Comparison of abnormalities in the sequence of growth stages in the skeletal maturity index vs cervical vertebral maturation: A retrospective study

ABSTRACT Objectives To evaluate the frequency of abnormal progression that could ultimately affect the reliability of the skeletal maturity index (SMI) and the cervical vertebral maturation (CVM) method that are most commonly used analyses for skeletal age assessment. Materials and Methods A retrospective design was used to compare 299 hand-wrist radiographs with 299 lateral skull radiographs regarding the number of abnormalities in the proposed sequence of maturation in the SMI and CVM methods. Results A significantly greater number of abnormalities occurred in the sequence of CVM progression compared with SMI (P < .001). Sex and age did not have an effect. Conclusions Skeletal age assessment based on SMI is more accurate than CVM regarding the progressive sequence of stages.

Changes in head posture after rapid palatal expansion in mouth-breathing children.

Introduction. It is well known that previously has been demonstrated a correlation between respiratory function and the harmonious craniofacial development and head posture respectively. Aim of the study. The purpose of this study was to investigate the correlation between rapid maxillary expansion (RME) and the change in natural head position (NHP) resulting from the consequent change in airway resistance and to elucidate how RME influences NHP in terms of cephalometric angles in children with nasal obstruction. Material and methods. The study included 12 girls and 8 boys who had a history of mouth breathing, as confirmed by the parents and ORL specialist and due to this fact, they underwent RME as part of orthodontic treatment. Dental casts, clinical photographs and lateral skull radiographs exposed in natural head position were obtained at the first visit (T1) and 8-10 months (T2) later for all subjects. In order to evaluate the patient’s lateral skull radiographs, I used AudaxCeph software, within which I created a new type of analysis. Student T test and Pearson correlation test were used to statistically analyze the results. Results. Our findings demonstrate that no significant changes in any of the variables are observed in patients treated with rapid maxillary expansion, however a positive correlation was observed in the variables measured before and after the treatment, respectively between the anomaly and the measured values. Positivity can also be detected when examining the correlation between the patient’s gender and the measured values. Conclusions. Based on the obtained results, we cannot state that there is a correlation between rapid maxillary expansion and cervical posture.

Radiographic analysis of the thickness of the cranial bones in captive compared to wild-living cheetahs and in cheetahs with hypovitaminosis A

Captive cheetahs often demonstrate a high incidence of diseases in which vitamin A imbalances are implicated. These can occur even under controlled and optimised feeding regimens, which is why surveillance of vitamin A status is mandatory in the successful health management of cheetahs. Serum levels of the vitamin do not reflect the true vitamin A status and liver tissue analysis is rather impractical for routine application in large felids. A biomarker for evaluating overt and subclinical vitamin A deficiency in cheetahs is needed. This study evaluates whether increased calvarial bone thickness can be detected on routine skull radiographs of vitamin A deficient cheetahs compared to unaffected animals, and secondly, evaluates whether there is increased bone thickness in clinically sound captive cheetahs in general compared to wild-living controls. Bone thickness in the neuro- and splanchnocranium was measured in 138 skull radiographs. Significant thickening of the parietal bones was found in latero-lateral radiographs of immature cheetahs (< 12 months) with vitamin A deficiency. This finding may allow a presumptive diagnosis of hypovitaminosis A in immature cheetahs. A general difference in skull thickness between free-living and captive cheetahs was not found.

Frontal sinuses as tools for human identification: a systematic review of imaging methods

The frontal sinuses are potential evidences for human identification because of the inherent distinctiveness of their morphology. Over the last decades, several techniques emerged to enable the visualization and analysis of the frontal sinuses via bi- and three-dimensional imaging. This systematic review aimed to compile different methodological approaches found in the scientific literature to contribute to human identification. Three examiners revisited the scientific literature in order to find imaging techniques for the visualization of the frontal sinuses applied to human identification. The standard search strings built-up from a PICO question identified 404 unique articles in the following databases Medline/Pubmed, Web of Science, Scopus, Lilacs and Scielo. Based on eligibility criteria applied during title, abstract and full-text reading, the sample reduced to 19 articles. The articles were published between 1987 and 2019 by research groups from 10 different countries. Computed tomography was used in 37% of the techniques, while the remaining (63%) techniques used skull radiographs. The techniques were highly heterogeneous and varied between metric analysis, direct image superimposition and morphology code-based systems. The authors considered their techniques useful for human identification and reported accuracy rates from 13 to 100%. Most of the studies revealed low risk of bias. More advantages were related with the techniques based on direct image superimpositions and three-dimensional visualization. Forensic experts must be aware of the use of frontal sinuses for human identification, especially when three-dimensional images are available as ante-mortem and post-mortem evidences for superimposition and comparison.

Parotid Duct Ectasia in a Dog

ABSTRACT A 3yr old spayed female Brittany was referred with a cylindrical mass on the right side of her face. Three months earlier, a small stone embedded in the right parotid duct was noted and removed through a ductal incision by the referring veterinarian. At referral, the dog’s general physical condition was normal except for a cylindrical mass on the right cheek. Skull radiographs showed a possibly retained sialolith or dystrophic mineralization within the previous surgical site. Aspiration of the mass yielded a thick, yellow/tan, mucopurulent fluid. Cytology of the fluid demonstrated degenerative neutrophils without bacteria. The cylindrical mass was excised with a carbon dioxide laser. The caudal end of the mass was connected to the parotid salivary gland and the rostral one-third of the mass tapered to a point. The caudal end of the mass was ligated with 3-0 polydioxanone and excised immediately rostral to the ligation. Histopathology revealed that the mass was parotid duct ectasia. The dog completely recovered with some mild temporary facial paresis and had no recurrence of parotid duct ectasia at 4 mo follow-up. The case report describes a dog with an unusual parotid salivary duct ectasia caused by parotid duct sialolith removal.

Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT: “a no-brainer?”

Objectives To assess whether head CT with 3D reconstruction can replace skull radiographs (SXR) in the imaging investigation of suspected physical abuse (SPA)/abusive head trauma (AHT). Methods PACS was interrogated for antemortem skeletal surveys performed for SPA, patients younger than 2 years, SXR and CT performed within 4 days of each other. Paired SXR and CT were independently reviewed. One reviewer analysed CT without and (3 months later) with 3D reconstructions. SXR and CT expert consensus review formed the gold standard. Observer reliability was calculated. Results A total of 104 SXR/CT examination pairs were identified, mean age 6.75 months (range 4 days to 2 years); 21 (20%) had skull fractures; two fractures on CT were missed on SXR. There were no fractures on SXR that were not seen on CT. For SXR and CT, respectively: PPV reviewer 1, 95% confidence interval (CI) 48–82% and 85–100%; reviewer 2, 67–98% and 82–100%; and NPV reviewer 1, 95%, CI 88–98% and 96–100%; reviewer 2, 88–97% and 88–98%. Inter- and intra-observer reliability were respectively the following: SXR, excellent (kappa = 0.831) and good (kappa = 0.694); CT, excellent (kappa = 0.831) and perfect (kappa = 1). All results were statistically significant (p < 0.001). Conclusions CT has greater diagnostic accuracy than SXR in detecting skull fractures which is increased on concurrent review of 3D reconstructions and should be performed in every case of SPA/AHT. SXR does not add further diagnostic information and can be omitted from the skeletal survey when CT with 3D reconstruction is going to be, or has been, performed. Key Points • Head CT with 3D reconstruction is more sensitive and specific for the diagnosis of skull fractures. • Skull radiographs can be safely omitted from the initial skeletal survey performed for suspected physical abuse when head CT with 3D reconstruction is going to be, or has been, performed.