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Background Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin. Objective This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear. Methods and materials Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed. Results The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management. Conclusion Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.

The spectrum of adrenal masses in the pediatric population markedly differs from that in the adult population. Imaging plays a crucial role in detecting adrenal masses, differentiating malignant from benign lesions, recognizing extra-adrenal lesions in the suprarenal fossa, and directing further management. Ultrasound is the primary imaging modality of choice for the evaluation of adrenal masses in the neonatal period, whereas MRI or CT is used as a problem-solving tool. In older children, computed tomography or magnetic resonance imaging is often required after initial sonographic evaluation for further characterization of a lesion. Herein, we discuss the salient imaging features along with pathophysiology and clinical features of pediatric adrenal masses.

Background and objectivesImage-guided intervention of the suprascapular nerve is a reported treatment to manage chronic shoulder joint pain. The suprascapular nerve is conventionally targeted at the suprascapular notch; however, targeting of its branches, the medial and lateral trunks, which are given off just posterior to the notch has not been considered. Since the lateral trunk supplies the posterior supraspinatus and articular branches to the glenohumeral joint capsule, while the medial trunk provides motor innervation to the anterior region, it may be possible to preserve some supraspinatus activation if the medial trunk is spared. The main objective was to investigate whether midpoint between suprascapular and spinoglenoid notches is the optimal target to capture articular branches of lateral trunk while sparing medial trunk.MethodsIn 10 specimens, using ultrasound guidance, one 17 G needle was placed at the suprascapular notch and a second at midpoint between suprascapular and spinoglenoid notches. The trunks and needles were exposed in the supraspinous fossa, digitized and modeled in 3D. Lesion volumes were added to the models to asses medial and lateral trunk capture rates. Mean distance of needle tips to origin of medial trunk was compared.ResultsConventional notch technique captured both lateral and medial trunks, whereas a midpoint technique captured only lateral trunk. Mean distance of needles from the origin of medial trunk was 5.10±1.41 mm (notch technique) and 14.99±5.53 mm (midpoint technique).ConclusionsThe findings suggest that the midpoint technique could spare medial trunk of suprascapular nerve, while capturing lateral trunk and articular branches. Further clinical investigation is required.

This article reports a patient with unruptured right vertebral artery aneurysm which deviates across the midline to the left side. The contralateral (left) transcondylar fossa approach with bilateral V3 exposure is used for aneurysm clipping. The literature related to this technique is also reviewed.

WOS: 000500024900111 PubMed: 31343591 Objectives: The authors investigated the olfactory fossa (OF) in patients with unilateral nasal septal deviation (NSD) and presented the lateral lamella-cribriform plate angle (LLCPA). Methods: Paranasal sinus computed tomography images of 300 adult subjects with unilateral NSD (111 males, 189 females) were evaluated retrospectively. Septal deviation angle (SDA), Keros Classification, OF depth and width, LLCPA; and orbital plate and cribriform plate (OPCP) distance were measured. Results: The OF depth values (ipsilateral, contralateral) were found as Keros III >Keros II >Keros I (P-adjustedKeros II and Keros I >Keros III (P-adjusted

Objective To investigate the incidence of postoperative overall complications or secondary procedures following distal radius fractures treated by volar locking plate (VLP) Methods Electronic medical records (EMR) of 1152 patients with 1175 distal radius fractures treated by volar locking plate between January 2013 and September 2018 were retrospectively reviewed and the data were extracted. The picture archiving and communication system (PACS) was inquired to assess the fracture severity and to determine the fracture type. Univariate and multivariate logistic regression analyses were used to identify the associated risk factors. Results During the median follow-up period of 6 months, a total of 138 complications in 131 patients were determined, indicating the accumulated rate of 11.7%; there were 68 cases of secondary procedures, with the rate of 5.8%. The independent associated factors for postoperative overall complications were AO type C fracture (OR, 2.6; 95%CI, 1.2 to 4.0), open fracture (OR, 4.2; 95%CI, 1.9 to 6.5), and significant collapse of the lunate fossa (OR, 2.9; 95%CI, 13 to 4.3), and for secondary procedures were significant collapse of the lunate fossa (OR, 3.7; 95%CI, 1.7 to 6.4) and the low-volume of surgeons (OR, 95%CI, 1.2 to 3.6) Conclusions Identification of these factors is of importance for the risk assessment of postoperative complications and the additional need of surgery. For patients with the above factors, especially those with combined risk factors, optimized operation scheme and high-volume surgeon should be considered to prevent or reduce the complications.

Background Upper lip burns and skin grafts used for the resulting deformities all contract, leading to distortion of regional tissues and producing a flattened upper lip devoid of normal anatomic landmarks. Absence of the philtral contour draws attention to the upper lip and can accentuate other reconstructive inadequacies. Philtral restoration requires a 3-dimensional reconstruction capable of resisting contractile forces to restore and maintain normal relationships between the upper and lower lips. Methods This was a 34-year retrospective review of a single surgeon's experience using a composite triangular fossa graft from the ear for philtral reconstruction. Ten patients were identified and analyzed using records of follow-up examinations, long-term clinical evaluations, and photographic documentation. Results Five males and 5 females were identified with 2- to 34-year follow-up. Age at operation ranged from 14 to 52 years. Percent total body surface area ranged from less than 1% to greater than 90%. Previous upper lip grafts prior to the auricular graft included 5 full-thickness skin grafts and 5 split-thickness skin grafts. No significant complications were noted. All patients were satisfied with the end aesthetic result and donor site morbidity. Conclusions A triangular fossa composite graft restores and preserves the philtral dimple and corrects the obvious visible deformity of a featureless upper lip. Addition of tissue loosens the lip transversely, and the cartilage component provides a consistent and predictable upper lip position. This results in improved projection, a concave shape to the upper lip, and a better relationship with the lower lip. Restoration of this anatomic landmark creates a more normal-appearing upper lip and helps to minimize the negative impact of other abnormalities in this vitally important area. The overall improvement in total facial appearance can be profound.

