Cone Beam CT Analysis of Haller Cells: Prevalence and Relationship with Orbital Floor Dehiscence

Background and aim: Haller cells arise from anterior ethmoid air cells and are located in the medial orbital floor, lateral to the maxillary infundibulum. The aim of this cross-sectional study was to determine the prevalence of the Haller cells and its relationship with orbital floor dehiscence on cone beam CT images. Materials and Methods CBCT images of 120 patients were interpreted in coronal plane for the presence of Haller cells and orbital floor dehiscence. The prevalence of Haller cell, presence of dehiscence, unilateral or bilateral frequency were assessed. In addition, the size were categorized in three groups of small, medium and large. Chi-square and Cochran-Mantel-Haenszel tests were used for statistical analysis of the data and p<0.05 was considered to be significant. Results A total of 51 male and 69 female with Mean±SD age of 38.84±68.14 were assessed. The overall prevalence of Haller cells was 56.7%, of which 44 (64.7%) were unilateral and 24 were bilateral (35.3%). The majority of the cells (70.7%) were seen in medium (2-4mm) sized. There was a significant association between Haller cells and orbital floor dehiscence (p=0.002). Conclusion The prevalence of Haller cells was remarkably high and presence of Haller cells was strongly associated with ipsilateral orbital floor dehiscence. Based on the findings of this study, CBCT can be useful in delineation of the bony anatomy of sinonasal complex.

The Use of Low-Profile Angular-Stability Plates in a “Nutcracker” Tarsal Navicular Fracture Combined with a Cuboid Fracture: ORIF Experience

Background: Clear recommendations about the optimal treatment of traumatic tarsal navicular fractures are still very debated in the literature, and this is due to several factors: navicular fractures are rare and often misdiagnosed injuries, they are frequently associated with other fractures or a dislocation of the midfoot, and the current knowledge is based on few papers mainly considering a limited number of cases and dealing with different therapeutic approaches. The treatment of navicular body fractures is controversial and burdened by a high incidence of complications; in particular, Sangeorzan type III comminuted fractures represent a real challenge for the orthopedic surgeon. An accurate preoperative planning, a scrupulous surgical technique aimed at restoring volume and bony anatomy, and the use of low-profile angular-stability plates can lead to optimal clinical and functional results, decreasing the chances of arthritic evolution of mid-foot joints.

Trochlear Development in Children From 1 Month to 10 Years of Age: A Descriptive Study Utilizing Analysis by Magnetic Resonance Imaging

Background: Understanding the morphology of cartilage/bony maturation in preadolescents may help explain adult trochlear variation. Purpose: To study trochlear morphology during maturation in children and infants using magnetic resonance imaging (MRI). Study Design: Descriptive laboratory study. Methods: Twenty-four pediatric cadaveric knees (10 male and 14 female knees; age, 1 month to 10 years) were included. High-resolution imaging of the distal femoral secondary ossification center was performed using 7-T or 9.4-T MRI scanners. Three-dimensional MRI scans were produced, and images were reformatted; 3 slices in the axial, sagittal, and coronal planes images were analyzed, with coronal and sagittal imaging used for image orientation. Biometric analysis included lateral and medial trochlear height (TH); cartilaginous sulcus angle (CSA); osseous sulcus angle (OSA); trochlear depth; and trochlear facet (TF) length symmetry. Sex comparisons were considered when ≥1 specimen from both sexes of the same age was available; these included 11 knees spanning 4 age groups (ages 1, 3, 4, and 7 years). Results: The analysis of trochlear morphology showed a lateral TH greater than the medial TH at all ages. The thickest cartilage was found on the lateral TF in the younger specimens. Regarding the development of osseous and cartilaginous trochlear contour, a cartilaginous sulcus was present in the 3-month-old specimen and continued to deepen up to the age of 4 years. The shape of the osseous center evolved from round (1 month) to oval (9 months) to rectangular (2 years); no distinct bony trochlear sulcus was present, although a well-formed cartilaginous sulcus was present. The first evidence of formation of a bony sulcus was at 4 years. By the age of 7 to 8 years, the bony contour of the adult distal femur resembled its cartilaginous contour. Female samples had a shallower CSA and OSA than did the male ones in all samples that had a defined OSA. Conclusion: Female trochlear grooves tended to be shallower (flatter). The lateral trochlea was higher (TH) and wider (TF length) during growth than was the medial trochlea in both sexes; furthermore, the development of the osseous sulcus shape lagged behind the development of the cartilaginous sulcus shape in the authors’ study population. Clinical Relevance: Bony anatomy of the trochlear groove did not match the cartilaginous anatomy in preadolescent children, suggesting that caution should be used when interpreting bony anatomy in this age group.

CT and MRI Evaluation of Bilateral Enlarged Vestibular Aqueduct Syndrome with Curved Reconstructions – A Case Report and Short Review of Literature

Enlarged Vestibular Aqueduct Syndrome (EVAS) is a known, but rare entity. It represents a common cause of congenital sensorineural hearing loss, diagnosed more often in children with a slight female predominance. Herein, we report a case of bilateral Enlarged Vestibular Aqueduct Syndrome [EVAS] in a 26-year-old male. As it is a subtle finding on imaging, the interpreting radiologist must be aware of this entity to make the diagnosis. The diagnostic CT and MRI images of this patient are given along with curved CT and MRI reconstructions along the plane of the Vestibular Aqueduct [VA] extending to the endolymphatic sac [ES]. The CT reconstructions demonstrate the bony anatomy in great detail and the bilateral dilated VA. These help in excluding diseases like otospongiosis and inner ear anomalies. The curved MRI reconstruction CISS images through the VA demonstrate the entire endolymph channel. The reconstructed MRI Images clearly demonstrate a patent endolymph channel without any focal abnormality such as stricture, or other associated congenital anomalies.

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.

Predictors of the Size and Surgical Freedom of the Trans-Cribriform and Trans-Clival Corridors, a Radiographic Analysis

Introduction The transcribriform and transclival corridors are endoscopic endonasal approaches used to treat pathologies of the skull base. We present a predictive model that uses the clival length and ethmoidal width to predict the size and surgical freedom (SF) of these corridors. Methods Adult facial computed tomography scans were reviewed. Exclusion criteria included patients <18 years of age or radiographic evidence of trauma, neoplasm, or congenital deformities of the skull base. The images were analyzed using OsiriX MD (Bernex, Switzerland). Patients' demographics, clival length, ethmoidal width, surface area, and others were collected. Linear regression was used to create prediction models for the size and SF of the transclival and transcribriform corridors. Results A total of 103 patients were included with an average age of 44.9 years and 47% males. Females had a smaller clival surface area (8 vs. 9.2 cm2, p = 0.001). For transclival corridor, clival length correlated positively with SF in the sagittal plane (rho = 0.44, p < 0.05) and negatively with SF in the coronal plane (rho = − 0.2, p < 0.05). For transcribriform corridor, ethmoidal width correlated positively with SF in the coronal plane (rho = 0.74, p < 0.05), and negatively with SF in the sagittal plane (rho = − 0.2, p < 0.05). Conclusion A significant variability of the bony anatomy of the anterior and central skull base was found. The use of clival length and ethmoidal width as part of preoperative surgical planning might help to overcome the anatomical variability which could affect the adequacy of surgical corridors.