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Purpose: Localization of the lacrimal sac is a critical step during endoscopic dacryocystorhinostomy (endo-DCR). A "light pipe" can be used to transilluminate the lacrimal sac endonasally. We hypothesized that this may misguide the surgeon learning endo-DCR to create an osteotomy mostly posterior to the maxillary line if only the bone overlying the transillumination was to be removed, as the thinner lacrimal bone will transmit light more readily than the thicker maxillary bone of the frontal process of the maxilla that forms the anterior lacrimal sac fossa.Methods: The charts of 32 patients with primary acquired nasolacrimal duct obstruction in whom a lighted system was used during endo-DCR at Massachusetts Eye and Ear from April 2015 through October 2016 were reviewed. Patients with prior history of lacrimal surgery or trauma directly to the lacrimal sac fossa were excluded. Location of the maximal point of transillumination in relation to the maxillary line was observed and noted intraoperatively.Results: Of a total of 39 endo-DCR surgeries performed, the intraoperative transillumination point was entirely posterior to the maxillary line in 32 instances (82%).Conclusions: Use of an endocanalicular light pipe preferentially illuminates posterior to the maxillary line endonasally. The anterior lacrimal sac fossa (maxillary line and anterior as visualized endonasally) is rarely transilluminated, likely due to thicker bone in that region. Surgeons learning how to perform endo-DCR using a light pipe should be aware of this phenomenon.

Anterior mandibular dislocation (AMD) is defined as the displacement of the condylar head out of the glenoid fossa beyond the articular eminence, and that does not reduce spontaneously to its normal position. The Hippocratic method is the usual approach for condylar repositioning at most health centers although it is perceived by the patient as an unpleasant, brusque technique and outcomes are not always favorable. OBJECTIVE: The aim of this work is to describe a new simplified nontraumatic manual technique and its application in a series of cases. METHOD: A procedure based on gently and constantly guiding the patient’s mouth opening and closing movements is described in detail. RESULTS: Forty-two patients were treated with a treatment success rate of 100%, and no pain associated with the procedure. Procedure time was 1.5–7 min in 40 of the 42 treated cases. CONCLUSION: The procedure presented here is an improvement on the original technique: it is simple, fast, effective, can be performed in any setting, and avoids use of brusque force, which is the factor that causes the patient most discomfort and fear.

The surgical approach of acoustic neuroma includes translabyrinthine, transcranial fossa, suboccipital retrosigmoid sinus, and presigmoid retrolabyrinthine approach. Aims/Objective: To provide the anatomical basis for the surgical selection of presigmoid retrolabyrinthine approach by measuring the anatomical parameters of retrolabyrinthine space of the petrous bone by high-resolution CT.A retrospective study of 208 high-resolution CT (HRCT) images of 104 patients examined in our hospital were analyzed retrospectively. Forty-nine males and 55 females were included in this study. Lines were drawn on the HRCT to measure the morphological data for pre-operational assessment.Morphological data were retracted from HRCT, for preoperational assessment.Using the standard postprocessing images of temporal bone HRCT can predict the size of the retrolabyrinthine space and the degree of exposure to the inner auditory canal, providing an important anatomical index for the choice of presigmoid retrolabyrinthine approach.

Gunshot wounds involving the periorbital region pose numerous challenges due to the high morbidity related to direct and collateral ophthalmic injury. Additionally, the critical structures of the orbit are often injured, resulting in a variety of serious sequelae. The technique for bullet retrieval is also a special concern, given the limited space in the orbit and presence of critical structures. We present a 34-year-old woman who received a gunshot wound through the right orbit, with the main bullet fragment lodging itself at the junction of the anteroinferior temporalis fossa and the skull base. We retrieved the fragment through an orbitozygomatic approach, where we dissected posterolaterally through the superior orbital fissure to reach the temporal fossa. Several smaller bullet fragments were also extracted along the way to the temporal fossa. The orbitozygomatic approach was particularly useful in this case due to the nature of the gunshot wound where the bullet had traversed through the globe and orbit to the temporal fossa. This approach avoided the need for a direct incision, which avoided potential frontal branch injury and further temporalis muscle trauma. It also provided a means to seal the small cerebral spinal fluid leak.

A paddle-shaped wing, the general morphology of the humerus, and the muscles involved in wing movement are among the most characteristic adaptations to diving in penguins. Particularly, the humeral fossa tricipitalis and the musculus humerotriceps are clear examples of muscular rearrangement accompanying skeletal changes. In extant Spheniscidae, we were able to identify two heads of this muscle attaching within a different compartment of the bipartite fossa. Since the partition of the fossa appeared as a novelty during the Miocene, we propose that this might have had implications for underwater flight contributing to wing-propelled diving efficiency. Fil: Haidr, Nadia Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto de Biología de Organismos Marinos; Argentina Fil: Acosta Hospitaleche, Carolina Ileana Alicia. Universidad Nacional de la Plata. Facultad de Ciencias Naturales y Museo. División Paleontología Vertebrados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

OBJECTIVE To evaluate the safety of thermal ablation for hepatocellular carcinoma (HCC) in patients with abnormal coagulation function. METHODS Fifty-seven HCC tumours in 50 patients were treated with thermal ablation. All patients had a meted platelet count

Basosquamous carcinoma is a rare, highly aggressive variant of basal cell carcinoma with elevated rates of recurrence, perineural invasion, and metastasis. We describe a patient who presented with unilateral complete ophthalmoplegia, ptosis, optic neuropathy, and trigeminal neuropathy due to perineural intracranial invasion of nasal basosquamous carcinoma via the sphenopalatine fossa to the cavernous sinus, orbit, and infratemporal fossa. To our knowledge, this is the first reported case of basosquamous carcinoma with perineural invasion involving the cavernous sinus in the English language ophthalmic literature. Physicians should be aware of the diagnostic features, clinical challenges and aggressive nature of basosquamous carcinoma, a rare diagnosis that can lead to significant morbidity/mortality when left unrecognized.

