Among TIA parameters only homogeneity was significantly lower in the F+ group. CONCLUSIONS: Presence of fungi should be suspected when the sinus is filled with a non-homogenous soft tissue content of a high CT density not necessarily presented as clearly visible hyperattenuation material. Additional criteria in radiological diagnostics of AFRS should encompass assessment of sinus bony wall density. TIA may serve as a tool for quantitative assessment of subjective CT features such as homogeneity of the soft tissue mass for investigative purposes. However, other TIA parameters showed limited potential.

Quality of life following two different techniques of an open ventral hernia repair for large hernias: a prospective randomized study.

BACKGROUND: We compare the health-related quality of life (QoL) of patients with incision hernias before and after surgery with two different techniques. METHODS: In this prospective randomized study, the study population consisted of all patients who underwent the first surgical incisional hernias repair during the 1-year study period. Patients who met the criteria for inclusion in the study were randomized into two groups: the first group consisted of patients operated by an open Rives sublay technique, and the second group included patients operated by a segregation component technique. The change in the quality of life before and 6 months after surgery was assessed using two general (Short form of SF-36 questionnaires and European Quality of Life Questionnaire-EQ-5D-3L), and three specific hernia questionnaires (Hernia Related Quality of Life Survey-HerQles, Eura HS Quality of Life Scale-EuraHS QoL, and Carolinas Comfort Scale-CCS). RESULTS: A total of 93 patients were included in the study. Patients operated on by the Rives technique had a better role physical score before surgery, according to the SF-36 tool, although this was not found after surgery. The postoperative QoL measured with each scale of all questionnaires was significantly better after surgery. Comparing two groups of patients after surgery, only the pain domain of the EuraHS Qol questionnaire was worse in patients operated by a segregation component technique. CONCLUSION: Both techniques improve the quality of life after surgery. Generic QoL questionnaires showed no difference in the quality of life compared to repair technique but specific hernia-related questionnaires showed differences.

Can lower third molar position indicate the need for preoperative cone beam computed tomography exploration of retromolar canal?

OBJECTIVES: This study aims to reveal whether and which position of lower third molar (M3), assessed on a 2D image, indicates or potentially exclude the need for the CBCT exploration of the retromolar canal (RMC). We hypothesized that some positions of M3 are associated with overall higher incidence of the RMC, and particularly clinically relevant ones, thus justifying additional CBCT diagnostics. METHODS: CBCT exam of 186 hemi-mandibles with present M3 were selected for the study. Explorations were made during the 2-year period from January 1th 2018 to December 31th 2019 with Scanora 3Dx Sorodex (Tussula, Finland). The following variables were assessed: the presence and width of the RMC, eruption status, and angulation of the M3. The RMC presence in relation to the M3 eruption status and angulation was analyzed using appropriate statistical tests. RESULTS: RMC was present in 89 (47.8%) out of 186 hemi-mandibles. Mean canal width was 1.51 mm. 22.5% of detected canals had the diameter exceeding 2 mm. Third molar's eruption status showed no statistical correlation with the occurrence of RMC. We observed significantly higher occurrence of RMC in the hemi-mandibles containing distally angulated M3 in comparison to other orientations (p = 0.025). CONCLUSION: Based upon our findings, we recommend preoperative CBCT in cases where distal angulation of M3 is observed on 2D images, for the purpose of RMC exploration. Lower resolution CBCT mode and limited field of view (XS or S) are sufficient for the visualization of potentially clinically relevant RMCs, with as much reducing the patient dose.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study

Abstract Objective This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. Methodology A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. Results Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. Conclusions RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.

Reconstructing the First Metatarsophalangeal Joint of Homo naledi.

The aim of the present study was to develop a new method to reconstruct damaged metatarsophalangeal joint (MTPJ) of Homo naledi's fossil and to deepen the understanding of the first metatarsal head (FMH) morphological adaptation in different gait patterns. To this purpose three methods were introduced. The first served to compare the anthropometric linear and volumetric measurements of Homo naledi's MTPJ to that of 10 various athletes. The second was employed to measure curvature diameter in FMH's medial and lateral grooves for sesamoid bones. The third was used to determine the parallelism between medial and lateral FMH grooves. The anthropometric measurements of middle-distance runner to the greatest extent mimicked that of Homo naledi. Thus, it was used to successfully reconstruct the damaged Homo naledi's MTPJ. The highest curvature diameter of medial FMH groove was found in Homo naledi, while in lateral FMH groove it was the highest in volleyball player, suggesting their increased bear loading. The parallelism of medial and lateral FMH grooves was observed only in Homo naledi, while in investigated athletes it was dis-parallel. Athletes' dis-paralleled structures make first MTPJ simple flexion movement a complicated one: not rotating about one axis, but about many, which may result in bringing a negative effect on running. In conclusion, the presented method for the reconstruction of the damaged foot bone paves the way for morphological and structural analysis of modern population and fossil hominins' gait pattern.

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies.

This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.

Nutrient canals and porosity of the bony palate: A basis for the biological plausibility of the anterior middle superior alveolar nerve block.

