Craniofacial measurements in children with sella turcica shape’s anomalies

Objectives: The objective of the study is to evaluate the cephalometric measurements of Tunisian children who presented sella turcica’s (ST) shape anomalies. Materials and Methods: This cross-sectional study was conducted between January and June 2019 in the Department of Pediatric Dentistry of Monastir and Faculty of Dentistry of Tunisia. Radiographs were gathered from patients aged between 7 and 12 years old (n = 104) who had consulted for a malocclusion. The inclusion criteria were considered as follows: Good visibility of anatomic structures and absence of congenital craniofacial deformities. We excluded bad radiographs with errors and discrepancies: Double limits, deformities as well as children having hereditary craniofacial anomalies and underlying diseases. The cephalometric analysis was conducted according to Segner and Hassund’s method. ST’s shape was identified according to Axelsson’s classification modified by Becktor. The sample size was divided into groups: Group 1 with normal ST’s shape and Group 2 with sella’s anomaly. Statistics were performed using IBM SPSS STATISTICS 22. Data normality has been tested using Shapiro–Wilk test. The normality of variance was investigated too with Levene’s test, and comparison of means between groups was performed with t-test. Results: The prevalence of aberrations of ST’s form in Tunisian children is about 59.6%. The inclination of upper incisors to the maxilla differed in children with ST’s anomaly compared to normal kids. Children with sella aberration are characterized by retroclination of upper incisors to the maxilla. The variables which showed a statistically significant relationship between abnormalities of ST and cephalometric measurements were 1+NA with P = 0.03 and NL-NSL with P = 0.04. Conclusion: The prevalence of ST’s shape anomalies in Tunisian children is about two-thirds. It seems that the anomaly of ST influences the position of the maxilla to the cranial base and the position of upper incisors to the maxilla.

Cranial bones mark hormonal disturbances in patients with gonadal dysgenesis

The data on roentgenologic peculiarities o f cranial bones including sella turcica in patients with gonadal dysgenesis are drawn in the paper. Besides that, the authors analyze the changes in size and configuration o f sella turcica under hormonal replacement therapy.

The Spheno-Occipital Synchondrosis and Morphometry of Sella Turcica Association with Different Phenotype Factors Related to Ectopic Eye Tooth/Teeth

Objectives: This study investigates the prevalence of Spheno-Occipital Synchondrosis (SOS) and sella turcica morphometry (STM) association with different phenotype factors related to ectopic eye tooth/teeth (EET) using cone beam computed tomography (CBCT) imaging. Methods: This comparative retrospective study analyzed 252 CBCT images. Subjects in the EET group consisted of 197 CBCT images with the phenotype factor in number, i.e., unilateral (13, n = 62; 23, n = 59) or bilateral (1323, n = 76) and matched control (n = 55). SOS and STM were investigated using 3D OnDemand Software. Seven parameters of STM were measured. To test the association X2 used for SOS prevalence, disparities in STM were tested using ANOVA and post hoc Tukey test. Results: The prevalence of unfused SOS was 48.4% and 16.1% in the 1323 and control groups, respectively. Fused SOS prevalence was quite similar in all four groups. Phenotype factor in number, i.e., unilateral 13, 23, or bilateral EET group showed significant disparities in six out of seven parameters (p = 0.044 to p ≥ 0.001). Additionally, phenotype factor in position, i.e., occlusal, buccal, or palatal group showed insignificant disparities (p = 0.463 to p = 1.00). Conclusion: SOS in the ectopic eye tooth group (EETG) was prevalent in the 1323 and buccal position groups. Differing from previous two-dimensional (2D) studies, there were statistically significant disparities in all seven measured variables of STM among control, and three different phenotype factors in numbers were revealed using three-dimensional (3D) CBCT imaging.

Pituitary MRI standard and advanced sequences: role in the diagnosis and characterization of pituitary adenomas

Pituitary adenomas (PAs) represent the most frequently found lesions in the sellar region; however, several other lesions may be encountered in this region, such as meningiomas, craniopharyngiomas and aneurysms. High-quality imaging is fundamental for diagnosis, characterization and guidance of treatment planning of PAs. Sellar magnetic resonance imaging (MRI) is considered the imaging modality of choice for the evaluation of lesions in the sella turcica. The sellar MRI standard protocol includes coronal and sagittal T1-weighted (T1w) spin-echo sequencing with and without gadolinium-based contrast agent and coronal T2-weighted (T2w) fast-spin echo sequencing. A systematic MRI approach to the pituitary region generally provides information that includes the size and shape of the PA, the presence of cysts or hemorrhage within the tumor, its relationship with the optic pathways and surrounding structures, potential cavernous sinus invasion, sphenoid sinus pneumatization type, and differential diagnosis with other sellar lesions. The standard protocol is sufficient for the evaluation of most cases; however, some advanced techniques (susceptibility imaging, diffusion-weighted imaging, 3D T2w high-resolution sequences, magnetic resonance elastography, perfusion-weighted imaging) may render additional information, which may be important for some cases. In this “Approach to the Patient” manuscript we will discuss the use of standard and advanced MRI sequences in the diagnosis and characterization of PAs, including MRI features associated with treatment response that may aid in presurgical evaluation and planning, and red flags that may point to an alternative diagnosis.