Objective The taxonomic affiliations can be detected via the skull morphology. The objective of this study was to give a detailed gross anatomical and radiographic description of the bones and foramina of the skull and mandible of the lion. This information could be used in the identification of the skull and mandible of the lion, which is of great importance in taxonomic affiliation and to help the zoo veterinarians to detect, diagnose, and treat head conditions. Materials and Methods The current work was conducted on two skulls and mandibles of lions. The skulls and mandible were prepared using standard boiling and maceration technique. The gross and radiographic photos of the bones and foramina of the skull and mandible were taken using a Kodak digital camera and Siemens mobile full wave X-ray machine (Siemens Medical Solutions, Erlangen, Germany). Results The skull of the lion comprised of facial and cranial parts. The nasal openings were large, and the bony orbit was incomplete. The supraorbital foramen was absent. The zygomatic arch was large. The frontal region had a deep longitudinal depression dorsally. The mandible was a paired bone with movable articulation, and it had strongly excavated masseteric fossa with a well-developed crest. The dental formula was 30 teeth consisting of small incisors, long canines and carnassial premolars. Conclusion The current study showed that the osteology and foramina of the skull and mandible of the lion were similar to those of other mammals. The information is important for taxonomic affiliation, and wildlife forensic as well as to help the zoo veterinarians to manage clinical head diseases in this species.

To compare characteristics of temporomandibular joint (TMJ) and related structures according to Angle class I, II1, II2, and III. 123 Chinese patients (13–36 years old, 60 males, and 63 females) were classified in four groups according to Angle’s classification: skeletal class I (31 patients), skeletal class II division 1 (30 patients), skeletal class II division 2 (30 patients), and skeletal class III (32 patients). Left and right TMJs of each subject were evaluated independently with cone-beam computed tomography (CBCT). The position of condyle in the joint fossa was analyzed according to Pullinger. There were significant differences between class III subjects and class I, II1, II2 in the superior joint space (p

Oceanites oceanicus (Procellariiformes, Hydrobatidae), commonly known as Wilson’s storm-petrel, is a small seabird frequenting the South Atlantic Ocean during the austral summer. Although a number of adaptations (such as the development of salt glands, two long and tubular external nostrils, an extraordinary olfactory system, and a hooked bill covered by several horny plates) are shared with all other Procellariiformes, the ongoing discrepancy between molecular and morphological data highlights the limited osteological information available for O. oceanicus. However, we strongly believe that osteology provides significant information to understand the evolutionary history of different groups of birds. Comparative analysis of the cranium and mandible shows that adult specimens of O. oceanicus have a globose and completely fused cranium without visible sutures, and a short beak. Besides, as in other storm-petrels, the fossa glandulae nasale is interrupted by the development of the processus postocularis and the angulus postocularis; the os lacrimale develops a complex structure, with a fenestra innominata between the rostral process of the lacrimal and the os frontale; the lamina parasphenoidalis has a simpler structure with poorly defined boundaries and without processi; and the processi basipterigoidea are present.

Purpose To analyze the morphology of the lacrimal sac fossa in the Japanese population using computed tomographic images. Materials and methods One-hundred-fifty-five Japanese patients diagnosed with unilateral orbital fracture were retrospectively reviewed. Measurements of the dimensions of the lacrimal sac fossa were taken on three anatomical planes (upper, middle, and lower planes) using a digital caliper/protractor tool. Results The mean maximum thickness of the maxillary bone at the upper, middle, and lower planes of the lacrimal sac fossa were 4.60 mm, 5.07 mm, and 6.30 mm, respectively. The midpoint thickness of the maxillary bone at each plane were 3.04 mm, 3.00 mm, and 2.17 mm, respectively. The lacrimal bone thickness at each plane were 1.13 mm, 1.13 mm, and 1.08 mm, respectively. The proportion of the lacrimal sac fossa comprising of the lacrimal bone at each plane were 39.00%, 42.05%, 38.92%, respectively. On the middle plane, the mean angle between the lacrimal bone and sagittal plane was 131.92°. Conclusions In Japanese patients, the proportion of the lacrimal bone on the lacrimal sac fossa tended to be of greater proportion compared to studies done on other races. The mean angle of the lacrimal sac fossa seemed to be comparatively high. These results indicate that performing an osteotomy during dacryocystorhinostomy could be relatively easier in the Japanese population compared to other races.

Background Primary intraosseous meningioma is a subset of extradural meningioma that arises in the bone, and only a few cases have been reported to date. Case presentation An 80-year-old man presented with decreased hearing on the right side accompanied by a disturbance of balance 10 months prior to admission. Magnetic resonance imaging revealed an 8 × 7 cm osteolytic mass in the right posterior fossa related to the petrous bone, with extension to the cervical region. During surgery, the tumor was found to be located extradurally, with no invasion of the dura. The tumor was removed entirely, apart from a small portion around the jugular foramen to avoid lower cranial nerve injury. Conclusion The final diagnosis was primary intraosseous osteolytic meningioma with atypical pathology. Here, we report a rare case of an osteolytic skull lesion in the skull base not invading the dura and with extensive bone destruction. Electronic supplementary material The online version of this article (10.1186/s12883-019-1392-5) contains supplementary material, which is available to authorized users.

Objective The aim of this study was to evaluate the prevalence of osteoarthritic alterations in the osseous components of the temporomandibular joint (TMJ) in asymptomatic patients with different skeletal patterns, gender, and age groups with cone beam computed tomography (CBCT) images. Study Design CBCT images of 213 asymptomatic patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex. Each TMJ was evaluated separately and was classified as normal, indeterminate for osteoarthritis, or affected by osteoarthritis. Differences were tested by using the χ2 and Fisher's exact tests (P Results In total, 52.3% of the joints presented some visible alteration in the osseous components. Abnormalities were detected in 32.6% of the condyles and 31.5% of the articular fossae/eminences, and flattening was the most prevalent alteration in all classes. There was no statistically significant difference in the prevalence of alterations in either the condyle or the articular fossa/eminence among the skeletal groups for the entire sample or for the gender and age subsets. Conclusions There are no differences in degenerative TMJ changes in patients with or without skeletal jaw discrepancies. No differences were found when gender and age were considered.

