Morphometric study of mandibular foramen in macerated skulls to contribute to the development of sagittal split ramus osteotomy (SSRO) technique

Purpose

The aim of this study was to provide morphometric data, obtained from macerated mandibles, which might facilitate the topographic location of the mandibular foramen, considering aspects such as gender, age and ethnicity.

Materials and methods

One hundred and eighty-five macerated mandibles of adult black and white individuals of both sexes were analyzed. Initially, 5 points were established: MF, the lowest point of the mandibular foramen; S, greatest concavity of the mandibular notch; A, anterior margin of the ramus of mandible; P, posterior margin of the ramus of mandible; and Go, gonion. Then the following measurements were performed bilaterally: MF-S, MF-A, MF-P and MF-Go.

Results

The following mean values were found: MF-S: 21.02 mm for white females (WF) and 22.00 mm for black females (BF); 24.40 mm for white males (WM) and 24.35 mm for black males (BM); MF-A: 17.05 mm for WF and 18.09 mm for BF; 17.18 mm for WM and 18.11 mm for BM; MF-P: 11.11 mm for WF and 12.24 mm for BF; 13.10 mm for WM and 14.15 mm for BM; MF-Go: 19.00 mm for WF and 19.44 mm for BF; 23.13 mm for WM and 22.12 mm for BM.

Conclusions

The values found in this study, considering gender, age and ethnic group, can be used as a parameter to carry out the sagittal split ramus osteotomy technique, making it more predictable and with less risk of complications.     

Appearance of the mandibular incisive canal on panoramic radiographs

Panoramic radiographs are routinely used in the dental office for various diagnostic purposes. This study aimed to evaluate the visibility of neurovascular structures in the mandibular interforaminal region on such radiographs. Panoramic radiographs were obtained with a Cranex Tome (Soredex) from 545 consecutive patients using a standard exposure and positioning protocol. For visibility scoring of neurovascular structures, a four-point rating scale was used. The mandibular canal and the mental foramen could be observed in the majority of the cases with good visibility. The lingual foramen was visualized in 71% of the cases, with good visibility in 12%. An incisive canal was identified in 15% of the images, with good visibility in only 1%. An anatomical variation to be considered is the anterior looping of the mental nerve (in 11% of images). Panoramic radiographs can be used for visualization of the mental foramen and a potential anterior looping but not for locating the mandibular incisive canal. To verify its existence for preoperative planning purposes, cross-sectional imaging modalities (HR-CT or spiral tomography) should be preferred.     

Impact of the mandibular divergence on the position of the inferior alveolar nerve and mylohyoid nerve: a computed tomography study and its relevance to bilateral sagittal split osteotomy

Purpose

Bilateral sagittal split osteotomy (BSSO) is the most common procedure used to treat mandibular deformities. BSSO procedures include the Epker technique and the Dal Pont technique which are the most frequently used. Because of the intramandibular pathway of the inferior alveolar nerve (IAN), neurosensory disturbance of the lower lip and chin is the most common complication of BSSO. This study performed quantitative measurements from computed tomographic (CT) data obtained on dry human mandibles. The main aim of the study was to evaluate if mandibular divergence can predict the position of the IAN and the mylohyoid nerve (MHN) to prevent nerve injury.

Methods

After CT and 3D reconstruction of 65 dry mandibles, 30 measurements were made on 3 planes for each hemi-mandible. This allowed analysis of the IAN and MHN pathways. Three groups of hemi-mandibles were created depending on their divergence, and a statistical analysis was performed.

Results

Eight out of the 30 measurements showed a significant difference among the 3 groups. There was no significant difference for the remaining 22 measurements.

Conclusions

The IAN seems to have a more superior position in the groups of mandibular hypo- and hyper-divergence. Orthognathic surgeons should use a more superficial retromolar bone incision in these cases. Finally, the Epker technique would be safer for preserving the MHN in normo- and hypo-divergent patients.     

