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[Radiologic aspects of temporal-bone fractures with facial paresis].

The value of the radiobiological diagnosis in establishing the localization of a facial palsy resulting from temporal bone fractures has been investigated in 49 cases. Radiological confirmation was found in 21 out of 37 cases of longitudinal fracture and in 11 out of 12 patients (90%) with a transverse fracture. The fracture line was seen by polytomography alone in 1 out of 21 (5%) longitudinal fractures and in 5 out of 11 (45%) transverse fractures. A precise readiological localization of the facial nerve lesion was only possible if the fracutre line was running across the long axis of the pyramid. The surgical revision of 37 patients has shown that the labyrinthine segment of the facial nerve was injured in 93% of longitudinal fractures and in 70% of the transverse fractures. Therefore, one should always be prepared to expose the labyringhine segment of the facial nerve when revising a facial nerve palsy due to a fracture of the temporal bone.

Adolescent↗

[Frontoethmoidal sinus mucocele as a rare finding in a patient with craniofacial fibrous dysplasia].

Fibrous dysplasia is a benign developmental skeletal disorder characterized by bony expansion secondary to replacement of the medullary cavity by fibroosseous connective tissue. A 16-year-old male patient underwent magnetic resonance imaging for headache, left proptosis, and a thrill over the left temporal artery. T1- and T2-weighted images showed extensive bone involvement of typical low signal intensity in the left hemicalvarium, skull base, and facial bones. Another striking finding was the presence of a frontoethmoidal sinus mucocele, which demonstrated high signal intensity both on T1- and T2-weighted images. The diagnosis was made as fibrous dysplasia after bone biopsy and histopathological evaluation.

Adolescent↗

Minimal-incision endoscopic face-lift.

Ptosis of the midfacial tissues with resultant deepening of the melolabial folds, vertical lengthening of the lower eyelid, and depression of the oral commissure are generally only slightly improved with traditional superficial musculoaponeurotic system (SMAS) suspension or rhytidectomy techniques. Subperiosteal, deep plane, and composite rhytidectomies have evolved in an attempt to rejuvenate these areas. This article reviews a series of patients who underwent an endoscopic subperiosteal face-lift either as an isolated procedure or in conjunction with an SMAS rhytidectomy. Although all patients showed good initial improvement, patients with thin faces and well-defined facial bone structure maintained the best long-term result. Complications were minimal, with no permanent facial nerve injuries observed. The endoscopic subperiosteal face-lift is a useful technique as an isolated procedure or in conjunction with facial liposuction or SMAS suspension rhytidectomy. Arch Facial Plast Surg. 2000;2:274-278

Adult↗

Comparison of fixation methods in treating mandibular fractures: scintigraphic evaluation.

The effects of rigid and nonrigid fixation methods in the treatment of long bones have been studied by many authors. A comparison of these two methods has been undertaken on long bones and documented in previous studies. However, there appears to be no such research on facial bone fractures. In this study a mandibular model was selected as an appropriate model for fracture site mobility in the face. Twenty-three patients with mandibular fractures were admitted to the study. Two groups were formed. The first group consisted of intermaxillary fixation patients and the second group was comprised of internal rigid fixation-treated patients. The callus deposit was evaluated by the technetium 99m methylene diphosphonate scintigraphic method on days 1, 10, 20, 30, and 40 postoperatively. The results of the study showed that the greatest level of callus formation is in the second exposure (days 1 to 10) for the first group and in the third exposure (days 10 to 20) for the second group. This study demonstrates that minimal motion on the fracture line after intermaxillary fixation increases local blood circulation and osteoblastic activity. The callus deposit reaches maximum in a short period of time with nonrigid fixation.

Adult↗

Induced osteogenesis for repair and construction in the craniofacial region.

Solid and powdered forms of undemineralized and demineralized bone grafts were implanted in rat cranial defects. Demineralized calvarial discs healed the defects as well as did the fresh discs, as judged by histology and 45Ca incorporation. Gross and histologic evaluations demonstrated predictable endochondrial osteogenesis by demineralized bone powder (DBP). Undemineralized grafts, in contrast, showed poor and unpredictable bony healing. Construction of facial bones was achieved by implantation of demineralized bone powder within the soft tissues. The phenomenon of induced osteogenesis by demineralized implants was not species specific. These studies of osseous transformation provide insight into the mechanism of, and possible answers to, the problems of osseous transplantation.

Animals↗

Acalvaria: a unique congenital anomaly.

Acalvaria is a rare malformation usually regarded as a postneurulation defect. It consists of absence of the calvarial bones, dura mater and associated muscles in the presence of a normal skull base and normal facial bones. The condition is frequently confused by prenatal ultrasonography with anencephaly or an encephalocele. Whereas the cerebral hemispheres are absent in anencephaly, the cranial contents in acalvaria are generally complete, though some neuropathological abnormality is often present. The presumed pathogenesis of acalvaria is faulty migration of the membranous neurocranium with normal placement of the embryonic ectoderm, resulting in absence of the calvaria but an intact layer of skin over the brain parenchyma. We describe 2 cases of acalvaria, one misdiagnosed ultrasonographically as an occipital encephalocele prenatally. The brain in one fetus demonstrated semilobar holoprosencephaly and micropolygyria, but in the other, was structurally and histologically normal with the exception of hydrocephalus.

Abortion, Therapeutic↗

The role of nuclear scanning in head and neck surgery.

