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This study describes three cases of patients who were victims of facial trauma and evolved with a condylar fracture associated with a fracture of the tympanic wall and/or glenoid fossa. In addition, a review of English-language literature involving condylar fracture associated with glenoid fossa and/or tympanic plate fractures from 1992 to 2019 was performed. In this article, we demonstrated that most patients received conservative treatment (40.6%) followed by the group that underwent surgical treatment (34.3%), but the treatment must be individualized for each case. Mandibular deviations, facial nerve paresis and ankylosis of the temporomandibular joint were observed. These fractures occur rarely but are often unnoticed in imaging studies. Patients with associated condylar fractures should be provided with a long-term follow-up due to the risk of late complications such as ankylosis, the most common.

Postoperative short nose is one of the most difficult problems encountered in plastic surgery. We propose a technique of lining rotation flaps combined with composite chondrocutaneous auricular graft from the triangular fossa to reconstruct the lining defect and improve surgical results.Twenty patients were operated on between 2016 and 2019 for postoperative short nose. Lining rotation flaps were used to supply missing medial mucosal lining with creation of a raw surface at the lateral lining in 10 patients (intervention group). A total of 17 composite chondrocutaneous grafts taken from the triangular fossa of the ears were used to resurface the defect. The other 10 patients received lining management using conventional techniques (control group).There was a near-complete take of 13/17 composite grafts (76.5%), with four partial losses that healed uneventfully. Anthropometric analysis of preop and postop profile photos showed statistically significant decreased nasolabial angle in both groups. The amount of derotation achieved was significantly increased (p 0.05) with our proposed method (Intervention group: 12.3 ± 9.3° vs. control group: 6.55 ± 4.5°). Donor sites healed uneventfully. Both groups of patients were satisfied with their results based on Rhinoplasty Outcomes Evaluation questionnaire.The lining rotation flap with triangular fossa composite graft is a safe and effective method for management of the postoperative short nose in Asians.

Ocular adnexal lymphoma accounts for approximately 1%-2% of non-Hodgkin lymphomas and 8% of extranodal lymphomas. Lacrimal gland lymphoma, especially bilateral lacrimal gland lymphoma, is rare, and imaging is often utilized to differentiate lacrimal lymphoma from other types of masses that involve the lacrimal gland and the fossa. We describe a 74-year-old male patient presenting with bilateral eye proptosis, lachrymose without pain, and no changes in eyesight. Brain-orbit magnetic resonance imaging revealed bilateral lacrimal fossa masses with regular contours, moderate enhancement, and restriction on diffusion imaging, consistent with a lymphoma diagnosis, which was confirmed by histopathological results. Positron emission tomography-computed tomography was used to determine lymphoma grading. MRI, especially diffusion imaging, can be useful for guiding clinicians in the diagnosis and differentiation of lacrimal gland lymphoma from other lesions.

