Retrospective Analysis of Ponticulus Posticus in Indian Orthodontic Patients-A Lateral Cephalometric Study

Background

The lateral cephalogram is the most common diagnostic radiograph used in clinical orthodontics. Significant cervical spine pathology can be detected on the routine lateral cephalogram. The aim of this study is to sensitize clinicians for examining the cervical area of lateral cephalogram carefully and thus record anatomical variations.

Materials and Methods

The presence and types of ponticuli posticus were investigated on 650 lateral cephalograms which were randomly selected from archived records at AECS Maaruti College of Dental Sciences & Research Centre, Bangalore

Results

The prevalence rate of Ponticulus Posticus in our study was found to be 11.1%. Though there was slight female predominance of 11.7% as compared to 10.4% in males, difference was not statistically significant.

Conclusion

Ponticulus posticus is a common anomaly in the Indian population. If any such anomaly is detected or suspected, it must be documented in the patient''s health record and specialist consultation must be sought. The lateral cephalogram must thus be considered as one of the baseline screening tool for detecting anomalies and pathology in the cervical spine region.     

上颌阻生尖牙患者寰椎形态变异情况的锥形束CT研究

目的 利用锥形束CT(cone-beam computed tomography,CBCT)研究上颌尖牙唇(腭)侧阻生(BIC/PIC)的患者寰椎形态变异的发生情况,以期辅助上颌阻生尖牙的预测和早期干预。方法 选取196例上颌阻生尖牙患者(研究组)和196例年龄、性别、安氏分类与之相匹配的尖牙正常萌出者(对照组)。将所有样本的CBCT导入Dolphin软件,重建头颅侧位片和三维图像,观察并记录各组寰椎后桥及寰椎后弓发育缺陷(包括寰椎后弓发育不全和寰椎后椎弓裂隙)的发生情况,并使用SPSS软件进行统计分析。结果 研究组寰椎后桥的发生率为32.6%,显著高于对照组(22.4%,P=0.024)。PIC组寰椎后桥发生率显著高于对照组(P=0.005),BIC组和对照组、BIC和PIC组之间无统计学差异(P>0.05)。寰椎后弓发育缺陷研究组和对照组之间的发生率并无统计学差异(P>0.05)。结论 上颌尖牙阻生患者较尖牙正常萌出者更容易发生寰椎后桥。     

Prevalence of ponticulus posticus in Indian orthodontic patients

Objectives

The purpose of this study was to investigate the prevalence of complete ponticulus posticus in Indian orthodontic patients.

Methods

The presence and types of ponticuli posticus were investigated on 858 lateral cephalograms.

Results

Complete ponticulus posticus was found in 4.3% of the subjects studied with a male (5.33%) predominance over female in the population (3.76%).

Conclusions

Ponticulus posticus is not a rare anomaly and the patient must be told of the implications and importance of detecting ponticulus posticus on a lateral cephalogram. This information can prove beneficial for the diagnosis of head and neck symptoms later.     

Bilateral variation of subclavius muscle resembling subclavius posticus

During routine anatomical dissection, a bilateral variation of the muscle subclavius was discovered with additional morphological features consistent with the muscle subclavius posticus. Attached medially to the first rib by tendon and to the clavicle by fibrous bands, the long triangular shaped muscle ran dorsal-laterally to attach onto the transverse scapular ligament and the coracoid process. The scapular insertion of the omohyoid muscle was just medial to this muscle, with some intermingling of fibers close to their insertions. In addition, the muscle on the left was split into two heads before inserting onto the scapula. Innervation was supplied by the nerve to the subclavius. We believe this muscle to be a hybrid of subclavius and subclavius posticus muscles, and we discuss the developmental origin of this rare subclavius variant, as well as the potential role this muscle may play in the development of thoracic outlet syndrome.     

囊袋张力环预防白内障超声乳化手术后后囊膜混浊的临床观察

目的:探讨晶状体囊袋张力环预防白内障超声乳化手术后后囊膜混浊的效果。方法:14例(28眼)双眼白内障患者,一眼行白内障超声乳化吸出 张力环 人工晶体植入术;另一眼则行白内障超声乳化吸出 人工晶体植入术。结果:14例(28眼)患者均顺利完成手术;术后随访3年,其中张力环植入组,后囊膜无明显皱缩,中央区无明显混浊,患者视力下降均≤0.3,有2例(2眼)行了YAG激光后囊膜切开;而未植入张力环组,后囊膜均明显皱缩,且术后视力下降明显,0.25~0.2有2例(2眼),0.4~0.3有4例(4眼),>0.4者有3例(3眼)。其中有7例(7眼)行了YAG激光后囊膜切开。结论:对于白内障超声乳化手术患者,术中植入囊袋张力环,能有效防止囊袋皱缩,抑制晶状体上皮细胞向后囊膜增殖,减少后囊膜中央区混浊及需行YAG切开的发生率。     

