Assessment of the temporomandibular joint condition using two-dimensional ultrasound scanning and doppler ultrasonography methods in patients with chronic inflammatory periodontal diseases

Introduction. Currently, dentists are increasingly detecting changes in the temporomandibular joint in patients with chronic inflammatory periodontal disease.Aim of the study. To carry out a comprehensive dynamic assessment of the temporomandibular joint (TMJ) condition and the registration of regional blood flow using two-dimensional ultrasound scanning to improve the efficiency of diagnostics of inflammatory periodontal diseases.Materials and methods. The study included 2 groups of patients: group 1 (control) consisted of 20 volunteers aged 20–25; Group 2 consisted of 52 people aged 25–45 years with moderate chronic periodontitis. For TMJ ultrasound and Doppler ultrasound, a portable ultrasound scanner LogicScan 128 with an HL-10 linear ultrasound transducer with an operating frequency of 5 to 12 MHz was used.Results and discussion. During ultrasound examination of the temporomandibular joint and measuring the size of the joint space in patients with moderate chronic periodontitis in a state of relative physiological rest, the following values were obtained: in the anterior region – 2.3 ± 0.5 mm; in the upper section – 1.6 ± 0.6 mm; in the posterior section – 1.8 ± 0.3 mm. We also measured the area of the temporomandibular joint disc in various positions. According to ultrasound data, an increase in the size of the joint space from 12.2 to 16.1% and an increase in the area of the articular disc by 17.1 to 36.7% were found in patients with chronic periodontitis. When assessing the trajectory of the articular track, motion delay and joint wedging are determined. In addition, in the color Doppler mapping (CDM) mode, the speed and index indicators of Doppler ultrasonography of the external carotid and temporal arteries were calculated.Conclusions. Modern diagnostic methods of ultrasound and Doppler mapping, assessing the hemodynamics and functional state of the TMJ, allow early diagnosis of changes in order to prevent the development of TMJ disorders in patients with chronic inflammatory periodontal diseases.

Internal carotid artery anatomy – not always straightforward

Objectives To present a rare variant of internal carotid artery anatomy. Methods Case report presenting CT angiography finding of internal carotid anatomy variant. Results We present the case of an unusual origin of the occipital artery from cervical portion of the internal carotid artery as an incidental finding during CT angiography of the carotid arteries. In discussion, we discuss the possible embryological basis, incidence and prevalence of such finding and its possible clinical implications. Conclusion One of the specific aspects of carotid arteries is their straightforward anatomy – the cervical portion of internal carotid artery, unlike the external carotid, does not give origin to any branches – this aspect is even used as a highlight for orientation, e.g. during ultrasound examination. However, although rare, variants exist, and sometimes can have clinical importance – in the endovascular access or surgical treatment.

Revisiting carotid endarterectomy: Neobulb technique using external carotid artery as a patch

Objectives This study describes an alternative carotid bifurcation endarterectomy technique in which the external carotid artery is used as a suture patch. Methods Charts of ten patients with atherosclerotic carotid stenosis that were treated using the neobulb technique between 2002 and 2019 were reviewed. Results No major surgical adverse event was observed in the postoperative assessments. No postoperative common or internal carotid stenosis was observed in the mid- or long-term follow-up. Conclusions The neobulb technique allows carotid endarterectomy closure without a synthetic or venous patch, using the external carotid artery as an autologous patch, while preserving distal flow into the external carotid artery branches.

Cavernous Sinus Dural Arteriovenous Fistula in a Patient with Thyroid-Associated Ophthalmopathy: Complete Resolution after Medical Treatment

Thyroid-associated ophthalmopathy (TAO) is a well-known and frequent epiphenomenon of a hyperthyroid autoimmune disease that can present with proptosis, strabismus, and diplopia. Ophthalmopathy can occur in the absence of overt Graves’ disease, even in euthyroid patients. Cavernous sinus dural fistulas (CS-DAVF) are abnormal communications between the cavernous sinus (CS) and dural branches from internal carotid or external carotid arteries. They can often present with ocular symptoms that can mimic a thyroid-associated ophthalmopathy. CS-DAVF are usually successfully treated with an endovascular embolization that can be pursued both through a transvenous or transarterial approach. TAO and CS-DAVF can coexist especially when the ocular symptoms are unilateral. In those cases, an endovascular embolization is usually curative, but sometimes the procedure can fail. Our hypothesis is that some cases of CS-DAVF may be of secondary nature (i.e., caused by compression of the venous outlet by the hypertrophic ocular muscles); therefore, treating the ocular disease with medical therapy may solve the vascular problem as well. We present a case of a CS-DAVF in a patient with TAO successfully treated with sole medical therapy after the failure of a first-line endovascular treatment.