This study aims to investigate the relationship of the persistence of metopic suture (PMS), frontal sinus volume (FSV), and olfactory fossa depth (OFD).Tomography scans of 1,603 patients aged 18-65 years were evaluated for the presence of PMS. In the study, 74 PMS cases and 74 controls were included. The appearance of each individual's frontal sinus was classified as aplasia, hypoplasia, or normal. Two observers independently measured the lateral lamella length (LLL), OFD, and FSV. Interobserver agreement was evaluated with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient (κ).The prevalence of PMS was found to be 4.99% [95% confidence interval (CI): 4.03-6.17]. The PMS group had five times higher hypoplasia/aplasia than the controls (52.70%, 95% CI: 41.48-63.66 and 10.81%, 95% CI: 5.58-19.91, respectively; p0.001). An "almost perfect" agreement was detected among observers for the frontal sinus appearance classification: κ=0.807, p0.001. The ICC of continuous measurements for OFD, LLL, and FSV, respectively, presented "excellent" reliability: 0.956, 0.958, and 0.981, with p0.001 for each. LLL was shorter, OFD was shallower, and FSV was smaller in the PMS group than the control group (p0.001). There was a moderate positive correlation between OFD, LLL, and FSV (r=0.306, r=0.302).This study interprets that the presence of PMS is related frontal sinus development and volume. With PMS, a smaller FS, shorter lateral lamella, and shallower olfactory fossa may be expected.Bu çalışma, persistan metopik sütür (PMS) ile olfaktör fossa derinliği (OFD), ve frontal sinüs volümü (FSV) arasındaki ilişkiyi araştırmayı amaçlamaktadır.Yaşları 18-65 arasında değişen 1.603 hastanın tomografileri PMS varlığı açısından değerlendirildi. Yetmiş dört PMS olgusu ve 74 kontrol çalışmaya dahil edildi. Her bireyin frontal sinüs görünümü aplazi, hipoplazi veya normal olarak sınıflandırıldı. Lateral lamella uzunluğu (LLU), OFD ve FSV ölçümleri iki gözlemci tarafından bağımsız olarak yapıldı. Gözlemciler arası uyum değerlendirilirken, sürekli değişkenler için sınıf içi korelasyon katsayısı (ICC) ve Cohen’s kappa katsayısı (κ) kullanıldı.PMS prevalansı %4,99 [güven aralığı (GA) %95: 4,03-6,17] olarak bulundu. Hipoplazi/aplazi, PMS grubunda kontrol grubuna göre beş kat daha fazlaydı (sırasıyla %52,70; GA %95: 41,48-63,66 ve %10,81; GA %95: 5,58-19,91, p0,001). Frontal sinüs görünüm sınıflandırması için gözlemciler arasında “mükemmel” bir uyum tespit edildi: κ=0,807, p0,001. OFD, LLU ve FSV için ICC “mükemmel” güvenilirlik sundu: Her biri için sırasıyla 0,956, 0,958 ve 0,981 ve p0,001. PMS grubunda, LLU daha kısaydı, OFD daha sığdı ve FSV, kontrol grubuna göre daha küçüktü (her biri için p0,001). OFD, LLU ve FSV arasında orta derecede pozitif korelasyon vardı (r=0,306, r=0,302).Bu çalışmanın sonucunda, PMS’nin frontal sinüs gelişimi ve volümü ile ilişkili olduğu bulunmuştur. PMS varlığında daha küçük bir FS, daha kısa lateral lamella ve daha az derin olfaktör fossa beklenebilir.

We evaluated coxofemoral joints from museum specimens of: Vulpes lagopus; Vulpes vulpes; Vulpes velox; Nyctereutes procyonoides; Urocyon cinereoargenteus; Aenocyon [Canis] dirus; Canis latrans; Canis lupus lupus; Canis lupus familiaris; C. l. familiaris x latrans; and Canis dingo. Acetabular components included: fossa; articular surface; medial and lateral articular margins; and peri-articular surfaces. Acetabular components variably revealed: osteophyte-like features; varying appearance of articular margin rims (especially contour changes); rough bone surfaces (especially fossa and articular surface); and surface wear. Proximal femoral components included: articular surface; articular margin; peri-articular surfaces; and joint capsule attachment. Femoral components variably revealed: rough bone surface; bone loss; articular margin osteophyte-like features (AMO); caudal post-developmental mineralized prominence (PMP); and enthesophytes along the joint capsule attachment. Non-metric multidimensional scaling (NMDS) was used to analyze right-left asymmetric relationships between observed traits, across taxa. Significantly different acetabular trait asymmetry involved only C. latrans - C. l. familiaris; V. vulpes - N. procyonoides, and U. cinereoargenteus - N. procyonoides. There were no significant lateralized differences in proximal femoral traits involving modern canids, ancient and modern C. l. familiaris, or modern vulpines. Thus, the observations were strongly bilateral. We hypothesized high similarity of traits across taxa. The data confirm the hypothesis and strongly suggest broad and deep morphological and mechanistic conservation that almost certainly pre-existed (at least) all modern canids. Further zoological studies are needed to evaluate phylogenic implications in greater detail. This article is protected by copyright. All rights reserved.

