Multiple coexisting variations of skull and cervical spine anatomy in a symptomatic patient - uncommon or uncommonly noticed? A CT-based case study.

INTRODUCTION: Among many anatomical variations of the skull and cervical spine, some may be an underlying cause of a disease, while others remain clinically silent. The estimated individual prevalences of them differ, but given the available data it is impossible to clarify how frequently they coexist with each other. The following study presents an example of seven anomalies, amongst which at least few have manifested clinically in the examined patient. CASE REPORT: A 35 y.o. Polish woman who suffered from chronic sinusitis was subjected to a computed tomography scan. Mild thickening of the anterior ethmoidal cells' mucosa, bilateral concha bullosa, paradoxical right middle turbinate, bilateral uncinate process pneumatization and arrested pneumatization of sphenoid sinus were found and addressed in context of the reported symptoms. Simultaneously other, clinically silent anatomical anomalies, were found - namely ossification of the anterior petroclinoid ligament, incomplete medial basal canal and bilateral arcuate foramen. CONCLUSION: To the best knowledge of the authors, this case report is the first to present such a coexistence of this many various anatomical anomalies, among which some played a crucial part in the chronic sinusitis experienced by the patient. Concurrence of multiple variations in the same anatomical area or functional unit may exacerbate clinical presentation of a patient. Identifying a single anomaly ought to warrant a thorough investigation into any other potentially existing variants.

Two simultaneous anatomical variations of the cervical spine - a case report discussing the concept of tandem anomalies.

forming a bony opening through which the vertebral artery (VA) enters the vertebral canal. Block vertebra is a synostosis of at least two vertebral bodies that did not separate during the embryological development. It is worth distinguishing it from the Klippel-Feil syndrome, as the latter oftentimes involves other abnormalities (namely skeletal) and is typically diagnosed in childhood. Both variants could potentially lead to an impairment of the blood flow through the VA. Case report: The following case report presents a finding of two anomalies of the cervical spine, found in a 38 y.o. female patient suffering from dizziness. A synostosis of the C4 and C5 vertebral bodies, arches and zygapophysial (facet) joint, was noted by the examining radiologist, with marked narrowing of the intervertebral foramen. Furthermore, second anatomical variation in the form of the complete bilateral arcuate foramen was identified superior to the groove for the VA on the upper surface of the posterior arch of the atlas. Conclusions: To the best knowledge of the authors, this case report is the first to present a co-existing block vertebra and bilateral complete arcuate foramen. Common presence of at least two anatomical variations that could have a synergistic clinical effect could possibly be termed 'tandem anomaly.' Notwithstanding, identification of a single anomaly explaining a patient's symptoms does not absolve the medical professionals from searching for any other potential variations that could also be present and could further influence the clinical picture.

The complete anatomy of the mandibular lingula: a meta-analysis with clinical implications.

BACKGROUND: The objective of this meta-analysis was to investigate the anatomical variations of the mandibular lingula (ML) and its relationship to surrounding anatomical structures. Understanding such variations is crucial to help determine the site and depth of a successful inferior alveolar nerve (IAN) anesthetic block as well as a safe area for oral and maxillofacial invasive procedures in order to minimize the risk of neurological or hematological damage to the inferior alveolar nerve. MATERIALS AND METHODS: A systematic search was conducted in which all studies were searched on the anatomy of ML. Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library were searched. RESULTS: All of the results were based on a total of 4694 subjects. The overall height of the ML was found to be 8.17 mm (SE =0.22). The Triangular Type of the ML was found to be the most common one. The pooled prevalence of this variation was found to be 29.33% (LCI = 23.57% ; HCI = 35.24%). The pooled prevalence of the Nodular Type was set to be 27.99% (LCI = 22.64% ; HCI = 33.67%). CONCLUSIONS: The present meta-analysis provides clinically relevant information regarding the shape, location, and height variations of the ML. Understanding such variations of the ML is crucial when performing malocclusion corrections procedures that require the ML as a landmark, namely sagittal split ramus osteotomy, and intraoral vertical ramus osteotomy. Furthermore, effective anesthetic blocks during oral and maxillofacial procedures can be accomplished with a higher success rate if the correct site of injection is identified. The possible locations of the ML should be considered in order to determine the location of the mandibular foramen and, therefore, inferior alveolar bundle in order to prevent motor, sensory, or perfusion pathology during maxillofacial and oral procedures of the lower jaw.