Renal cell cancinoma (RCC) is a unique malignancy with features of late recurrences, metastasis to any organ, and frequent association with second malignancy. It most commonly metastasizes to the lungs, bones, liver, renal fossa, and brain although metastases can occur anywhere. RCC metastatic to the duodenum is especially rare, with only few cases reported in the literature. Herein, we review literature of all the reported cases of solitary duodenal metastasis from RCC and cases of neuroendocrine tumor (NET) as synchronous/metachronous malignancy with RCC. Along with this, we have described a unique case of an 84-year-old man who had recurrence of RCC as solitary duodenal metastasis after 37 years of radical nephrectomy and metachronous pancreatic NET.

In children with brachial plexus birth palsy (BPBP), a shoulder joint internal contracture is commonly observed, which may result in glenohumeral osseous deformities and posterior joint subluxation. The purpose of this retrospective study was to evaluate the impact of an isolated anterior shoulder release on osteoarticular disorders and assess the subsequent clinical improvements.Forty consecutive BPBP patients with glenohumeral dysplasia underwent an open anterior shoulder release. Shoulder scans (ie, magnetic resonance imaging preoperatively and computed tomography postoperatively) were conducted to assess glenoid version and the percentage of the humeral head anterior to the middle of the glenoid fossa. Clinical data including analytical shoulder range of motion and modified Mallet scores were collected.After a mean follow-up period of 23 months, glenoid version and the percentage of the humeral head anterior to the middle of the glenoid fossa significantly improved from -32° and 18%, respectively, to mean postoperative values of -12° (P.001) and 45% (P.001), respectively. Passive and active external rotation increased from -2° and -43°, respectively, to 76° (P.001) and 54° (P.001), respectively. The mean modified Mallet score significantly improved from 14.2 to 21.4 points (P.001). In 8 children with satisfactory passive motion, a latissimus dorsi transfer was performed secondarily to obtain satisfactory active motion.In BPBP patients with glenohumeral deformities, isolated open anterior release of the shoulder induces significant remodeling of the joint, reducing posterior joint subluxation and improving both passive and active shoulder ranges of motion. Additional latissimus transfer remains mandatory in selected cases to achieve satisfactory function.

Introduction: Superior border of scapula presents a suprascapular notch. Suprascapular nerve entrapment syndrome may be caused due to compression of the nerve at the notch. Previous studies have shown that there are various types of suprascapular notch and clinicians must be aware of these types and their prevalence. Aim: This study was conducted with the following objectives, a: To know the morphometry and morphological variations of suprascapular notch; b: To measure the safe zone distance necessary to avoid iatrogenic injuries to nerve; c: To correlate the major scapular dimensions with that of suprascapular notch. Materials and Methods: We collected 100 dried human scapulae from department of Anatomy and medical students of AIMS&RC, Devanahalli, Karnataka and Sri Narayana Institute of Medical Sciences, Ernakulam, Kerala. The Suprascapular notch was classified according to Rengachary’s classification. Dimensions of all different class of suprascapular notches, that of scapulae and safe zone distance was measured using digital Vernier calipers. Results: Majority of scapulae had type II SSN (33%) and least common variety found was type IV (4%). Least surface area in type V notch measured was 36.16mm2. Mean safe zone distance between SSN and supraglenoid tubercle (S1) in all 100 scapulae is 30.31+/-3 mm. The mean distance between spinoglenoid notch and posterior rim of glenoid (S2) is 16.82+/-2.19 mm. Mean length of all 100 scapulae is 135.12+/-1 mm. Mean width of scapula is 101.69+/-6.8 mm. Mean length and width of glenoid fossa is 33.83+/- 3.25 mm and 24.2+/-2.34 mm respectively. Conclusion: Ossified superior transverse scapular ligament can compress the nerve causing entrapment syndrome. Since suprascapular notch presents various shapes, this study is an attempt to add further data to the existing studies about suprascapular notch, its morphometry and safe zone distance to avoid injury to nerve during surgery. Keywords: Neuropathy, Scapula, Shoulder join

Introduction: The lacrimal gland is secretory gland situated in the lacrimal gland fossa. Adenoid cystic carcinoma of lacrimal gland is most common malignant tumor of lacrimal gland and very crucial to differentiate between adenocystic carcinoma and pleomorphic adenoma of lacrimal gland because of different outcome. Aims and Objectives: To study the incidence, histopathological pattern, and distribution into the age, sex of Adenoid cystic carcinoma in to the lacrimal gland. Materials and Methods: A Retrospective study of 14 cases of Adenoid cystic carcinoma in lacrimal gland during period of 10 years were studied A detailed history of patients were taken with special attention to the age, sex, macroscopic (gross examination) and microscopic features of tissue. Microscopic examination is done under standard H & E staining procedure. Result and Conclusion: Total 57 cases of lacrimal gland tumor were studied among them 14 cases of adenoid cystic carcinoma, its most common malignant tumor of lacrimal gland. It’s most common age for presentation is 4th to 6th decade, and most common histological pattern present in mixed pattern. And its incidence are slightly more common in female. Other detail discussed in to the result and discussion section. Keywords: Adenoid cystic carcinoma, Lacrimal gland, Histological patterns, Age, Sex.

Teratomas are benign germ cell tumors that usually found out of their anatomical origin. Teratomas usually are found in sacrococcygeal area, gonads, mediastinum, cervicofacial region and intracranial fossa. Spinal teratomas are rare. In this study we describe a case of conus medullaris teratoma which was diagnosed based on imaging studies. The patient underwent surgery. We did bilateral laminectomy. The mass lesion had an obvious and rigid attachment to the conus medullaris. The wall of the lesion was resected as much as possible, but total resection of the lesion’s wall could not be done due to changes in neural monitoring. Previous related studies are reviewed.