INTRODUCTION It has been well established that the subscapularis is divided in two different parts with a tendinous insertion at its superior two-thirds and a muscular attachment on its inferior third. The objective of this cadaveric study was to follow the muscular insertion of the subscapularis medially in order to determine the origin of this inferior muscle insertion and whether a subscapularis minor can be individualized MATERIALS AND METHODS: Twenty-six shoulders from thirteen fresh-frozen cadaveric specimens (5 males and 8 females; mean age, 74.4 years) were dissected in our anatomy lab. The humeral insertion of the subscapularis was then analyzed, and the inferior muscular part of the insertion was identified. The muscle fibers were followed medially until their scapular origin which was recorded as line drawings and photographs. We measured the dimensions of both the humeral insertion and of the scapular origin of the fibers going to the muscular portion. RESULTS In all cases, the fibres going to the tendinous portion and those going to the muscular portion of the insertion had a different orientation. The fibres going to the muscular portion of the humeral insertion did not originate from the subscapularis fossa but on the glenoid neck and in a depression at the infero-lateral part of the scapular pillar. The mean length of the superior tendinous portion of the humeral insertion was 3.42 cm (± 0.43 cm); the mean length of the inferior muscular portion of the humeral insertion was 1.88 cm (± 0.80 cm). The mean length of the scapular origin in the depression at the infero-lateral part of the scapular pillar of the fibres going to the muscular portion of the humeral insertion was 3.7 cm (± 0.17 cm). CONCLUSION The fibres of the subscapularis do not all originate from the subscapularis fossa. An additional origin exists at the inferior part of the glenoid neck and in a depression at the infero-lateral part of the scapular pillar. The fibers which originate at this location all insert on the humerus at the muscular portion of the subscapularis humeral insertion. This portion however does not seem to correspond to the so-called subscapularis minor which has been previously described.

Purpose Temporomandibular joint (TMJ) discectomy is performed for patients with degenerative joint disease with an unsalvageable disc, but with a salvageable condylar head and glenoid fossa. The purpose of this study was to estimate the incidence and risk factors associated with poor postoperative outcomes following TMJ discectomy and abdominal fat grafting. Methods A retrospective cohort study was conducted on patients who underwent TMJ discectomy. Included in this study were patients who had complete data sets with a minimum of 1-year follow-up. Potential risk factors included demographics, preoperative findings (mouth opening, pain levels, previous TMJ surgery), operative findings (disc degeneration, state of TMJ components), and postoperative outcomes (pain levels, mouth opening). Failed outcomes were those who had return of pain postoperatively, no improvement in mouth opening following TMJ discectomy, and/or those who progressed to TMJ total joint replacement (TJR). Statistical methods included Kaplan-Meier curves and Cox proportional hazards regression time to event analyses. Results This study included 129 patients who had undergone 132 TMJ discectomies. Most patients were female (89.9%), with a mean age of 43.2 years, standard deviation 14.2. The success rate for discectomy was 75.2% and the conversion rate of TMJ discectomy to TJR was 11.7%. A total of 32 patients (24.8%) experienced return of pain. The median time to return of pain or second surgery was 94.4 months (95% CI = 88.3 to 101.8). No risk factors were statistically significant, although mouth opening improvement of less than 10% was associated with higher risk of poor outcome (P = .77). Conclusion The findings of this study suggest that lower improvement in mouth opening at 1 year following surgery is likely to result in failure of the TMJ discectomy procedure although the result was not statistically significant. This outcome may ultimately necessitate a TJR.

Background The objective of this study was to evaluate the short-term and long-term effects of tooth-anchored and bone-anchored maxillary expansion appliances on the condyle–fossa relationship, compared to those in a matched control group. Another objective of the study was to evaluate whether the amount of dental and skeletal expansion is correlated with the condyle–fossa relationship. Methods A total of 180 cone-beam computed tomography scans (CBCTs) for 60 subjects were analyzed for 3 groups: 1) bone-anchored maxillary expansion (BA; n = 20); 2) tooth-anchored maxillary expansion (TA; n = 21); and 3) controls (n = 19) at pretreatment, post-expansion (T2), and post-treatment (T3). The posterior joint space (PJS), superior joint space (SJS), anterior joint space, angle of mandibular condyle, distance of the condyle to the mid-sagittal plane, the inter-molar cuspal width, and the skeletal maxillary width (SMW) were measured for all 3 groups. Results Both BA and TA led to a significant increase in inter-molar cuspal width, SMW, and TA led to a significant increase in PJS as compared to controls at T2. However, there was no significant difference in the joint spaces between the BA, TA, and control groups in the long term. Both the BA and TA groups showed a significant increase in SMW at T3 compared to the control group. Molar extrusion showed a weak correlation with PJS at T2 (r = 0.46) and T3 (r = 0.51), and a moderate correlation with SJS at T2 (r = 0.61) and T3 (r = 0.69). Conclusions TA led to a significant increase in PJS, compared to a control group, at T2, but there was no long-term difference in the condyle–fossa relationship among the BA, TA, and control groups. Molar extrusion showed moderate correlation with SJS and PJS.

