Calvarial tuberculosis

We report a six-year-old boy who presented with swelling of the forehead, and had calvarial tuberculosis, a rare form of tuberculous osteitis.     

Local effects of transforming growth factor-β1 on rat calvaria: Changes depending on the dose and the injection site

Transforming growth factor-β₁ (TGF-β₁) has opposite effects on osteoblastic cells in vitro, namely an inhibitory or stimulatory effect on cell differentiation. Because these effects are dependent on TGF-β₁ concentration or culture condition, we investigated whether the in vivo effects of TGF-β₁ on bone formation in infant rat calvaria were affected by the dose or the injection site. Human platelet-derived TGF-β₁ was injected subcutaneously onto the periosteal surface of parietal bone of 4-week-old rats at doses of 5 or 20 ng/100 μl per animal for 14 days, and the local effect on bone formation was examined by bone histomorphometry. TGF-β₁ treatment for 7 days decreased the mineral apposition rate, bone formation rate, and elongated mineralization lag time at the injection site. This change became more prominent when treatment continued for 14 days. These changes were restricted to the TGF-β₁-exposed area. Multiple subcutaneous injections of a relatively high dose (200 ng/100 μl per animal) of TGF-β₁ induced woven bone formation, in addition to marked inhibition of bone formation rate and prolongation of mineralization lag time. On the other hand, direct exposure of TGF-β₁ in the subperiosteal layer induced woven bone with periosteal cell proliferation even at a single injection of a low dose (5 or 50 ng/25 μl) of TGF-β₁. In conclusion, the in vivo effects of TGF-β₁ on bone formation varied depending on its concentration and injection site. Also, subcutaneous injection of relatively low doses of TGF-β₁ inhibited local lamellar bone formation. Received: Feb. 2, 1998 / Accepted: Aug. 25, 1998     

Enhancing the outcome of free latissimus dorsi muscle flap reconstruction of scalp defects

BACKGROUND: Reconstruction of scalp and calvarial defects after tumor ablation frequently requires prosthetic cranioplasty and cutaneous coverage. Furthermore, patients often have advanced disease and receive perioperative radiotherapy. We evaluated the complications of scalp reconstruction with a free latissimus dorsi muscle flap in this setting. METHODS: The complications and the oncologic and aesthetic outcomes of six consecutive scalp reconstructions with a free latissimus dorsi muscle flap and skin graft in five patients with advanced cancer were retrospectively evaluated. Patient, tumor, defect, reconstructive, and other treatment characteristics were reviewed. Reconstructive and perioperative techniques intended to improve flap survival and aesthetic outcome and reduce complications in these patients. RESULTS: All patients (52-76 years old) had recurrent tumors (sarcoma, melanoma, or squamous cell carcinoma) and received postoperative radiotherapy. The mean scalp defect size was 367 cm(2), and partial-thickness or full-thickness calvarial resection was required in all six cases. No vein grafts were needed. The mean follow-up period and disease-free survival time were 18 and 13 months, respectively. Three patients died of their disease, and two survived disease free. There were no flap failures or dehiscences. Complications consisted of donor site seroma in two patients; partial skin graft loss in one patient; and radiation burns to the flap, face, and ears in one patient. Scalp contour and aesthetic outcome were very good in all cases except for the one case with radiation burns. CONCLUSIONS: Good outcomes were achieved using a free latissimus dorsi muscle flap with a skin graft for flap reconstruction in elderly patients with advanced recurrent cancers who received perioperative radiotherapy. Several technical aspects of the reconstruction technique intended to enhance the functional and aesthetic outcome and/or reduce complications were believed to have contributed to the good results.     

Correlation in the densities of augmented and existing bone in guided bone augmentation

Objectives: Our previous work used a rabbit experimental model to investigate the effectiveness of guided bone augmentation (GBA). Although a density similar to that of existing bone is required for successful bone augmentation, few studies have compared the densities of augmented and existing bone. The purpose of the present study was to investigate the correlation in the densities of existing and augmented bone following GBA in rabbit calvaria. Material and methods: The calvaria of 18 adult male Japanese white rabbits were exposed. A circular groove and nine small holes were drilled into the cortical surface of each left parietal bone. A customized, standardized, hemispherical titanium cap was press‐fitted into each groove. Six animals were sacrificed after each healing period of 1, 3, and 6 months and histomorphometric analyses were conducted. Results: Significant increases were observed in the area of augmented bone between 1 and 6 months (62.7±21.6% vs. 93.4±3.9%). In contrast, no significant differences among healing periods were observed in the density of augmented or existing bone. Regression analysis demonstrated a significant positive correlation between the densities of augmented and existing bone; the strength of this correlation increased with the length of healing (R²=0.97). Conclusions: These results suggest that the area of augmented bone increases significantly with the length of healing, filling the occlusive space after 6 months, and that the density of augmented bone depends on that of the existing bone, such that augmented bone has a density about half that of the existing bone. To cite this article:
Yamada Y, Sato S, Yagi H, Ujiie H, Ezawa S, Ito K. Correlation in the densities of augmented and existing bone in guided bone augmentation. Clin. Oral Impl. Res. 23 , 2012; 837–845
doi: 10.1111/j.1600‐0501.2011.02204.x     