A number of procedures in nuclear medicine are available to assist the surgeon in evaluating pathologic conditions of the head and neck. Gallium-67 citrate scanning is occasionally useful in determining the extent of head and neck tumors but rarely can it detect an occult tumor and it cannot distinguish between an infection and a tumor. Technetium-99m pertechnetate can be used to evaluate diseases of the salivary glands including 123 and technetium-99m pertechnetate are commonly used to obtain images of the thyroid, but some malignant thyroid nodules will accumulate technetium-99m pertechnetate and the suspicious character of the nodule may be only appreciated by iodine scanning. The use of iodine 131 is generally limited to the detection of a substernal thyroid, therapeutic thyroid ablation, and the treatment of hyperthyroidism and thyroid cancer. Bone scanning has been used experimentally to evaluate the healing of mandibular bone grafts and to detect local extension of primary head and neck tumors to skull and facial bones.

Abscess↗

Clinical experience in cranial and facial reconstruction with demineralized bone.

While autogenous bone is the preferred building material for skull and facial bone reconstruction, it has definite disadvantages that make the continued use of alloplastic materials inviting. Studies in the past few years have generated considerable publicity about demineralized bone as a possible substitute for autogenous bone. A clinical study using commercially available, demineralized bone in 25 patients with a follow-up period of 6 to 18 months was completed. Results indicated that where there was a functional need or the environment (tissue envelope) was satisfactory, the demineralized bone induced osteogenesis; otherwise, there was considerable resorption of the implant. This implies that, for filling bony defects or reconstructing posttraumatic deformities, the implant generally worked fairly well, while attempts to augment bony contours, especially large areas such as the forehead, were generally not satisfactory. Even where there was a functional need for bone, a significant degree of unpredictable resorption of the demineralized implant occurred.

Adult↗

[3D-CT highly useful in diagnosing foreign bodies in the paraesophageal orifice].

Multislice computed tomography (CT) enables rapid, easy construction of 3-dimensional CT images (3D-CT), aiding diagnostic imaging. 3D-CT is reported to be highly useful in diagnosing temporal bone disorders, in otorhinolaryngology, especially abnormal shape and the ossicular chain of the auditory ossicles and facial bone fractures. Given the complexity of laryngeal anatomy, 3D-CT is useful in diagnosing the extent of infiltration of laryngeal cancer and in examining vocal cord movement, which is difficult to evaluate by conventional CT, magnestic resonance imaging (MRI), and fiberscopy. Among patients seen for a suspected foreign body between June 2002 and May 2003, we chose 3 in whom laryngoscopy at the first examination could not detect a foreign body but in whom symptoms and findings suggested such presence in the paraesophageal orifice. In all 3 cases, 3D-CT imaging showed the size, length, location, and direction of the foreign body, providing information useful for the surgical approach.

Adult↗

Bone scintigraphy evaluated in diagnosing and staging Langerhans' cell histiocytosis and related disorders.

UNLABELLED: An analysis of patients with proven Langerhans' cell histiocytosis (LCH) was undertaken with the aim of evaluating the role of bone scintigraphy in the diagnosis and staging of LCH. METHODS: Radiographic skeletal surveys and whole-body bone scintigraphy study results were reviewed for all patients treated at the Mayo Clinic in Rochester, Minnesota during 1965-1994 with histologic proven LCH. All available studies were then reported in a randomized and blinded fashion. RESULTS: Of the 73 patients with the histologic diagnosis, 56 (76%) had a definite lesion reported on radiographs and subsequent biopsy-proven bone involvement. For this population, the sensitivity and specificity of radiographic survey were 100% and 61%, respectively, compared to 91% and 55% for bone scintigraphy. Solitary bone lesions were reported on 21 radiographic surveys and 24 bone scintigrams. For solitary lesions, radiograph sensitivity and specificity were 95% and 73%, respectively, compared to 88% and 77% for bone scintigraphy. Bone scintigraphy receiver operating characteristic curves showed the region of greatest diagnostic accuracy to be skull, facial bones and mandible (88% sensitivity, 52% specificity). Radiation dosimetry to adult reproductive organs was less favorable for radiographic skeletal survey compared to bone scintigraphy. CONCLUSION: Our results support the use of radiographic skeletal survey in the initial diagnosis of LCH. Bone scintigraphy may have a role in monitoring a patient's progress in which the initial scintigram and radiographic survey show good correlation.

Adult↗

Acute and chronic effects of bone ablation with a pulsed holmium laser.

A pulsed holmium laser transmitted through a quartz fiber was used to create osteotomies in the facial bones and sinuses of rabbits. The ablation process was quantified and residual thermal injury was assessed by light microscopy. Adjacent thermal damage was determined to vary between 130 and 220 microns and was independent of radiant exposure and pulse repetition rate. In other studies, large osteotomies were made to examine the biological response and to assess the technical feasibility of using fiber-delivered laser pulses in an operative setting. The animals tolerated the procedure without obvious problems and postoperative follow-up revealed a vigorous healing response. Because it can ablate both bone and soft tissue and can be transmitted through readily available, flexible quartz fibers, the holmium laser may prove to be a useful adjunct to endoscopic sinus surgical procedures.

Animals↗

Giant-cell reparative granuloma of the hand and foot bones.

Giant-cell reparative granuloma (GCRG) is an uncommon benign reactive intraosseous lesion. It occurs in the skull, jaw, hand, foot, and facial bones and rarely in other skeletal sites. It is a solitary, lytic, expanded lesion and infrequently may extend into the surrounding soft tissue. Histologically, it is composed of fibrous stroma with spindle-shaped fibroblasts, multinucleated giant cells, and inflammatory mononuclear cells. Areas of hemorrhage are uniformly present. It may be difficult to distinguish this entity from an aneurysmal bone cyst, giant-cell tumor, or brown tumor of hyperparathyroidism because of roentgenographic and histologic similarities. Accurate diagnosis is essential for appropriate treatment; serum calcium, phosphorus, and parathyroid hormone levels should be measured. Curettage and bone graft are effective treatments for both primary lesions and recurrences. Second recurrences are rare.

Adolescent↗