The surgical anatomy of the inferior alveolar nerve: a meta-analysis with clinical implications.

BACKGROUND: The main goal of the present meta-analysis was to provide physicians, especially surgeons, with crucial data on the complete anatomy of the inferior alveolar nerve (IAN). It is hoped that our results may help reduce the rates of complications in procedures associated with this anatomical entity. MATERIALS AND METHODS: Major online medical databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and Cochrane Library were searched to gather all studies on IAN anatomy, including topography, morphology, and variations. RESULTS: IAN mean thickness of the IAN in the mandibular angle area was set to 2.32 mm (LL: 1.82 ; HL: 2.78-). IAN mean thickness of the IAN in the mandibular body region was found to be 2.49 mm (LL: 2.02 ; HL: 2.98). The mean thickness of the IAN in the mental region was established at 1.70 mm (LL: 1.54 ; HL: 1.86). The mean distance from the IAN to the external (buccal) surface of the 1st molar was set to be 4.99 mm (LL: 3.84 ; HL: 6.13). CONCLUSIONS: In conclusion, this is the most up-to-date and thorough analysis of the complete anatomy of the IAN. We provided morphometric data that present the spatial relationship of the IAN with numerous anatomical landmarks in the mandibular region. These include the ramus of the mandible, the first, second, and third molars, and the body of the mandible, among others. It is hoped that the results of the present meta-analysis may be a helpful tool for physicians, especially surgeons, performing various oral and maxillofacial procedures, such as third molar removal or IAN block anesthesia.

The course of the main septum in the sphenoid sinuses - evaluation before the FESS.

The purpose of this study was to determine the course of the main septum (MS) in the sphenoid sinuses in the adult population. Materials and Methods: 296 patients (147 females, 149 males), who did not present any pathology in the paranasal sinuses, were included in this retrospective analysis of the computed tomography (CT) scans. Spiral CT scanner (Siemens Somatom Sensation 16) was used in order to glean the images of the paranasal sinuses, using standard procedure, in the option Siemens CARE Dose 4D, without using any contrast medium. Secondary reconstructions of the sagittal and frontal planes were obtained using multi- plans reconstruction (MPR) tool after obtaining transverse planes in the first instance. R e s u l t s: The course of the MS changed the most often from the anterior to the posterior part of the sphenoid sinuses. Such situation took place in 83.78% of the patients, in 32.43% of whom a clear shift to the lateral side was noticed only in the posterior part of the MS: in 18.24% of the patients to the right side, and in 14.19% of the patients to the left side. In 17.57% of the patients the lateral shift was visible in both anterior and posterior parts of the septum, where in 9.46% of the patients it was from the left side to the right, whereas in 8.11% of the patients the shift took place from the right side to the left. The MS had the shape of the letter 'C' in 22.29% of the cases, and 11.82% had the typical shape of the letter 'C,' and in 10.47% of the patients it paralleled the inverted letter 'C' (upside down). Amongst the types of the MS shifting directions the rarest was the MS that resembled the letter 'S' - 11.48% of the patients. In 5.74% of the cases it looked like the typical letter 'S,' and in 5.74% of the cases it was similar to the inverted letter 'S.' Only 16.22% of the cases had the MS that did not change its course nor its shape and ran medially in the sagittal plane from the anterior to the posterior part of the sinuses. Conclusions: In furtherance of reducing the risk of problems occurring during a surgery in the paranasal sinuses, it is prudent to have a CT scan done in all the patients beforehand, due to the high prevalence of the anatomical variations in the sinuses.