BACKGROUND: The authors investigated morphologic parameters of the palatal cortex that affect the diffusion of local anesthetic solution in the region of the anterior middle superior alveolar (AMSA) nerve block injection site. METHODS: The authors used computed tomographic (CT) and micro-CT imaging to assess 20 human skulls from an anatomic collection. Analysis of the CT images included frequency, distribution, and width of the nutrient canals in the bony palate, according to to the person's sex and age. Micro-CT analysis involved measuring the thickness and porosity of palatal cortical bone in the area of the AMSA injection site in relation to the thickness and porosity of the opposite buccal cortical bone. RESULTS: There was a statistically significant difference (P = .042) in the location of the nutrient canals between male specimens (> 50% in the border region) and female specimens (> 50% in the palatal process). Furthermore, the female skulls had significantly wider nutrient canal foramina (P = .042) than did the male skulls. Despite greater thickness, the palatal cortex in the area of the AMSA injection site had slightly greater porosity than did the buccal cortex. A significantly greater number of microcanals penetrated the whole cortical thickness in palatal than in buccal cortical bone (P = .001). CONCLUSIONS: The distribution and width of nutrient canals differed between male and female skulls. At the microscopic level, structural characteristics of the palatal cortex provide a good anatomic basis for the potential of a satisfactory AMSA injection success rate. PRACTICAL IMPLICATIONS: The AMSA technique success rate might be increased if the clinician adjusts the injection site to the distribution of nutrient canals, depending on the sex of the patient.

Trauma of the Frontal Region Is Influenced by the Volume of Frontal Sinuses. A Finite Element Study.

Anatomy of frontal sinuses varies individually, from differences in volume and shape to a rare case when the sinuses are absent. However, there are scarce data related to influence of these variations on impact generated fracture pattern. Therefore, the aim of this study was to analyse the influence of frontal sinus volume on the stress distribution and fracture pattern in the frontal region. The study included four representative Finite Element models of the skull. Reference model was built on the basis of computed tomography scans of a human head with normally developed frontal sinuses. By modifying the reference model, three additional models were generated: a model without sinuses, with hypoplasic, and with hyperplasic sinuses. A 7.7 kN force was applied perpendicularly to the forehead of each model, in order to simulate a frontal impact. The results demonstrated that the distribution of impact stress in frontal region depends on the frontal sinus volume. The anterior sinus wall showed the highest fragility in case with hyperplasic sinuses, whereas posterior wall/inner plate showed more fragility in cases with hypoplasic and undeveloped sinuses. Well-developed frontal sinuses might, through absorption of the impact energy by anterior wall, protect the posterior wall and intracranial contents.

Impact of the lower third molar and injury mechanism on the risk of mandibular angle and condylar fractures.

BACKGROUND: Previous studies have shown the influence of the mandibular third molar on mandibular angle and condylar fractures, but have not comparatively analyzed the impact of the injury mechanism on these fractures. The purpose of this study was to evaluate the influence of the lower third molar (M3) and injury-related factors (fracture etiology and site of impact of the traumatic force) on the risk of mandibular angle and condylar fractures. MATERIAL AND METHODS: The study included 615 patients who sustained a mandibular fracture in a 13-year period (from January 2000 to December 2013). The independent variables were presence, position and the root number of the M3, fracture etiology, and site of impact of the force. The outcome variables were mandibular angle and condylar fractures. Other variables included in the study were patients' gender and age. The data were analyzed using the chi-square test. Univariate and multivariate binary logistic regression analyses were used to evaluate the relationship between angle and condylar fractures and to show potential determinants. RESULTS: Angle fractures were significantly influenced by the M3, site of impact, and age, but the main predictors were the eruption status and vertical position of the M3 (classified by Pell and Gregory) and site of impact of the force. Condylar fractures were significantly influenced by the M3 and site of impact of the force, but only the last showed as a predictor. CONCLUSIONS: Factors related to the M3 showed more significant influence on angle fractures than on condylar fractures.

Specificities of transplantation of kidneys procured from donors with situs inversus totalis--a case report and review of the literature.

INTRODUCTION: Situs inversus totalis (SIT) represents a total vertical transposition of the thoracic and abdominal organs which are arranged in a mirror image reversal of the normal positioning. We presented a successful pre-dialysis kidney transplantation from a living sibling donor with SIT and the longest donor follow-up period, along with analysis of the reviewed literature. CASE REPORT: The pair for pre-dialysis kidney transplantation included a 68-year-old mother and 34-year-old daughter at low immunological risk. Comorbid- ities evidenced in kidney donors with previously diagnosed SIT, included moderate arterial hypertension and borderline blood glucose level. Explantation of the left donor kidney and its placement into the right iliac fossa of the recipient were performed in the course of the surgical procedure. A month after nephrectomy, second degree renal failure was noticed in the donor. A 20-month follow-up of the donor's kidney and graft in the recipient proved that their functions were excellent. CONCLUSION: In donors with previously di- agnosed SIT the multidisciplinary approach, preoperative evaluation of the patient and detection of possible vascular anomalies are required to provide maximum safety for the donor.

Impact of the lower third molar presence and position on the fragility of mandibular angle and condyle: A Three-dimensional finite element study.

The aim of the present study was to investigate the influences of the presence and position of a lower third molar (M3) on the fragility of mandibular angle and condyle, using finite element analysis. From computed tomographic scans of a human mandible with normally erupted M3, two additional virtual models were generated: a mandibular model with partially impacted M3 and a model without M3. Two cases of impact were considered: a frontal and a lateral blow. The results are based on the chromatic analysis of the distributed von Mises and principal stresses, and calculation of their failure indices. In the frontal blow, the angle region showed the highest stress in the case with partially impacted M3, and the condylar region in the case without M3. Compressive stresses were dominant but caused no failure. Tensile stresses were recorded in the retromolar areas, but caused failure only in the case with partially impacted M3. In the lateral blow, the stress concentrated at the point of impact, in the ipsilateral and contralateral angle and condylar regions. The highest stresses were recorded in the case with partially impacted M3. Tensile stresses caused the failure on the ipsilateral side, whereas compressive stresses on the contralateral side.