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Strontium transfer from maternal skeleton to the fetus estimated on the basis of the Techa river data.

Measurements of 90Sr in human bone of inhabitants of the Techa river region were started in 1951, and since 1974 the Techa river population has been studied with a whole-body counter. One of the dosimetric tasks that could be decided using data on 90Sr measurements is direct evaluation of strontium transfer to the fetus from the maternal skeleton. Six cases were selected for which 90Sr measurements were available both for stillborn infants and their mothers. The ratio of 90Sr concentrations in fetal bone to maternal bone for the year of pregnancy has been evaluated. Two clusters of values were found and the difference between clusters could be explained by age-dependent features of maternal bone formation and remodelling. When the mother's 90Sr intake occurred in the period of intensive compact bone growth, the transfer coefficient was very low (0.012-0.032). If 90Sr ingestion occurred during the woman's reproductive age, the transfer to fetus was equal to 0.21-0.26.

Adult↗

Genetic predisposition to low bone mass is paralleled by an enhanced sensitivity to signals anabolic to the skeleton.

The structure of the adult skeleton is determined, in large part, by its genome. Whether genetic variations may influence the effectiveness of interventions to combat skeletal diseases remains unknown. The differential response of trabecular bone to an anabolic (low-level mechanical vibration) and a catabolic (disuse) mechanical stimulus were evaluated in three strains of adult mice. In low bone-mineral-density C57BL/6J mice, the low-level mechanical signal caused significantly larger bone formation rates (BFR) in the proximal tibia, but the removal of functional weight bearing did not significantly alter BFR. In mid-density BALB/cByJ mice, mechanical stimulation also increased BFR, whereas disuse significantly decreased BFR. In contrast, neither anabolic nor catabolic mechanical signals influenced any index of bone formation in high-density C3H/HeJ mice. Together, data from this study indicate that the sensitivity of trabecular tissue to both anabolic and catabolic stimuli is influenced by the genome. Extrapolated to humans, these results may explain in part why prophylaxes for low bone mass are not universally effective, yet also indicate that there may be a genotypic indication of people who are at reduced risk of suffering from bone loss.

Adaptation, Physiological↗

The skeletonized body: suicidal inhalation of motorbike exhaust.

An adolescent boy who was being treated for psychiatric illness went missing. The body was discovered a year later, and he appeared to have committed suicide by inhaling the exhaust fumes from his motorbike. This report highlights the procedure used for the identification of his skeletonized body and the unusual nature of the source of exhaust fumes.

Administration, Inhalation↗

A classification of injuries of the nasal skeleton.

A classification of fractures of the nasal skeleton is presented, based on both the pattern of impact and the subsequent damage sustained. The fractures are broadly classed into those resulting from lateral force and those from frontal impact. The latter are further subdivided into three levels of planes of injury; knowledge of the applied anatomy of these injuries is shown to be essential. The clinical findings and the management of each group are discussed.

Adult↗

Bone lengthening in the craniofacial skeleton.

The process of bone lengthening by cortical fracture and gradual distraction of callus has become well established in the enchondral bones of the extremities. In this study the principles of bone lengthening were applied to the membranous bone of the craniofacial skeleton using the growing dog mandible as a model. Six mongrel dogs five months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external minilengthening device was fixed to the mandible perpendicular to the corticotomy. After 10 days of external fixation, the mandible was lengthened 1 mm/day for 20 days and then held in external fixation for 56 days (8 weeks) after which all dogs were killed. Anthropometric measurements and histological analysis of the specimens confirmed that bone lengthening had occurred and that new cortical bone was formed in the expanded areas.

Animals↗

Endoscopic-assisted recontouring of the facial skeleton: the forehead.

Endoscopic techniques have revolutionized current surgical techniques and have now been introduced to plastic surgery. Advantages of endoscopic assistance include direct visualization, hidden scars, and decreased morbidity. We sought to implement endoscopic techniques to recontour the facial skeleton and avoid the disadvantages of open procedures. A standard video system and endoscopic instrumentation including a 4-mm 30-degree endoscope and a power bur were used. Cadaveric dissections were performed before clinical use. Using endoscopic assistance, the frontal bone of a 42-year-old Korean woman with bony deformities was visualized and sculpted using a power bur. An uneventful postoperative course ensued. This case illustrates the feasibility of using endoscopic techniques in forehead recontouring and sets the stage for further work in malar and mandible recontouring.

Adult↗

Hematogenous osteomyelitis of the hand skeleton in adults after dental maxillary infections.

Hematogenous ostemyelitis is infrequently seen in adults and primary involvement of the hand skeleton is extremely rare. Little has been reported about the foci of hematogenously spread infections. Two cases of hematogenous osteomyelitis of the hand originating from dental maxillary infections were reported. The first patient suffered an acute hematogenous osteomyelitis of the wrist join, spreading from dental granulomas and massive periodontitis. Despite early radical debridement, attempts to salvage the wrist joint and the extensor tendons failed, so that a wrist fusion had to be performed. The functional outcome was poor. The second patient demonstrated a chronic hematogenous osteomyelitis of the fourth and fifth metacarpals originating from chronic maxillary sinusitis. Radical debridement and use of "spare parts" of the fifth metacarpal prevented an amputation of the fourth ray. The functional outcome was excellent. These cases emphasize the importance of including an examination of the dental maxillary area when searching for a primary focus of hematogenous osteomyelitis.