The auricular cartilage is considered to develop from a funnel-like arrangement of six embryonic hillocks. However, there is little information as to when and how the initial cartilage plate differentiates into the major three hollows or caves: the concha, the scapha and the triangular fossa. We examined semiserial histological sections from 42 human fetuses as well as from seven cadavers of elderly individuals. Tangential sections from adults suggested that three ring-like cartilages were combined to provide a single auricular cartilage and that the external auditory meatus was attached to the lowest ring or concha. All of the fetuses studied carried the three major hollows delineated by skin folds. These skin folds often contained a cartilage loop as a core in place of a thickening or tubercle. Conversely, some of the skin folds corresponded to a highly wavy cartilage plate without looping. According to whether the cartilage loop was present or absent in horizontal sections from 35 fetuses, we classified the cartilage morphology into four patterns, the most frequent of which was absence of the triangular fossa loop (27 fetuses), followed by absence of the scapha loop (11 fetuses). Each pattern was evenly distributed among small and large fetuses. This suggested that some form of cartilage correction or reconstruction was likely to occur after birth, especially at the triangular fossa and/or scapha. Infants appear to show significant region-specific variation in the postnatal growth of the auricular cartilages, especially at the triangular fossa and/or scapha. This article is protected by copyright. All rights reserved.

The rate of attendance to sanitary sewage services is low in rural communities, representing precarious sanitation conditions with dumping in rudimentary cesspools or in the open. Knowledge of the fractions of effluents generated and the places where they are released is important, since inadequate disposal generates public health problems and negatively impacts the environment. In this way, the objective of this work was to identify the amounts of effluent fractions generated and the deficit of sanitary sewage in rural communities in the state of Goiás. The study area included 97 rural communities, from which data were collected regarding the existence of bathrooms, alternatives and disposal sites for domestic sewage fractions, such as feces separated from urine. The results indicated an absence of a bathroom in 6.6% of the analyzed rural households, being in 2.5 and 18.2% in the households of the settlements and quilombolas, respectively, highlighting in the latter the occurrence of disposal in the open or stream in 13.7%. There was a predominant use of rudimentary cesspools to receive sewage and fecal water, while gray water from the kitchen sink and washing tanks are mainly disposed in the backyard, representing the greatest deficit in the communities. Thus, in most of the studied households there is a deficit due to lack of service, due to the release of untreated effluents into ditches/open air, mainly for gray water, and precarious service due to the unsafe disposal of treated effluents or the use of rudimentary cesspools. Few alternative technologies were found for the treatment of effluents, with ecological pit, biodigester and Tapiocanga stone pit being identified. It was concluded that the deficit of sewage in the households of the studied communities is high, due to the release of effluents without treatment and the use of rudimentary cesspools, characterized as lack of service and precarious service, respectively, observed in 84.6% of households. RESUMO Em comunidades rurais, o índice de atendimento aos serviços de esgotamento sanitário é baixo, representando condições precárias de saneamento, com lançamento de efluentes em fossas rudimentares ou a céu aberto. O conhecimento das frações de efluentes geradas e os locais de seu lançamento são importantes, uma vez que a destinação inadequada gera problemas de saúde pública e impacta negativamente o meio ambiente. Desta forma, o objetivo do trabalho foi identificar as quantidades de frações de efluentes geradas e o déficit do esgotamento sanitário em comunidades rurais do estado de Goiás. A área de estudo contemplou 97 comunidades rurais, das quais coletou-se dados quanto à existência de banheiro e às alternativas e locais de disposição das frações do esgoto doméstico, como fezes separado da urina. Os resultados apontaram para ausência de banheiro em 6,6% dos domicílios rurais analisados, sendo 2,5 e 18,2% nos domicílios dos assentamentos e quilombolas respectivamente, destacando neste último a ocorrência de disposição a céu aberto ou ribeirão em 13,7%. Observou-se uso predominante de fossas rudimentares para recebimento de esgotos e águas fecais, enquanto a água cinza produzida por pias de cozinha e tanques de lavar roupas é disposta principalmente no quintal, representando o maior déficit nas comunidades. Assim, a maioria dos domicílios apresenta déficit de esgotamento sanitário por ausência de atendimento, devido ao lançamento de efluentes sem tratamento em valas/céu aberto, principalmente as águas cinza, e precariedade de atendimento devido à disposição não segura de efluentes tratados ou uso de fossas rudimentares. Foram constatadas poucas tecnologias alternativas para tratamento de efluentes, sendo identificadas fossas ecológicas, biodigestor e fossa de pedra Tapiocanga. Concluiu-se que o déficit do esgotamento nos domicílios das comunidades visitadas é elevado, devido ao lançamento de efluentes sem tratamento e ao uso de fossas rudimentares, caracterizado como ausência e precariedade de atendimento, respectivamente, constatado em 84,6% dos domicílios.