Topographic and anatomical features of muscular and vascular structures in lateral cervical region during prenatal period of human ontogenesis

Background. One of topical areas of morphological research is features of topographic a relationships of the vascular, nervous, muscular, fascial and cartilaginous structures of the neck in prenatal period of human ontogenesis, as data on their formation at different stages of development will improve diagnostic methods of visualization and surgical correction of congenital and acquired pathologies of head and neck. Objective. To find out the peculiarities of synthopia of vascular and muscular structures of the lateral cervical region in human prefetuses. Methods. 9 human prenatal specimens aged 9-12 weeks of prenatal development have been studied by using a set of morphological methods, according to existing bioethical norms. Results. During 9th week of development, bony and musclar boundaries of the lateral triangle of the neck, the carotid vagina, and the components of the vascular-nervous bundle of the neck have been determined. Within the carotid triangle, the external carotid artery is located superficially; it is crossed frontally by the cervical branch of facial nerve and the sublingual nerve. The superior thyroid artery departs from the external carotid artery at the level of the cartilaginous model of the large horns of hyoid bone and passes to the rudiment of thyroid gland. Retropharyngeal space is found at 9th week of development, moderately filled with adipose tissue. The anterior vertebral plate of the cervical fascia forms the bottom for posterior triangle of neck. Conclusion. The lateral cervical region in human prefetuses is represented by a multilayered topographic zone with formed boundaries and contents. Cervical fascia forms carotid vagina within the carotid triangle, and pharyngeal space. The course of blood vessels and nerves within the lateral cervical region is variable. Three-dimensional reconstructions of prefetuses serve as evidence of the early formation of definitive topographic connections within early bony and cartilaginous models in relation to the muscles of the anterior and lateral cervical regions.

Dural arteriovenous fistula presenting as reversible dementia

DAVF is an abnormal connection between arteries and veins, where supply is mainly through branches arising from the external carotid artery. A 30 years old male had multiple episodes of seizures and progressive behavioral and cognitive decline, inattention and disorientation to time, place and person, along with ptosis and ophthalmoplegia in the right eye. DSA provided a definitive diagnosis of hypervascular Dural AV fistula at the right transverse sigmoid junction with significant cortical venous hypertension. Through femoral access, both underwent transarterial embolization through the Middle Meningeal branch of the right external carotid artery using onyx, resulting in complete occlusion of fistula and resolution of venous hypertension. Post embolisation, cognitive function assessment revealed increased attention span and improved orientation with time, place and person. Thus, DAVF can be one of the rare but reversible causes of dementia. Early diagnosis and treatment may help to dramatically improve patients’ clinical condition and minimize long-term disability.

Cranial Transposition and Revascularization of Autologous Omentum: A Novel Surgical Technique for Bypassing the Blood Brain Barrier after Resection of Recurrent Glioblastoma Multiforme

Background: Glioblastoma multiforme (GBM) patients continue to suffer a poor prognosis. The blood brain barrier (BBB) comprises one of the obstacles for therapy, creating a barrier that decreases the bioavailability of chemotherapeutic agents in the central nervous system. Previously, a vascularized temporoparietal fascial scalp flap (TPFF) lining the resection cavity was introduced in a trial conducted in our institution, in newly-diagnosed GBM patients in an attempt to bypass the BBB after initial resection. In this paper, we report on a new technique to bypass the BBB after re-resection and potentially to allow tumor antigens to be surveilled by the immune system .Objective: Assess the feasibility of performing a cranial transposition and revascularization of autologous omentum after re-resection of GBM.Methods: Laparoscopically harvested omental free flap was transposed to the resection cavity by a team consisting of neurosurgeons, otolaryngologists, and general surgeons. This was done as part of a single center, single arm, open-label, phase I study.Results: Autologous abdominal omental tissue was harvested laparoscopically on its vascularized pedicle in 2 patients, transposed as a free flap, revascularized using external carotid artery, and carefully laid into the tumor resection cavity. Patients did well postoperatively returning to baseline activities. Graft viability was confirmed by cerebral angiogram. Conclusion: Omental cranial transposition of a laparoscopically harvested, vascularized flap, into the cavity of re-resected GBM patients is feasible and safe in the short term. Further studies are needed to ascertain whether such technique can improve progression free survival and overall survival in these patients.