Sachs, S. & Kear, B.P. Month, 20XX. A rare new Pliensbachian plesiosaurian from the Amaltheenton Formation of Bielefeld in northwestern Germany. Alcheringa XX, XXX–XXX. ISSN 0311-5518.We describe a new plesiosaurian from the upper Pliensbachian Amaltheenton Formation of Bielefeld in northwestern Germany. The taxon is based upon an incomplete associated skeleton comprising part of the right mandibular ramus, several teeth, a series of cervical, pectoral, dorsal and caudal vertebrae, as well as ribs, limb girdle elements including a nearly complete right scapula, and various distal limb bones. A unique character state combination serves to distinguish the Amaltheenton Formation remains from other previously documented Early Jurassic plesiosaurians. The most important features are the presence of a longitudinal notch incising the posterior rim of the glenoid fossa and retroarticular process, and a pronounced ventrolateral shelf on the scapula, both of which constitute derived states otherwise shared with Ear...

†Whakakai waipata is a new genus and species of Mysticeti from the Kokoamu Greensand (Chattian, Late Oligocene, 25–27 Ma) of ‘The Earthquakes’, North Otago. The holotype of †Whakakai waipata is a partial skull, periotics, tympanic bulla, vertebrae and scapula. The earbone morphology of †Whakakai waipata shows a unique combination of diagnostic features including: massive periotic; flange of posterior process and caudal tympanic process flooring stapedial muscle fossa; and an elongated stylomastoid fossa that invades the robust posterior process of the periotic. The tympanoperiotic features in †Whakakai waipata suggest a different acoustic niche from other Oligocene mysticetes, and by inference different feeding habits and habitat.http://zoobank.org/NomenclaturalActs/9D04EC04-1425-4631-9B96-3C279C51E928http://zoobank.org/urn:lsid:zoobank.org:act:9D04EC04-1425-4631-9B96-3C279C51E928

Purpose The purpose of this study is to determine variations in hard palate thickness among sexes and four ethnic groups to identify optimum area for temporary anchorage devices (TADs) placement. Materials and methods Cone-beam computed tomography (CBCT) volume data on 160 patients were selected. Patients belonged to one of four ethnic groups (Asian, African-American, Caucasian or Hispanic; 20 men and 20 women in each group, 16–45 years old). Hard palate thickness from the incisor fossa to the palatal root of the maxillary first molar was determined on each image and compared between sexes and ethnic groups. Results The data revealed that thickness was greatest at the paramedian area in the incisive canal zone (C-zone) and the median area posterior to the incisive foramen. A significant difference in thickness of palate was confirmed between sexes, and was approximately 0.5 mm and 1 mm greater in men at the median and paramedian, respectively. Among ethnic groups, a trend of decreasing thickness was as follows: Caucasian > Hispanic > African-American > Asian. Conclusion The anterior (incisive canal zone) paramedian and posterior median areas of the hard palate were thicker and suggest that these areas are appropriate for TADs placement. Some differences were also observed local to the paramedian in the C-zone among ethnicities. This indicates that sex and ethnicity should be taken into consideration in selecting sites for placement of TADs.

Pseudaptenodytes macraei is redescribed in detail using current avian anatomical terminology. The age of the species is constrained to the late Miocene, and two humeral autapomorphies are identified for the species: a flattened elliptical ventral portion of the fossa tricipitalis and a curved margo cranialis lacking a preaxial angle. Pseudaptenodytes macraei is a distinct taxon based on a diagnostic-type specimen, but it is recommended that the nominal congener Pseudaptenodytes minor be designated a nomen dubium pending the discovery of more complete material.

This retrospective study evaluated outcomes with the use of calvarial bone grafts (CBGs) in maxillofacial reconstruction as well as donor and recipient site complications. The records of 50 consecutive patients from a private practice were reviewed; there were 34 women and 16 men, with an average age of 32.4 years (range 16 to 66 years). Among the 50 patients, CBGs were placed in 63 sites: the ramus (10), nasal dorsum (14), maxilla/alveolar ridge (12), glenoid fossa/temporal bone (14), mandibular body/symphysis (3), and orbitozygomatic complex (10). The longest follow-up averaged 22.4 months (range 12 to 48 months). An outer-table CBG harvest technique was utilized. All subjects were evaluated for infection, dehiscence, loss of graft, and any other complications. Three complications occurred (5%) at the recipient sites. Two grafts became infected requiring removal, and one nasal dorsal graft was mobile but remained in position. At 50 donor sites, 2 complications (4%) occurred, resulting in dural tears in two patients that were immediately repaired with no untoward consequence. In conclusion, CBGs are an effective bone source for maxillofacial reconstruction with low donor and recipient site complications.