Background: Within the hip joint, the anatomy of the acetabulum and cotyloid fossa is well established. There is little literature describing the association between the size of the cotyloid fossa relative to the acetabulum and characteristics of patients with femoroacetabular impingement (FAI). Purpose/Hypothesis: The purpose was to calculate the cotyloid fossa coverage percentage in the acetabulum and determine its association with patient characteristics, radiographic parameters, intra-articular findings, and preoperative patient-reported outcomes in patients with FAI. We hypothesized there is an association between the cotyloid fossa coverage percentage of the acetabulum and characteristics of patients with FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were included who underwent standard clinical 3-T magnetic resonance imaging of the hip and primary arthroscopic FAI correction surgery during 2015 and 2016. Exclusion criteria were age 40 years, osteoarthritis, labral reconstruction, previous ipsilateral hip surgery, and hip dysplasia. Measurements of the cotyloid fossa and surrounding lunate cartilage were performed to calculate cotyloid fossa width (CFW) and cotyloid fossa height (CFH) coverage percentages. The relationships between coverage percentages and patient characteristics and intraoperative findings were assessed using independent t tests or Pearson correlations. Results: An overall 146 patients were included. Alpha angle negatively correlated with CFH coverage percentage ( r = −0.19; P = .03) and positively correlated with labral tear size ( r = 0.28; P < .01). CFH coverage percentage was negatively correlated with labral tear size ( r = −0.24; P < .01). Among patients with degenerative tears, CFH was negatively correlated with labral tear size ( r = −0.31; P < .01). However, this association was no longer significant after adjusting for sex (partial r = −0.10; P = .39). Cotyloid fossa coverage was not associated with the condition of the cotyloid fossa synovium (synovitis vs no synovitis). CFW coverage percentage was negatively correlated with the 12-Item Short Form Health Survey (SF-12) physical component summary score ( r = −0.23; P < .01). Conclusion: The CFW and CFH coverage percentages may be associated with alpha angle, labral tear size, and SF-12 physical component summary score in patients with FAI. We may be able to predict the labral condition based on preoperative measurements of CFH and CFW coverage percentages.

Varanopids are a group of Palaeozoic terrestrial amniotes which represent one of the earliest-diverging groups of synapsids, but their palaeoneurology has gone largely unstudied and recent analyses have challenged their traditional placement within synapsids. We utilized computed tomography (CT) to study the virtual cranial and otic endocasts of six varanopids, including representative taxa of both mycterosaurines and varanodontines. Our results show that the varanopid brain is largely plesiomorphic, being tubular in shape and showing no expansion of the cerebrum or olfactory bulbs, but is distinct in showing highly expanded floccular fossae. The housing of the varanopid bony labyrinth is also distinct, in that the labyrinth is bounded almost entirely by the supraoccipital-opisthotic complex, with the prootic only bordering the ventral portion of the vestibule. The bony labyrinth is surprisingly well-ossified, clearly preserving the elliptical, sub-orthogonal canals, prominent ampullae, and the short, undifferentiated vestibule; this high degree of ossification is similar to that seen in therapsid synapsids and supports the traditional placement of varanopids within Synapsida. The enlarged anterior canal, together with the elliptical, orthogonal canals and enlarged floccular fossa, lend support for the fast head movements indicated by the inferred predatory feeding mode of varanopids. Reconstructed neurosensory anatomy indicates that varanopids may have a much lower-frequency hearing range compared to more derived synapsids, suggesting that, despite gaining some active predatory features, varanopids retain plesiomorphic hearing capabilities. As a whole, our data reveal that the neuroanatomy of pelycosaur-grade synapsids is far more complex than previously anticipated.

The aim of this retrospective study was to verify the three-dimensional morphological change in neocondyle bone growth after fibula free flap (FFF) reconstruction. The independent variables were age, sex, and diagnosis. Outcome variables included the direction and volume of neocondyle bone growth, and the time to a stable neocondyle following bone growth. The outcome variables were measured on postoperative computed tomography scans using iPlan 3.0. Of the 35 patients included, 25 showed neocondyle bone growth. The direction of neocondyle bone growth included the direction of lateral pterygoid traction (DLPT) and the direction towards the glenoid fossa (DGF). The bone growth of the neocondyle showed three patterns: only DLPT (eight patients), only DGF (two patients), and a combination of DLPT and DGF (15 patients). The average volume of bone growth in the 25 patients was 0.479 ± 0.380 cm3. The average volume of neocondyle bone growth was significantly greater in patients aged 18 years (0.219 ± 0.191 cm3) (P

