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An unusual case is described in which a false aneurysm of the brachial artery secondary to an exostosis of the proximal humerus caused a compressive lesion of the brachial plexus. Surgical treatment of the exostosis and the false aneurysm relieved the symptoms.
PURPOSE: Our goal was to determine the feasibility of high-resolution sonography for the detection of condylar erosion and associated disc displacement at the temporomandibular joint (TMJ) condyle. MATERIALS AND METHODS: Forty-eight consecutive patients (96 joints) with TMJ disorders were investigated prospectively using a 12.5-MHz array transducer. Images were assessed for condylar erosion and disc displacements. Sonographic findings were correlated with those of magnetic resonance imaging (MRI). RESULTS: At MRI, 18 osseous changes were diagnosed with condylar erosion. Sonographically, 15 of the 18 condylar erosions were diagnosed correctly. Sensitivity, specificity, and accuracy of sonography in the depiction of condylar erosion were 83%, 63%, and 67%, respectively. The positive predictive value was 34%, and the negative predictive value was 94%. Disc displacement without reduction (43 of 96) and disc displacement without reduction concomitant with condylar erosion (16 of 96) were detected with an accuracy of 93% and 80%. CONCLUSION: Sonography is an insufficient imaging technique for the detection of condylar erosion. Assessment of disc displacement without reduction may be reliably made with sonography.
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PURPOSE: Effusion is the term used by radiologists for a hyperintensity signal seen inside a joint on magnetic resonance imaging (MRI). The aim of this study was to correlate the clinical and imaging features of this phenomenon, with the ultimate purpose of clarifying its meaning in dysfunctional processes of the temporomandibular joint (TMJ). PATIENTS AND METHODS: The clinical histories of 111 patients (123 joints) with effusion on MRI were reviewed. Thirty-one patients (46 joints) with articular pathology but without effusion, chosen at randomized, served as a control group. Five clinical variables (articular pain, radiating pain, limited mouth opening, clicking, and clinical stage) and five imaging findings (disc displacement, effusion location, disc morphology, osteophytes, avascular necrosis, and osteochondritis dissecans) were evaluated. RESULTS: Effusion in TMJ could be seen in relation to disc displacement and degenerative changes (osteophytes, avascular necrosis, osteochondritis dissecans). Clicking was more frequently found in TMJs without effusion. CONCLUSIONS: These results suggest that effusion may be a marker of articular degeneration in the TMJ.
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PURPOSE: This study was designed to obtain views of the temporomandibular joint (TMJ) by means of computed arthroscopic simulation (virtual arthroscopy) using three-dimensional (3D) processing. MATERIAL AND METHODS: Volume renderings of the TMJ from very thin cryosection slices of the Visible Human Female were taken off the Internet. Analyze(AVW) software (Biomedical Imaging Resource, Mayo Foundation, Rochester, MN) on a Silicon Graphics 02 workstation (Mountain View, CA) was then used to obtain 3D images and allow the navigation "fly-through" of the simulated joint. RESULTS: Good virtual arthroscopic views of the upper and lower joint spaces of both TMJs were obtained by fly-through simulation from the lateral and endaural sides. It was possible to observe the presence of a partial defect in the articular disc and an osteophyte on the condyle. Virtual arthroscopy provided visualization of regions not accessible to real arthroscopy. CONCLUSION: These results indicate that virtual arthroscopy will be a new technique to investigate the TMJ of the patient with TMJ disorders in the near future.
This report describes a rare case of restricted mandibular opening caused by zygomatic exostosis and hyperplasia of the coronoid process. Computed tomography revealed the presence of a pseudojoint between the exostosis and the enlarged coronoid process; the bony restriction was surgically removed through an intraoral approach. Only 3 similar cases have been reported in the literature.
As a late complication after radical neck dissection, this paper reports a bony mass at the sternal end of the clavicle associated with hypertrophy of the sternohyoid muscle. The bony mass and hypertrophy of the muscle were considered due to continuous mechanical strain by the drooping of the shoulder caused by injury of the accessory and cervical nerves, left-handed physical labour, and the lack of the sternocleidomastoid muscle in rotating the head.
A total of 1187 cartilage tumors have been diagnosed at the Reference Center for Bone Tumors of the University of Freiburg; 67 of these were chondrosarcomas. All tumors were coded in terms of their frequency, age distribution, and localization. The typical radiographic, macroscopic, and histologic architecture is described for each tumor, and differential diagnostic aspects are described. Special attention is devoted to the distinction between proliferating chondromas and well-differentiated chondrosarcomas. which are often very difficult or even impossible to distinguish histologically. A grading system for chondrosarcomas is described. Cytophotometric DNA measurements may be applied to cartilage tumor cells in an effort to objectify the radiologic and histologic findings, and to make possible a decision between "benign" and "malignant". With the help of these modern histochemical methods it should be possible to solve differential diagnostic problems in cartilage tumors.