Pitana, V.G., Esteban, G.I., Ribeiro, A.M. & Cartelle, C. 2013. Cranial and dental studies of Glossotherium robustum (Owen, 1842) (Xenarthra: Pilosa: Mylodontidae) from the Pleistocene of southern Brazil. Alcheringa, 1–16. ISSN 0311-5518. Mylodontine ground sloths were studied from several Pleistocene localities of Rio Grande do Sul State: Sao Gabriel (central region), Quarai, Uruguaiana and Alegrete (western region) and Santa Vitoria do Palmar (coastal region) municipalities. The cranial and mandibular material is assigned to Glossotherium robustum based on the enlargement of the anterior portion of the maxilla, a rounded and ventrolaterally arched fossa for the estylohyal, an elliptical occipital condyle, a spatulate symphyseal region of the mandible, together with the size and degree of lobulation of the teeth. Comparison with specimens from the Pampean region of Argentina, western Uruguay and northeastern Brazil revealed that the Rio Grande do Sul material is most similar morphologically to that of th...

We describe the basal sauropodomorph Eoraptor lunensis, based on the nearly complete holotypic skeleton and referred specimens, all of which were discovered in the Cancha de Bochas Member of the Ischigualasto Formation in northwestern Argentina. The lightly built skull has a slightly enlarged external naris and a spacious antorbital fossa with a prominent, everted dorsal margin and internal wall lacking any pneumatic extensions into surrounding bones. The tall quadrate is lapped along its anterior margin by the long, slender ventral process of the squamosal, and the lower jaw has a mid-mandibular joint between a tongue-shaped splenial process and a trough in the angular. All but the posterior-most maxillary and dentary crowns have a basal constriction, and the marginal denticles are larger and oriented more vertically than in typical theropod serrations. Rows of rudimentary palatal teeth are present on the pterygoid. Vertebral centra are hollow, although not demonstrably pneumatized, and all long...

In this study we describe an isolated petrosal from the middle Eocene of northwestern Argentina assigned to Dasypodinae (Mammalia, Xenarthra, Cingulata). The specimen was recovered from the Geste Formation, Antofagasta de la Sierra, Catamarca, Argentina. The material is an incomplete right petrosal preserving the pars cochlearis and the anterior third of the pars canalicularis. It is described in detail and compared with extant and fossil cingulates. Additionally, we performed a cladistic analysis in order to define its phylogenetic position. The most remarkable traits of this petrosal include an anteromedially-posterolaterally elongated Promontorium, open cavum supracochleare, wide and smooth crista interfenestralis, roof of the post-promontorial tympanic sinus triangular, reduced, and well separated from the stapedius fossa, and poorly developed epitympanic wing and crista petrosa. The phylogenetic analysis reveals affinities with Dasypus and Stegotherium that are supported by the weakly develo...

Rhoetosaurus brownei is the only known named pre-Cretaceous sauropod from Australia. It is therefore a potentially important taxon for understanding global paleobiogeographic and phylogenetic patterns among early sauropods. Despite its obvious significance, Rhoetosaurus has been too poorly understood to be included in most recent analyses of early sauropod evolution. With this in mind, we evaluated the osteology and phylogeny of undescribed materials of Rhoetosaurus, in order to attempt to close the gap in this understanding. The lower hind limb of Rhoetosaurus highlights a plethora of differences from other sauropods, supporting the distinctiveness of Rhoetosaurus even in the absence of other materials. Some unique traits include prominent crests and sulci on the tibia medially, a narrow metatarsal articular bridge, and pedal claws with an accessory groove or fossa. The pes plesiomorphically retains four claws where most sauropods have three, and bears superficial similarity to that of Shunosaur...

The Jebel Qatrani Formation in the Fayum Depression, Egypt, has yielded a diverse hyracoid fauna that includes both small- and large-bodied forms. Thyrohyrax domorictus is one of the most common hyracoids found in the upper sequence of the Formation, from sites dating to between 29 and 31 Ma. The dental morphology of T. domorictus is more similar to that of living hyraxes than other Paleogene species, but additional morphological evidence is needed to test the hypothesis of procaviid affinities. Two fairly complete crania of T. domorictus are now known and provide a number of additional craniofacial characters for phylogenetic analysis. The specimens are comparable in size to other small-bodied Fayum hyracoids and extant procaviids. T. domorictus has a relatively long rostrum that is perforated by a nasomaxillary fossa, which is also present in Miocene Afrohyrax and Prohyrax and older Thyrohyrax pygmaeus. The anterior border of the orbit is positioned above the molars, and the orbital aperture is...

To describe the morphometric and geometric relationships of the orbital floor in a Caucasian population.Exenterations of 47 orbits from 24 formalin fixed cadavers were performed. Morphometric measurements were taken between anatomical landmarks located along the orbital floor and the orbital apex. The mean measurements were used to calculate geometric data. These results were analysed according to sex and side and compared to results from other ethnic populations.The average distances from the infraorbital foramen to the nasolacrimal fossa, inferior orbital fissure, optic canal and inferior orbital rim were 20.67 mm (± 2.42), 25.40 mm (±2.70), 43.23 mm (±3.35) and 8.95 mm (± 1.53), respectively. The average distances from the tip of the infraorbital groove to the tip of the inferior orbital fissure, lateral aspect of the inferomedial strut, optic canal and the intersection with the inferior orbital fissure were 14.08 mm (±2.41), 12.12 mm (±2.42), 35.02 mm (±3.17) and 20.05 mm (± 2.87), respectively. The distances from the tip of the inferior orbital fissure to the optic canal and the intersection with the inferior orbital groove were 29.56 mm (±2.73) and 13.37 mm (±2.76), respectively.Orbital surgeons should be aware of the morphometric relationships of the orbital floor due to the degree of variation that exists between different ethnic groups. Geometric data may be used to provide orbital surgeons with a navigational template that can be used to plan surgery and as a guide intraoperatively.