Sphenoid bone and its sinus - anatomo-clinical review of the literature including application to FESS.

Authors paid attention to anatomy and clinical implications which are associated with the variations of the sphenoid sinus. We discuss also anatomical structure of the sphenoid bone implementing clinical application of this bone to different invasive and miniinvasive procedures (i.e. FESS).

Oxygen consumption, rate of perceived exertion and enjoyment in high-intensity interval eccentric cycling.

The objectives of this article are to compare oxygen consumption (VO2) and perceptual responses between continuous and interval eccentric cycling protocols in order to test the hypothesis that metabolic demand and enjoyment would be greater for interval than continuous eccentric cycling protocols. Eleven recreationally active men (n = 9) and women (32.6 ± 9.4 years) performed a concentric cycling test to determine peak power output (PPO) followed by five eccentric cycling protocols on separate occasions: continuous eccentric cycling at 60% of PPO for 20 min at 60 rpm (CONT20@60%) and 13.2 min at 90 rpm (CONT13@60%), 4 × 4 min at 75% of PPO with 2-min rest (INT4×4@75%), 12 × 1 min at 100% of PPO with 1-min rest (INT1×12@100%) and 10 × 1 min at 150% of PPO with 1-min rest (INT1×10@150%). Gas exchange and power output were recorded continuously, and rate of perceived exertion (RPE) and enjoyment were assessed after each exercise. Total VO2 including the rest periods was the greatest (p < 0.0001) during INT1×10@150% (382 ± 73 ml kg-1) and lowest (p < 0.0001) during CONT13@60% (146 ± 27 ml kg-1). Total VO2 during INT1×12@100% (312 ± 59 ml kg-1) was greater (p < 0.0001) than CONT20@60% (246 ± 63 ml kg-1) and INT4×4@75% (257 ± 42 ml kg-1). RPE was greater (p < 0.0001) after INT1×10@150% (17 ± 2) than other conditions, but perceived enjoyment was not significantly different between protocols. It was concluded that the interval protocols increased metabolic demand without increasing RPE and enjoyment. It appears that high-intensity interval protocols can be used in eccentric cycling prescription.

Cardio-pulmonary responses to incremental eccentric and concentric cycling tests to task failure.

PURPOSE: This study compared cardio-pulmonary responses between incremental concentric and eccentric cycling tests, and examined factors affecting the maximal eccentric cycling capacity. METHODS: On separate days, nine men and two women (32.6 ± 9.4 years) performed an upright seated concentric (CON) and an eccentric (ECC) cycling test, which started at 75 W and increased 25 W min-1 until task failure. Gas exchange, heart rate (HR) and power output were continuously recorded during the tests. Participants also performed maximal voluntary contractions of the quadriceps (MVC), squat and countermovement jumps. RESULTS: Peak power output was 53% greater (P < 0.001, g = 1.77) for ECC (449 ± 115 W) than CON (294 ± 61 W), but peak oxygen consumption was 43% lower (P < 0.001, g = 2.18) for ECC (30.6 ± 5.6 ml kg min-1) than CON (43.9 ± 6.9 ml kg min-1). Maximal HR was not different between ECC (175 ± 20 bpm) and CON (182 ± 13 bpm), but the increase in HR relative to oxygen consumption was 33% greater (P = 0.01) during ECC than CON. Moderate to strong correlations (P < 0.05) were observed between ECC peak power output and CON peak power (r = 0.84), peak oxygen consumption (r = 0.54) and MVC (r = 0.53), while no significant relationships were observed between ECC peak power output and squat as well as countermovement jump heights. CONCLUSION: Unexpectedly, maximal HR was similar between CON and ECC. Although ECC power output can be predicted from CON peak power output, an incremental eccentric cycling test performed after 3-6 familiarisation sessions may be useful in programming ECC training with healthy and accustomed individuals.