Adult↗

Repair of the immature craniofacial skeleton with a calcium phosphate cement: quantitative assessment of craniofacial growth.

The potential for growth restriction has limited the use of alloplastic materials for reconstruction of the growing craniofacial skeleton. A calcium phosphate cement that has been introduced recently for craniofacial reconstruction crystallizes in situ into a substance that resembles more closely the mineral phase of bone, thereby offering the potential for enhanced bioresorption and osteoconductivity. The purpose of these experiments was to assess quantitatively craniofacial growth after reconstruction of frontal craniectomy defects in skeletally immature animals with this calcium phosphate bone mineral substitute. To simulate the calvarial defects that result from unilateral fronto-orbital advancement procedures, unilateral frontal bone flaps were removed in 3-week-old female Yorkshire piglets. The bone flaps were trimmed medially and posteriorly, and were then reattached to the supraorbital ridge. The resulting 5-mm gap between the frontal bone flap and the native bone was either filled with Norian CRS bone cement (N = 3) or left empty (N = 3). After 90 days, the animals were killed and the skulls were harvested and cleared. Direct craniometric measurements were performed on the prepared dry skulls to assess craniofacial growth in all dimensions. Extensive remodeling was observed within defects treated with the calcium phosphate cement, with complete or near-complete replacement of the cement by host bone, resulting in a solid bony union. Direct craniometric measurements revealed no differences in craniofacial growth in any dimension between the operated and unoperated sides of the cranium in either group. These studies demonstrate that craniofacial growth is not restricted after reconstruction of frontal craniectomy defects with carbonated calcium phosphate cement in skeletally immature animals. The remodeling capacity of this material offers promise for its safe use in reconstruction of the growing calvarium.

Animals↗

Cranial versus iliac onlay bone grafts in the facial skeleton: a macroscopic and histomorphometric study.

We compared autologous bicortical ilial and cranial bone grafts onlaid to the facial skeleton in 60 adult New Zealand rabbits to evaluate the initial phase of incorporation of these grafts. The animals were distributed in two equal groups in which either cranial or iliac grafts were harvested and fixated, devoid of their periosteum, in direct contact with the nasal bone with micro screws. Each of these two groups were then subdivided into three groups, which corresponded to the three times the animals were killed: 18 days, 30 days, and 60 days. The grafts were measured in their linear dimensions and weighed before fixation and after harvesting when the animals were killed. Undecalcified histological sections were prepared, and histomorphometric parameters of bone formation (bone volume, osteoid volume, surface thickness, and osteoblastic surface) and resorption (osteoclastic surface and eroded surface) were measured. The results confirmed those of previous studies in that cortical grafts maintained their volumes to a greater extent than their cancellous counterparts indicating that the remodeling process may be uncoupled in the transplanted iliac grafts. It is postulated that the significant decrease in mechanical stimulus that the cancellous grafts undergo determines this imbalance in the remodeling activity, which results in greater bone resorption than formation and thus decreased volume.

Animals↗

Distraction osteogenesis of the human craniofacial skeleton: initial experience with new distraction system.

Application of distraction osteogenesis to the human craniofacial skeleton in properly selected cases represents a major advance in the treatment of craniofacial deformities. We report our initial clinical experience with a system of miniature distraction devices that permitted maxillary, orbital, and mandibular distraction in a 4-month-old boy with unilateral craniofacial microsomia and anophthalmia. At 6 months of age, after maxillary repositioning and orbital expansion, a costochondral rib graft was used to construct the missing left mandibular ramus and condyle.

Bone Lengthening↗

Absorbable, invisible, and flexible plating system for the craniofacial skeleton.

This report demonstrates further experience in the use of the absorbable plating system since our preliminary report in 1996. We found more indications for the application of the absorbable plating system in the craniofacial skeleton in children and in covering cranial bone graft donor sites. The system is unique, the applications are widespread over the horizon, and the only limitations are those of the operating surgeon. The advantage is that in 1 year the system absorbs completely by hydrolysis, giving minimal inflammatory reaction at the site.

Absorbable Implants↗

Relationship in hypoplasia between the masticatory muscles and the craniofacial skeleton in hemifacial microsomia, as determined by 3-D CT imaging.