Evaluation of: Zhang GY, Liu LZ, Wei WH, Deng YM, Li YZ, Liu XW. Radiologic criteria of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma treated with radiation therapy. Radiology 255(2), 605-612 (2010). Nasopharyngeal carcinoma (NPC) is the most common nasopharyngeal neoplasm and has a high propensity for developing regional neck adenopathy. NPC arises most often in the fossa of Rosenmüller, and differs significantly from other head and neck cancers with respect to its incidence, etiology, clinical behavior and treatment. NPC is commonly associated with retropharyngeal nodes. As retropharyngeal nodes are anatomically difficult to approach for biopsy/fine-needle aspiration cytology, imaging plays a critical role in their detection and staging. The paper by Zhang et al. reports data on 303 NPC patients from a large center in China and highlights specific radiologic criteria for assessing retropharyngeal nodal metastases in nasopharyngeal carcinoma.

Most recent phylogenetic analyses place the Cainotheriidae within the Tylopoda, but doubts about this placement within Tylopoda have been persistent. The Cainotheriidae are well known from numerous specimens and their cranial anatomy is well documented from complete, partial and disarticulated cranial material. However, high-resolution computed tomographic (CT) scans can still provide additional data to resolve problems in the interpretation of the auditory region, and allow comparison with other tylopod and ruminant taxa. Cainotheriids share several features with various groups within the Tylopoda, including an enlarged mastoid fossa, an inflated auditory bulla filled with cancellous bone, the presence of a sinus venosus temporalis, and what has been interpreted as a large flange of the periotic enclosing the petrobasilar canal. The reconstruction of the petrobasilar canal has been difficult to interpret, as the published figures are unclear. A micro-CT scan of Cainotherium (YPM 25037) shows the...

Conclusion: Preoperative imaging is important, because of the small size of the cribriform plate, different anatomical variants of the olfactory fossa in varied patients and unequal width of the cribriform plate in the anterior and posterior third. Objective: Digital volume tomography (DVT) is a rather new imaging technique for the diagnosis of diseases of paranasal sinuses. This technology is dedicated to the evaluation of the distinctive structures of the anterior skull base due to the high resolution of the DVT. Based on the Keros classification this anatomic area was analyzed radiologically and also in relation to the uncinate process. Methods: The investigation was performed on 111 patients. The Accu-I-tomo F17 was used. Patients with total nasal polyposis and patients who had undergone sinus surgery were excluded from the study. Results: Keros type I was found in 11.25% of the patients, type II in 68.05% and type III in 20.7%. Significant asymmetry of the olfactory fossa was identified in nine patients (8.1%). The width of the olfactory cleft varied from 0 to 3.25 mm. No relation between Keros type and a particular onset of the uncinate process to orbit, skull base or middle turbinate could be detected.

Metriorhynchids have been interpreted as the only archosaurs entirely adapted to pelagic marine life, given the deep morphological modifications of their skeletons. The most conspicuous feature in the skull involves the “fenestra and fossa antorbitalis complex.” Exceptionally preserved natural cast of snout cavities of Geosaurus araucanensis, found in the Late Jurassic of the Neuquen Basin (northwestern Patagonia, Argentina), allow exploration of the rostral anatomy of this metriorhynchid. The presence of a paranasal sinus system, hypothetically reconstructed by other authors using EPB method approach, can now be confirmed based on direct morphological evidence. We propose that the openings classically identified in the literature as internal and external antorbital fenestrae of metriorhynchid have been misidentified; the preorbital opening of metriorhynchids is a neomorph associated with a novel salt gland that evolved independent of the antorbital fenestra, and that the true antorbital cavity o...

To report a novel method of repairing a large periorbital defect with exposed bone, using a pedicled temporalis muscle flap and split thickness skin graft.Interventional case note review with clinical photographs, computerised tomography (CT) imaging, intra-operative photographs and histology.A 77-year-old man presented with an extensive neglected ulcerating lesion extending from the left lateral canthus to the tragus of the left ear. An incisional biopsy of the 15 cm lesion confirmed the clinical diagnosis of an invasive squamous cell carcinoma. A CT scan demonstrated the tumour depth and there were no infra-temporal fossa or intra-orbital extensions or associated lymphadenopathy. A wide surgical excision was performed which resulted perioperatively in a large area of exposed zygomatic and temporal bone. A pedicled temporalis muscle flap was rotated to cover the exposed bone and therefore allow placement of a split thickness skin graft. At 3 months' follow-up the graft is viable and the surgical rehabilitative result is satisfactory.A pedicled temporalis muscle flap and split thickness skin graft is a good one-stage reconstruction technique when faced with a large area of exposed bone. The temporalis muscle provides a suitable recipient site for a split skin graft and enhances its chances of survival. This technique, to our knowledge, had not previously been reported in the literature.

Various transpetrosal approaches have been described for excision of lesions extending into both the middle fossa and the upper petroclival region. These approaches may be associated with significant morbidity. Six patients with lesions along the medial part of the middle fossa and the upper petroclival region were operated by the trans-sylvian transtentorial approach. The surgical corridor was along the tentorial edge with excision of the tentorium providing adequate access to the tumour without the need for petrosectomy. Three patients had a trigeminal schwanomma, one each had a petroclival meningioma, clival chordoma and an epidermoid tumour. In 5 patients a total/near total excision was achieved while in one patient with petroclival meningioma, a subtotal excision was possible. All patients improved clinically after the surgery. There was no procedure related morbidity. The transsylvian transtentorial approach provides adequate access to upper petroclival lesions allowing the tumours in this region to be removed without the need for a petrosal resection.

