Assessment of the anterior superior alveolar nerve and its  impact on surgery of the lateral nasal wall

Background: The anterior superior alveolar nerve (ASAN) plays a major role in innervation of the lateral nasal wall. Its damage during nasal surgery can cause dental paraesthesia and numbness around the upper lip. Methodology: Retrospective evaluation of the computed tomographic (CT) scans of 50 consecutive patients analysing 100 sides. We measured the mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve, to the anterior superior alveolar canal and the anterior-posterior distance between the “shoulder” of the inferior turbinate and the pyriform aperture. Results: The mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve was 6.4 ± 2.33 mm, with no difference between sides The mean relative height of the shoulder in relation to the anterior superior alveolar nerve canal was 4.78± 2.31mm with no significant difference between the two sides. The anterior-posterior distance between the “shoulder” of inferior turbinate and the pyriform aperture was 6.96± 2.28mm, with no significant difference between the two sides. Conclusions: We found the anterior superior alveolar nerve to be a constant landmark in the lateral nasal wall. Therefore, the course of the ASAN should be assessed on a CT scan when a surgical approach through the pyriform aperture or anterior medial wall of the maxillary sinus is planned.

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Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1724092 ◽

2021 ◽

Author(s):

Navarat Vatcharayothin ◽

Pornthep Kasemsiri ◽

Sanguansak Thanaviratananich ◽

Cattleya Thongrong

Keyword(s):

Confidence Interval ◽

Maxillary Sinus ◽

Inferior Turbinate ◽

Radial Access ◽

Sinus Wall ◽

Nasal Floor ◽

Significant Difference ◽

Anterolateral Wall ◽

The Mean ◽

Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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Anterior-Posterior (AP) Calcaneal Profile View: A Novel Radiographic Image to Assess Varus Malalignment

Foot & Ankle International ◽

10.1177/1071100720937297 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1249-1255

Author(s):

John Y. Kwon ◽

Bruno Moura ◽

Tyler Gonzalez ◽

Christopher P. Miller ◽

Jorge Briceno

Keyword(s):

Pairwise Comparison ◽

Bonferroni Correction ◽

Varus Malalignment ◽

Profile View ◽

Varus Angulation ◽

Significant Difference ◽

The Mean ◽

Calcaneus Fractures ◽

Axial View ◽

Anterior Posterior

Background: Assessing and correcting malalignment is important when treating calcaneus fractures. The Harris axial view is commonly utilized to assess varus deformity but may be inherently inaccurate due to its tangential nature. The anterior-posterior (AP) calcaneal profile view is a novel radiographic view that is easily obtained with demonstrated increased accuracy for assessing calcaneal axial alignment. Methods: Five nonpaired ankle cadaveric specimens were used in this investigation. Oblique osteotomies were created in relation to the long axis, and varus deformities were produced by inserting solid radiolucent wedges into the osteotomies to create models of 10, 20, and 30 degrees of angulation of the calcaneal tuberosity. Specimens were imaged using both the Harris axial view and the AP calcaneal profile view. Results: For cadavers with 10 degrees of actual varus angulation, the mean Harris axial view angle and the AP calcaneal profile view angle were 10.9 ± 4.8 (range, 5.5-16.0) degrees and 13.0 ± 5.5 (range, 7.3-20.9) degrees, respectively. For cadavers with 20 degrees of actual varus angulation, the mean Harris view angle and the AP calcaneal profile view angle were 11.5 ± 2 (range, 8.2-13.6) degrees and 18.1 ± 4.8 (range, 11.7-23.5) degrees, respectively ( P = .005). On pairwise comparison with Bonferroni correction, there was a significant difference between the Harris axial view angle and both the AP calcaneal profile view angle ( P = .012) and actual angulation ( P = .011). For cadavers with 30 degrees of actual varus angulation, the mean Harris axial view angle and the AP calcaneal profile view angle were 18.3 ± 4.3 (range, 13.3-23.6) degrees and 28.3 ± 2.9 (range, 24.4-31.1) degrees, respectively ( P < .001). On pairwise comparison with Bonferroni correction, there was a significant difference between the Harris axial view angle and both the AP calcaneal profile view angle ( P = .001) and actual angulation ( P < .001). There was no significant difference between the AP calcaneal profile view angle and actual angulation ( P > .999). Conclusion: The AP calcaneal profile view is a novel radiographic view that is easily obtained with demonstrated increased accuracy for assessing calcaneal axial alignment. While both views demonstrated similar measurement error for lesser degrees of varus malalignment, the AP calcaneal profile view demonstrated more accurate measurement of increasing heel varus compared with the Harris view. Clinical Relevance: The AP calcaneal profile view could be used in addition to other radiographic views when treating displaced, intra-articular calcaneus fractures to help optimize correction of hindfoot alignment.

