Condrosarcoma de base de cráneo: análisis clínico-patológico de un caso

Introducción: El condrosarcoma es un tumor maligno poco común; la localización craneal es rara. En ocasiones, su resección total no es posible debido a la proximidad de la masa a estructuras vasculares y neurales importantes. Caso Clínico: Mujer de 56 años que presentó cefalea en el lado derecho, parestesia en el lado derecho del labio superior, pérdida de la memoria a corto plazo y ageusia. La RM mostró una masa extraaxial realzada. La paciente tuvo una resección quirúrgica completa. Los resultados anatomopatológicos mostraron un condrosarcoma bien diferenciado de la base del cráneo. Conclusión : El condrosarcoma es un tumor maligno con diferenciación pura del cartílago hialino, representa el 0.15 % de todos los tumores intracraneales, siendo este el segundo caso de localización de la base del cráneo reportado en el Perú. Las características histológicas más los marcadores de inmunohistoquímica revelaron características clásicas de este tumor. El tratamiento aún depende de la individualización de cada caso.

Introduction: Chondrosarcoma is an unusual malignant neoplasm; cranial location is rare. Sometimes its complete resection is not possible because of vicinity of the mass to important vascular and neural structures. Clinical case: This is a 56-year old female subject who developed headache in the right side, paresthesia in the right side of her upper lip, short term memory loss, and ageusia. A magnetic resonance imaging study showed an enhanced extra-axial mass. This patient underwent complete surgical resection. The anatomopathological study showed a well differentiated chondrosarcoma of the cranial base. Conclusion: Chondrosarcoma is a malignancy with pure differentiation of the hyaline cartilage. It represents 0.15% of all intracranial tumors, and this is the second case with a cranial base location reported in Peru. Both histological characteristics and immunohistochemistry markers revealed the classic characteristics of this tumor. Therapy is given on an individualized basis.

Influence of cranial base angle and posterior occlusal plane inclination on sagittal dentoskeletal types / 中国组织工程研究

BACKGROUND: Cranial base angle is related to the formation of sagittal dentoskeletal type, and the effect of occlusal plane or posterior occlusal plane on the formation of sagittal dentoskeletal type remains controversial. OBJECTIVE: To compare the importance of occlusal plane inclination and posterior occlusal plane inclination in determining the formation of sagittal dentoskeletal type, and to explore the combined influence of the cranial base angle and posterior occlusal plane inclination on the formation of sagittal dentoskeletal type, and its correlation. METHODS: The study was implemented in accordance with the ethical requirements of Hospital of Stomatology, Southwest Medical University. Patients and their guardians signed the informed consents. Totally 207 lateral cephalograms from patients (100 males and 107 females, aged 12-20 years) were selected. Dentoskeletal landmarks and subsequent measurements were performed and analyzed using Uceph software and SPSS 17.0 software, respectively. The samples were classified as three sagittal dentoskeletal types according to the anteroposterior dysplasia indicator (APDI) value: Class I, class II, and class III. The SNK and LSD methods were used for comparison among the three groups. The Pearson correlation coefficient analysis was used to analyze the correlation between skull base angle (NSBa angle), occlusion plane (FH-OP), posterior occlusion plane (FH-POP) and other related measurement indexes. Descriptive statistical methods were used to group occlusal plane inclination, posterior occlusal plane inclination and skull base angle, and the two-sample f-test was used to compare relevant bone and tooth indexes. Four dentoskeletal groups were established according to the posterior occlusion plane inclination and skull base angle: Small skull base angle-flat posterior occlusion plane group (S-F), small skull base angle-steep posterior occlusion plane group (S-S), large skull base angle-flat posterior occlusion plane group (L-F), large skull base angle-steep posterior occlusion plane group (L-S). Intergroup comparison was completed using crossover one-way analysis of variance. RESULTS AND CONCLUSION: The skull base angle was significantly smaller in the class III group than the class I and II group. Significantly higher posterior occlusion plane inclination was observed in the class II group than the class I and III groups. No differences were found in the APDI and ANB between occlusal plane groups. Significant differences in the ANB angle and APDI value were shown on the small skull base angle-flat posterior occlusal plane group and the large skull base angle-steep posterior occlusal plane group. These results indicate that among the factors affecting the formation of sagittal dentoskeletal type, the posterior occlusal plane is more representative than the occlusal plane. The curvature of the skull base and the inclination of the posterior occlusal plane affect the formation of sagittal dentoskeletal type. During the formation of sagittal dentoskeletal type, there may be some compensatory mechanisms between the curvature of the skull base and the posterior occlusal plane.