局部应力对颅盖内,外板影响的生物力学研究

应用电测法研究了颅盖额、颞、枕部在局部应力作用下,其内、外板上的应力场之分布概况.应力从外板经板障传到内板后,主应力方向发生偏转,最大主应力和最小主应力也出现变化,表明应力场有了新的分布.本研究为临床上诊断和分析颅盖骨折的类型、部位及骨折线的方向等提供了生物力学依据.     

Progressive destructive vertebral sarcoid leading to surgical fusion

Skeletal sarcoidosis is rare. This report describes a 31-year-old African American man who presented with a destructive osteolytic lesion of C2 and another lesion in a rib. The lesion at C2 was treated with corpectomy and bone graft. Four months later the lesion recurred and a new lesion was discovered in the cervical vertebral column. The patient declined surgery for instability for another 3 months, choosing to remain in a halo. Seven months following the initial operation, a technetium bone scan showed spread of the disease to the calvarium and thoracic and lumbar vertebrae. The patient had no symptoms referable to these sites. The patient agreed to have his neck fused at this point. For the next 10 months, the patient was on steroids and a further new lesion appeared at L5 without localizing signs or symptoms. The patient declined further evaluation over the next 12 months and is now considered lost to follow-up. Received: 29 July 1999 Revision requested: 26 August 1999 Revision received: 1 September 1999 Accepted: 2 September 1999     

Skull metastasis from hepatocellular carcinoma

Summary Metastasis to the skull frequently occurs in patients with lung, breast and prostate cancer. However, skull metastases from hepatocellular carcinoma (HCC) have been rarely reported. We review the literature on skull metastasis from HCC and report a case of a 46-year-old male, who was diagnosed as HCC and was operated on by trans-arterial embolization and lobectomy in Oct. 2004. He complained of a painless mass over the left frontal region for two months. Radiograph of the skull revealed an osteolytic mass about 4–5 cm in size over the left frontal region. A cranial computerized tomography demonstrated a destructive lesion with soft tissue mass over the left frontal region. A left frontal craniectomy was performed and tumor was totally removed. The histological diagnosis was cranial metastasis from HCC. Postoperative recovery was uneventful without any neurological deficits. Because of improved and advancing treatment for HCC, survival time for HCC has been lengthened and distant metastasese will thus be found to increase. Early diagnosis is essential to treat the primary disease. Skull metastases from HCC should be considered as a differential diagnosis in patients with scalp subcutaneous mass and osteolytic defect on X-ray skull films.     

Local flaps in the treatment of full thickness scalp defects secondary to advanced cutaneous malignancy. About 21 clinical cases

SUBJECT: The advanced tumors of the scalp can involve the calvarium, the dura and the cerebral tissue. The medium sized full thickness scalp defects secondary to the excision of such cutaneous malignancy can be successfully treated with local flaps coming from the remaining scalp if these flaps are large and including at least one major pedicle of the scalp. The cranioplasty can be done immediately or secondarily. PATIENTS AND METHODS: From May 2001 to July 2006, 21 patients aged between 52 and 78 years old, suffering from advanced basal and squamous cell carcinomas with invasion of the calvarium in all cases, the dura in 1 case and the cerebral tissue in 2 cases have benefited from an excision of the scalp and calvarium with a margin between 1 and 3 cm. The secondary defects measured between 9 and 15 cm for the scalp and between 6 and 9 cm for the calvarium. In 1 case, the dura was resected and reconstructed with a fascia lata graft. The flaps used were: a single pedicled transposition flap based on one or two occipital pedicles in 10 cases--a bipedicled transposition flap based on the superficial temporal pedicles in 3 cases and on the frontal and occipital pedicles in 4 cases--a large rotation flap in 4 cases. These flaps were undermined under the galea without any galeotomies. Their donor sites were immediately grafted. The calvarium was reconstructed by a methylmetacrylate implant in 9 cases, simultaneously with these flaps in 4 cases and secondarily in 5 cases. RESULTS: There were no vascular problems in all these flaps--3 cases of infection in the simultaneous reconstruction of the scalp and calvarium are reported. The two patients with cerebral invasion are deceased 1 year after the surgery. The other patients are still alive without any recurrence or metastasis with a mean follow-up of 36 months. CONCLUSION: Such complex defects of the tumoral scalp can be reconstructed with large and axial local flaps of the remaining scalp with safety. The cranioplasty has to be delayed.