Torticollis,Facial Asymmetry,Local Pain,and Barré‐Liéou Syndrome in Connection with One‐Sided Ponticulus Posticus: A Case Report and Review of the Literature

BackgroundPonticulus posticus (PP) occurs frequently and may cause symptom series, including vertebrobasilar insufficiency, migraine, hearing loss, and Barré‐Liéou syndrome. However, few studies to date have described surgical treatment of PP. We report a rare case of a patient who suffered from torticollis, facial asymmetry, localized pain, and Barré‐Liéou syndrome in connection with PP. We also review the pertinent literature, focusing on surgical treatment for symptoms due to PP.Case presentationA 23‐year‐old male presented with the chief complaint of continuous significant dizziness to the point of losing consciousness while rotating his head to the right. Plain radiographs and computed tomography (CT) scans of the cervical spine showed a С1 anomaly with the formation of complete PP on the left (dominant) side, with acute‐angled, С‐shaped kinking of the vertebral artery. Resection of PP via the posterior midline was performed successfully. The patient had satisfactory postoperative relief from localized pain and Barré‐Liéou syndrome, but there were no obvious changes in the torticollis and facial asymmetry observed during the 3‐month follow‐up period.ConclusionsThis case is a rare presentation of torticollis, facial asymmetry, localized pain, and Barré‐Liéou syndrome in connection with one‐sided complete PP. This tetrad indicates that PP may affect the patient earlier than expected. In such situations, early diagnosis and timely surgical treatment may significantly improve patients'' quality of life and avoid the development of torticollis and face asymmetry.     

Evaluation of prevalence and characteristics of ponticulus posticus among Japanese adults: A comparative study between CBCT imaging and lateral cephalogram

Purpose

Purpose of the study was to evaluate the prevalence and precise characteristics of ponticulus posticus (PP) among Japanese adults using CBCT, and to evaluate the accuracy of PP by using the lateral cephalogram.

A case of muscle subclavius posticus with special reference to its innervation

Summary A subclavius posticus muscle was found in the left side of a Japanese male cadaver. This muscle arose from the first costal cartilage, inserted to the upper margin of the scapula, and was innervated by a branch from the nerve to the subclavius. This excess intermediary muscle between the subclavius and the inferior belly of the omohyoid appears to be more closely related to the subclavius, based on detailed examination of the innervation of this muscle. A possible schematic model of the origin of this muscle is proposed.

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Un cas de muscle subclavius posticus — Étude spéciale de son innervation

Résumé Un muscle subclavius posticus a été découvert du côté gauche d'un cadavre Japonais de sexe masculin. Ce muscle s'étendait du premier cartilage costal au bord supérieur de la scapula et était innervé par une branche du nerf du m. subclavier. Ce muscle accessoire situé entre le m. subclavier et le ventre inférieur du m. omo-hyoïdien semblait plus étroitement lié au m. subclavier en raison des conclusions de l'analyse détaillée son innervation. Une proposition de modèle schématique de l'origine de ce muscle est avancée.

     

寰椎椎动脉沟环综合征的防治研究

目的　研究寰椎椎动脉沟环激压椎动脉引起供血障碍导致以眩晕为主的供血区组织器官功能障碍 ,称之为沟环综合征及其防治办法。方法　通过 2 0 0具成年尸骨形态学的观察 ,沟环出现率为 2 8.5 % ,临床 170 0 0例颈性眩患者沟环发病率为 7.4 % ,进一步从临床症状研究 ,12 5 8例沟环患者都有枕颈失稳 ,而 5 0 0例无症状者 2 .4 %有沟环皆无枕颈失稳 ,证明枕颈失稳是沟环发病的主要原因。用 D.S.A.MRA.CT,脉冲多普勒检测成年活弥猴 8条椎动脉 ,成年患者 18条椎动脉和手术治疗患者所见得知沟环激压椎动脉外膜上的椎神经使椎动脉痉摩血流梗阻导致的眩晕 ,结果　发病机制为 :沟环 枕颈失稳 头颈转动至某种特定姿位→椎动脉外膜上的椎神经受刺激→椎动脉痉挛→供血障碍→眩晕”。结论　根据发病机制制定的治疗原则疗效优良率 98%以上。沟环综合征不是久治不愈的疾患。