Assessments of Prevalence of Ponticulus Posticus, Atlas Posterior Arch Deficiency, Sella Turcica Bridging, Maxillary Canine Impaction, and Associations Among Them in 500 CBCTs of Italian Orthodontic Patients

Background: The ponticulus posticus (PP) is an important anomaly of the atlas (C1 vertebra) with a complete or partial bone bridge that transforms the groove of the vertebral artery (VA) into a canal (arcuate foramen). The aim was to retrospectively determine prevalence of PP evaluating morphological features and the possible association with other dentoskeletal anomalies in the midface and neck area such as maxillary canine impaction (MCI), atlas posterior arch deficiency (APAD), and sella turcica bridging (SB).Methods: This study was conducted in the Department of Medical, Oral and Biotechnological Sciences of the University “G. D'Annunzio” in Chieti. The detection of PP was performed on 500 patients with cone beam CT (CBCT) images (6 to 87 years).Results: Analysis revealed the presence of uni- and bi-lateral PP in 110 patients (22%): 24 (4.8%) patients with bilateral complete PP, 12 (2.4%) patients with complete PP on the left, 6 (1.2%) patients with complete PP on the right, 8 (1.6%) patients with complete PP on the right and partial PP on the left, 6 (1.2%) patients with complete PP on the left and partial PP on the right, 26 (5.2%) patients with partial bilateral PP, 18 (3.6%) patients with partial left PP, and 10 (2%) patients with partial PP on the right. The Chi-squared statistic confirmed that there are significant associations between MCI and PP (p = 0.020) and between SB and MCI (p <0.00001). No correlation between chronological age and presence of the PP (p = 0.982), between chronological age and morphotypes of the PP (p = 0.779), between APAD and the PP (p = 0.0757), between SB and the PP (p = 0.111), and between APAD and MCI (p = 0.222) were found.Conclusion: This observational study showed how bilateral partial variant and bilateral complete variant are the most represented morphotypes in all the age groups. The prevalence of MCI is positively associated with PP and with SB.

Transcranial Sonography in the Diagnosis of Pituitary Tumor—A Direct Comparison With MRI

BackgroundTranscranial sonography (TCS) is a convenient tool for detecting certain brain diseases, such as brain tumors. Few studies have reported on the use of TCS in the area of Sella turcica. The accuracy and repeatability of Sella turcica with or without pituitary tumor is not clear.PurposeThis study aimed to investigate the feasibility and accuracy of TCS to measure the size of Sella turcica according to the measurement in MRI and determine its diagnostic performance in individuals with pituitary tumor.Materials and MethodsIn this cross-sectional comparative study, healthy volunteers and patients with pituitary tumor were enrolled for examination of TCS and MRI between October 2020 and July 2021. The transverse diameter (D1, cm) of Sella turcica and the volume of the pituitary tumor were measured by TCS and MRI, respectively, and compared by using Student’s t-test or Mann–Whitney test, using the receiver operating characteristic (ROC) curve to analyze the diagnostic value of D1 in TCS for pituitary tumor.ResultsA total of 75 healthy volunteers and 51 patients with pituitary tumor were evaluated. In healthy volunteers, the mean D1 was 1.30 ± 0.35 (range, 0.82–3.22) by TCS and 1.32 ± 0.29 (range, 0.94–3.02) by MRI (P = 0.054). In patients with pituitary tumor, the mean D1 was 2.0 ± 0.65 (range, 0.90–3.48) by TCS and 2.42 ± 1.0 (range, 0.80–4.70) by MRI (P = 0.000). The median measurement volume was 4.41 and 6.59 cm3 in TCS and MR, respectively (P = 0.000). The mean D1 was 1.31 ± 0.35 in healthy volunteers and 2.0 ± 0.65 cm in patients with pituitary tumor (P = 0.000). In the ROC curve analysis, the area under the curve was 0.836, and the optimal cutoff value (1.56) exhibited a sensitivity and specificity of 67.31 and 88.0%, respectively.ConclusionThe consistency between the two imaging technologies performed well in D1 measurement, while the volume of the pituitary tumor was smaller as assessed by TCS than by MRI. D1 in TCS had good diagnostic performance in pituitary tumor.