Variación del ángulo SN-Frankfort en los diferentes biotipos faciales / Variation of the SN-Frankfort angle in the different facial biotypes

RESUMEN Introducción: La determinación del ángulo SN-Frankfort ha sido una constante utilizada por muchas décadas con un valor de 7°, sin embargo, son diversas las investigaciones que han refutado esta afirmación, debido a que los factores sociodemográficos influyen en la variación de este ángulo. Asimismo, la importancia de determinarlo es pieza clave para establecer un diagnóstico certero. Objetivo: Evaluar la variación del ángulo SN-Frankfort según el biotipo facial en pacientes. Métodos: Estudio descriptivo, transversal, retrospectivo y observacional. La muestra estuvo conformada por 225 radiografías cefalométricas laterales de pacientes entre 12 a 35 años que acudieron al Servicio de Ortodoncia del Hospital Hipólito Unanue durante los años 2014-2017. Se cumplieron los criterios de inclusión y la selección se realizó de forma probabilística por el método aleatorio simple. Para la evaluación de las radiografías cefalométricas se realizó el trazado manual. El biotipo facial se determinó mediante el índice de VERT y luego se obtuvo el ángulo SN-Frankfort. Se emplearon dos métodos estadísticos para la evaluación de la concordancia y reproducibilidad: El índice de Kappa para la evaluación del biotipo facial y el coeficiente de correlación interclase para la determinación del ángulo. Resultados: El promedio del ángulo SN-Frankfort en los pacientes con biotipo dolicofacial fue de 10,46 ± 3,02°, con biotipo mesofacial 10,12 ± 3,03° y con biotipo braquifacial 10,39 ± 3,48°. Los pacientes del sexo femenino presentaron una mayor angulación SN-Frankfort (10,69 ± 3,04) en comparación con los pacientes del sexo masculino (9,73 ± 3,23); p= 0,026. Conclusiones: Existe una variación en el ángulo SN-Frankfort según el tipo de biotipo facial, sin embargo, estas diferencias no fueron significativas. De modo contrario, se encontró que existe una significativa mayor angulación de ángulo SN-Frankfort en los pacientes del sexo femenino(AU)

ABSTRACT Introduction: Determination of the SN-Frankfort angle has been a constant used for many decades with a value of 7°. However, several studies have refuted that statement, based on the influence of sociodemographic factors on the variation of this angle. On the other hand, the importance of its determination is crucial to achieve an accurate diagnosis. Objective: Evaluate the variation of the SN-Frankfort angle according to the facial biotype of patients. Methods: A descriptive cross-sectional observational retrospective study was conducted. The sample was 225 lateral cephalometric radiographs of patients aged 12-35 years attending the Orthodontics Service of Hipólito Unanue Hospital in the period 2014-2017. Inclusion criteria were complied with, and selection was made by simple random probability sampling. Manual tracing was performed to evaluate the cephalometric radiographs. Facial biotype was determined by the VERT index, and the SN-Frankfort angle was then obtained. Two statistical methods were used for agreement and reproducibility evaluation: the Kappa index for evaluation of the facial biotype and the interclass correlation coefficient for determination of the angle. Results: Average SN-Frankfort angle was 10.46 ± 3.02° for the dolichofacial biotype, 10.12 ± 3.03° for the mesofacial biotype and 10.39 ± 3.48° for the brachifacial biotype. Female patients had greater SN-Frankfort angulation (10.69 ± 3.04) than male patients (9.73 ± 3.23); p= 0.026. Conclusions: Variation was found in the SN-Frankfort angle according to the facial biotype, but those differences were not significant. Significantly greater SN-Frankfort angulation was found among female patients(AU)

Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.

Advantages of scalp acupuncture at cranial base zone for refractory ophthalmopathy / 中国针灸

The cranial base zone is located in the lower posterior part of harnpan, the area 0.5 up and down from the line from Yamen (GV 15) to Yifeng (TE 17). There are Tianzhu (BL 10) in the bladder meridian, Fengchi (GB 20) and Wangu (GB 12) in the gallbladder meridian, and Yiming (EX-HN 14). The four acupoints own the function of treating eye diseases. The auther find acupuncture at the cranial base zone can obviously improve the effect on refractory eye diseases. The manipulation mainly shows small amplitude lifting and thrusting with multiple filiform needles. The functions of exciting meridian , smoothing meridian and collateral, and making go into the sick part fast could occur with eye movement and orbital relaxation movement during manipulation. Thus, the effect is achieved. This paper explain the advantages of acupuncture at the cranial base zone for eye diseases in detail, with 1 case for example.

Aberrant growth of the anterior cranial base relevant to severe midface hypoplasia of Apert syndrome / 대한악안면성형재건외과학회지

BACKGROUND: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. METHODS: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. RESULTS: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. CONCLUSION: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.