The aim of this study was to evaluate whether a correlation exists between temporal bone pneumatization and the morphology of the articular eminence and glenoid fossa. A sample of 100 cone beam computed tomography scans was used, for a total of 200 temporomandibular joints (TMJ). Paracoronal and parasagittal images of the TMJ were evaluated by two examiners. For all TMJ, pneumatization was classified in the mid-lateral direction using a score of 0 or 1, and in the anteroposterior direction using a score ranging from 0 to 3. The inclination and height of the articular eminence and the thickness of the roof of the glenoid fossa were obtained. Pneumatization was found in the mid-lateral direction in 83.5% of the cases and in the anteroposterior direction in 88%. The age of the patient and side did not influence the prevalence or degree of pneumatization (P=0.051-0.953), but female patients showed more pneumatization in the mid-lateral direction than male patients (P=0.014). The presence of pneumatization did not affect articular eminence and mandibular fossa morphology. It is concluded that the presence and extent of pneumatization of the TMJ temporal component does not affect its morphology. However, professionals should be aware of the high prevalence of pneumatization and take this into account when performing TMJ assessment.

Background: This study evaluated postoperative changes in the supraspinatus from time-zero to 6 months, using magnetic resonance imaging (MRI). We hypothesized that restoration of the musculotendinous unit of the rotator cuff by tendon repair immediately improves the rotator cuff muscle status, and maintains it months after surgery.Methods: Totally, 76 patients (29 men, 47 women) with rotator cuff tears involving the supraspinatus tendon who underwent arthroscopic rotator cuff repairs were examined. MRI evaluation showed complete repair with intact integrity of the torn tendon at both time-zero and at 6 months follow-up. All patients underwent standardized MRI at our institution preoperatively, at 1 or 2 days postoperative, and at 6 months after surgery. Supraspinatus muscular (SSP) atrophy (Thomazeau grade) and fatty infiltrations (Goutallier stage) were evaluated by MRI. The cross-sectional area of SSP in the fossa was also measured.Results: As determined by MRI, the cross-sectional area of SSP significantly decreased 11.41% from time-zero (immediate repair) to 6 months post-surgery, whereas the Goutallier stage and Thomazeau grade showed no significant changes (p

X-ray computed tomography of the cladotherian Henkelotherium guimarotae from the Kimmeridgian Guimarota coal mine (Portugal) adds new information on its postcranial skeleton. Contrary to earlier description, the humerus of Henkelotherium shows a plesiomorphic cladotherian condition similar to that seen in Dryolestes leiriensis in having individual radial and ulnar condyles on the anterior aspect of the distal joint, whereas the posterior aspect appears to be trochlear. The scapula is also more plesiomorphic than previously assumed in having a laterally flared crest on the inferior margin. In this regard, it is similar to the scapula of spalacotherioid “symmetrodontans” such as Zhangheotherium but more derived than the latter, in having a larger supraspinous fossa. The hind limb is similar to that of small extant therians, which is interpreted to be assocated with an upright limb posture. The previously proposed hypothesis of an arboreal lifestyle for Henkelotherium is corroborated by a number of skeletal features such as large humeral entepicondyles, prominent digital flexor tubercles, elongated and slender tail vertebrae, as well as a high pedal phalangeal index of 153%.

Objective:The present study was conducted to evaluate the efficacy of conventional TMJ imaging in depicting osseous changes in mandibular condyle and glenoid fossa in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) by comparing the finding against CT and with an objective that if conventional TMJ imaging modality can appreciate the osseous changes in RA and OA then what is the need for CT scan. Thus further reducing the patient’s radiation dose.Materials and Methods:A total of 70 patients (40 Rheumatoid Arthritis; 30 Osteoarthritis) were taken in the study aged between 40 - 60 years and divided in to age groups. Then according to clinical history they were divided according to being symptomatic and asymptomatic. Further radiographic examination was carried out. First the trans-cranial view was obtained (conventional view left and right TMJ) and subsequently a CT scan was obtained and the interpretation was carried out to note the osseous changes like erosion, flattening, sclerosis and osteophyte formation.Results:After comparison of the two radiographic methods it was observed that both were equally efficacious in evaluating the osseous changes in arthritic patients.Conclusion:Thus, it was concluded that when both the radiographic methods (conventional and CT scan) are equally efficacious in evaluating the osseous degenerative changes of TMJ in arthritis. Thus we should prefer the conventional technique so that the patient in not exposed to unnecessary radiation dosage.

Background: The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients. Methods: The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed. Results: The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06–4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54–3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found. Conclusions: With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients. Key words: Neuroendoscopy; Pterygopalatine fossa; Infratemporal fossa; Maxillary sinus; Surgical approach

Purpose. Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures.Methods. In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm.Results. Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect.Conclusion. Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

Made available in DSpace on 2019-10-06T15:43:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 This study aimed to investigate the olfactory fossa according to the Keros classification using cone beam computed tomography. This cross-sectional study analysed cone beam computed tomography images selected from a database belonging to a radiology centre. The scans of 174 healthy patients were analysed by using the Xoran software. Gender, age, and side were correlated with the Keros classification. The mean age of the 174 patients was 45.3 years. The most prevalent Keros classification was type II (65.52%), followed by type III (20.69%) and type I (13.79%). No significant differences were found between Keros classification and the variables age, right side (p value = 0.4620), and left side (p value = 0.5709). There were also no significant differences between gender and the variables right side (p value = 0.1421) and left side (p value = 0.2136). Based on these results, we suggest that cone beam computed tomography can be recommended for analysis of the anterior skull base. Keros type II was the most prevalent type in our sample. Postgraduate Program in Dentistry Cruzeiro do Sul University (UNICSUL) Department of Diagnosis and Surgery São José dos Campos Dental School São Paulo State University (UNESP) Department of Orthodontics and Radiology University of São Paulo City (UNICID) Department of Diagnosis and Surgery São José dos Campos Dental School São Paulo State University (UNESP)