Characterization of tumor remnants in intraoperative MRI-assisted microscopic and endoscopic transsphenoidal resection of less invasive pituitary adenomas

Introduction Intraoperative magnetic resonance imaging (iMRI) improves the intraoperative detection of adenoma remnants in transsphenoidal surgery. iMRI might be redundant in endoscopic pituitary surgery in non-invasive tumors (Knosp 0–2) due to a superior visualization of anatomical structures in the periphery of the sella turcica compared to the microscopic technique. We identified the anatomical location of tumor remnants in iMRI and evaluated risk factors for secondary resection after iMRI and hereby selected patients with pituitary adenomas who may benefit from iMRI-assisted resection. Methods We conducted a retrospective monocenter study of patients who underwent iMRI-assisted transsphenoidal surgical resection of pituitary adenomas at our department between 2012 and 2020. A total number of 190 consecutive iMRI-assisted transsphenoidal surgeries of pituitary adenomas graded as Knosp 0–2 were selected for analysis. Exclusion criteria were missing iMRI availability or pathologies other than adenomas. Of these 190 cases, 46.3% (N = 88) were treated with microscopic, 48.4% (N = 92) with endoscopic, and 5.3% (N = 10) with endoscopic-assisted technique. Volumetric measurement of preoperative, intraoperative, and postoperative tumor extension was performed. Demographic data, tumor characteristics, and MRI features were evaluated. Additionally, analysis of adenoma remnants identified by iMRI was performed. Results An additional resection after iMRI was performed in 16.3% (N = 31). iMRI helped to reach gross total resection (GTR) in 83.9% (26/31) of these cases. False-positive resection was found in 1 patient (0.5%). Multivariable logistic analysis identified tumor volume (OR = 1.2, p = 0.007) recurrence (OR = 11.3, p = 0.002) and microscopic technique (OR = 2.8, p = 0.029) as independent risk factors for additional resection. Simultaneously, the endoscopic technique was significantly associated with GTR as evaluated by iMRI (OR = 2.8, p = 0.011) and postoperative MRI (OR = 5.8, p = 0.027). The detailed analysis of adenoma remnants on iMRI revealed the suprasellar location in a diaphragm fold, penetrating tumor above the diaphragm, or undetected invasion of cavernous sinus as well as in case of microscopic resection tumor location outside the line of sight as the main reasons for incomplete resections. Conclusion Tumor volume, recurrence, and microscopic technique were identified as independent predictors for additional resection in patients with Knosp 0–2 adenomas. iMRI might increase the extent of resection (EOR) safely even after the endoscopic visualization of the sella with very low risk for false-positive findings. Remnants of tumors hidden within the diaphragmic folds, intrathecally, or behind the infiltrated wall of cavernous sinus not recognized on preoperative MRI were the most common findings in iMRI.

Differences of anteroposterior facial dimensions in male and female children on intermediate mixed and early permanent dentition using Cervical Vertebrae Maturation Index

Introduction: Cervical vertebrae are one of the indicators for craniofacial bones maturation. Timing of craniofacial bone maturation determined achievement of orthodontic early treatment. Some previous researchers recommended cervical vertebral maturation to assess craniofacial growth. This study was aimed to analyse the differences of anteroposterior facial dimensions in male and female children on intermediate mixed and early permanent dentition using Cervical Vertebrae Maturation Index (CVMI). Methods: An analytic observational study with a cross-sectional design was conducted on the students of Islamic Elementary School (Madrasah Ibtidaiyah) in Depok district, Sleman, Yogyakarta, from July 2019 to January 2020. Subjects consisted of 22 males and 22 females aged 8-11 years, obtained by a consecutive sampling technique. The anteroposterior facial analysis was performed on the lateral cephalometry for measuring the distance of Sella turcica to Nasion (S-N) representing the anterior cranial base, Posterior Nasal Spine to Anterior Nasal Spine (PNS-ANS) representing the maxilla and Gonion-Menton (Go-Me) and Condylion-Gnathion (Co-Gn) represents the mandible. Assessment of CVMI was decided by the Hassel and Farman methods. Data were analysed by One Way ANOVA. Results: The mean value of S-N, PNS-ANS, Go-Me, and Co-Gn dimensions, generally were higher in males than females; however, only dimensions of maxillary and mandibular were showed significant difference (p<0.05), while the S-N dimension was not significantly different (p>0.05). At the interval of CVMI 3 and 4, the Go-Me and Co-Gn dimensions showed a significant difference (p<0.05) both in males and females. Conclusion: There was a difference in anteroposterior dimensions of the maxillary and mandibular in cervical vertebral maturation in children with intermediate mixed and early permanent dentition, however, no difference was found in the anterior cranial base.