Morphological characteristics of the cranial base of early Angle's class II division 1 malocclusion in permanent teeth / Características morfológicas de la base de cráneo en la maloclusión temprana clase II división 1 de Angle en dientes permanentes

To investigate the effects of morphological characteristics of cranial base on malocclusion by analyzing characteristics of sagittal and vertical facial types of Angle's class II division 1 malocclusion so as to provide theoretical references for clinical diagnosis and correction of early Angle's class II division 1 malocclusion in permanent teeth. We randomly selected lateral radiographs of the skull of 80 patients at the age of 12­14 years old from the Department of Orthodontics, Stomatological Hospital, Shanxi Medical University, China. There were 20 cases of Angle's class I malocclusion with average angle, 20 cases of Angle's class II division 1 malocclusion with average angle, 20 cases of Angle's class II division 1 malocclusion with low angle, and 20 cases of Angle's class II division 1 malocclusion with high angle. Winceph 8.0 software was used to measure 39 hard tissue markers and 13 indicators reflecting the characteristics of cranial base structure. One-way t-test was used in the average-angle class II division 1 group and average-angle class I group. Least significantdifference was utilized in patients with different vertical types of class II division 1 malocclusion.nterior (S-N) and posterior (S-Ba) cranial base lengths,and total cranial base length(Ba-N) were significantly longer in the class II division 1 patients compared with the class I patients. Significant differences in anterior cranial floor base angle (CF-PM), middle cranial floor base angle (Ba-SE-PM), and posterior cranial base inclination (SBa-FH) were determined between class II division 1 malocclusion and class I malocclusion patients. CF-PM angle and SBa-FH were smaller in class II division 1 subjects than in class I subjects. Ba-SE-PM angle and cranial floor base angle (Ba-SE-FMS) were larger in class II division 1 subjects than in class I subjects. No significant difference in cranial base angle (N-S-Ba) and anterior cranial base inclination (SN-FH) was detected between class II division 1 subjects and class I subjects. Morphology of cranial base and cranial floor base has a significant effect on sagittal and vertical facial types of Angle's class II division 1 malocclusion. The changes in the length of the posterior skull base and the inclination of the anterior skull base are mainly presented in the sagittal direction. Angle of cranial base and cranial floor base plays a certain role in vertical facial type of Angle's class II division 1 malocclusion.

El objetivo de este trabajo consistió en investigar los efectos de las características morfológicas de la base craneal sobre la maloclusión, a través del análisis de los siferentes tipos faciales de maloclusión Clase II de Angle (sagital y vertical), para proporcionar referencias teóricas para el diagnóstico clínico y la corrección temprana de la maloclusión de clase II división 1 de Angle en dientes permanentes. Se seleccionaron al azar radiografías laterales de cráneo de 80 pacientes, entre 12-14 años de edad, del Departamento de Ortodoncia, Hospital de Estomatología, Universidad Médica de Shanxi, China. Hubo 20 casos de maloclusión clase I de Angle con ángulo promedio, 20 casos de maloclusión clase II de Angle con ángulo promedio, 20 casos de maloclusión Clase II de Angle con ángulo bajo y 20 casos de maloclusión clase 1 de Angle con ángulo alto. Se utilizó el software Winceph 8.0 para medir 39 marcadores de tejido duro y 13 indicadores que reflejan las características de la estructura de la base de cráneo. Se usó la prueba t de una vía en el grupo clase II de división 1 con ángulo promedio y el grupo clase I con ángulo promedio. Se detectaron diferencias mínimas significativas en pacientes con diferentes tipos verticales de maloclusión clase II división 1. Las longitudes de la base de cráneo posterior (SN) y posterior (S-Ba), y la longitud total de la base craneal (Ba-N) fueron significativamente mayores en la clase II, en comparación con los pacientes de la clase I. Se determinaron diferencias significativas en el ángulo de la base del piso craneal anterior (CF-PM), el ángulo de la base del piso craneal medio (Ba-SE-PM) y la inclinación de la base craneana posterior (SBa-FH) entre la maloclusión clase II división 1 y los pacientes con maloclusión de clase I. Los ángulos de CF-PM y SBa-FH fueron más pequeños en la clase II división 1 que en la clase I. El ángulo de Ba-SE-PM y el ángulo de base del piso craneal (Ba-SE-FMS) fueron mayores en sujetos de clase II división 1 que en sujetos de clase I. No se detectaron diferencias significativas en el ángulo de la base craneana (N-S-Ba) y la inclinación de la base craneal anterior (SN-FH) entre los sujetos de la clase II división 1 y los de la clase I. La morfología de la base craneal y de la base del suelo craneal tiene un efecto significativo en los tipos faciales sagital y vertical de maloclusión Clase II división 1 de Angle. Los cambios en la longitud de la base posterior del cráneo y la inclinación de la base anterior del cráneo se presentaron principalmente en la dirección sagital. El ángulo de la base craneal y la base del suelo craneal tiene cierto rol en el tipo facial vertical de la clase II de Angle.