Shape of the lingula and its localization by panoramic radiograph versus dry mandibular measurement

BACKGROUND: To evaluate the incidence of lingula shapes in Thai adult mandibles and to compare the accuracy of panoramic radiograph measurement with the dry mandible measurements for localizing the position of the lingula. METHODS: Seventy-two dry adult mandibles (144 sides) from 52 males and 20 females of Thai origin were classified as triangular, truncated, nodular or assimilated. Twenty-three mandibles, composed of both first molar and canine on the same side (33 sides), were selected for distance measurement. The ten distances from the lingula to the anterior, posterior ramus, to the coronoid notch and lower border of the mandible were measured on the dry mandibles and compared with the same distances on panoramic radiographs. The distribution of the lingula shape is described. Paired t test and correlation were used to evaluate the accuracy of panoramic radiographs in localizing the position of the lingula. RESULTS: Truncated lingula were most commonly found (68 sides or 47%). Nodular, triangular and assimilated shapes were found in 33 (23%), 24 (17%) and 19 subjects (13%), respectively. The distance differences between the panoramic radiograph measurement and the dry mandible measurement were statistically significant (P < 0.01). The positive correlations between the panoramic and dry skull measurements were high (0.59-0.91). CONCLUSIONS: The lingula has different shapes in different populations. In adult Thai mandibles, the truncated lingula shape is most common. Panoramic radiographs present not only the position but also the shape and number of lingula and mandibular foramen. There is a high concordance between the measured distances in panoramic radiography and dry mandibles.     

Localizing the mandibular canal on dental CT reformatted images: usefulness of panoramic views

Purpose

The aim of this study was to compare panoramic and paraxial views of dental CT reformatted images to detect the mandibular canal, and to evaluate the usefulness of the dental CT software function of “Outlining the Mandibular Canal in the Panoramic View”.

Methods

One hundred and fifty-five patients (310 sides), who underwent multi-slice computed tomography examination for pretreatment planning of dental implant were analyzed. After scanning, two types of dental CT reformatted image, panoramic and paraxial views were obtained. Two oral radiologists evaluated both views for the visibility of the mandibular canal using a 5-point rating scale: score 5, 100–80 % visible, to score 1, 20–0 % visible. The visibility scores of the two views were evaluated and compared by Wilcoxon’s signed rank test.

Results

The mean ± standard deviations of panoramic and paraxial views were 4.2 ± 1.1 and 3.5 ± 1.2, respectively, and the former was significantly higher than the latter (p < 0.001). On the basis of these results, we attempted to apply the function of “Outlining the Mandibular Canal in the Panoramic View” to cases with poor visibility of the canal (score 1, 2 or 3) on paraxial views. Consequently, we could reduce the number of such cases from 128 (41 %) to 56 (18 %).

Conclusions

The detectability of the mandibular canal was significantly higher in panoramic views than in paraxial views. Using the function of “Outlining the Mandibular Canal in the Panoramic View”, the precision for identifying the canal on paraxial views was considered to be improved.     

螺旋CT三维成像及曲面断层片对下颌神经管走向的研究

目的　通过螺旋CT及曲面断层片探讨下颌神经管与下颌骨的实际位置关系。 方法　利用螺旋CT扫描机对正常年青人进行下颌骨的横断面连续薄层扫描及多平面重建后,测量并计算下颌神经管在下颌骨中的实际位置及其走行方向。对上述人群拍摄曲面断层片,在曲面断层片上测量并计算下颌神经管在下颌骨中的位置并将两种测量结果进行比较。 结果　在颊舌方向,下颌神经管总体走行是由舌侧逐渐向颊侧倾斜达颏孔,在走行高度上,在第三磨牙区由上向下走行,自第二磨牙开始下颌神经管逐渐由下向上走行达颏孔。下颌神经管在下颌骨中位置的测量并计算的比值,在两种检测方法中无显著性差异（P＜0.05）。 结论　本研究螺旋CT测量并计算出的比值校正曲面断层片测量并计算的结果,可以在临床工作中指导牙槽外科手术。     

下颌角整形术对下颌骨应力以及颞下颌关节功能的影响

目的分析基于东方经典美丽分析面罩的下颌角整形术对人体下颌骨及颞颌关节功能的影响。方法获取病人术前和术后头部CT图像数据,通过Simpleware有限元建模软件生成计算模型,利用Abaqus软件观察手术前后模型上的应力分布及数值大小。结果获得了具有良好形态的下颌骨三维有限元模型,根据在不同部位施加不同负荷模拟模型各部分的力学改变,发现手术前后下颌骨部及关节附近的应力分布有差异。结论基于东方经典美丽分析面罩的下颌角整形术,手术前后对病人的下颌骨及颞颌关节附近的应力减小。     

Microcomputed tomography (microCT) and histology of the mandibular canal in human and laboratory animals