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Anatomical Study of the Clavicles in a Chinese Population

BioMed Research International ◽

10.1155/2016/6219761 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Xu-sheng Qiu ◽

Xiao-bo Wang ◽

Yan Zhang ◽

Yan-Cheng Zhu ◽

Xia Guo ◽

...

Keyword(s):

Chinese Population ◽

Three Dimensional ◽

Anatomical Study ◽

Anatomical Studies ◽

Intramedullary Canal ◽

Significant Difference ◽

New Development ◽

Clavicle Fractures ◽

The Mean ◽

Two Sides

Background. A reemergence of interest in clavicle anatomy was prompted because of the advocacy for operative treatment of midshaft clavicle fractures. Several anatomical studies of the clavicle have been performed in western population. However, there was no anatomical study of clavicle in Chinese population.Patients and Methods. 52 patients were included in the present study. Three-dimensional reconstructions of the clavicles were generated. The length of the clavicle, the widths and thicknesses of the clavicle, curvatures of the clavicle, the areas of the intramedullary canal, and sectional areas of the clavicle were measured. All the measurements were compared between genders and two sides.Results. The mean length of the clavicles was144.2±12.0 mm. Clavicles in males were longer, wider, and thicker than in females; also males have different curvatures in both planes compared with females. The men’s intramedullary canals and sectional areas of the clavicle were larger than those of women. No significant difference between the sides was found for all the measurements.Conclusion. This study provided an anatomical data of the clavicle in a Chinese population. These clavicle dimensions can be applied to the modifications of the contemporary clavicle plate or a new development for the Chinese population.

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Prenatal Development of the Maxillary Sinus

Otolaryngology ◽

10.1177/0194599811435883 ◽

2012 ◽

Vol 146 (6) ◽

pp. 997-1003 ◽

Cited By ~ 9

Author(s):

Alfredo Nuñez-Castruita ◽

Norberto López-Serna ◽

Santos Guzmán-López

Keyword(s):

Maxillary Sinus ◽

Inferior Turbinate ◽

Prenatal Development ◽

Cross Sectional Study ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

Cross Sectional ◽

School Of Medicine ◽

Significant Difference ◽

Anterior Posterior

Objective. To review the prenatal development of the maxillary sinus under the perspective of the sinus surgery. Study Design. Cross-sectional study. Setting. Basic embryology laboratory. Subjects and Methods. Morphometry and morphology of the maxillary sinus and its ostium were studied under stereomicroscopy in 100 human fetuses from the 9th to the 37th week. Fetuses were obtained from the Fetal Collection of the School of Medicine of the Universidad Autónoma de Nuevo León. Approval was granted by the Ethics Committee. Statistics were applied. Results. The maxillary sinus begins its development at the 10th week. On the 37th week, the anterior-posterior diameter has a mean of 4.36 mm; ossification of the medial wall was absent, and the floor was located below the attachment of the inferior turbinate. Septa and recesses were temporarily observed. Some variations in shape were observed; however, only the oval shape persisted. Maxillary sinus hypoplasia was not found, although asymmetry was present in 30% of cases. The ostium was located at the anterior third of the ethmoid infundibulum; its final dimensions were 1.96 mm in length and 0.44 mm in width. The mean length between the ostium to the lamina papyracea and nasolacrimal duct was 1 mm. One case of double maxillary sinus was observed. Significant difference between the variables, in accordance with the age, was found ( P = .02). Conclusion. Knowledge of prenatal development of the maxillary sinus improves the perspective of the sinus surgeon and helps the understanding of postnatal anatomy, especially in children.