BACKGROUND Since arterial supply of the anterior ear was described in 1992 by Park et al, various anatomical studies and surgical techniques have been published in the literatures. Although anatomic studies about the vascular pattern of the ear have been previously reported, most were incomplete to understand the vascular anatomy of the ear and its surgical outcomes. In this report, the authors defined further detailed vascular pattern of the arterial networks and of the main perforators of the anterior ear. METHODS The authors dissected in a total of 11 auricles that had been fixed in 10% formalin solution. Prior to dissection, a red latex solution was injected into the common carotid artery. The anteroauricular and postauricular skin was dissected to expose the arterial network under ×10 microscope magnification. RESULTS There are 2 arterial networks in the anteroauricular surface of the ear: triangular-scapha fossa and concha network. In this study, triangular-scapha fossa network has 2 vascular patterns by a dominant arterial supply: the superficial temporal artery (STA) type (6/11, 54.5%) and the posterior auricular artery (PAA) type (5/11, 45.4%). The STA type is distributed by a subbranch of the ascending helical artery of the STA, whereas the dominant arterial supply of the PAA type is a perforator of the triangular fossa from the PAA. We describe an important inflow to the triangular-scapha fossa network as blood supply from the middle division of the PAA, which directly emerges from the posterior to the anterior surface over the cartilage border at midhelix. CONCLUSIONS The detailed vascular anatomy of this report allows surgeons to perform surgical procedures safely and to develop various flaps in the field of the ear reconstruction.

To demonstrate our experience in treating pyriform fossa sinus tracts (PFST) using a novel technique of endoscopic cauterisation of the pyriform fossa sinus opening combined with injection of sodium carboxymethylcellulose gel (VoiceGel) lateral to the tract to encourage tight closure.Over a 48-month period, we used this technique on 11 patients who were diagnosed with PFST at BC Children's Hospital, a tertiary paediatric centre in Vancouver, BC, Canada.The 11 patients included 8 males and 3 females, and mean age at presentation was 69 months (range 22-108 months). Mean time from beginning of symptoms till diagnosis was 15 months (range 12-22 months). Ten PFST were on the left side of the neck and one on the right. Nine patients presented with recurrent neck infections and two had suppurative thyroiditis. All patients had endoscopic cauterisation of their PFST opening combined with injection of carboxymethylcellulose lateral to the sinus tract to cause tract collapse. Mean follow up was 15.8 months (range 8-24). All patients are asymptomatic without recurrence at the last follow-up visit. No post-operative complications were reported.Endoscopic management of paediatric PFST combined with the injection of sodium carboxymethylcellulose gel lateral to the sinus tract appears to be a safe and effective treatment option for PFST.Trattamento delle fistole congenite del seno piriforme mediante cauterizzazione endoscopica e iniezione di Voicegel.Descrivere la nostra esperienza nel trattamento delle fistole congenite del seno piriforme (PFST) utilizzando una nuova tecnica di cauterizzazione endoscopica del seno piriforme ed iniezione di gel di sodio carbossimetilcellulosa (VoiceGel) per favorire la chiusura del tramite.Per un periodo di 48 mesi, abbiamo utilizzato questa tecnica su undici bambini a cui è stata diagnosticata la PFST al BC Children’s Hospital, un centro pediatrico terziario di Vancouver, BC, Canada.Il gruppo di bambini includeva 8 maschi e 3 femmine, l’età media era di 69 mesi (range 22-108 mesi). Il tempo medio dall’inizio dei sintomi fino alla diagnosi è stato di 15 mesi (range 12-22 mesi). Dieci PFST erano sul lato sinistro del collo e uno a destra. 9 pazienti soffrivano di infezioni ricorrenti del collo e due avevano tiroidite suppurativa. Tutti i pazienti sono stati trattati mediante cauterizzazione endoscopica ed iniezione di carbossimetilcellulosa per cicatrizzare il tratto fistoloso. Il follow-up medio è stato di 15,8 mesi (range 8-24). Tutti i pazienti sono asintomatici, senza recidive al follow-up. Non sono state riportate complicanze postoperatorie.Il trattamento endoscopico della PFST pediatrica combinata con l’iniezione di gel di carbossimetilcellulosa di sodio sembra essere un’opzione terapeutica sicura ed efficace per le PFST.