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Spatial properties of central vestibular neurons of monkeys after bilateral lateral canal nerve section

Thirty-seven neurons were recorded in the superior vestibular nucleus (SVN) of two cynomolgus monkeys 1-2 yr after bilateral lateral canal nerve section to test whether the central neurons had spatially adapted for the loss of lateral canal input. The absence of lateral canal function was verified with eye movement recordings. The relation of unit activity to the vertical canals was determined by oscillating the animals about a horizontal axis with the head in various orientations relative to the axis of rotation. Animals were also oscillated about a vertical axis while upright or tilted in pitch. In the second test, the vertical canals are maximally activated when the animals are tilted back about -50 degrees from the spatial upright and the lateral canals when the animals are tilted forward about 30 degrees . We reasoned that if central compensation occurred, the head orientation at which the response of the vertical canal-related neurons was maximal should be shifted toward the plane of the lateral canals. No lateral canal-related units were found after nerve section, and vertical canal-related units were found only in SVN not in the rostral medial vestibular nucleus. SVN canal-related units were maximally activated when the head was tilted back at -47 +/- 17 and -50 +/- 12 degrees (means +/- SD) in the two animals, close to the predicted orientation of the vertical canals. This indicated that spatial adaptation of vertical canal-related vestibular neurons had not occurred. There were substantial neck and/or otolith-related inputs activating the vertical canal-related neurons in the nerve-sectioned animals, which could have contributed to oculomotor compensation after nerve section.     

Spatial orientation of the angular vestibulo-ocular reflex (aVOR) after semicircular canal plugging and canal nerve section

We investigated spatial responses of the aVOR to small and large accelerations in six canal-plugged and lateral canal nerve-sectioned monkeys. The aim was to determine whether there was spatial adaptation after partial and complete loss of all inputs in a canal plane. Impulses of torques generated head thrusts of ≈ 3,000°/s2. Smaller accelerations of ≈ 300°/s2 initiated the steps of velocity (60°/s). Animals were rotated about a spatial vertical axis while upright (0°) or statically tilted fore-aft up to ± 90°. Temporal aVOR yaw and roll gains were computed at every head orientation and were fit with a sinusoid to obtain the spatial gains and phases. Spatial gains peaked at ≈ 0° for yaw and ≈ 90° for roll in normal animals. After bilateral lateral canal nerve section, the spatial yaw and roll gains peaked when animals were tilted back ≈ 50°, to bring the intact vertical canals in the plane of rotation. Yaw and roll gains were identical in the lateral canal nerve-sectioned monkeys tested with both low- and high-acceleration stimuli. The responses were close to normal for high-acceleration thrusts in canal-plugged animals, but were significantly reduced when these animals were given step stimuli. Thus, high accelerations adequately activated the plugged canals, whereas yaw and roll spatial aVOR gains were produced only by the intact vertical canals after total loss of lateral canal input. We conclude that there is no spatial adaptation of the aVOR even after complete loss of specific semicircular canal input.     

Complementary gain modifications of the cervico-ocular (COR) and angular vestibulo-ocular (aVOR) reflexes after canal plugging

To determine whether the COR compensates for the loss of aVOR gain, independent of species, we studied cynomolgus and rhesus monkeys in which all six semicircular canals were plugged. Gains and phases of the aVOR and COR were determined at frequencies ranging from 0.02 to 6?Hz and fit with model-based transfer functions. Following canal plugging in a rhesus monkey, the acute stage aVOR gain was small and there were absent responses to thrusts of yaw rotation. In the chronic state, aVOR behavior was characterized by a cupula/endolymph time constant of ??0.07?s, responding only to high frequencies of head rotation. COR gains were ??0 before surgery but increased to ??0.15 at low frequencies just after surgery; the COR gains increased to ??0.4 over the next 12?weeks. Nine weeks after surgery, the summated aVOR?+?COR responses compensated for head velocity in space in the 0.5?C3?Hz frequency range. The gains and phases continued to improve until the 35th week, where the combined aVOR?+?COR stabilized with gains of ??0.5?C0.6 and the phases were compensatory over all frequencies. Two cynomolgus monkeys operated 3?C12 years earlier had similar frequency characteristics of the aVOR and COR. The combined aVOR?+?COR gains were ??0.4?C0.8 with compensatory phases. To achieve gains close to 1.0, other mechanisms may contribute to gaze compensation, especially with the head free. Thus, while there are individual variations in the time of adaptation of the gain and phase parameters, the essential functional organization of the adaption to vestibular lesions is uniform across these species.     