The purpose of this study, based on three-dimensional (3-D) computed tomographic (CT) reconstructions, was to evaluate the relation between underdevelopment of masticatory muscles and hypoplasia of the craniofacial skeleton in hemifacial microsomia (HFM). In 25 patients with HFM and 19 control patients the volumes of the masseter, the temporal, and the medial-pterygoid and lateral-pterygoid muscles were measured on the basis of CT scans, using three-dimensional segmentation and voxel addition. The size and shape of the craniofacial structures were classified, using three-dimensional imaging based on CT scans. Contiguous 1.5-mm computed tomography scans were made with a Philips Tomoscan 350 and processed by a Cemax 1500X 3-D workstation. Using the Pearson product moment correlation coefficient, the Pruzansky/Kaban classification system, the new Craniofacial Deformity Scoring System, Cranial Deformity Scoring System, and Mandibular Deformity Scoring System (MDS) demonstrated correlation coefficients with the "masseter muscle percentage" varying from 0.71 to 0.81 (P < 0.05), with the medial pterygoid muscle percentage correlation coefficient varying from 0.43 to 0.56 (P < 0.05), with the lateral pterygoid muscle percentage correlation coefficient varying from 0.55 to 0.61 (P < 0.05), and with the temporal muscle percentage correlation coefficient varying from 0.67 to 0.84 (P < 0.05). The normal right/left difference in volume of the masticatory muscles of the control patients, calculated as a percentage of the total, demonstrated small differences of 3.4% to 4.8%. Bony malformations are associated with underdevelopment of the masseter and the temporal muscles, and demonstrate a tendency toward a clear relationship. The degree of muscular underdevelopment of the different muscles of mastication in one patient could vary widely. The normal right/left difference of the masticatory muscles of the control patients is minimal. The volume of the masticatory muscles of the non-affected side does not demonstrate a compensatory effect in patients with HFM.

Analysis of Variance↗

Ivory osteoma of the craniofacial skeleton.

The authors describe the clinical presentation, investigation, and surgical management of two cases of benign ivory osteoma of the craniofacial skeleton. In the first case, a bony mass located over the frontal region had become a cosmetic burden to the patient, and she requested removal with minimal morbidity. Accordingly, an endoscopic procedure, with minimal access incisions located behind the hairline, was devised. In the second case, the patient, a Jehovah's Witness, presented with a long history of slowly enlarging bony masses over the maxilla and in the pterygopalatine space. She finally requested surgical intervention when the symptoms of pain related to fifth nerve compression at the foramen ovale became intolerable. Key aspects of the preoperative and perioperative management strategies used to avoid blood transfusion are detailed, as is the surgical approach, which included a bicoronal scalp flap with temporary removal of the zygomatic arch and the coronoid process. Finally, the etiology, histology, and natural history of ivory osteomas are discussed.

Adult↗

Melorheostosis involving the craniofacial skeleton.

Melorheostosis is a rare bone disorder, usually affecting the long bones and adjacent soft tissue. It was originally described by Leri and Joanny in 1922, after its classic x-ray features of flowing hyperostosis resembling dripping candle wax. There have been fewer than 10 reported cases of craniofacial involvement, and in most instances these have also involved the appendicular skeleton. The authors report a case of melorheostosis with isolated craniofacial involvement, describe the clinical course and radiologic and histologic features, and review the pertinent literature.

Aged↗

Hinged silicone covered metallic implant for repair of large fractures of the internal orbital skeleton.

The objective of this study was to determine the effectiveness of hinged silicone covered metallic implant for the repair of large fractures of the internal orbital skeleton. Twelve patients underwent reconstruction of the orbital floor (and medial wall) with a hinged silicone covered metallic implant that was fixated at or just inside the inferior orbital rim with screws. The surgical technique permits intraoperative graded overcorrection because the implant is secured at the orbital rim and bent at its "hinge" to elevate the entire implant to the desired height. Nine of 12 patients had late repairs (> or = 4 weeks after injury); 3 patients had early repairs < or = 3 weeks of injury. All 12 patients had acceptable results with regards to enophthalmos and hypo-ophthalmos. One patient underwent secondary soft tissue upper eyelid augmentation for a residual superior sulcus deformity. The hinged silicone covered metallic implant is a useful technique for reconstruction of large orbital floor and medial wall defects. Long-term complications of this implant are unknown.

Adult↗

Sarcoidosis of the axial skeleton.

Sarcoidosis of the bones in the hands and feet is not uncommon. However, sarcoidosis involving the axial skeleton is unusual. The authors present the case of a 37-year-old man with sarcoidosis who developed low-back pain. Radionuclide bone scan demonstrated abnormalities in the pelvis, spine, and scapulae. A bone scan directed open biopsy of an abnormality in diagnostic tissue from the ilium.

Adult↗

Giant-cell tumor of the appendicular skeleton.

The common objective of all surgical procedures in the treatment of giant-cell tumor of bone is to minimize the incidence of local recurrence. The purpose of this study was to determine what, if any, patient factors, tumor characteristics, or surgical practices correlate with local recurrence. Seventy-five patients treated for a giant-cell tumor of the appendicular skeleton were followed up for at least 2 years. The mean duration of followup was 62 months (range, 24-224 months). The highest proportion of patients had intralesional curettage, high-speed burring, and adjuvant treatment. Ten patients (13%) had a local recurrence. Bivariate analysis revealed that, with the numbers available, none of the patient variables, tumor variables, or surgical approaches correlated with local recurrence. Post hoc power analysis revealed the power of the study to be 33% to detect a clinically significant difference between treatment groups. The data presented here potentially could contribute to a metaanalysis, which would have the statistical power to determine which tumor-related factors and surgical techniques are most important in predicting recurrence in giant-cell tumor of bone.

Adolescent↗