Summary Objectives Understanding the mechanism of mandibular asymmetry (MA) is important to provide suggestions for occlusal treatment and to know the developmental process of masticatory dysfunction. To investigate the morphological and functional effects on MA, we evaluated the three-dimensional position of the glenoid fossa and its relationship to asymmetrical condylar translational movement. Methods In this retrospective study, 50 subjects who previously underwent computed tomography for surgical purposes were divided into MA and control groups according to a menton deviation of at least 4 mm from the mid-sagittal plane. The glenoid fossae positions were evaluated using a three-dimensional analysis program. Condylar translational movements were recorded and measured by computerized axiography on protrusion. Side-to-side asymmetry was measured for each parameter. Asymmetry index value was calculated to assess the correlation between glenoid fossa position and condylar movement. Wilcoxon’s signed-ranked test, Mann–Whitney U-test, and Spearman’s rank correlation were used for the statistical analysis. Results In the MA group, glenoid fossa position on the shifted side was significantly inferior and posterior as compared to that on the non-shifted side and of the control group. Condylar path length and sagittal condylar inclination were significantly greater on the shifted side versus non-shifted side, while no significant difference was found in transverse condylar inclination. The asymmetry index of the anterior–posterior glenoid fossa position was significantly correlated with that of condylar path length and bilateral transverse condylar inclination. In the control group, there were no significant correlations among the morphological and functional parameters. Limitations This study did not consider muscle activity and disc position, which may affect condylar movement. Conclusions Functional asymmetry of condylar translational movements is closely related to asymmetry of glenoid fossa position in MA patients.

BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice. AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint. METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year. RESULTS Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) (P ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group (P = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group (P < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group (P < 0.001). CONCLUSION Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.

Objective Our aim is to present the anomalies included empty renal fossa (ERF) in the ultrasonographic examination performed in the perinatology outpatient clinic of our hospital in 2020. Methods Ultrasonography requests were made in Kayseri City Hospital Perinatology Outpatient Clinic between January 1 and December 31, 2020, and 2405 ultrasonographic examinations were performed on 1961 pregnant women. The reports of the patients were analyzed retrospectively after the ethics committee approval of our hospital was obtained. All ultrasonographic examinations were performed by an experienced perinatologist using Samsung HS70A (Hampshire, UK), probe CA 1-7A. The fetuses diagnosed with empty renal fossa were screened in terms of accompanying anomalies and the detected anomalies were noted. Results Pregnant women were between 13 and 34 (mean 23.9) years old and their gestational ages were between 17 and 34 weeks. The incidence of empty renal fossa was found to be 0.75% for all pregnant women. An empty renal fossa finding was observed in a total of 15 fetuses. Horseshoe kidneys were present in four fetuses (0.20%), bilateral renal agenesis was present in five fetuses (0.25%), left renal agenesis was present in two fetuses (0.10%), pelvic kidneys (one on the right and two on the left) were present in three fetuses (0.15%), and crossed fused ectopic kidney was present in one fetus (0.05%). Conclusion The cause of ERF seen with anhydramnios is bilateral renal agenesis. In the presence of normal amniotic fluid, it should be considered that ERF may be due to various reasons and since the prognosis may change according to the accompanying anomalies, we must increase the accuracy of prenatal diagnosis.

Objectives Pneumatized articular tubercle/eminence (PAT) and glenoid fossa (PGF) are important air gaps in the skull bone. Aim of this study is to evaluate the prevalence and radiographic features of PAT and PGF in a group of children by cone-beam computed tomography (CBCT). Methods CBCT images of 120 patients (71 males, 49 females, age range 4–16 years) were retrospectively examined in terms of prevalence and characteristic features of pneumatizations and the findings were recorded according to age and gender. Results In our study, 40.2% PGF and 32.2% PAT were detected. The youngest patient with pneumatization was seven years old. PGF and PAT were observed less in females (PGF: 23, PAT: 10) than males (PGF: 33, PAT: 16); but this difference was not statistically significant (p > 0.05). PGF was also observed in all cases with PAT. There was a statistically significant relationship between PGF and PAT (p Conclusion This current study results demonstrate that the pneumatization of accessory air cells starts before puberty, surprisingly. Pneumatic cavities that can increase the risk of spread of infection such as tumour, inflammation and fractures should not be overlooked in children before puberty.