This study evaluated 1) the efficacy of packing autologous fat grafts around temporomandibular joint (TMJ) total joint prosthetic reconstructions to prevent fibrosis and heterotopic bone formation and 2) the effects on postsurgical joint mobility and jaw function. One hundred fifteen patients (5 males and 110 females) underwent TMJ reconstruction with total joint prostheses and simultaneous fat grafts (88 bilateral and 27 unilateral) for a total of 203 joints. The abdominal fat grafts were packed around the articulating portion of the joint prostheses after the fossa and mandibular components were stabilized. Patients were divided into two groups: group 1 (n = 76 joints) received Christensen total joint prostheses, and group 2 (n = 127 joints) received TMJ Concepts total joint prostheses. Clinical and radiographic assessments were performed before surgery, immediately after surgery, and at long-term follow-up. In group 1, maximal incisal opening (MIO) increased 3.5 mm, lateral excursions (LE) decreased 0.2 mm, and jaw function improved 1.9 levels. In group 2, MIO increased 6.8 mm, LE decreased 1.4 mm, and jaw function improved 2.4 levels. The improvement for MIO and patient perception of jaw function in both groups was statistically significant; no significant difference was found for LE. There was no radiographic or clinical evidence of heterotopic calcifications or limitation of mobility secondary to fibrosis in either group. Twenty-five Christensen prostheses (33%) were removed because of device failure and/or metal hypersensitivity; no fibrosis or heterotopic bone formation was seen at surgical removal. Four TMJ Concepts prostheses (3%) were removed because of metal hypersensitivity. In all instances, removal of the prostheses was unrelated to the autologous fat grafting. Ten patients (8.7%) developed complications involving the fat donor site: two patients (1.8%) developed abdominal cysts requiring surgery, and eight patients (6.9%) developed seroma formation requiring aspiration. Autologous fat transplantation is a useful adjunct to prosthetic TMJ reconstruction to minimize the occurrence of excessive joint fibrosis and heterotopic calcification, consequently providing improved range of motion and jaw function.

A wide range of disease process involve the lacrimal gland/fossa. In this pictorial review, we use histology-proven cases to illustrate conditions that affect the lacrimal gland/fossa. CT and MRI features of neoplastic, inflammatory, infiltrative, and developmental conditions are discussed.

Richalpheus dahabensis n. sp. is described from a single female specimen collected at a depth of 10–13 m from the mound of the callianassid mudshrimp, Glypturus sp., in the shallow lagoon near Dahab, Egyptian Red Sea. The new species differs from the type species, R. palmeri Anker and Jeng, 2006, by the absence of the fossa/tooth system on the pollex of the major chela. The diagnosis of Richalpheus is emended to accommodate the new species. The two possible pathways for the evolution of the fossa/tooth system within the leptalpheoid lineage are discussed.

The dicynodont species “Cryptocynodon” parringtoni von Huene, 1942 was described from a single poorly preserved specimen collected from the Upper Permian Kawinga Formation, Ruhuhu Basin, Tanzania. No additional specimens have been referred to the species since its erection. Two new specimens of “C.” parringtoni, which were collected from the Kawinga Formation in 1933, are described. The holotype and new specimens share tusks, the absence of postcanine teeth, a shortened snout, relatively large palatines that contact the premaxillary secondary palate, a blade-like mid-ventral vomerine plate, and an intertuberal ridge between the basisphenoid-basioccipital tubera. The new specimens also allow the description of many previously unknown characters of the species, including an intertemporal region in which the postorbitals extensively overlap the parietals but are relatively horizontally oriented for most of their width; the presence of paired anterior palatal ridges; the absence of a labial fossa; th...

Primary optic nerve meningiomas occur at lower ages than meningiomas arising from the coverings of the brain and spinal cord. Here we report the case of a 20-year-old female with an aggressive orbital meningioma referred to the Ophthalmology Department of the Farabi Hospital in Tehran. The patient had a history of orbital meningioma from 10 years ago and several surgical resections due to tumor recurrence during these 10 years. On admission, the patient had a large orbital mass and severe proptosis. MRI images revealed a large left orbital mass with optic nerve involvement and extension to the left maxillary sinus, pterygoid fossa and the dura in the floor of the anterior fossa. Fine-needle aspiration cytology of the mass confirmed tumor recurrence. The patient first received radiotherapy due to the inoperable mass, and the tumor was resected 1.5 month later. Microscopic study showed meningotheliomatous meningioma with extensive involvement of the optic nerve and invasion of the optic disc, sclera and choroid. The interesting aspect of this case was the aggressive behavior of the tumor with intraocular invasion, despite its benign histopathological features, which led to wide exenteration of the eye together with resection of the upper and lower lids.

The management of the normal appearing appendix during laparoscopy for right fossa syndrome remains a matter of debate when no other cause is found. Recent data suggest that the appendix modulates both the normal brain-gut axis and the pathophysiology of inflammatory bowel disease by neuro-immunological pathways. Recurrence of symptoms caused by acute appendicitis is uncommon when the appendix is left in place. The decision to remove a normal appendix should therefore not be taken lightly, but after consideration of the patient's age, medical history and expectations as well as the timing and specificity of the presenting symptoms. An overview of the relevant literature is provided with an algorithm to aid in clinical decision making.