Background: Endovascular treatment often achieves complete obliteration of VA giant aneurysm; however, retreatment may be required because of late recanalization. We report a case of giant VA aneurysm that showed regrowth after endovascular treatment and was treated with VA clipping using the endoscopic endonasal transclival approach. Case description: A 47-year-old man with chief complaint of ataxia underwent endovascular treatment of giant VA aneurysm. One year later, he needed additional treatment to regrowth of the aneurysm. We were not able to accomplish aneurysmectomy via the transcondylar fossa approach because of difficulty in achieving hemostasis and ended with partial thrombectomy. Digital subtraction angiography (DSA) performed after 4 months revealed coil compaction and distal flow due to recanalization. Right VA elongation and position of anterior spinal artery (ASA), these factors made possible for us to perform transclival approach to VA. Despite the limited indications for its use, endonasal endoscopic transclival clipping may be effective in limited anatomical cases. Conclusion: We report the use of endonasal endoscopic transclival clipping for giant VA aneurysm. This endonasal endoscopic treatment may be an optional alternative in only limited cases depending upon the anatomical location of the lesion because of limitations of vascular control and the inability to visualize the field in the presence of major bleeding. For treatment of progressive giant VA aneurysm, it is very important to avoid optimistic strategy for giant VA aneurysm initially. Keywords: Transclival clipping, Giant vertebral artery aneurysm, Vasa vasorum, Cerebrospinal fluid leakage, Flow diverter stent

Background Temporomandibular disorders (TMD) are the most common reason of non-dental pain in the orofacial region. A clinical examination of the temporomandibular joint (TMJ) with additional imaging is the most recommended procedure for TMD diagnosis. Objectives The objective of this study was to evaluate the association between TMD and the condylar position in the glenoid fossa by examining a group of patients suffering from TMD compared with a control group of patients without TMD. In this study, we used cone-beam computed tomography (CBCT) images for measurements. Material and methods Sixty-five symptomatic joints were selected from 48 patients with TMD. Sixtyfive joints were selected from a total of 96 asymptomatic joints in the control group. The superior, anterior and posterior area of the joint, and the steepness of the articular eminence were measured on the CBCT images. The data was analyzed using Pearson's χ2 test. Results The position of the condyle was significantly more posterior in the joints with TMD, and more anterior and centric in the asymptomatic joints. Statistically, the vertical position of the condyle and the steepness of the articular eminence had no significant relation with the occurrence of TMD. Conclusions In this study, we observed that the posterior condylar position is more common in TMD patients, but it is not the reason for diagnosing TMD, and the reason of the posterior position of the condyle should be investigated before any decisions pertaining to treatment are made. In future, studies should focus on evaluating how the position of the condyle will change after the treatment of patients with TMD.

Objective: To determine the olfactory fossa depth according to the Keros classification and determine the incidence of asymmetry in height and configuration of the ethmoid roof. Materials and Methods: Retrospective analysis of 75 coronal computed tomography studies of paranasal sinuses and facial bones were performed. Measurement of the depth of the lateral lamella, classification of the depth according to Keros type and determination of the asymmetries in the ethmoid roof depth and configuration were done. Results: The mean height of the lateral lamella cribiform plate (LLCP) was 2.15+1.29 mm. The cases were classified as 87.33% Keros type1 and 12.67 % as Keros type 2. No Keros type 3 was found .There was asymmetry in the LLCP height of 33.33% of cases and a configuration asymmetry in 8% of the cases. No significant difference between the mean height and distribution of Keros type between gender and laterality were also found. Conclusion: As regards the olfactory fossa depth, the Keros type 1 was most frequently found. Asymmetry in the depth and configuration were detected in 33.33 and 8% respectively. Risk of inadvertent intracranial entry through the lateral lamella among Thai may be lower than other studies with majority of cases classified as Keros type 2 or 3.

Posterior crossbite is one of the most frequently occurring malocclusions in adolescents with a prevalence of 7% to 23%. The most common form of posterior crossbite is a unilateral posterior crossbite with a functional side shift. It has been suggested that functional posterior crossbites (FUPXB) may result in right-to-left-side differences in the condyle fossa relationship, resulting in temporomandibular joint (TMJ) problems. The objective of this study was to determine if pathological position of the condyles can cause condylar signs or symptoms like degenerative joint disease (DJD) or juvenile condylar resorption (JCR), or if the position of the condyle is just an altered position within the TMJ. Sixty patients with an average age of 9.6years were randomly selected from the office of one of the investigators (T.S.). The study group consisted of 29 patients with a FUPXB and the control group had 31 patients with no posterior crossbite. All patients had multislice CT scans of the TMJ taken as part of the orthodontic records. Transverse widths were measured at the skeletal base and the dentoalveolar base. Molar inclinations, condylar angulations, condylar anterior joint space, superior joint space, and posterior joint space were measured. Independent sample t-tests were used to compare different measurements between groups and paired sample t-tests were used to compare differences within the same patient. Reliability of measurements were determined using pairwise correlation. For dentoalveolar measurements of transverse width, the maxillomandibular difference for the study group was -8.2 mm and for the control group was -4.0 mm. No significant differences were found between the molar inclinations, condylar width, angulation, or any joint space measurements between the two groups. A total of 61.3% of the subjects in the control group and 72.4% in the study group had a radiographic sign of joint disease. The lack of condylar positional differences between the control and crossbite groups suggests that TMJ signs and symptoms in the study group may be related to remodeling in the TMJ instead.

Glenohumeral combination fractures are severe shoulder injuries for which, however, few data are available in the literature. The aim of the study was to analyze the incidence and numeric distribution of glenohumeral combination fractures using a classification system. Furthermore, treatment methods and complications are discussed. This retrospective study is based on the data evaluation of a level I trauma center between 1998 and 2016. Glenohumeral combination fractures are classified into four types, and the incidence, treatment method, and complications are evaluated. Additionally, the fracture morphology and displacement of the different fracture types are analyzed. In total, 52 patients with a glenohumeral combination fracture were identified. There were 26 (50%) type 1 fractures (anterior glenoid rim fracture/greater tuberosity fracture), 20 (38%) type 2 fractures (anterior glenoid rim fractures and proximal humerus fractures), four (8%) type 3 fractures (glenoid fossa fractures and greater tuberosity fractures), and two (4%) type 4 fractures (glenoid fossa fractures and proximal humerus fractures). In the majority of patients (n = 25), both lesions of the combined fractures were treated operatively, in 15 both fractures were treated nonoperatively, and in 12 patients only one of the two lesions was treated surgically. Complications were encountered in 21% of cases, particularly on the humeral side. Glenohumeral combination fractures are rare. Type 1 and type 2 fractures are the most frequent combination fractures. The indications for treatment are based on the displacement of the respective fragments, which can be addressed during the same operation if surgery is indicated. Complications are more frequently found on the humeral side.