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External syringomyelia in longstanding benign foramen magnum tumors

Surgical Neurology International ◽

10.25259/sni_106_2020 ◽

2020 ◽

Vol 11 ◽

pp. 92

Author(s):

Aimee Goel ◽

Abhidha Harshad Shah ◽

Ravikiran Vutha ◽

Atul Goel

Keyword(s):

Cerebrospinal Fluid ◽

Spinal Canal ◽

Foramen Magnum ◽

Resonance Imaging ◽

Canal Diameter ◽

Significant Difference ◽

Cranial Fossa ◽

The Mean ◽

Pontomedullary Junction ◽

Anterior Posterior

Background: The effect of benign foramen magnum tumours on cranial and spinal dimensions and cerebrospinal fluid (CSF) spaces is unclear. In this study, we measured alterations in cerebrospinal fluid (CSF) spaces in the spinal canal and in the posterior cranial fossa distant from the site of benign foramen magnum tumors. Methods: Twenty-nine magnetic resonance imaging scans of patients with foramen magnum tumors (8 meningiomas and 21 C2 neurinomas) were identified for radiological morphometric analysis and compared with normal control scans. The anterior-posterior distance between the pontomedullary junction and the clivus, the spinal canal diameter, spinal cord diameter, and cord-canal ratios were measured at the C6 and T2 levels. Results: The mean spinal canal diameter was significantly higher in tumor scans at both the C6 and T2 spinal levels than in controls (13.8 mm vs. 11.4 mm at C6; p<0.0001, and 12.9 mm vs. 11.9 mm at T2; P=0.01). Further, the mean cord:canal ratio was significantly lower in tumor scans at both levels (0.49 vs. 0.64 at C6; P<0.0001, and 0.45 vs. 0.54 at T2; P=0.0009). There was no significant difference in mean anteroposterior distance from the clivus to the pontomedullary junction (10.4 mm vs. 10.3 mm; P=0.91). Conclusion: In the presence of benign foramen magnum tumors, the spinal canal diameter and CSF volume in the spinal canal increased at the C6 and T2 levels, distant from the tumor site, a phenomenon we describe as “external syringomyelia”.

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Photographic Analysis of Aesthetically Pleasant Facial Profile in Aryan Group of Nepalese Population

Europasian Journal of Medical Sciences ◽

10.46405/ejms.v2i2.196 ◽

2020 ◽

Vol 2 (2) ◽

pp. 89-95

Author(s):

Angelica Karki ◽

Hui-Yong Xu ◽

Bu-Ling WU ◽

Sagar Panthi ◽

Suyachha Chettri

Keyword(s):

Treatment Plan ◽

Angular Measurement ◽

Upper Lip ◽

Gender Dimorphism ◽

Lower Lip ◽

Facial Profile ◽

Nasolabial Angle ◽

Photographic Analysis ◽

Significant Difference ◽

Anterior Posterior

Background: Facial aesthetics has been considered as the most significant factor for individual. The aim of the study was to identify the standard linear and angular measurement of facial profile in Aryan group of Nepalese population so as to set up aesthetic treatment goal.Methods: A cross-sectional observational study was done in fifty-seven subjects (27: females and 30: males, from 17-30 years). The landmarks were marked and two most commonly used lines were taken as reference lines E-line and S-line and seven facial angles were measured: Total Facial Convexity Angle (G-Prn-Pog), Facial Convexity Angle (G-Sn-Pog), Nasofacial Angle (G-Pog-N-Prn), Nasolabial Angle (Ls-Sn-Cm), Mentolabial Angle (Pog-B-Li),Nasofrontal Angle (G-N-Nd) and Nose tip Angle (N-Prn-Cm).Data was analyzed using Statistical Package for the Social Sciences (SPSS) 21. To assess anterior-posterior relationship of upper and lower lips judged by E-line and S-line were determined using correlation co-efficient (r). Likewise, to compare the angular measurement between males and females were determined using Mann-Whitney U test. Result: The anterior-posterior position of upper lip and lower lip judged by E-line were -3.78±0.67 mm and -1.92±0.61 mm respectively whereas upper and lower lips judged by S-line were 0.18±0.58 mm and 0.06±0.44 mm respectively. Statistically significant (p<0.001) strong correlation(r) was found between upper lip to E-line and S-line (0.999) and between lower lip to E-line and S-line. Out of seven angular parameters, four parameters showed gender dimorphism which means statistically significant difference (p<0.001) were seen in Nasofrontal Angle.Conclusion: Either one of the reference line can be used for evaluation of facial profile at the time of diagnosis. The parameters calculated by photographic analysis serve as a comparing guide for setting up aesthetic treatment plan and can be used both before and after orthodontic treatment.

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Fetal cerebellar development: 3D morphometric analysis of fetal postmortem MRI among Chinese fetuses.