Fossil crania from the late middle or early late Miocene (ca. 12–10 Ma) Ichibangawa Formation, Hokkaido, northern Japan, are described as a new genus and species of the archaic odobenid, Pseudotaria muramotoi, gen. et sp. nov. Pseudotaria muramotoi is characterized by having a dorsoventrally thick, posterolaterally expanded pterygoid strut, bony tentorium appressed to the petrosal (odobenid synapomorphies), double-rooted M1, reduced pseudosylvian fossa, and transversely arched palate (basal odobenid synapomorphies), and by retention of double-rooted premolars, except the P1. A phylogenetic analysis reveals that P. muramotoi possesses basal odobenid synapomorphies but lacks synapomorphies of the later diverging odobenids, and therefore, the taxon is nested in the paraphyletic stem group within the Odobenidae. The analysis also indicates that P. muramotoi might be viewed as a metataxon that shows the least modified condition in the transformation series to the later diverging odobenids.

To study a radiological classification, originally described by Keros in 1965, which provides an objective assessment of anterior skull base anatomy relevant in patients undergoing external medial orbital decompression.The classification is based on anatomical landmarks measured via coronal CT-scan. The patients are divided into 3 Keros categories based on their olfactory fossa depth; Keros 1 (1-3 mm), Keros 2 (4-7 mm) and Keros 3 (8-16 mm). A cross-sectional group of 32 consecutive patients on the hospital radiology database with coronal CT scans were classified according to the Keros system.All the patients fell into one of the three Keros categories. Anatomical associations of the Keros classification suggest that Keros 1 patients have the least risk of intracranial entry whilst Keros 3 patients carry the greatest risk.Keros classification provides an objective assessment of anterior skull base anatomy and can therefore guide the surgeon on the superior extent of medial wall bone removal during orbital decompression. This may help improve the safety profile of the procedure.

A partial rostrum with an attached lower jaw, a posterior neurocranium, and a proximal hyomandibular from the Lincoln Creek Formation (late Oligocene, Washington) are described and identified as Aglyptorhynchus columbianus sp. nov. In addition, ten articulated anterior caudal vertebrae presumably from the Lincoln Creek Formation are described and identified as Aglyptorhynchus sp. This is a second record of an Aglyptorhynchus from a deposit bordering the Pacific Ocean. The specimens are compared with other billfishes (Perciformes: Scombroidei), both extant and extinct. Unusual features include a tripartite celous occipital condyle composed equally of the basioccipital and exoccipitals, a lower jaw that is nearly twice as deep as the corresponding section of the rostrum, a subtemporal fossa, an oval-shaped fossa in the parasphenoid, two sphenotic ridges separated by a fossa, a bifurcated pterotic ridge, and a hyomandibular with a laterally curved posterior margin. With the exception of the deep low...

Invasive aspergillosis is observed mainly in immunodepressed patients. Here we report a case of pulmonary aspergillosis with CNS involvement in a pregnant woman without other known causes of immunodeficiency.A 23-years old pregnant woman underwent a caesarean because of unexplained seizures. During the subsequent days worsening headache and a deteriorating neurological status were reported suggesting meningitis. Stiffness, right sided hemiparesis and cranial nerve palsies were observed at admission. Radiological findings revealed lesions involving the right pulmonary apex, the right cerebellar hemisphere and the Pterygopalatina fossa. Microbiological studies revealed large colonies of Aspergillus fumigatus. A favorable outcome was observed after administration of liposomal amphotericin B and 5-fluorocytosine and, at improved conditions, when oral uptake of itraconazole was given. The authors conclude that risk of infections sustained by fungal opportunistic agents during pregnancy must be considered. Sequential antifungal administration may be an efficient therapy able to shorten hospitalization.

An exceptionally well-preserved skull and associated dentary from the Chiquimil locality in the Andal-huala Formation (Huayquerian Age, late Miocene), Santa Maria Basin, Catamarca Province, northwestern Argentina, represent a new giant porcupine, Neosteiromys pattoni, sp. nov. N. pattoni is derived relative to Neosteiromys bombifrons Rovereto, 1914, the type species of the genus, by having pentalophodont m2-m3, a markedly infected angular region, more prominent masseteric crest, deeper masseteric fossa, and larger auditory bullae. Both species of Neosteiromys appear to have been adapted to eat harder, more abrasive food items than those consumed by extant porcupines, as inferred from their stronger masticatory apparatus. They may have inhabited more open environments than those of living Neotropical porcupines.

The skull and dentition were analysed and compared in a number of species of Old World scincid lizards, genus Chalcides (including Sphenops). The major differences are related to the decrease in absolute skull size, which entails an increase in the relative size of the otic capsule and the progressive obliteration of the supra‐ and post‐temporal fossae. The greatest reduction of the post‐temporal fossa is observed in the smallest species, resulting in close proximity of parietal and supraoccipital bones and in a possible reduction of metakinesis. Another major difference concerns the relationships between pre‐ and post‐frontal bones, widely separated in Chalcides sensu stricto and articulated in the taxa formerly attributed to the genus Sphenops. This close connection likely represents an internal reinforcement preventing deflection or fracture in these sand‐swimming taxa by reducing the mobility of the fronto‐parietal mesokinetic joint. The teeth are conical, pleurodont and ankylosed to the inne...

Three acaremyid rodents from the Miocene of Patagonia are described. Galileomys antelucanus, gen. et sp. nov. (Colhuehuapian SALMA, early Miocene) is the most plesiomorphic genus within the Acaremyidae. Galileomys? colloncurensis, sp. nov. is the first acaremyid recorded from the Colloncuran SALMA (middle Miocene). The generic referral is tentative because the known material does not display enough characters. Acaremys cf. murinus Ameghino, 1887 represents a second Colhuehuapian acaremyid. Cladistic analyses of dental and mandibular characters do not support previous hypotheses that Sciamys and Acaremys are the ancestors of the Octodontidae. On the contrary, these two genera and Galileomys constitute a monophyletic group united by the presence of a hypoflexus in P4, a well defined anterodorsal limit of mandibular masseteric fossa, and a figure-eight-shaped molar pattern. The inclusion of other genera in the Acaremyidae is not supported by cladistic analysis. A shared figure-eight-shaped dental pa...

