Unusual Supero-Lateral Dislocation of Intact Bilateral Mandibular Condyles Associated with Right Parasymphysis Mandibular Fracture:A Case Report and Review of Literature

The dislocation of the mandibular condyle / condyles occurs most commonly in an anterior direction due to trauma. This is a known fact as due to pull of lateral pterygoid muscle. On the contrary, posterior, superior, or lateral dislocations of the intact mandibular condyle occur rarely, and very few such cases have been reported in the English language literature. The rarity of these dislocations can be attributed to the varying anatomy of the condyle, the direction of pull of muscles attached to the condyle and low incidence of skull base fractures from an indirect blow. A case of bilateral supero-lateral dislocation of the condyle associated with a symphyseal fracture is presented. We discuss the dynamics, diagnostic features and clinical management of such dislocations with extensive review of literature

Management of mandibular symphysis fracture associated with superolateral dislocation of the mandibular condyle: 10 case report / 实用口腔医学杂志

Mandibular symphysis fracture combined with anteromedial dislocated condyle fracture is commom in clinical,but mandibular symphysis fracture associated with superolateral dislocation of the mandibular condyle is rare,which is often misdiagnosed or completely over-looked.Malpractice can lead to ankylosis and other sequelae.This article reviews 10 patients with mandibular symphysis fracture associated with superolateral dislocation of the mandibular condyle,discusses the causative mechanism,diagnostic features and clinical management according to literature data.

Local compressive strength of the superolateral and sueromedial aspects of the anterior half of the talar dome: A biomechanical and histological study.

One cause of osteochondritis dissecans of the talar dome is related to trauma. The lesion occurs at the anterior half of the talar dome. The lateral osteochondritis dissecans is located at the superolateral aspect, while the medial lesion is located at the superomedial aspect. The lateral lesion is more common and its crater is shallower than that of the medial lesion. This study was therefore carried out to determine the local compressive strength of the superolateral and superomedial aspects of the anterior half of the talar dome. Ten pairs of fresh normal cadaveric tali were obtained. Using a universal testing machine, a compressive load was applied through a metal indenter at the superolateral and superomedial aspects of the talar dome until the maximal load was obtained. The maximal load and depth of depression were recorded. Histological studies of the compressive lesion was done using decalcified hematoxylin eosin stain. The results of the study showed that the superolateral aspect of the talar dome could withstand 1.27 times less compression load than could the superomedial aspect without a significant difference in stiffnesses. Moreover, the depth of depression of the superolateral compressive lesion was shallower than that of superomedial. Histological studies showed that the compressive lesion was a depression fracture. The depression fracture was a free osteochondral fragment surrounded by normal osteochondral tissue. The free fragment included articular cartilage, subchondral plate, and subchondral cancellous bone. The result of this study may explain why the prevalence of the lateral traumatic osteochondritis dissecans is higher, and its lesion crater shallower, than that of the medial aspect of the talar dome.

Periorbital Cerebrospinal Fluid Collection after Orbital Roof Craniotomy and Superolateral Orbital Craniotomy

OBJECTIVE: The aims of this study are to review the incidence of cerebrospinal fluid(CSF) collection complicating the simplified anterior skull base approaches via an eyebrow incision and to identify factors that influence its occurrence and treatment. METHODS: The authors retrospectively analyzed the clinical records and radiologic data of 47 cases(45 patients) who underwent superolateral orbital craniotomy or orbital roof craniotomy via an eyebrow incision at the Eulji Medical Center from September 1998 to August 2002. Forty-three cases were anterior circulation aneurysms and four cases were brain tumors. RESULTS: Significant periorbital CSF collection occurred in 13 cases(11 aneurysms, 2 brain tumors). It was managed with aspiration(8 cases), aspiration and lumbar drainage(2 cases), and dural repair(3 cases). There was no statistically significant difference in operative approaches and patient's characteristics. Periorbital CSF collection occurred in one(16.7%) of six cases using preventive lumbar CSF drainage over two days and in 12 (29.3%) out of 41 cases without it(p>005). CONCLUSION: The authors suggest that careful dissection and water-tight closure of frontal dura, sealing with fibrin glue and compressive dressing of operative wounds are important for the prevention of this complication. However, statistically not significant, preventive lumbar CSF drainage seem to be effective. Aspiration and/or lumbar drainage seem to be sufficient for management of postoperative CSF collection and dural repair could be reserved for refractory cases.