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.

Background The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported. Objective To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient >3 years of age. Methods A multicenter, retrospective cohort study. Results In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. P osterior fossa malformations, h emangiomas, a rterial anomalies, c ardiac defects, e ye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or β-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (β-blockers) for late IH growth. Limitations The retrospective nature and ascertainment by investigator recall are limitations of the study. Conclusion Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues.

Objectives The aim of this study is to investigate the effect of internal derangements and degenerative bone changes on the minimum thickness of the roof of the glenoid fossa (RGF). Methods MRI and cone beam CT records of temporomandibular joints (TMJ) of 68 patients were evaluated retrospectively in this study. The joints were divided into three groups according to TMJ disc status which had been diagnosed in MRI: normal disc status, anterior disc displacement with reduction, and anterior disc displacement without reduction. Cone beam CT was used to evaluate the degenerative bone changes of TMJ and to measure the minimum thickness of RGF. The joints were categorized as "with osteoarthritis (OA)" or "without OA". The findings of OA were determined as erosion, osteophyte, flattening, sclerosis, and pseudocyst. Results No significant relationship was found between gender and the thickness of RGF (p > 0.05). RGF was found significantly higher in "with OA" group compared to "without OA" group (p < 0.001). No significant difference was found between disc displacement groups for minimum thickness of RGF (p > 0.005). No significant difference was found between condyles without erosion and condyles with erosion for the minimum thickness of RGF (p = 0.272). In the present study, osteophyte, sclerosis, flattening, and pseudocyst were found to be associated with the minimum thickness of RGF. Conclusions Osteophyte, flattening, pseudocyst, and sclerosis have an influence on RGF thickness. The minimum thickness of RGF is not significantly correlated with internal derangements. Erosion is not significantly correlated with RGF thickness. RGF thickness may be unaffected by the early stages of OA.

Objective Posterior fossa meningiomas are surgically challenging tumors that are associated with high morbidity and mortality. We sought to investigate the anatomical distribution of clinically actionable mutations in posterior fossa meningioma to facilitate identifying patients amenable for systemic targeted therapy trials. Methods Targeted sequencing of clinically targetable AKT1, SMO, and PIK3CA mutations was performed in 61 posterior fossa meningioma using Illumina NextSeq 500 to a target depth of >500 × . Samples were further interrogated for 53 cancer-relevant RNA fusions by the Archer FusionPlex panel to detect gene rearrangements. Results AKT1 (E17K) mutations were detected in five cases (8.2%), four in the foramen magnum and one in the cerebellopontine angle. In contrast, none of the posterior fossa tumors harbored an SMO (L412F) or a PIK3CA (E545K) mutation. Notably, the majority of foramen magnum meningiomas (4/7, 57%) harbored an AKT1 mutation. In addition, common clinically targetable gene fusions were not detected in any of the cases. Conclusion A large subset of foramen magnum meningiomas harbor AKT1 E17K mutations and are therefore potentially amenable to targeted medical therapy. Genotyping of foramen magnum meningiomas may enable more therapeutic alternatives and guide their treatment decision process.

We compared the temporomandibular joint structure between species of the order Carnivora and investigated its variation among family lineages. We also investigated the effect of the masticatory muscle physiological cross-sectional area (PCSA) on temporomandibular joint structure. The masticatory muscle is composed of multiple muscles, which contract in different directions and exert pressure on the temporomandibular joint. We investigated the effect of the ratio of each muscle’s PCSA—an indicator of muscle force—and muscle size relative to body size on temporomandibular joint structure. The temporalis PCSA relative to body size showed the highest correlation with temporomandibular joint structure. When the temporalis PCSA is large relative to body size, the preglenoid projects caudally, the postglenoid projects rostrally and the pre-postglenoid angle interval is small, indicating that the condyle is locked in the fossa to reinforce the temporomandibular joint. Most Carnivora use blade-like carnassial teeth when slicing food. However, dislocation occurs when the carnassial teeth are used by the temporalis muscle. Our results suggest that the temporomandibular joint is reinforced to prevent dislocation caused by the temporalis muscle. In Mustelidae, the temporomandibular joint with a rostrally projecting postglenoid is suitable for carnassial biting using the temporalis muscle. In Felidae, the force of the masseter onto the carnassial teeth is diverted to the canine by tightening the temporomandibular joint. In Canidae, the masticatory muscle arrangement is well-balanced, enabling combined action. Hence, reinforcement of the temporomandibular joint by bone structure is unnecessary.

Background Patients with Parkinson's disease and related disorders (PDRD) may exhibit dropped head syndrome (DHS), which does not yet have an effective treatment. Objectives To evaluate the effect of combining lidocaine injection into the bilateral scalene muscles and neck corset wearing on dropped head syndrome. Methods We performed needle electromyography assessments of the scalene, sternocleidomastoid (SCM), levator scapulae, splenius capitis, and trapezius muscles. Patients received 2.5–5 ml injections of 1% lidocaine into both sides of the scalene muscles for 4/5 consecutive days and were instructed to wear a neck corset. We measured the neck flexion angle, which formed between the horizontal line and the straight line passing through the ear canal and orbital fossa, before (baseline) and after (Day 8 and Day 90) the intervention. Results Seven males and eight females (mean age, 68.9 years; range 56 to 85 years) who had PDRD with dropped head syndrome were enrolled in this study. Needle electromyography examination revealed abnormal discharge of the scalene muscles in all patients when the neck position was corrected; however, some patients did not show abnormal discharge of the SCM muscle. At Day 8, we observed an improvement of the neck flexion angle in 13 of the 15 patients, from an average of 27.7° ± 13.9° to 11.7 ± 14.6°. At Day 90, the average neck flexion angle was 15.3° ± 17.2°. Conclusions Combining lidocaine injection into the scalene muscles and neck corset wearing is an effective treatment regimen for DHS in patients with PDRD.