A case of an unusual cause of locking of the finger is described. This was brought about by the presence of an exostosis arising from the metacarpal bone, causing rupture of the capsule of the metacarpophalangeal joint with entrapment of the interosseus tendon.
Blocking of motion of an interphalangeal joint in the hand by an osteochondroma has not been reported previously. Osteochondromas, which are uncommon in the hand, are encountered most frequently in patients with hereditary multiple exostosis. They can occur away from the epiphyseal plate region at the distal end of the proximal and middle phalanges. Osteochondromas that occur in these locations characteristically cause angular and rotational deformities. Early recognition and prompt surgical treatment in this child resulted in full motion with minimal angular deformity.
Thirty of 50 patients with hereditary multiple exostosis developed significant deformities of the arm in one extremity. The degree of deformity is dependent on the location of the osteochondroma. If the osteochondroma is on the radius, deformity will usually be only minimal. If the osteochondroma is at the distal end of the ulna, the epiphysis usually stops growing. We believe that the ulnar collateral ligament then acts as a tether, very similar to that seen in the ulnar clubhand. The radius then has to either bow or dislocate at the elbow, and the wrist displaces ulnarly. We performed operations on 10 patients that consisted of cutting the ulnar collateral ligament, lengthening the ulna, osteotomizing the radius, and removing any osteochondromas. In the young, growing child, staples are placed across the lateral side of the distal radial epiphysis. The cosmetic results of the surgery were very gratifying. Nine patients also had osteochondromas removed from the hands and the forearms.
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A case of osteoma of the external auditory canal in a 19-year-old male patient was reported. The differentiation between osteoma and exostosis was discussed clinically, histopathologically and scanning electron microscopically.
A discoid medial meniscus is an extremely rare anomaly. We present 4 cases of symptomatic discoid medial meniscus. Furthermore, magnetic resonance imaging (MRI) of the unaffected knee was obtained in 3 cases, and 1 patient had bilateral discoid medial menisci as well as a unilateral discoid lateral meniscus proven by MRI. Another patient had bilateral discoid medial menisci. In one of the other 2 cases, an MRI of the unaffected knee was not obtained. However, in the involved knees of both cases, medial and lateral menisci were discoid. The incidence of bilateral discoid medial menisci is unknown. In the past, the diagnosis of a discoid meniscus was made with an arthrogram or at arthrotomy. Therefore, whether some of the unilateral cases reported in the literature might have been bilateral is unknown. The reported prevalence of bilateral discoid medial menisci will probably increase, because when a discoid medial meniscus is encountered currently, an MRI is used to find knee disorders, including in the contralateral knee. Axial multiplanar gradient-recalled-echo imaging could provide images of the discoid meniscus, depicted in its entirety in one section. This would make the recognition of a discoid meniscus simple.
Fiolle reported the first description of a "carpal boss". The "hump" is cosmetically disturbing and sometimes painful. It has to be distinguished from a ganglion. A lateral X-Ray with 30 degrees of supination reveals a spur or a styloid bone (12.5%). In a series of 44 patients, treated over a period of 7 years, 21 needed operation for pain or a complication of previous surgery. The technique described by Cuono and Watson was successfully used without recurrence of deformity but in 2 cases some pain remained during strenuous efforts.
This procedure is a minimally invasive method of excising a retrocalcaneal exostosis and has been performed at the authors' facility for several years with excellent results and no incidence of Achilles tendon compromise. Postoperative recovery and return to weight bearing are accelerated compared with procedures that reflect the Achilles tendon from its insertion.
Parathyroid hormone (PTH) and PTH related peptide (PTHrP) have a common main receptor: type I PTH-PTHrP receptor. PTH expresses its main metabolic actions, and PTHrP part of its autocrine or paracrine actions through this receptor. Jansen chondrodysplasia is a very rare disease mainly characterized by severe metaphyseal growth disorders leading to dwarfism and hypercalcemia. The group of Jüppner from the Massachusetts General Hospital in Boston recently demonstrated mutations on the gene of the type I PTH-PTHrP receptor in five patients with Jansen chondrodysplasia. These mutations result in permanent activation of the receptor responsible for the observed hypercalcemia and bone growth abnormalities due to the disease. Therefore Jansen chondrodysplasia appears as a remarkable clinical model outlining the major role of PTHrP in bone growth regulation.