Metric and angular variables of the mandibular ramus on panoramic radiographs, as indicators for chronologic age

This paper had as goals to identify the presence of age indicators in the mandibular ramus and to study their applicability in estimating the chronological age of children between the ages of 6 and 12 years. For this, a sample of 128 individuals (70 males and 58 females) was selected, all without chronic or acute sicknesses. An evaluation was made of the metric and angular variables of the mandibular ramus on panoramic radiographs of the oral cavity. The Greulich-Pyle method was applied to estimate the skeletal age, and the Demirjian et al. method was applied to estimate the dental age. A positive correlation, statistically significant, could be observed between the metric variables studied and the chronological age; nevertheless, the angular variables did not show correlation with the chronological age. Regression models were built using metric variables of the mandibular ramus in order to estimate the age, which made a significant contribution to the calculation of the age. A consistent subestimation of the skeletal age and an overestimation of the dental age were found in both sexes. It was evident that a combination of the dental age, the skeletal age and the metric variables obtained in the mandibular ramus, increases the precision for calculating the chronological age, when compared to separate-made estimations of the dental and skeletal age. The proposed regression models can be used for estimating the age of cadavers in advanced states of decomposition and in living individuals without valid identification documents.     

Anatomical study of pterygoid canal (PC) and palatovaginal canal (PVC) in endoscopic trans-sphenoidal approach

Purpose

The primary purpose of our work was to make anatomical measurements of pterygoid canal (PC) and palatovaginal canal (PVC). The secondary goal was to locate the two structures based on the landmarks in the trans-sphenoidal surgery and draw a safe corridor of fenestration in the bottom of sphenoid sinus during surgical procedure to sphenopalatine region.

Materials and methods

Computed tomographic angiography (CTA) images of PC, PVC and sphenoid sinus in 200 adults were reviewed. Multiplanar reconstruction of the CT images was performed, and the anatomical features of the PC and PVC were studied in the coronal, sagittal, and axial planes. The length, diameter and direction of PC and PVC were measured in the plane through or perpendicular to them. The anterior and posterior opening of PC and PVC were identified by the surgical landmarks such as the middle lowest point of sellar floor, the sagittal midline and the bottom of the sphenoid sinus.

Result

Both PC and PVC can be found and identified easily on CTA image, the shape and size of the PC and PVC were in agreement with those retrieved from previous literatures, the position of them can be located by the anatomical landmarks in sphenoid sinus.

Conclusion

Knowing the anatomical features of PC and PVC and their location based on the anatomical landmarks are helpful to the endoscopic trans-sphenoidal surgery. These data in our study will provide surgeons a better understanding of PC and PVC and their relationship to sphenoid sinus. Notably, it will not help the surgeons to avoid injuring neurovascular structures as well as provided supportive information for the choice of the appropriate endoscopic equipment.

     

Selective brain cooling after bilateral superior cervical sympathectomy in sheep (Ovis aries)

We have investigated the role of the sympathetic innervation of the vasculature of the head in the control of selective brain cooling of sheep, during exposure to high and low ambient temperatures and during endotoxin-induced fever. Bilateral removal of the superior cervical ganglia resulted in a significant reduciton of hypothalamic temperture during all procedures. Respiratory rate was also depressed by the sympathectomy, apparently mainly as a result of a decrease in nasal airway patency. Rectal temperature changes after sympathectomy were dependent on the experimental conditions, and the rectal — hypothalamic temperature difference was enhanced during heat exposure and fever. Our results support the contention that sympathetically mediated changes in nasal blood flow and in venous return from the nasal cavity, via the angularis oculi and facial veins, may be involved in the control of selective brain cooling in sheep.     

