Zygomaticomaxillary Complex Anatomy

SummaryAim: The precise localisation of osteoarthritic and inflammatory changes is crucial for selective treatment planning of radiosynovectomy (RSV). The present study evaluated the diagnostic accuracy of planar bone imaging and SPECT for the detection of pathological bone metabolism and inflammation in joints of the foot and ankle, compared with SPECT/CT. Patients, methods: 39 patients (mean age 65.6 ± 11.1 years) with suspected inflammatory osteoarthritis underwent SPECT/CT of the feet. After injection of approximately 500 MBq 99mTc DPD, all patients had three-phase planar bone imaging and late-phase hybrid SPECT/CT. late-phase SPECT, and CT of the foot. Increased bone metabolism and blood-pool was assigned to the respective joint of the fore-, mid-, and hindfoot, using SPECT/CT as the reference standard. Results: Overall, SPECT had a higher sensitivity than planar imaging (0.80 vs 0.68, n.s.). The advantage of SPECT was most obvious in the anatomically complex midfoot area (0.63 vs 0.26, p < 0.05) and less obvious in the forefoot (0.85 vs 0.79, n.s.) and hindfoot (0.89 vs 0.89, n.s.). The overall concordance (Cohen`s Kappa) between SPECT/CT and planar (late-phase) imaging and SPECT was high for the forefoot and the hindfoot (planar: 0.78/0.81; SPECT 0.86/0.88) and comparatively low for the midfoot (planar: 0.27; SPECT 0.61). Conclusion: SPECT was significantly superior to planar bone imaging for the detection of joint lesions in the midfoot. The differences between SPECT and planar imaging in the fore- and hindfoot were not significant, most likely due to the inherently less complex anatomy. Compared with SPECT alone, a benefit from the use of SPECT/CT can be observed in the midfoot region where it facilitates the identification of the correct joint for RSV.

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Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1714407 ◽

2020 ◽

Author(s):

Pinar E. Ocak ◽

Selcuk Yilmazlar

Keyword(s):

Cranial Nerve ◽

Cranial Nerves ◽

Posterolateral Approach ◽

Left Vertebral Artery ◽

Posterior Arch ◽

Upper Cervical Spine ◽

Two Dimensional ◽

Lower Cranial Nerve ◽

Complex Anatomy ◽

Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

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Utilization potential of intraluminal optical coherence tomography for the Eustachian tube

Scientific Reports ◽

10.1038/s41598-021-85634-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hayoung Byun ◽

Yeon Hoon Kim ◽

Jingchao Xing ◽

Su-Jin Shin ◽

Seung Hwan Lee ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Eustachian Tube ◽

Balloon Dilatation ◽

Optical Coherence ◽

Cross Sectional ◽

Anatomical Structures ◽

Complex Anatomy ◽

Before And After ◽

Tubal Lumen ◽

Oct Image

AbstractImaging the Eustachian tube is challenging because of its complex anatomy and limited accessibility. This study fabricated a fiber-based optical coherence tomography (OCT) catheter and investigated its potential for assessing the Eustachian tube anatomy. A customized OCT system and an imaging catheter, termed the Eustachian OCT, were developed for visualizing the Eustachian tube. Three male swine cadaver heads were used to study OCT image acquisition and for subsequent histologic correlation. The imaging catheter was introduced through the nasopharyngeal opening and reached toward the middle ear. The OCT images were acquired from the superior to the nasopharyngeal opening before and after Eustachian tube balloon dilatation. The histological anatomy of the Eustachian tube was compared with corresponding OCT images, The new, Eustachian OCT catheter was successfully inserted in the tubal lumen without damage. Cross-sectional images of the tube were successfully obtained, and the margins of the anatomical structures including cartilage, mucosa lining, and fat could be successfully delineated. After balloon dilatation, the expansion of the cross-sectional area could be identified from the OCT images. Using the OCT technique to assess the Eustachian tube anatomy was shown to be feasible, and the fabricated OCT image catheter was determined to be suitable for Eustachian tube assessment.

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Incidence, Aetiology, and Associated Fracture Patterns of Infraorbital Nerve Injuries Following Zygomaticomaxillary Complex Fractures: A Retrospective Analysis of 272 Patients

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211022569 ◽

2021 ◽

pp. 194338752110225

Author(s):

Kathia Dubron ◽

Maarten Verbist ◽

Eman Shaheen ◽

Titiaan Jacob Dormaar ◽

Reinhilde Jacobs ◽

...