Application of radioactive particle interstitial implant brachytherapy in the treatment of malignant adenogenous tumors invaded into cranial base area / 实用口腔医学杂志

Objective:To study the effects of brachytherapy with 125I in the treatment of malignant adenogenous tumors invaded into cranial base area,and to evaluate the correlative factors of prognosis.Methods:24 patients with malignant adenogenous tumors invaded into cranial base area were treated by 125I seeds implanted into the tumors with the spacing of 1-1.5 cm and guided by CT,individual guide plate and navigation system respectively or in combination with the dose of 60-160 Gy.Survival rate,local recurrence rate,distant metastasis and safty of the treatment were evaluated.The correlative factors of prognosis included age,pathology diagnosis,diameter of the tumor,area of tumor invasion and history of radiotherapy were analyzed.Results:The follow-up time of the patients was 3-76 months and the median was 27 months.2 patients came up with radiotherapy reaction of level 4.The total survival rate was 41.7％,the local recurrence rate was 25.0％ and the distant metastasis rate was 37.5％.The cumulative survival rate of 1,3 and 5 years was 79％,67％ and 24％ respectively.Significant correlation was found between prognosis and local recurrence as well as the diameter of the tumor.Conclusion:125I brachytherapy provides a safe and feasible technique with minimal damage for treating malignant adenogenous tumors invaded into cranial base area.The prognosis is related to local recurrence and the diameter of the tumor.

Plasmocitoma solitario de la base craneal: Reporte de tres pacientes / Solitary cranial base plasmocytoma: Three cases report

Plasmocytomas constitute a group of malignant neoplasm arise from clonal plasmatic cells being solitary extramedular form infrequent. Here we report three patients with solitary anterior and middle cranial base plasmocytoma. The importance of these tumors in differential diagnoses of cranial base lesions and the role of endoscopic endonasal biopsy before deciding definitive clinical approach was emphasized.

Los plasmocitomas constituyen neoplasias malignas de las células plasmáticas clónales. La forma extramedular solitaria en la base craneal es infrecuente. Se reportan tres pacientes con plasmocitoma solitario de la base craneal anterior y media. Se enfatiza en la importancia de esta afección en el diagnóstico diferencial de las lesiones de base de cráneo así como la biopsia endonasal endoscópica antes de decidir el tratamiento definitivo.

The effects of the Seven Acupoints of the Cranial Base on health related quality of life for patients with Parkinson’s disease：a randomized controlled trial / 国际中医中药杂志

Objectives To evaluate the effects of“the Seven Acupoints of the Cranial Base”(SACB) in improving quality of life(QOL)of patients with PD. Methods The study Subjects were seventy(70)patients with a diagnosis of Parkinson's disease. The Subjects were divided into two groups, i.e. acupuncture group and drug group.The former was treated by SACB every two days,while the latter took Levodopa and Benserazide Tablet250mg tid. The subjects all received treatment for 6 months. PDQ-39,UPDRSⅡand PDSS were adopted to measure quality of life at 4 time points. Results The total effective rate of the treatment group was 85.71%, the control group was 71.43%. And there was a statistical difference of level distribution between the two groups(P<0.01). The total score of PDQ-39, UPDRSⅡ and PDSS of patients in the treatment group [(20.41± 11.64), (9.09±5.02), (126.31±8.37)]were significantly improved compared with the control group[(27.48± 8.69), (10.29±4.93), (109.94±8.11), P<0.01]. The 5 dimension score of PDQ-39, and the 4 single item score of UPDRSⅡ in the treatment group[(8.60±5.07), (3.20±2.08), (2.34±1.73), (1.20±1.68), (1.63±1.96),(1.31±0.68), (0.77±0.94), (0.91±0.74), (0.77±0.65)]were significantly improved compared with the control group[(11.69±4.11), (5.09±3.72), (5.37±1.99), (2.86±2.33), (2.74±2.08), (1.74±0.98), (1.31±0.93), (1.43±0.78), (1.20±0.68), P<0.01 or 0.05]. Conclusion SACB can markedly and multi-dimensionally improve the QOL of patients with PD and has a higher efficacy than Levodopa and Benserazide Tablet.

Comparative analysis of the anterior and posterior length and deflection angle of the cranial base, in individuals with facial Pattern I, II and III

OBJECTIVE: This study evaluated the variations in the anterior cranial base (S-N), posterior cranial base (S-Ba) and deflection of the cranial base (SNBa) among three different facial patterns (Pattern I, II and III). METHOD: A sample of 60 lateral cephalometric radiographs of Brazilian Caucasian patients, both genders, between 8 and 17 years of age was selected. The sample was divided into 3 groups (Pattern I, II and III) of 20 individuals each. The inclusion criteria for each group were the ANB angle, Wits appraisal and the facial profile angle (G'.Sn.Pg'). To compare the mean values obtained from (SNBa, S-N, S-Ba) each group measures, the ANOVA test and Scheffé's Post-Hoc test were applied. RESULTS AND CONCLUSIONS: There was no statistically significant difference for the deflection angle of the cranial base among the different facial patterns (Patterns I, II and III). There was no significant difference for the measures of the anterior and posterior cranial base between the facial Patterns I and II. The mean values for S-Ba were lower in facial Pattern III with statistically significant difference. The mean values of S-N in the facial Pattern III were also reduced, but without showing statistically significant difference. This trend of lower values in the cranial base measurements would explain the maxillary deficiency and/or mandibular prognathism features that characterize the facial Pattern III.