A Simplified Skull Base Approaches for Anterior Circulation Aneurysms: Superolateral Orbital Craniotomy and Orbital Roof Craniotomy viaan Eyebrow Incision

OBJECTIVE: Previous standard surgical approaches for aneurysms of anterior circulation are concerned with possible injury to the normal brain by cerebral retraction. Simplified skull base approaches have been introduced to fulfill the ideal goals of skull base surgery, brain protection and technical minimalism. Superolateral orbital craniotomy and orbital roof craniotomy via eyebrow incision offered sufficient working space for aneurysmal neck clipping of anterior circulaton and have advantages of minimal brain retraction and rapid recovery. METHODS: The concept and technique of the superolateral orbital craniotomy and orbital roof craniotomy are presented in detail. We conducted a retrospective study in which we evaluated the technical aspect of the superolateral orbital craniotomy and orbital roof craniotomy considering the indications, limitations, and complications of these approaches. RESULTS: The superolateral orbital craniotomy and orbital roof craniotomy provide an ample space to access the neurovascular structure of the anterior skull base without using brain retractors, enable rapid anatomical reconstruction for closure and acceptable cosmetic results. CONCLUSION: The superolateral orbital craniotomy and orbital roof craniotomy via eyebrow incision offer better surgical possibilities and approach related morbidity than conventional approaches in the treatment of anterior circulation aneurysms.

A Simplified Skull Base Approaches for Anterior Circulation Aneurysms: Superolateral Orbital Craniotomy and Orbital Roof Craniotomy viaan Eyebrow Incision

OBJECTIVE: Previous standard surgical approaches for aneurysms of anterior circulation are concerned with possible injury to the normal brain by cerebral retraction. Simplified skull base approaches have been introduced to fulfill the ideal goals of skull base surgery, brain protection and technical minimalism. Superolateral orbital craniotomy and orbital roof craniotomy via eyebrow incision offered sufficient working space for aneurysmal neck clipping of anterior circulaton and have advantages of minimal brain retraction and rapid recovery. METHODS: The concept and technique of the superolateral orbital craniotomy and orbital roof craniotomy are presented in detail. We conducted a retrospective study in which we evaluated the technical aspect of the superolateral orbital craniotomy and orbital roof craniotomy considering the indications, limitations, and complications of these approaches. RESULTS: The superolateral orbital craniotomy and orbital roof craniotomy provide an ample space to access the neurovascular structure of the anterior skull base without using brain retractors, enable rapid anatomical reconstruction for closure and acceptable cosmetic results. CONCLUSION: The superolateral orbital craniotomy and orbital roof craniotomy via eyebrow incision offer better surgical possibilities and approach related morbidity than conventional approaches in the treatment of anterior circulation aneurysms.

Microvascular Lesions of the Vocal Folds in the Patients with Hoarseness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The various types of varix which has a dilated, tortous, elongated blood vessel arising from the microcirculation of the vocal folds may cause different types of dysphonia. There have not been many specific studies on the characteristics of microvascular lesions of the vocal folds, so authors tried to evaluate the shapes, traveling pathway, and predilection site of the microvascular lesions. MATERIALS AND METHODS: A retrospective review of 119 patients with dysphonia was undertaken. All findings of videotapes were evaluated according to the shapes, the traveling pathway, the predilection sites and accompanying disorders of the microvascular lesions. RESULTS: The most common shapes of the microvascular lesions were the abrupt developed type and the multiple dilated type. The longitudinal type was the most common traveling type. The superolateral surface of the vocal folds was the predilection site of the microvascular lesions. Functional voice disorders, such as laryngeal nodule, laryngeal polyp, laryngeal edema, were more common as accompanying disorders. CONCLUSION: Authors found that there were a variety of types of microvascular lesions.

Clinical Study of Cementless Femoral Stem: Comparative Study between Porous Coating and Uncoating in Superolateral Portion of the Femoral Stem / 대한정형외과학회잡지

The authors analyzed clinical and radiographic results of the 87 cases which had done THRA with porous coated femoral stem followed up more than 2 years to study the difference of clinical and radiologic findings between the absence (group 1 ; 53 cases) and presence(group 2 ; 34 cases) of the porous coating in superolateral portion of the femoral stem. The following results were obtained : 1. Harris hip scores were improved 34.4 points from 56.5 points preoperatively to 90.9 points postoperatively in group Ι, and 32.7 points from 61 points preoperatively to 93.7 points postoperatively in group 2. The clinical results of the group 1 were Excellent in 45 cases, Good in 5 cases and Fair in 3 cases, and clinical result of the group 2 were Excellent in 33 cases and Good in 1 case. 2. The changes of femoral stem angle were below 2 degrees in 7 cases, above 2 degrees in 2 cases in group 1, and below 2 degrees in 5 cases, but not found more than 2 degrees of change of the femoral stem angle in group 2. 3. The osteolysis around femoral stem were 15 cases(28%) in Group 1, and 5 cases(15%) in Group 2. Diffuse osteolysis were 3 cases in Group 1, but was not observed in Group 2. 4. The vertical subsidence more than 2 mm was 3 cases in group 1, but was not observed in group 2. 5. The stable femoral stem were 51 cases in group 1, and 34 cases in group 2. The unstable femoral stem were 3 cases in group 1, but was not observed in group 2. Above results suggest that the porous coating in the superolateral portion of the femoral stem showed better results in radiologic and clinical findings in short term follow up.