Objective: To describe an isolated unilateral sixth nerve palsy, as a rare neuro-ophthalmic presentation of nasopharyngeal carcinoma. Methods: We report a 54-year-old female, known case of nasopharyngeal carcinoma who was treated with chemo-radiotherapy, and presented with isolated right sixth nerve palsy. Magnetic resonance imaging (MRI) indicated extension of tumor to intracranial fossa with clival involvement. Results: The patient was referred to an otolaryngologist for further evaluation and necessary intervention due to invasion of the cancer to intracranial fossa with involvement of right abducens nerve. Conclusions: Although, isolated sixth nerve palsies in adults over the age of 50 are usually ischemic; but in enduring cases, neoplastic processes should be considered.

Highlights • Hydatid cyst represents the parasitic infection by Genus Echenococcus Granulosis. The disease involves mainly Liver followed by lungs and rare involvement is seen in CNS. • When it is found in Brain it is usually present in supratentorial compartment rather than infratentorial compartment. The usual area is intracerebral hemisphere. They can be isolated cyst or multicystic. Involvement of Infratentorial compartment of CNS is extremely rare. • In this case report we are presenting a rare case of Multiple Hydatid cysts involving the peripontomedullary area and extending all the way down to the foramen magnum., Introduction: Hydatid cyst represents the parasitic infection by Genus Echenococcus Granulosis. This disease usually involves liver followed by lungs and rarely the CNS. The CNS involvement by the Hydatid Cyst is present in 1–2% of all hydatidosis. Even when it is found in the Brain it presents usually in the supratentorial compartment. However this case was unique in having the Hydatid cyst within the infratentorial fossa. With multiple small cysts, causing mass effect and challenging for surgical resection. Presentation: A 44 years female presented with headache, diplobia and bulbar symptoms, followed by ataxia. Full examination, proper investigations showed the peripontomedullary hydatid cysts. Surgical management is illustrated. Discussion: It is still challenging for the neurosurgeons to operate on these lesions in spite of modern technologies and fancy approaches due to its delicate nature, associated risk of allergic reaction, cyst’s material dissemination and irreversible injury of multiple neurological structure due to prolonged compression of cranial nerves crossing the cerebellopontine angle. Conclusion: In this case report we are presenting a rare case of Multiple Hydatid cysts involving a rare location in the brain; peripontomedullary area and extending all the way down to the foramen magnum. Supported with a literature review in relation to disease etiology, epidemiology, clinical presentation and management.

Highlights • Osteoid osteoma is a benign bone neoplasm, with significant nocturnal pain that responds to NSAIDs. • A case of an intra-articular osteoid osteoma involving the articular eminence and glenoid fossa of TMJ in a 46-years-old female is reported. • CT scan imaging is helpful in displaying the typical radiographic features and localization of the lesion., Introduction An osteoid osteoma is a benign bone neoplasm with limited growth potential, characterized by significant nocturnal pain that usually responds to non-steroidal anti-inflammatory drugs (NSAIDs). The tumor may occur in any part of the skeleton, most commonly in the lower extremities and vertebrae. Presentation of case A 46-year-old female was diagnosed with a rare case of an intra-articular variant of osteoid osteoma, involving the articular eminence and glenoid fossa of the temporo-mandibular joint (TMJ). Discussion The tumor presented as a painful progressive swelling in the right pre-auricular area that had lasted for more than 2 years and which had been previously treated as a TMJ disorder. Computed tomography revealed a well-defined heterogeneous nidus involving the articular eminence of the TMJ. Surgical excision was performed and histological examination confirmed the diagnosis. In this article, in addition to describing the case, all cases of osteoid osteoma of the jaws and TMJ reported in the English-language literature are reviewed. Conclusion Osteoid osteoma involving the TMJ is a rare presentation and may exhibit ambiguous symptoms, which could lead to misdiagnosis and delayed treatment.

In forensic anthropology, the pelvis is the most reliable indicator of sex, followed by the skull, with several studies having used the morphometry of the orbital aperture of dry skulls to estimate sex. However, age, sex, ancestry, and evolutionary periods cause variations in orbital characteristics. In this study, we analyzed measurements of orbital fossa from adult human craniums and employed discriminant function analysis to establish a model to predict sex. A manual Vernier caliper was used to obtain measurements of the left and right orbital fossa. On comparing the measurements (including mean, minimum, and maximum), we found that all the dimensions were greater in males than in females. Wilks' lambda for the sex-discriminating model was 0.533, signifying a moderate discriminating power. The discriminant function equation was: df = −10.274 × right orbit width + 13.44 × left orbit width − 7.982 × right orbit height + 7.694 × left orbit height − 12.234 (constant). The cutoff point was (90.567− [−1.512])/2 = 1.0395. Therefore, above this value of 1.0395, cases were predicted to be male, while below it, they were predicted to be female. Orbital aperture measurements can play an important role in estimating sex from dry craniums. Orbital measurements could be a useful adjunctive test for sex estimation in forensic practice.