OBJETIVO: o presente estudo avaliou as variações da base craniana anterior (S-N), base craniana posterior (S-Ba), e ângulo de deflexão da base do crânio (SNBa) entre três diferentes padrões faciais (Padrão I, II e III). MÉTODOS: selecionou-se uma amostra de 60 telerradiografias em norma lateral de pacientes brasileiros leucodermas, de ambos os sexos, com idades entre 8 anos e 17 anos. A amostra foi dividida em três grupos (Padrão I, II e III), sendo cada grupo constituído de 20 indivíduos. Os critérios de seleção dos indivíduos para cada grupo basearam-se nos valores de ANB, Wits e ângulo do contorno facial (Gl.Sn.Pg'). Para observar se houve diferença nos valores médios de SNBa, S-N e S-Ba entre os diferentes grupos, utilizou-se a Análise de Variância One Way - ANOVA, seguida de testes post-hoc de Scheffé. RESULTADOS E CONCLUSÕES: não houve diferença estatisticamente significativa na deflexão da base do crânio entre os diferentes padrões faciais (Padrão I, II e III). Também não houve diferença significativa nos valores da base anterior e posterior do crânio entre o Padrão I e o Padrão II. Os valores médios de S-Ba apresentaram-se reduzidos no Padrão III, com diferença estatisticamente significativa. Os valores médios de S-N também se apresentaram reduzidos no Padrão III, embora sem diferença estatisticamente significativa. Essa tendência a valores reduzidos da base do crânio poderia explicar a deficiência maxilar e/ou prognatismo mandibular, características que podem estar presentes no Padrão III.

Study on Characteristics of Maxillofacial Growth in Class III Malocclusion Patients by Cranial Base Growth

Comparative study of linear and angular measures of the cranial base in skeletal Class I and III malocclusion / Estudo comparativo de medições lineares e angulares da base do crânio em maloclusão esquelética Classe I e III

PURPOSE: To evaluate the effect of flexion and linear measures of the cranial base on the anteroposterior position of the jaws in skeletal Class III malocclusion compared with skeletal Class I. METHODS: One hundred-twenty lateral radiographs were divided in two groups: Group 1 - 60 radiographs of individuals with a Class I skeletal pattern; and Group 2 - 60 radiographs of individuals with a skeletal Class III pattern. The radiographs were of adult Caucasian individuals with no previous orthodontic treatment. Data were analyzed by using ANOVA. RESULTS: There were significant differences in the cranial base angle (NSBa) and anterior cranial base length (S-N) between the two groups. Group 2 had the lowest values for NSBa and S-N. The analysis of cranial base complementary angles (NSGn and BaSGn) revealed a significant statistical difference in NSGn: Group 2 had lower NSGn values, which indicates a more anterior position of the gnathion. Variations of the cranial base angle and the Y axis were inversely correlated with variations of SNA and SNB angles, and the differences were statistically significant for the two groups. CONCLUSION: This study supports previous findings that the cranial base flexion contributes to skeletal configuration in Class III skeletal patterns. Therefore, the cranial base should be evaluated for growth predictions and Class III diagnosis. The effect of the cranial base on the positioning of the jaws should be further assessed.

OBJETIVO: Avaliar o efeito da flexão a das medidas lineares da base do crânio na posição anteroposterior da maxila e da mandíbula na maloclusão de Classe III esquelética através da comparação com a Classe I esquelética. MÉTODOS: A amostra selecionada foi composta de 120 radiografias cefalométricas, em norma lateral, divididas em dois grupos: Grupo 1: 60 radiografias de indivíduos com padrão de Classe I esquelética; e Grupo 2: 60 radiografias de indivíduos com padrão de Classe III esquelética. As radiografias selecionadas foram de indivíduos adultos, Caucasianos e sem tratamento ortodôntico prévio. Os dados foram analisados por ANOVA. RESULTADOS: Houve diferença significativa no ângulo da base do crânio (NSBa) e no comprimento da base anterior do crânio (S-N) entre os dois grupos. O Grupo 2 obteve valores menores para NSBa e S-N. A análise dos ângulos complementares da base do crânio (NSGn and BaSGn) revelou uma diferença estatisticamente significativa no NSGn: O Grupo 2 obteve menores valores de NSG o que indica uma posição mais anterior do gnátio. Variações no ângulo da base do crânio e no eixo Y foram inversamente correlacionadas com variações nos ângulos SNA e SNB, e as diferenças foram estatisticamente significativas para os dois grupos. CONCLUSÃO: Este estudo concorda com estudos anteriores de que a flexão da base do crânio contribui para a configuração esquelética no padrão de Classe III esquelética. Logo, a base do crânio deve ser avaliada nas previsões de crescimento e no diagnóstico da Classe III. O estudo do efeito da base do crânio no posicionamento dos maxilares deve ser mais aprofundado.