10.1101/2021.10.10.462694 ◽

2021 ◽

Author(s):

Liu Shuwei ◽

Emmanuel Henry Suluba

Keyword(s):

Gestational Age ◽

Cerebellar Development ◽

Degree Polynomial ◽

Cerebellar Volume ◽

Significant Difference ◽

Cerebellar Malformations ◽

The Mean ◽

The Relationship ◽

Best Fit ◽

Anterior Posterior

The development of the cerebellum starts from early gestational period and extends postnatal. Because of its protracted development, the cerebellum is susceptible to developmental anomalies such as Dandy-Walker malformations, Blakes pouch cysts and vermin hypoplasia. Measurements of fetal cerebellar parameters of a normal growing fetus in each week of gestation is important for setting up morphometric standards and hence used as clinical reference data. Any deviation from the normal cerebellar parameters alerts the clinicians for the possibility of presence of cerebellar malformations. Study objective: The objective of this study was to assess the fetal cerebellar growth by quantifying the following parameters; fetal cerebellar volume, anterior-posterior diameter and superior-inferior diameter. Methods: We used 3T and 7T MRI to scan the postmortem fetal brains at different stages of development and subsequently analyze the images using ITK-SNAP software. Results: The mean superior-inferior cerebellar diameter was found to be 19.12+2. 70mm.The linear(y=bo+b1t) model was the best fit (r2=0.996, F=32022.961) to describe the relationship between the gestational age and the superior-inferior diameter(y=5.89+0.49t). There was significant correlation between the superior-inferior cerebellar diameter and the gestation age, Pearson correlation coefficient of 0.999, r=0.001. The median cerebellar volume was 8607.7mm, the mean rank high among males(78.12) as compared to female(68.25). There was no statistically significant difference of the cerebellar volume between males and females (u=2193.5,p=0.16). The quadratic(y=bo+b1t+b2t2) model was the best fit regression equation (r2=0.994,F=10791.157) describing the relationship between the cerebellar volume and the gestational age. The median anterior-posterior diameter was 12.45 mm. There was significant correlation between anterior-posterior diameter and the gestational age with Spearmans rho of (0.997, p=0.01). The linear model was the best fit the best fit model (y=bo+b1t) describing the relationship between anterior-posterior diameter and the gestational age(y=3.31+0.5t) r2=0.998, F=70646.838. Conclusion: Significant correlation between the superior-inferior cerebellar diameters, the anterior-posterior cerebellar diameter and the gestational age was found. These two linear parameters follow the first-degree polynomial in relation to the gestational age. The cerebellar volume follows the second-degree polynomial as it increases with the gestational age and correlate significantly with the gestational age. This study has provided new insight to the development of the cerebellum, and setup a benchmark data of which the deviation from it will alert the clinicians for the possibility of presence of cerebellar malformations. Key words: Cerebellar Development, Cranial Magnetic Resonance imaging, Cerebellar Malformations

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Computed Tomographic Evaluation of the Position of the Leg for Mortise Radiographs

Foot & Ankle International ◽

10.1177/107110070102201009 ◽

2001 ◽

Vol 22 (10) ◽

pp. 828-831 ◽

Cited By ~ 10

Author(s):

Masato Takao ◽

Mitsuo Ochi ◽

Kohei Naito ◽

Atsushi Iwata ◽

Yuji Uchio ◽

...

Keyword(s):

Internal Rotation ◽

Rotation Angle ◽

Average Height ◽

Computed Tomographic ◽

Foot Length ◽

Significant Difference ◽

Tibiofibular Joint ◽

Internal Rotation Angle ◽

The Mean ◽

Set Up

We investigated the most advantageous internal rotation angle of the leg for mortise radiographs. One hundred and twenty-eight feet of 64 healthy volunteers with no histories of ankle or foot pathology (72 feet of 36 males, 56 feet of 28 females) were examined. The subjects had an average age of 29 years (range, 19 to 51 years), average height of 167 cm (range, 157 to 181 cm), and average foot length of 25 cm (range, 23 to 27 cm). We obtained a plain axial view at the level of the central patella and 5 mm proximal to the tibial plafond using computed tomography, and investigated the inclination angle of the distal tibiofibular joint to a horizontal plane, regarding it as a mortise angle. The mean mortise angle was 19.1 + 5.0°. However, two peaks were observed at around 15° and 20°. This indicated that the mean mortise angle of the males was 21.2 + 4.6°, and the mean mortise angle of the females was 16.4 + 4.1°, with a significant difference between the males and the females' mortise angle (P < 0.0001). There was no correlation between the mortise angle and the height (P = 0.899 in the males, and P = 0.871 in the females), nor between the mortise angle and the foot length (P = 0.359 in the males, and P = 0.512 in the females). Therefore, we concluded that the internal rotation angle of the leg for mortise radiography should be generally set up at about 20° on males and 15° on females.