Aim The study tests the correlation between the enlargement of the nasal cavity width, interglenoid fossa distance, and intercondylar distance after rapid maxillary expansion (RME) in growing patients. Materials and methods Cone beam computed tomography (CBCT) was performed for 25 patients presenting a bilateral crossbite (11 males, 14 females, and mean age 11.6 ± 1.6 years) at baseline (T0) and at 6 months after RME (T2), T1 being the end of expander activation. Images were digitized for linear measurements using specific software. Values were compared at the nasal width, interglenoid fossa distance, and intercondylar distance to test the correlation in the transverse dimension. Results At T0, a correlation already existing between the interglenoid fossa distance and the intercondylar distance persisted at T2. The correlation between the nasal cavity width and interglenoid fossa distance nonexistent at T0 ended toward statistically significant at T2. Additionally, the lateral position of the condyles was not correlated with the nasal cavity width neither at T0 or T2. Conclusion A correlation between the interglenoid fossa distance and intercondylar distance was exhibited 6 months after RME. The correlation between the nasal cavity width and interglenoid fossa distance was close to significant at T2.

Introduction: Computed tomogram (CT) of nose and paranasal sinuses provides the detailed knowledge of depth of olfactory fossa as per Keros' classification, which is important in endoscopic sinus surgery. Objective: To analyze the types and frequency of depth of olfactory fossa in Nepalese population. Methodology: This was a longitudinal study conducted from 1 May to 30 August 2018. Coronal CT scans of nose and paranasal sinuses were taken for analysis of olfactory fossa depth. The landmarks like infraorbital foramen, point of articulation of medial ethmoidal roof with lateral lamella of cribriform plate (MERP) and lowest point on the cribriform plate (CP) were taken. The lateral lamella of cribriform plate (LLCP) was calculated by subtracting CP height from MERP height (MERP-CP = LLCP). Results: There were total 101 patients included. The distribution of age was 33.72 ± 15.15 years. The keros' type I was the most common (86.1%). Regarding the olfactory fossa depth, right side was deeper in male whereas in females, the left side was deeper, but overall right side was deeper in 52(51.5%) patients. Conclusions: Type I Keros' was the most common whereas type III Keros' was the least common. A deep olfactory fossa is more common on right.

Objectives To identify the relationship between surgical success rate and preoperative nasal mucosal thickness around the lacrimal sac fossa, as measured using computed tomography. Methods We reviewed 33 eyes from 27 patients who underwent endoscopic dacryocystorhinostomy after diagnosis of primary nasolacrimal duct obstruction and who were followed-up with for at least six months between 2011 and 2014. We measured preoperative nasal mucosal thickness around the bony lacrimal sac fossa using computed tomography and analyzed patient measurements after classifying them into three groups: the successfully operated group, the failed operation group, and the non-operated group. Results Surgery failed in six of the 33 eyes because of a granuloma at the osteotomy site and synechial formation of the nasal mucosa. The failed-surgery group showed a clinically significantly greater decrease in nasal mucosal thickness at the rearward lacrimal sac fossa compared with the successful-surgery group. However, nasal mucosal thickness of fellow eyes (i.e., non-operated eyes) was not significantly different between the two groups, and the location of the uncinate process did not appear to influence mucosal thickness. In the failed group, posteriorly located mucosal thickness of operated eye fossa was thinner than that of the non-operated eyes, but not significantly so. Conclusions Our results from this quantitative anatomical study suggest that nasal mucosal thickness is a predictor of endoscopic dacryocystorhinostomy results.

Background: Bleeding is the frequent intraoperative complication in most of the surgeries and remains a challenge for the surgeons and anesthesiologists. Major blood loss during FESS is rare but even a small amount of bleeding disturbs the endoscopic surgery field, increases the likelihood of complications, lengthens the time of surgery and results in incomplete surgery. The greater palatine canal (GPC) local injection is used to limit posterior bleeding during sinus surgery. Objective: To study the effect of pterygopalatine fossa block on intraoperative bleeding and operative field optimization during endoscopic sinus surgery. Methods: Prospective double blind randomized control trial. Thirty six patients were recruited in the study who also acted as their own control. PPFB was done only on one side of the nostril and the side was randomized by the lottery; neither the patient nor the operating surgeons were aware of the laterality. Boezaart score was used to quantify the intra-operative blood loss. Results: Blood loss between block group and non-block group was compared. Patients in block group had more stable hemodynamics with no fluctuations, better visibility of the surgical field and decreased blood loss as compared with non-block group. Conclusion: Greater palatine fossa block is a useful adjunct in patients undergoing endoscopic sinus surgery. It provided more stable hemodynamics, good operative conditions by lowering blood loss.

Background: Intracranial dermoid cysts (DC) are rare benign embryologic tumors. They represent approximately 0.3% of all intracranial tumors. The association of intracranial DC and multiple dermal sinuses is exceptional. Methods: A 3 year-old girl presented with headache and vomiting. Physical examination showed nothing abnormal except for a small subcutaneous nodule above the occipital protuberance with a small skin opening. She had no neurological deficits. MRI and CT scan showed a cyst in the posterior fossa with occipital sinuses. The child was treated by total resection of the intra-dural occipital cyst and the abscess though a suboccipital approach and antibiotics after surgery with good outcome. Results: Histopathologic examination confirmed a diagnosis of DC, and bacterial investigation of the abscess did not yield any microbes. Conclusion: Infected Intradural DC with complete dermal sinus is a rare type. Radical neurosurgical treatment of DC and dermal sinus associated with antibiotics should be planned early to prevent infections such as abscess and meningitis. Keywords: Dermoid cyst, Dermal sinus, Intradural, Cerebral posterior fossa

Introduction Computerized tomographic imaging of the nasal and paranasal regions has become an indispensable tool for the endoscopic sinonasal surgery. The uncinate process is an important bony structure located in the lateral wall of the nose.The olfactory fossa is a space, situated superior to the cribriform plate and has a variable depth. Methods A descriptive, case-control study was carried out on 120 patients with a clinical diagnosis of chronic rhino sinusitis who were referred for a sinus CT scan by ENT specialists. Results Right side type I uncinate process of 90% was more prevalent in the males of the cases group and 86% is in the females of the control group. Prevalence of left side type II keros classification was seen in 66.7% and 63.3% of cases group and 73.3% and 83.3% of the control group for both the genders. Discussion Knowledge about the superior insertion of uncinate process and height of the olfactory fossa provides understanding about the upper limit of surgical dissection and aids in road mapping the confident direction for the functional endoscopic surgeons.