The Role of Microtubule in the Regulation of Endochondral Bone Formation in the Developing Mouse Cranial Base / 체질인류학회지

Endochondral bone formation of the developing cranial base is a complex process. This mechanism requires precise orchestration of many cellular events and cartilage matrix metabolism, such as proliferation, becoming round in shape, termination of proliferation, hypertrophic size-increase, and finally programmed cell death. Active formation and degradation of cartilage matrix take place, in which microtubules are involved for intracellular events; bone apposition follows these events. However, the involvement of microtubules during these changes in the developing cranial base has not been identified yet. Thus, we investigated the involvement of microtubules in the regulation of endochondral bone formation during cranial base development. Using tubulin-binding drug nocodazole, we examined the effects of altering the structure and function of microtubules during in vivo organ culture of the mouse cranial base. Cultured specimens were analyzed with HE staining, immunohistochemistry, and cell counting in order to study the morphological and molecular changes that occurred in the tissues. Disruption of the microtubular array by nocodazole reduced cells expressing proliferation marker Ki67, osteogenic marker BSP, and BMP4 within the sphenooccipital synchondrosis region; chondrocyte hypertrophy was ceased in the hypertrophic zone; degeneration of cartilage matrix and bone matrix apposition was inhibited in the ossification center of the basooccipital cranial base. Our data demonstrated that disruption of microtubules by nocodazole have multiple inhibitory effects on the sequential changes that occur during endochondral bone formation, suggesting the importance of normal microtubule-polymerization in cranial base development.

Meningo-encefalocele esfenopalatina: um desafio diagnóstico e terapêutico / Sphenopalatine meningoencephalocele: a diagnosis and therapeutic challenge

Introdução: Encefaloceles e mieloceles são deformidades de fácil diagnóstico clínico, porem em alguns casos este diagnóstico pode estar dificultado pela ausência de sinais clínicos e queixas. Objetivo: O presente trabalho pretende relatar o caso de um paciente do sexo masculino, de 2 anos de idade, com uma meningocele transesfenoidal, sem sintomatologia, associada a discretas alterações no exame físico e tratada através de cirurgia endoscópica transnasal. Relato de Caso: Tratamento cirúrgico de meningocele transesfenoidal em um paciente de 2 anos de idade, através de cirurgia endoscópica transnasal, utilizando retalho de mucosa septal nasal bilateral, pediculado na artéria esfenopalatina. Conclusão: A abordagem da meningoencefalocele, utilizando retalhos de mucosa septal mostrou-se uma opção viável e eficaz em pacientes pediátricos.

Introduction: Encephalocele and myelocele are deformities of easy clinical diagnosis, however, in some cases this diagnosis can be complicated for the clinical signs and complaints' absence. Objective: The present study intends to report the case of a two-year-old patient of the male sex with a trans sphenoidal meningocele without symptomatology associated to discrete alterations in the physical exam and treated through endoscopic transnasal surgery. Case Report: Trans sphenoidal meningocele' surgery treatment in a two-year-old patient, through endoscopic transnasal surgery, using bilateral septal nasal mucosa shred, pedicellate in the sphenopalatine artery. Conclusion: The meningoencephalocele approach, using septal nasal mucosa it is showed a viable and effective option in pediatric patients.

Displasia fibrosa recidivante de antro maxilar com invasão de base do crânio / Recurring fibrous dysplasia of anthro maxillary with cranial base invasion

Introdução: A displasia fibrosa é uma lesão óssea com etiologia ainda desconhecida. Caracteriza-se pela incapacidade de maturação óssea. Pode acometer qualquer osso, mas é o acometimento dos ossos craniofaciais o de maior interesse na otorrinolaringologia. A maxila é o osso facial mais afetado, sendo a invasão orbitária um evento incomum. Os sintomas são inespecíficos e, pela baixa suspeição e raridade, o diagnóstico é geralmente tardio. A forma monostótica apresenta crescimento lento e curso assintomático, necessitando apenas de acompanhamento. O tipo poliostótico possui um comportamento progressivo e associa-se a recorrência e complicações. Objetivo: Apresentar dois casos de pacientes com diagnóstico de displasia fibrosa, discutindo a apresentação clínica, os achados radiológicos e o tratamento desta patologia. Relato do Caso: São relatados dois casos de displasia fibrosa que inicialmente apresentaram sintomatologia inespecífica, mas com sinais radiológicos característicos. Foram submetidos a tratamento cirúrgico para ressecção das lesões e evoluíram com recidivas frequentes com acometimento extenso de seios da face, sendo que em um paciente ocorreu invasão de base do crânio havendo necessidade de craniotomia frontal para excisão tumoral. Conclusão: A displasia fibrosa é uma osteopatia incomum. A tomografia é o método de eleição na caracterização da expansão tumoral, auxiliando no planejamento cirúrgico. A estratégica cirúrgica está indicada em lesões sintomáticas, alterações funcionais ou distorções anatômicas. O presente artigo descreve duas raras apresentações de displasia fibrosa recidivante com extenso acometimento de antro maxilar, seios etmoidais e esfenoidais, além de invasão orbitária e base do crânio.