Anatomical study of the palatine aponeurosis: application to posterior palatal seal of the complete maxillary denture.

The palatine aponeurosis is a thin, fibrous lamella comprising the extended tendons of the tensor veli palatini muscles, attached to the posterior border and inferior surface of the palatine bone. In dentistry, the relationship between the "vibrating line" and the border of the hard and soft palate has long been discussed. However, to our knowledge, there has been no discussion of the relationship between the palatine aponeurosis and the vibrating line(s). Twenty sides from ten fresh frozen White cadaveric heads (seven males and three females) whose mean age at death was 79 years) were used in this study. The thickness of the mucosa including the submucosal tissue was measured. The maximum length of the palatine aponeurosis on each side and the distance from the posterior nasal spine to the posterior border of the palatine aponeurosis in the midline were also measured. The relationship between the marked borderlines and the posterior border of the palatine bone was observed. The thickness of the mucosa and submucosal tissue on the posterior nasal spine and the maximum length of the palatine aponeurosis were 3.4 mm, and 12.2 mm on right side and 12.8 mm on left, respectively. The length of the palatine aponeurosis in the midline was 4.9 mm. In all specimens, the borderline between the compressible and incompressible parts corresponded to the posterior border of the palatine bone.

Difference in Pacing Between Time- and Distance-Based Time Trials in Trained Cyclists.

The purpose of this study was to compare the pacing profiles between distance- and duration-based trials of short and long duration. Thirteen trained cyclists completed 2 time-based (6 and 30 min) and 2 distance-based (4 and 20 km) self-paced cycling time trials. Participants were instructed to complete each trial with the highest average power output. Ratings of perceived exertion (RPEs) were measured throughout the trials. Average power output was not different between the 4-km and 6-min trials (324 ± 46 vs 325 ± 45 W; P = .96) or between the 20-km and 30-min trials (271 ± 44 vs 267 ± 38 W; P = .24). Power output was greater on commencement of the distance-based trials when short and long trials were analyzed together. Furthermore, the rate of decline in power output over the 1st 40% of the trial was greater in the 20-km trial than in the 30-min trial (P = .01) but not different between the 4-km and the 6-min trials (P = .13). RPE was greater in the 4-km trial than in the 6-min trial but not different between the 20-km and 30-min trials. These findings indicate that athletes commenced distance-based time trials at relatively higher power outputs than a similar time-based trial. Such findings may result from discrete differences in our ability to judge or predict an exercise endpoint when performing time- and distance-based trials.

Quantitation of condylar position in temporomandibular joint. A methodological study.

Ten CBCT scans of asymptomatic patients were evaluated on sagittal slices to obtain condylar position in temporomandibular joint. Measurements focused on antero-posterior and superior-inferior position of the condyle. The study the study was performed to investigate reproducibility of the method described before using Dahlberg formula. The method seems to be fair reproducible.

Syndrome of canal of Guyon - definition, diagnosis, treatment and complication.

Syndrome of canal of Guyon is the second after carpal tunnel syndrome, compression syndrome in the wrist. Opposite to median nerve compression, ulnar nerve compression is not very popular. However it impairs functioning of the hand even more than median nerve lesion. Authors deal with definition, possible diagnostic methods, treatment and most frequent complication.

Clinical crown lengthening - a case report.