Optokinetic nystagmus (OKN) and optokinetic after-responses after bilateral vestibular neurectomy in the monkey

Summary The superior branch of the vestibular nerve containing peripheral axons of primary afférents originating in the lateral and anterior semicircular canals was cut bilaterally in three monkeys (vestibular neurectomy). Vertical and horizontal components of eye position were monitored by electro-oculography (EOG) during different stimulus and behavioral paradigms. Postoperatively, monkeys were unable to hold their eyes in eccentric lateral positions in complete darkness. The eyes drifted slowly back to the primary position where eye drift was minimal (null-zone). After vestibular neurectomy the time constant of the eye position integrator in darkness was 4–8 s. Constant velocity optokinetic stimuli produced peak velocities of horizontal OKN that were similar to those before operation. Consistent optokinetic after-responses could not be observed after neurectomy for stimulus durations of less than 60 s. However, with stimulus periods greater than 60–120 s a drift near the primary position of the eyes appeared in darkness which had the same direction as the slow phases of the preceding OKN. Drift velocity was too high to be explained by drift due to the imperfect eye position integrator alone. We assume that drift after prolonged optokinetic stimulation is a combination of an after-response similar as it can be observed after smooth pursuit and of drift due to an imperfect eye position integrator. Secondary optokinetic after-nystagmus was not observed after neurectomy.Supported by Swiss National Foundation for Scientific Research (Nr. 3.718-0.80 and 3.593-0.84)     

Modelling non-linearities in the vestibulo-ocular reflex (VOR) after unilateral or bilateral loss of peripheral vestibular function

We recorded the vestibulo-ocular reflex (VOR) in 18 normal subjects, 50 patients with unilateral loss of vestibular function and 18 patients with bilateral loss of vestibular function. The unilateral cases had either partial loss (i.e. vestibular neuronitis or Meniere's disease) or total loss (i.e. vestibular nerve section), whereas bilateral cases had only partial loss (i.e. due to ototoxicity or to suspected microangiopathy, secondary to severe kidney disease). Tests were performed at 1/6-Hz passive head rotation in the dark, with peak head velocities ranging from 125 to 190°/s. We report on the distinct VOR non-linearities observed in unilateral versus bilateral patients: whereas unilateral patients all exhibit an asymmetric hypofunction with decreasing VOR gain at higher head velocities, bilateral patients have a more severe but symmetric hypofunction associated with increasing VOR gain at higher head velocities. We present a model study that can duplicate the nature of these characteristics, based mainly on peripheral non-linear semicircular canal characteristics and secondary central compensation. Theoretical analyses point to the importance of clinical test parameters (rotation speed and frequency) in the determination of a functional VOR and the detection of reflex non-linearities, so that test protocols can seriously bias the evaluation of adequate functional recovery. Electronic Publication     

Effect of osteoarthritis severity on survival and clinical outcomes after high tibial osteotomy

BackgroundThis study aimed to evaluate the effect of osteoarthritis severity on clinical outcomes using the 2011 Knee Society Score (KSS2011) and survival rates after closed wedge high tibial osteotomy (CWHTO).MethodsIn this retrospective study, KSS2011 questionnaires were mailed to patients who had undergone CWHTO between January 1991 and December 2011. The completed questionnaires returned by the patients were analyzed. Preoperative osteoarthritis severity was evaluated by Kellgren-Lawrence (K-L) grade. KSS2011 was compared between the K-L grade groups. To determine the effect of K-L grade for revision surgery, Kaplan-Meier survival curves were created using the need for total knee arthroplasty (TKA) as the endpoint to estimate the probability of failure.ResultsThere were 16, 81, and 47 knees with preoperative K-L 2, 3, and 4, respectively. Among the KSS2011 sub-scores, the symptom score showed significant differences between the groups (p = 0.006). However, no significant difference was found regarding satisfaction, expectation, and functional activity scores. No significant difference in the symptom score was found between the K-L 2 and 3 groups (p > 0.05). Eighteen knees were treated with TKA at a mean of 9 years after CWHTO. Using the Kaplan-Meier survival estimates, the K-L 4 group showed a significantly higher rate of total knee arthroplasty conversion than the K-L 2 and 3 groups (p < 0.001).ConclusionsOsteoarthritis severity affects clinical outcomes and survival rates during long-term follow-up after CWHTO. Surgeons should consider the preoperative osteoarthritis grade for long-term outcomes when considering CWHTO for patients with varus knees.     

Nonrandom association of atrioventricular canal and del (8p) syndrome

We describe a patient with partial deletion of the short arm of chromosome 8 with an atrio-ventricular canal. This type of congenital heart defect was found in 4 of the 7 previously reported del (8p) children with e congenital heart defect in which the cardiac assessment was complete. The prevalence of an atrioven-tricular canal in this aneuploidy is high and suggests a nonrandom association of the 2 anomalies.