Introduction: Fibrous dysplasia is an osseous lesion with an unknown etiology. It is characterized by the osseous maturation insufficiency. It may affect any bone, but the affection of craniofacial bones is the most critical for otorhinolaryngology. Maxilla is the most affected facial bone and the orbitary invasion is an uncommon event. The symptoms are unspecific and for its low suspicion and uncommonness, the diagnosis is generally late. The monostotic form presents a slow growth and asymptomatic course and needs to be followed up. The polyostotic type has a progressive behavior and is associated to recurrence and complications. Objective: To present two cases of patients with fibrous dysplasia diagnosis and describe the clinical presentation, radiological findings and the treatment of this pathology. Cases Report: Two cases of fibrous dysplasia are reported, which initially presented unspecific symptomatology, but with characteristic radiologic signs. They were submitted to surgical treatment for resection of the lesions and evolved with frequent recurrences with extensive affection of the facial sinuses, one patient had cranial base invasion and frontal craniotomy was needed for tumoral excision. Final Comments: Fibrous dysplasia is an uncommon osteopathy. The tomography is the choice method for characterization of the tumoral expansion, and helps in the surgical planning. The surgical strategy is indicated for symptomatic lesions, functions alterations or anatomic disorders. This article describes two uncommon manifestations of recurrent fibrous dysplasia with an extensive affection of anthro maxillary, ethmoidal and sphenoid sinuses, in addition to orbitary and cranial base invasion.

Diagnóstico diferencial en patología tumoral de la base de cráneo anterior / Differential diagnosis in tumor pathology of the anterior skull base

Objective. To describe a series of tumoral lesions of the anterior fossa that were treated at the Hospital de Clinicas during a determined lapse of time.Material and Methods. We evaluated the image archive and medical charts of all the patients operated on between January 2005 and May 2009 at the Neurosurgery Division of the Hospital de Clínicas. Results. From a total of 142 surgeries for expansive supratentorial lessions, 19 were for lessions of the anterior skull base (n=19) of which 7 were meningiomas (36%); four patients with gliomas (21%); one with GBM (5%); one with astrocitoma (5%); two with oligodendroglioma (10%); three patients presented tumors of the paranasal sinuses (15%); two had mucoceles (10%); one with squamous cell carcinoma (5%); three with orbital tumors; one with fibrous bone dysplasia (5%) and one with metastasis of a meduloblastoma of the posterior fossa (5%). Conclusion. The most frequent pathology found at this site is the meningioma, and secondly, gliomas. The third in frequency are the paranasal sinus tumors whose most malignant pathology is the squamous cell carcinoma. Our findings are statistically correspondent to other large series in literature.

Condroblastoma do osso esfenóide / Chondroblastoma of the sphenoid bone

Introdução: Condroblastoma é uma rara neoplasia benigna cartilaginosa, altamente destrutiva, que caracteristicamente surge na epífise de ossos longos em pacientes jovens. Sua ocorrência é extremamente rara na base do crânio, normalmente ocorrendo no osso temporal. Objetivo: Descrever um raro caso de um paciente apresentando um condroblastoma de osso esfenóide que invadia a fossa média, submetido a ressecção cirúrgica com sucesso, sem recorrência após 2 anos. Relato do Caso: W.J.S., 37 anos, masculino, encaminhado ao ambulatório de otorrinolaringologia com otalgia persistente e de forte intensidade há 3 meses. Apresentava otoscopia normal e sem tumorações visíveis. Tomografia computadorizada evidenciou massa tumoral em fossa infra-temporal à esquerda, invadindo fossa cerebral média. Biópsia sugeria tumor de células gigantes. Realizada ressecção ampla por abordagem anterior via osteotomia orbito-zigomática. Durante a cirurgia, confirmando achados tomográficos, não foi encontrado envolvimento do osso temporal. Exame histopatológico evidenciou condroblastoma. Após 18 meses da cirurgia, não apresenta queixas, sem déficits motores, sensitivos ou de nervos cranianos e sem sinais tomográficos de recorrência. Conclusão: Destaca-se a importância do diagnóstico diferencial do condroblastoma nas lesões da base do crânio e sua abordagem terapêutica, cujo objetivo sempre deve ser a maior ressecção possível com a máxima preservação de função.