Keyword(s):

Neuropathic Pain ◽

Interpersonal Violence ◽

Fracture Line ◽

Infraorbital Nerve ◽

Type B ◽

Treatment Methods ◽

Infraorbital Canal ◽

Pain Symptoms ◽

Fracture Types ◽

Zygomaticomaxillary Complex

Study Design: Retrospective study. Objective: Zygomaticomaxillary complex (ZMC) fractures are common facial injuries with heterogeneity regarding aetiologies, fracture types, infraorbital nerve (ION) involvement, and treatment methods. The aim of this study was to identify associations between aetiologies, fracture types, and neurological complications. Additionally, treatment methods and recovery time were investigated. Methods: Medical files of 272 patients with unilateral and bilateral ZMC fractures were reviewed, whose cases were managed from January 2014 to January 2019 at the Department of Oral and Maxillofacial Surgery, University hospitals Leuven, Belgium. History of ION sensory dysfunction and facial nerve motoric dysfunction were noted during follow-up. Results: ION hypoaesthesia incidence was 37.3%, with the main causes being fall accidents, road traffic accidents, and interpersonal violence. Significant predictors of ION hypoaesthesia were Zingg type B fractures ( P = 0.003), fracture line course through the infraorbital canal ( P < .001), orbital floor fracture ( P < 0.001), and ZMC dislocation or mobility ( P = 0.001). Conclusion: Of all ZMC fractures, 37.3% exhibited ION hypoaesthesia. Only ZMC Zingg type B fractures (74.0%) were significantly more associated with ION hypoaesthesia. ION hypoesthesia was more likely (OR = 2.707) when the fracture line course ran through the infraorbital canal, and was less dependent on the degree of displacement. Neuropathic pain symptoms developed after ZMC fractures in 2.2% patients, posing a treatment challenge. Neuropathic pain symptoms were slightly more common among women, and were associated only with type B or C fractures. No other parameters were found to predict the outcome of this post-traumatic neuropathic pain condition.

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Midface Reconstruction: Planning and Outcome

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1721870 ◽

2020 ◽

Vol 53 (03) ◽

pp. 324-334

Author(s):

Gautam Biswas

Keyword(s):

Digital Imaging ◽

3D Structure ◽

Three Dimensional ◽

The Past ◽

Complex Anatomy ◽

Osseointegrated Implants ◽

Low Profile ◽

3D Printed ◽

Midface Reconstruction ◽

Reconstruction Planning

Abstract Reconstruction of the complex anatomy and aesthetics of the midface is often a challenge. A careful understanding of this three-dimensional (3D) structure is necessary. Anticipating the extent of excision and its planning following oncological resections is critical.In the past over two decades, with the advances in microsurgical procedures, contributions toward the reconstruction of this area have generated interest. Planning using digital imaging, 3D printed models, osseointegrated implants, and low-profile plates, has favorably impacted the outcome. However, there are still controversies in the management: to use single composite tissues versus multiple tissues; implants versus autografts; vascularized versus nonvascularized bone; prosthesis versus reconstruction.This article explores the present available options in maxillary reconstruction and outlines the approach in the management garnered from past publications and experiences.

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Assessment of myocardial deformation with CMR: a comparison with ultrasound speckle tracking in a cohort of highly trained endurance athletes

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.272 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

B Domenech-Ximenos ◽

M Sanz-De La Garza ◽

A Sepulveda-Martinez ◽

D Lorenzatti ◽

F Simard ◽

...

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Myocardial Deformation ◽

Endurance Athletes ◽

National Budget ◽

Complex Anatomy ◽

Exercise Induced ◽

Public Grant

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Plan Nacional I.D., Del Programa Estatal de Fomento De La Investigación Científica y Técnica de Excelencia, Subprograma De Generación Del Conocimiento, Ministerio de Economía y Competitividad 2013. Background Myocardial deformation integrated with cardiac dimensions provides a comprehensive assessment of the ventricular remodelling patterns induced by cumulative effects of intensive exercise. Feature tracking(FT) can measure myocardial deformation from cardiac magnetic resonance(CMR) cine sequences; however, its accuracy is still scarcely validated. Purpose Our aim was to compare FT’s accuracy and reproducibility to speckle tracking echocardiography (STE) in highly trained endurance athletes (EAs). Methods 93 EAs (>12 hours training/week during the last 5 years, 52% male, 35 ± 5.1 years) and 72 age-matched controls underwent a resting CMR and a transthoracic echocardiography to assess biventricular exercise-induced remodelling and biventricular global longitudinal strain (GLS) by CMR-FT and STE. Results High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and mildly reduced systolic function of both ventricles (p < 0,05). Strain values (both by CMR-FT and STE) proportionally decreased with increasing ventricular volumes potentially depicting the increased volume and functional biventricular reserve that characterize EAs heart. Strain values were lower when assessed by CMR-FT as compared to STE (p < 0.001), with good reproducibility for the LV (bias = 3.94%, LOA= ± 4.27%) but wider variability for RV strains (Figure 2). Conclusions Biventricular longitudinal strain values were lower when assessed by FT compared to STE. Both methods were comparable when measuring LV strain but not RV strain. These differences might be justified by FT’s lower in-plane spatial and temporal resolution, which is particularly relevant for the complex anatomy of the RV. Abstract Figure. Fig 1. Bland-Altman plots; FT vs STE.