Two well-preserved specimens of a “cetothere” from the Lower Miocene Awa and Mizunami Groups, Japan, are described as Isanacetus laticephalus, gen. et sp. nov. It is distinguished by the following combination of characters: fossa for the stapedial muscle elongated anteroposteriorly, with a fully ossified floor; anteroposteriorly broad supraorbital process of frontal, with the orbital margin concave in dorsal view; posterior thrust of the medial rostral elements reaches the level of the center of the orbit; apex of the occipital shield reaches beyond the level of the anterior end of the zygomatic process of the squamosal; nasal slender, elongate, and partly located anterior to level of the preorbital angle of the supraorbital process of the frontal; and zygomatic process of the squamosal slender, elongate, and directed forward and slightly outward. A parsimony analysis of 16 cetaceans and 77 characters failed to identify any synapomorphies for the “Cetotheriidae.” The analysis supports the followi...

The morphology and systematic position of the capitosauroid amphibian “Parotosuchus” africanus (latest Early(?)–earliest Middle Triassic, Middle Cynognathus Subzone, Karoo Basin, South Africa) are re-evaluated on the basis of a nearly complete, hitherto undescribed, skull from the Museum of Paleontology, University of California. The attribution of the UCMP specimen to “P.” africanus is based on direct comparison with the holotype. This species is shown to be markedly advanced over the Parotosuchus level in the structure of the tabulars and the postglenoid division of the lower jaw, in the shape of the posterior rim of the mandibular adductor fossa, and in the strong development of the medial plate of the surangular. This pattern of the cranial structure is combined with a set of primitive characters lost in true Parotosuchus, such as the broad nasals, weakly developed interorbital projections of the frontals, elliptic choanae, short palatal exposure of the parasphenoid cultriform process, and a ...

Neurenteric or enterogenous cysts are rare, congenital, benign lesions of the central nervous system. Not more than 35 case reports of neurenteric cysts occurring in the cranial cavity have been documented. We describe two cases of intracranial neurenteric cysts.

Leptotragulus, from the upper middle Eocene of North America, is the most plesiomorphic member of the Protoceratidae, an enigmatic group of selenodont artiodactyls. Until now Leptotragulus was known primarily from teeth, limb bones and a few skull fragments. A previously undescribed series of crania shows that Leptotragulus exhibits the typical protoceratid skull morphology, with a broad, flattened forehead, pronounced lambdoid crests enclosing a deep complexus fossa, and broad occipital condyles with a pronounced anteroventral margin. It is suggested that these features, which are suited to forms of agonistic, intraspecific behaviour such as head-butting, may indicate that the evolution of such behaviour occurred comparatively early in the history of the protoceratids. Study of the anatomy of the otic region in Leptotragulus suggests that there are a number of similarities in periotic morphology between leptotragulines and plesiomorphic ruminants such as hypertragulids and leptomerycids, which m...

Schwannomas are rare benign nerve sheath tumours that account for 1% of orbital tumours and, although sometimes associated with neurofibromatosis, most occur as isolated lesions and arise from branches of the ciliary or trigeminal nerves.Two rare cases of Schwannoma arising within the lacrimal gland fossa are presented, these tumours being managed with intact surgical excision.A 66-year-old Caucasian female was referred with 6 months of progressive left painless proptosis and intermittent diplopia. Restriction of left upgaze was associated with 3 mm relative proptosis. On a presumptive preoperative diagnosis of pleomorphic adenoma, the patient underwent a bone-swinging lateral orbitotomy with intact excision of a moderately-firm, lobulated lesion which proved to be a Schwannoma. A 30-year-old White female was referred with a 4-year history of slowly progressive right supratemporal periocular lump. There was 2 mm of right relative proptosis and slight restriction of right extraocular movements. Although lacrimal gland remnants were present at the edge of both specimens, at surgery it was evident that the tumours completely occupied the lacrimal gland fossa and any normal orbital lobe of the lacrimal gland had undergone atrophy.Two very rare cases of Schwannoma arising within the lacrimal gland fossa are presented, the tumours causing complete atrophy of the normal orbital lobe of the lacrimal gland.

Observations of four crania of the homacodont artiodactyl Bunomeryx suggest that this taxon has strong affinities with the Tylopoda. In particular, Bunomeryx possesses a deep mastoid fossa on the endocranial surface of the petrosal, a feature which is confined, within the living artiodactyls, to the Camelidae. Mastoid fossae are also found in members of the Cainotheriidae, Anoplotheridae and Xiphodontidae (collectively Anoplotheroidea), suggesting that the presence of a mastoid fossa may be a feature linking Bunomeryx to more derived artiodactyl taxa in the late Eocene of North America and Europe. Expansion of the ventral margin of the petrosal and its contribution to the roof of the petrobasilar canal, together with a reduction in the size of the internal auditory meatus, are characters which may unite a broader grouping of camelids, anoplotheroids, oreodonts and bunomerycids. While not providing any additional evidence for the ongoing debate on the ruminant affinities of the protoceratids, the ...