Introduction: Chondroblastoma is an uncommon cartilaginous benign neoplasm, highly destructive, which specifically appears in the epiphysis of long bones in young patients. Its occurrence is extremely rare in the cranial base, normally occurring in the temporal bone. Objective: To describe a rare case in a patient presenting with a sphenoid bone chondroblastoma that invaded the middle cranial cavity, submitted to a successful surgical resection, without recurrence after 2 years. Case Report: W.J.S, 37 years old, male, forwarded to the otorhinolaryngology service with persistent and strong otalgia for 3 months. He had normal otoscopy and without visible tumorations. The computerized tomography confirmed tumor mass in the left infra-temporal cavity, invading the middle cranial cavity. The biopsy suggested giant cells tumor. After wide resection by frontal approach via orbitozygomatic osteotomy. During the surgery, we confirmed tomographic statements and didn't find temporal bone involvement. The histopathological exam confirmed chondroblastoma. After 18 months after the surgery, he doesn't present with complaints, without motor, sensitive deficits or of cranial nerves and without recurrence tomographic signals. Conclusion: The importance of differential diagnosis of chondroblastoma is remarkable in the cranial base lesions and its therapeutic approach, whose objective must always be the major possible resection with the maximum function conservation.

Estudo cefalométrico da correlação da anatomia da base craniana com o padrão facial e as bases apicais / Cephalometric study of the cranial base anatomy correlation with the facial pattern and apical bases

OBJETIVOS: este estudo transversal foi realizado com o objetivo de avaliar cefalometricamente a correlação da anatomia da base craniana com o padrão facial e as bases apicais. METODOLOGIA: foram utilizadas 88 telerradiografias de norma lateral de jovens leucodermas brasileiros com média de idade de 10,3 anos. Utilizou-se o índice VERT de Ricketts para a determinação do padrão facial, distribuindo a amostra em: 37 para o grupo M (mesofaciais), 34 para o grupo D (dolicofaciais) e 17 para o grupo B (braquifaciais). Realizaram-se, manualmente: o desenho anatômico, a demarcação de pontos, o traçado de linhas e planos e a aferição de medidas lineares e angulares. As medidas da base do crânio utilizadas foram S-N, N.S.Ba e S-N.Po-Or, e as medidas das bases apicais foram S.N.A, S.N.B e A.N.B. RESULTADOS E CONCLUSÕES: concluiu-se que, na correlação entre a base craniana e o padrão facial, houve significância entre a variável N.S.Ba e o índice VERT. Na correlação entre a base craniana e as bases apicais, houve significância entre N.S.Ba e as variáveis S.N.A e S.N.B, e entre S-N.Po-Or e as variáveis S.N.A e S.N.B.

AIM: This cross-sectional study was conducted with the object of making a cephalometric evaluation of the cranial base anatomy correlation with the facial pattern and apical bases. METHODS: 88 lateral teleradiographies of young white Brazilian with mean age of 10.3 years were used. The Ricketts VERT index was used to determine the facial pattern, and the sample was distributed as follows: 37 in group M (mesofacial), 34 in group D (dolicofacial) and 17 in group B (brachyfacial). The anatomic drawing, demarcation of points, line and plane tracings, and linear and angular measurement gauging were done manually. The cranial base measurements used were S-N, N.S.Ba and S-N.Po-Or and the apical base measurements were S.N.A, S.N.B and A.N.B. RESULTS AND CONCLUSION: It was concluded that, in the correlation between the cranial base and the facial pattern, there was significance between the variable N.S.Ba and the VERT Index. In the correlation between the cranial base and the apical bases, there was significance between N.S.Ba and the variables S.N.A and S.N.B, and between S-N.Po-Or and the variables S.N.A and S.N.B.

Comparison of cranial base morphology between the mandibular prognathism and maxillary retrognathism in skeletal class III patients

This study was intended to compare the cranial base morphology between the mandibular prognathism and maxillary retrognathism in skeletal class III patients. The subject of the present study was composed of 88 patients divided into two groups; Group 1 (Skeletal Class III with mandibular prognathism. SNA within normal range, SNB over normal range, n=54) and Group 2(Skeletal Class III with maxillary retrognathism. SNA below normal range, SNB within normal range, n=34). Lateral cephalogram were taken immediate before surgery and 18 landmarks were used to analyze the characteristics of cranial base and maxillomandibular skeleton. The result revealed that cranial base angle is significantly smaller in Group 1 than Group 2, which implies the influence of the cranial base angulation on the mandibular position. However the posterior cranial base length did not influence the mandibular horizontal position and anterior cranial base length did not influence the maxillary horizontal position. As the anterior cranial base length was closely related with ramal height, it is recommendable to investigate the regulatory mechanism of chondrogenesis of cranial base and condyle cartilage in the future research.