In this study, data related to the total soft tissue thickness and fat layer thickness of 41 anatomical landmarks were extracted from the craniofacial computerized tomography data of 280 Chinese individuals (160 males and 120 females). The measurements were assessed according to the following factors: a. sex, b. age, and c. sex × age. Descriptive statistics and a differential analysis were carried out in each group to analyze both the total soft tissue thickness and fat layer thickness. The results showed the following. 1. The results showed that the greater the total thickness of the soft tissue, the thicker the fat layer. 2. The thicknesses of the head and face soft tissues are strongly affected by sex. The total thickness of all landmark points in the men, except for the zygomatic points, was on average greater than that in the women. In contrast to the total thickness, the fat layer, except for the point of rhinion, in the women was larger than that in the men. 3. In the comparison of the 4 age groups, most feature points did not show an evident increasing or decreasing trend with age in the total thickness of the soft tissue. However, regarding the thickness of fat, the thickness at the other points, except for the feature infraorbital fossa point, decreased with age. 4. In the analysis of the sex × age group, no statistically significant differences were found at any landmark points. This paper is significant for facial reconstruction and cosmetic surgery in the Chinese population.

AIM: Based on the accumulated clinical material, this study aims to show the possibilities of diagnosing and treating direct inguinal hernias in children. MATERIALS AND METHODS: During the period from 2000 to 2020, 3221 children with inguinal hernias were treated in the surgical department of the Republican Childrens Clinical Hospital in Syktyvkar. Of the above group of children with inguinal hernias, seven patients (0.22%) had direct inguinal hernias. The above was confirmed by ultrasound examination. In laparoscopic imaging, a rectal hernia was defined as a recess of the peritoneum of a stellate or rounded shape in the projection of the medial umbilical fossa. Two patients underwent the Bassini herniation procedure. Two children underwent laparoscopic hernia repair with intracorporeal suture insertion. In three patients, hernia repair was performed using the PRMS method. RESULTS: Long-term results were followed up from six months to 15 years. Immediate and postoperative complications were noted. No recurrence of hernia was reported. CONCLUSIONS: When establishing direct inguinal hernia diagnosis in children is clinically determined in the form of a rounded, soft-elastic formation localized medially and above the Pupart ligament next to the projection of the external (superficial) inguinal ring of the inguinal canal. It is easily set into the abdominal cavity with rumbling and confirmed by ultrasound examination results. The most preferred treatment method for direct inguinal hernia in children, in our opinion, is hernia repair using the percutaneous internal ring suturing (PIRS) method.

In our study, we aimed to evaluate the risk of skull base perforation during endoscopic sinus surgery in individuals with hypoplasic maxillary sinuses using Cone Beam Computed Tomography (CBCT). We included 52 patients with bilateral maxillary sinus hypoplasia and 52 patients with normal maxillary sinus in the study. Reviewing paranasal CBCT scans, we noted the olfactory fossa depths and lateral lamella lengths of all the groups and compared between the hypoplasia groups and the control group. Compared the maxillary hypoplasia sinus individuals with the control group, both the olfactory fossa depths and the lateral lamina length were different in the maxillary hypoplasic individuals. In individuals with hypoplasic maxillary sinus, the olfactory fossa depth and the lateral lamina length values are higher, which increases the risk of complications in endoscopic sinus surgery.

The fossa is a specialized Malagasy carnivore housed in ex situ facilities since the late 19th century. Moderate breeding success has occurred since the 1970s, and welfare issues (notably stereotypic pacing behaviour) are commonly documented. To understand challenges relating to fossa housing and husbandry (H&H) across global facilities and to identify areas of good practice that dovetail with available husbandry standards, a survey was distributed to ZIMS-registered zoos in 2017. Results showed that outdoor housing area and volume varied greatly across facilities, the majority of fossa expressed unnatural behaviours, with pacing behaviour the most frequently observed. All fossa received enrichment, and most had public access restricted to one or two sides of the enclosure. The majority of fossa were locked in/out as part of their daily management and forty-one percent of the fossa surveyed as breeding individuals bred at the zoo. Dense cover within an enclosure, restricted public viewing areas, a variable feeding schedule and limited view of another species from the fossa exhibit appear to reduce the risk of unnatural behavior being performed. The achievement of best practice fossa husbandry may be a challenge due to its specialized ecology, the limited wild information guiding captive care, and the range of housing dimensions and exhibit features provided by zoos that makes identification of standardized practices difficult. We recommended that holders evaluate how and when enrichment is provided and assess what they are providing for environmental complexity as well as consider how the public views their fossa.