Migration of retained bullets or bullet fragments may present as a complication of gunshot wounds to the head. This phenomenon has been reported in cases of abscess formation or retained copper fragments. Management of such migratory fragments is controversial. The purpose of this study is to determine the incidence of fragment migration in a population of neurosurgical patients treated for gunshot wounds to the head. Two-hundred and thirteen cases treated at Detroit Receiving Hospital between 1985 and 1987 were reviewed. Each patient treated had initial and one week follow-up imaging studies. Nine cases of documented migratory intracranial bullet fragments were identified. Thus, the incidence in this population is 4.2%. The fragments in eight cases were composed of copper, and in the remaining case, lead. No case was associated with an abscess. Fragments in the anterior fossa were found to migrate towards the sella turcica, while those of the middle fossa and posterior hemispheres migrate towards the confluence of sinuses (Torcula Herophili). Fragment migration was documented as early as 36 h post-injury. Based on this study, we recommend serial imaging studies to look for migrating bullet fragments and surgical removal aided by intra-operative ultrasound to localize the fragment when possible.

We present a case of severe intractable epistaxis after midfacial trauma in which the bleeding was identified as coming from the descending palatine artery, a branch of the maxillary artery. It could not be controlled by simple packing, and was stopped by inserting a balloon into the maxillary sinus, tamponading the injured vessel in the sphenopalatine fossa (pterigopalatine fossa). We describe an easy and practical emergency manoeuvre to control bleeding from inaccessible branches of the maxillary artery and to prevent rebleeding after embolisation.

Cranial features of Prosalirus bitis, an Early Jurassic anuran from the Kayenta Formation, include a dentigerous premaxilla and maxilla; a parasphenoid with a lanceolate cultriform process and posterolateral alae; a well ossified, unpaired sphenethmoid; and a stapes of modern form. The atlas bears a notochordal fossa between the cotyles. The number of vertebrae is unknown but anterior, middle, and posterior presacrai vertebrae are represented. The sacrum, which lacks postzygapophyses, possesses elongate, narrow alae and a cartilaginous intercentral articulation with a short urostyle. The appendicular skeleton exhibits a relatively primitive glenoid, prolongation of the iliac shaft, elongation of the hind limbs, radio-ulnar and tibiofibular fusion, and unfused, elongate proximal tarsals. Mobile sacro-urostylic and ilio-sacral joints are important kinetic links in the anuran caudopelvic mechanism for saltation. The angular appearance of the back common among living anurans reflects a pronounced fle...

The rich Pleistocene (Ensenadan) mammalian fauna from Tarija, Bolivia, contains abundant fossil horses. Traditionally, it has been stated that three genera, Equus and the hippidiforms Hippidion and Onohippidium, and as many as five species are represented by the equids in the Tarija fauna. Recently, it has been proposed that Onohippidium is a junior synonym of Hippidion and thus there is only one valid genus of hippidiform at Tarija. The present study reports new data from upper and lower dentitions, metapodials, and the skull (particularly the preorbitai facial fossa) showing that three monospecific equid genera are present in the Pleistocene of Tarija, including the primitive hippidiforms Hippidion principale and Onohippidium devillei, and the advanced equine Equus insulatus. The genus Onohippidium is indeed valid and distinct from Hippidion based on facial characters, dental pattern, and metatarsal proportions. Comparisons with relevant equids from North America confirm that the hippidiform ho...

The purpose of the present study was to analyse the position of the glenoid fossa in subjects with different sagittal and vertical skeletal features. A cephalometric study was carried out on a sample of 180 subjects (90 males and 90 females, aged 7-12 years) who were combined to form three groups (60 subjects each) according to skeletal sagittal relationships and three groups (60 subjects each) according to skeletal vertical relationships. Cephalometric analysis comprised both sagittal and vertical measurements for the assessment of the position of the glenoid fossa in relation to surrounding skeletal structures. As for sagittal measurements, TMJ position was more posterior in skeletal Class II when compared with skeletal Class III. In the vertical plane, the position of the glenoid fossa relative to basicranial structures was more caudal in low angle subjects when compared with subjects with normal or high angle vertical relationships. Both basicranial structures and the posterior nasal spine may be used as reference structures for the assessment of vertical position of the glenoid fossa in diagnosis and treatment planning.

Dacryocystectomy was a commonly used operation for dacryocystitis before dacryocystorhinostomy became more popular. At present, the major use of this procedure is for tumors of the lacrimal sac and less frequently for correction of chronic dacryocystitis in the elderly. Although the operation has a relatively low rate of complications, scarring in the medial canthal area, recurrent infections in the lacrimal sac fossa, regeneration of the lacrimal sac and recurrence of the malignancies may occur postoperatively.A 29-year-old woman who had undergone removal of her right lacrimal sac for dacryocystitis eleven years ago presented with a mass in the right lacrimal sac region. She had had bilateral epiphora since childhood. Ocular examination showed a non-tender, cystic mass in the right medial canthal region. She had upper and lower punctal agenesis bilaterally. Computed tomography demonstrated a soft tissue mass located medial to the globe that extended to the proximal nasolacrimal duct. The lesion was excis...

Disk displacement of the temporomandibular joint (TMJ) without reduction has been considered a fundamental pathophysiologic abnormality of the joint. In this paper there are supportive clinical and MRI evidence of a successful repetitive manipulative technique for the treatment of acute and chronic locking. In 1500 treated cases, documented on videotape, only five cases required surgical intervention. The success of the therapy was confirmed by 13 MRI images of the TMJ of patients with acute and chronic locking before and after therapy. In all cases the anteriorly dislocated disk in closing and opening position was recaptured and repositioned in a normal position in the temporomandibular fossa. Three complete cases are reported with complete clinical and MRI documentation.