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Three-dimensional printing for heart diseases: clinical application review

Bio-Design and Manufacturing ◽

10.1007/s42242-021-00125-8 ◽

2021 ◽

Author(s):

Yanyan Ma ◽

Peng Ding ◽

Lanlan Li ◽

Yang Liu ◽

Ping Jin ◽

...

Keyword(s):

3D Printing ◽

Clinical Application ◽

Heart Diseases ◽

Three Dimensional ◽

Convincing Evidence ◽

Surgical Interventions ◽

Three Dimensional Printing ◽

Complex Anatomy ◽

Precise Understanding ◽

3D Printed

AbstractHeart diseases remain the top threat to human health, and the treatment of heart diseases changes with each passing day. Convincing evidence shows that three-dimensional (3D) printing allows for a more precise understanding of the complex anatomy associated with various heart diseases. In addition, 3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions. We introduce examples of the clinical applications of different types of 3D printing based on specific cases and clinical application scenarios of 3D printing in treating heart diseases. We also discuss the limitations and clinically unmet needs of 3D printing in this context.

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Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Journal of Clinical Medicine ◽

10.3390/jcm10050946 ◽

2021 ◽

Vol 10 (5) ◽

pp. 946

Author(s):

Federico Marin ◽

Roberto Scarsini ◽

Rafail A. Kotronias ◽

Dimitrios Terentes Printzios ◽

Matthew K. Burrage ◽

...

Keyword(s):

Aortic Valve ◽

Severe Aortic Stenosis ◽

Myocardial Revascularization ◽

Coronary Intervention ◽

Hemodynamic Instability ◽

Bleeding Complications ◽

Diagnostic Tools ◽

Heart Team ◽

Complex Anatomy ◽

Increased Risk

Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.

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Desiccation Tolerance as the Basis of Long-Term Seed Viability

International Journal of Molecular Sciences ◽

10.3390/ijms22010101 ◽

2020 ◽

Vol 22 (1) ◽

pp. 101

Author(s):

Galina Smolikova ◽

Tatiana Leonova ◽

Natalia Vashurina ◽

Andrej Frolov ◽

Sergei Medvedev

Keyword(s):

Desiccation Tolerance ◽

Vascular Plants ◽

Molecular Mechanisms ◽

Regulation Of Gene Expression ◽

Seed Viability ◽

Late Embryogenesis Abundant ◽

Maturation Stage ◽

Terrestrial Plants ◽

Complex Anatomy ◽

Orthodox Seeds

Desiccation tolerance appeared as the key adaptation feature of photoautotrophic organisms for survival in terrestrial habitats. During the further evolution, vascular plants developed complex anatomy structures and molecular mechanisms to maintain the hydrated state of cell environment and sustain dehydration. However, the role of the genes encoding the mechanisms behind this adaptive feature of terrestrial plants changed with their evolution. Thus, in higher vascular plants it is restricted to protection of spores, seeds and pollen from dehydration, whereas the mature vegetative stages became sensitive to desiccation. During maturation, orthodox seeds lose up to 95% of water and successfully enter dormancy. This feature allows seeds maintaining their viability even under strongly fluctuating environmental conditions. The mechanisms behind the desiccation tolerance are activated at the late seed maturation stage and are associated with the accumulation of late embryogenesis abundant (LEA) proteins, small heat shock proteins (sHSP), non-reducing oligosaccharides, and antioxidants of different chemical nature. The main regulators of maturation and desiccation tolerance are abscisic acid and protein DOG1, which control the network of transcription factors, represented by LEC1, LEC2, FUS3, ABI3, ABI5, AGL67, PLATZ1, PLATZ2. This network is complemented by epigenetic regulation of gene expression via methylation of DNA, post-translational modifications of histones and chromatin remodeling. These fine regulatory mechanisms allow orthodox seeds maintaining desiccation tolerance during the whole period of germination up to the stage of radicle protrusion. This time point, in which seeds lose desiccation tolerance, is critical for the whole process of seed development.

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