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Novel morphological classification of the normal pancreatic uncinate process based on computed tomography

Journal of International Medical Research ◽

10.1177/0300060520957453 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052095745

Author(s):

Chunfu Zhu ◽

Le Ma ◽

Zhongzhi Jia ◽

Haifeng Shi ◽

Jianliang Jin ◽

...

Keyword(s):

Morphological Characteristics ◽

Uncinate Process ◽

Transverse Diameter ◽

Type I ◽

Pancreas Head ◽

Type Iii ◽

Computed Tomographic ◽

Significant Difference ◽

The Mean ◽

Ct Features

Objectives This study aimed to assess computed tomographic (CT) features of the normal pancreatic uncinate process (UP) and to classify UP types on the basis of morphological characteristics. Methods From November 2017 to December 2018, consecutive Han Chinese adults were enrolled in this retrospective study. Morphometric evaluation of the UP was performed using CT imaging, including assessment of the maximal transverse diameter of the UP (MTDUP) and pancreas head, and assessment of the relationship between the UP and superior mesenteric vessels. Results A total of 318 participants were studied. The mean MTDUP and maximal transverse diameter of the pancreas head were 15.89 ± 4.82 mm and 46.47 ± 7.18 mm, respectively. The mean MTDUP was 10.83 ± 2.59 mm for type I UP (21.70% of participants), 13.87 ± 2.35 mm for type II (13.21%), 17.08 ± 3.43 mm for type III (56.29%), and 23.74 ± 5.02 mm for type IV (8.81%). There was a significant difference among the UP types. Conclusions Four types of normal UP can be defined on the basis of morphological CT features. The length of the UP significantly increases from types I to IV, and type III accounts for > 50%.

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Palatal Bone Thickness of MSE Implantation area in Adult Patients with Skeletal Class Ⅲ Malocclusion: A Cone-beam Computed Tomographic Study

10.21203/rs.3.rs-137676/v1 ◽

2021 ◽

Author(s):

Weiting Chen ◽

Kaili Zhang ◽

Dongxu Liu

Keyword(s):

Inferior Turbinate ◽

Adult Patients ◽

Cone Beam ◽

Bone Thickness ◽

Female Ratio ◽

Skeletal Class ◽

Computed Tomographic ◽

Significant Difference ◽

The Difference ◽

Palatal Bone

Abstract Background: Analyze the palatal bone thickness of maxillary skeletal expander (MSE) implantation area in adult patients with skeletal class Ⅲ malocclusion based on Cone-beam computed tomography (CBCT) data, and to provide a reference for the implantation of the miniscrew.Methods: A total of 80 adult patients (40 M, 40 F) with an normal angle before treatment were divided into two groups; skeletal class Ⅲ malocclusion group and skeletal Ⅰ malocclusion group according to sagittal facial type, with 40 patients in each group, with a male to female ratio of 1: 1. CBCT scanner was used to obtain DICOM data from all patients.The palatal bone thickness was measured at 45 sites with MIMICS 21.0 and SPSS 22.0 was employed for statistical analysis. The bone thickness of different regions of the palate in the same group was analyzed by one-way analysis of variance (ANOVA) method; Fisher’s least significant difference (LSD)-t method was used for comparison in pairs, and an independent sample t-test was employed to test the difference of bone thickness in the same area between the two groups.Results: (1) There was no significant difference among the anterior, middle, and posterior regions of the midline area in patients with skeletal class Ⅲ malocclusion (P > 0.05). Palatal bone thickness decreased gradually from front to back in the middle and lateral areas in both groups (P < 0.001). (2) The bone thickness of the anterior, middle, and posterior regions of the two groups gradually decreased from the middle area to the parapalatine region. (3) The palatal bone were significant thinner in the area 9.0 mm before the transverse palatine suture in midline area, 9.0 mm before and after the transverse palatine suture in the middle area, and 9.0 mm after the transverse palatine suture in the lateral area.Conclusion: (1) The palatal bone of patients with class Ⅲ malocclusion was thinner in some areas, so the MSE implant anchorage position could be moved forward appropriately. (2) The thin palatal bone increased the risk of MSE anchorage screw penetrating nasal mucosa and even inferior turbinate. Patients should be given a more precise and personalized implantation scheme based on factors such as palatine bone thickness and palatal morphology.

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