Cerebrospinal Fluid Rhinorrhea and Seizure Caused by Temporo-Sphenoidal Encephalocele

This case report describes the symptoms and clinical course of a 35-year-old female patient who was diagnosed with a temporo-sphenoidal encephalocele. It is characterized by herniation of cerebral tissue of the temporal lobe through a defect of the skull base localized in the middle fossa. At the time of first presentation the patient complained about recurrent nasal discharge of clear fluid which had begun some weeks earlier. She also reported that three months earlier she had for the first time suffered from a generalized seizure. In a first therapeutic attempt an endoscopic endonasal approach to the sphenoid sinus was performed. An attempt to randomly seal the suspicious area failed. After frontotemporal craniotomy, it was possible to localize the encephalocele and the underlying bone defect. The herniated brain tissue was resected and the dural defect was closed with fascia of the temporalis muscle. In summary, the combination of recurrent rhinorrhea and a first-time seizure should alert specialists of otolaryngology, neurology and neurosurgery of a temporo-sphenoidal encephalocele as a possible cause. Treatment is likely to require a neurosurgical approach.     

Craniofacial bone atrophy in Parry Romberg syndrome demonstrated using a Bayesian hierarchical model

PurposeParry Romberg syndrome (PRS) is a condition characterized by progressive hemifacial atrophy, predominantly affecting the soft tissues. Associated bone retraction is a common clinical feature of PRS but has never been assessed. Here we used 3D imaging and Bayesian statistics in order to demonstrate and quantify bone atrophy in PRS.Materials and methodsTen non-operated patients with PRS (4/10 males) and 12 age-matched controls (7/12 males) were included into the study. The average age at CT-scan was 9.67 ± 4.13 years for PRS patients and 12.5 ± 4.37 years for controls. Soft and hard tissue atrophy levels were quantified using computed tomography scans, based on the distances between surfaces of the affected side and the non-affected contralateral side, both for the skin and the bone. We used a hierarchical Bayesian model with clinical priors in order to assess the relationship between hard and soft tissue atrophies.ResultsPRS patients had significant hard tissue atrophy, and atrophy extents were similar for soft and hard tissues. There was a trend for a correlation between the extent of hard tissue retraction and the extent of soft tissue retraction, and we could not demonstrate that the relationship between hard and soft tissue retractions was different in PRS and controls.ConclusionOur results indicated that bone atrophy was most probably a primary process rather than a phenomenon secondary to soft tissue retraction. We have provided the first assessment of bone atrophy in PRS patients using Bayesian statistics.     

根管治疗失败原因及再治疗诊治策略

牙髓病和根尖周病主要是细菌感染性疾病,根管治疗术则是国际上公认的最有效的治疗方法。随着口腔新技术、新材料的研发和应用,其成功率也在不断提高。但由于根尖周感染状况不同、根管系统和髓腔的解剖结构的复杂性和多样性、微生物变种及毒力改变、医疗器械或医生临床技能的差异等因素,仍有一些病例治疗效果不佳或者治疗失败,需要进行根管再治疗。文章旨在通过分析初次根管治疗失败的原因,对根管再治疗的诊治策略做一介绍。     

Histomorphometric analysis of the temporal bone after change of direction of force vector of mandible: an experimental study in rabbits

Objectives

The present study aimed at performing a histological evaluation of the response of temporal bone tissue to a change of direction of the force vector of the mandible in relation to the base of the skull.

Material and methods

Adult rabbits were assigned into four groups with two control and four experimental animals in each group. Experimental animals underwent surgery, which resulted in a change of direction of the force vector on the right temporomandibular joint. Samples were collected after 15, 30, 60 and 90 days for histological analysis.

Results

In the two-way analysis of variance, the effect of group and time was statistically significant (p<0.001). Additionally, a statistically significant interaction between group and time was observed (p<0.001). Control animals showed normal growth and development of the temporal region. In the experimental group, the change in direction of the force vector of the mandible induced significant changes in the temporal bone, with a bone modeling process, which suggests growth of this cranial structure.

Conclusions

The methodology used in this experiment allows us to conclude that the change in direction of the force vector of the mandible in relation to the skull base induces remodeling and modeling processes in the temporal bone. The resumption of normal oral functions after bone healing of the mandibular fracture appears to increase cell activation in the remodeling and modeling of the temporal bone structure. The observation of areas of temporal bone modeling shows the relevance of further investigation on the correlation between the joint structures and craniofacial growth and development.