Maintaining healthy parodontium during teeth restoration procedures is an indispensable condition for obtain- ing regular functionning and esthetics. Thus, the knowledge of correct anatomy and the influence of filling and complement on paradontium tissue is vital. Difficulty in maintaining appropriate gingival biological width (GBW) is a frequent problem encountered in this type of reconstruction. Preservation of unchanged biological width conditions predictible treatment result and, what is more, lack of inflammatory lesions in marginal parodontium. The ideal situation for parodontium is localizing the filling/complement border supragingivaly, which is at least 3 mm from alveolar process edge. In the case, when the above conditions are impossible to fulfil, elongation of clinical crown is a metod of choice. The effect is possible to achieve by surgical treatment or combined orthodontic - surgical treatment. Surgical treatment is faster and preferred procedure for indirect reconstruction, where achieving high clinical crown is necessary. Three clinical cases of performing method of surgical clinical crown elongation were presented in the article. Performing the described procedure enables correct tooth crown reconstruction and, what is most important, keeping individual toothing.

Application of Duracryl plus for preparation of corrosion casts of venous coronary tree of human heart.

Duracryl Plus is a synthetic resin, self-polymerizing copolymer of methyl methacrylate and acrylate, which is widely used in dental practice. The aim of this study was to apply it to fill the venous vascular beds of human hearts to obtain corrosion cast ready to describe wanted parameters of venous coronary vessels.

Anatomy of the pterygomandibular space - clinical implication and review.

AIM: The aim of this study was to present review of the pterygomandibular space with some referrals to clinical practice, specially to the methods of lower teeth anesthesia. CONCLUSIONS: Pterygomandibular space is a clinically important region which is commonly missing in anatomical textbooks. More attention should be paid to it both from theoretical and practical point of view, especially in teaching the students of first year of dental studies.

Mandible - clinically revisited.

Based on the current literature authors revised anatomical and clinical datas considering the mandible.

Controversies on the position of the mandibular foramen - review of the literature.

Foramen of mandible is the most important point considering the Halsted anesthesia. Position of this foramen seems to be stable, however there are lots of controversies regarded to its position. Based on the current literature authors revised datas from literature considering the location of the mandibular foramen.

Influence of postexercise cooling on muscle oxygenation and blood volume changes.

PURPOSE: The aim of this study was to investigate the effects of postexercise cold water immersion (CWI) on tissue oxygenation and blood volume changes after intense exercise. METHODS: Nine physically active men performed 30 min of continuous running (CR) at 70% of their maximal treadmill velocity (Vmax), followed by 10 bouts of intermittent running at Vmax. After exercise, one of the participants' legs was immersed in a cold water bath (10°C, CWI) to the level of their gluteal fold for 15 min. The contralateral leg remained outside the water bath and served as a control (CON). Vastus lateralis (VL) skin temperature (TskVL), VL oxygenation (tissue oxygenation index [TOI]), and blood volume changes (total hemoglobin [tHb] volume) were monitored continuously throughout exercise and CWI using near-infrared spectroscopy. RESULTS: TskVL, TOI, and tHb were not significantly different between CON and CWI during continuous running and intermittent running, respectively (P > 0.05). In contrast, TskVL was significantly lower in CWI compared with CON throughout immersion, with peak differences occurring at the end of immersion (CON = 35.1 ± 0.6 vs CWI = 16.9°C ± 1.7°C, P < 0.001). tHb was significantly lower during CWI compared with CON at most time points, with peak differences of 20% ± 4% evident at the end of the 15-min immersion (P < 0.01). Likewise, TOI was significantly higher in CWI compared with CON, with peak differences of 2.5% ± 1% evident at the 12th min of immersion (P < 0.05). CONCLUSIONS: Postexercise cooling decreased microvascular perfusion and muscle metabolic activity. These findings are consistent with the suggested mechanisms by which CWI is hypothesized to improve local muscle recovery.

[Cervical vertebral column--anatomy, fractures, treatment]. / Kregoslup szyjny--anatomia, zlamania, leczenie.

The paper deals with anatomy of human cervical spine. It shows close relation between knowledge on the normal structure and methods of treatment of different kinds of spine injuries. It describes detailed anatomy and mechanical features of cervical vertebral column, including the structure of distinct vertebrae, their joints and arrangement of muscles. It reviews also historical methods of treatment of fractures in this region considering current methods.