Frecuencia de Ponticulus posticus en Telerradiografías Laterales de Cráneo / Frequency of Ponticulus posticus in Digital Lateral Cephalograms

En el arco posterior del atlas se describe una variación de tejido óseo denominada Ponticulus posticus (PP), la cual se ha relacionado con el desarrollo de dolor cervical. El objetivo de este estudio fue determinar la frecuencia de PP en telerradiografías laterales digitales. Este estudio correspondió a un estudio observacional descriptivo, donde se analizaron 450 telerradiografías laterales digitales obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Se analizó la presencia de PP en cada cefalograma, y se utilizó la clasificación de Cederberg y Stubbs para determinar los grados de osificación. Se aplicó la prueba de Chi-cuadrado para establecer una asociación entre la presencia de PP con el sexo y la edad. De las 450 telerradiografías laterales el 42,4 % presenta PP, con una mayor prevalencia entre el rango de 21-40 años. En cuanto al grado de osificación, el grado 2 fue el tipo más prevalente (25 %), seguido del grado 4 (9,5 %), el grado 3 (8 %). No se encontró asociación entre la presencia de PP con edad y género (P > 0,05). La PP es frecuente en la población y se observa a diferentes edades sin predilección por sexo.

SUMMARY: A bony tissue variation called Ponticulus posticus (PP) is described in the posterior arch of the atlas, which has been associated with the development of cervical pain. The aim of this study was to determine the frequency of PP in digital lateral cephalograms. This study was an observational descriptive study, in which 450 digital lateral cephalograms obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile, were analyzed. The presence of PP was analyzed in each cephalogram, and the Cederberg and Stubbs classification was used to determine the degrees of ossification. The Chi-square test was applied to establish an association between the presence of PP with gender and age. Of the 450 lateral cephalograms, 42.4 % presented PP, with a higher prevalence in the 21-40 year range. In terms of the degree of ossification, grade 2 was the most prevalent type (25 %), followed by grade 4 (9.5 %), and grade 3 (8 %). No association was found between the presence of PP with age and gender (P > 0.05). PP is common in the population and is observed at different ages without a sex preference.

Evaluation of the normal craniocervical junction craniometry in 137 asymptomatic patients / Evaluación de la craneometría de la unión craneocervical normal en 137 pacientes asintomáticos

SUMMARY: To our best knowledge, most of the craniometric studies on the normal craniocervical junction (CCJ), are still poorly studied and based on measurements taken from plain radiographs. In this study, the authors conducted a craniometric evaluation of the CCJ in a population without known CCJ abnormalities. The purpose of the study was to assess the normal CCJ craniometry based on measures obtained from CT scans. The authors examined 137 consecutive CCJ CT scans obtained in patients evaluated at their hospital for treatment of non-CCJ conditions between 2018 and 2019. Twelve craniometrical dimensions were conducted, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, and the clivus-canal angle (CCA).

Hasta donde sabemos, aun son escasos y pocos los estudios craneométricos respecto a la unión craneocervical normal (UCCN) y estos se basan en mediciones tomadas de radiografías simples. En este estudio, realizamos una evaluación craneométrica de la UCCN en una población sin anomalías conocidas. El propósito del estudio fue evaluar la craneometría UCCN normal en función de las medidas obtenidas de las tomografías computarizadas. Los autores examinaron 137 tomografías computarizadas UCCN consecutivas obtenidas en pacientes evaluados en su hospital para el tratamiento de condiciones no UCCN entre los años 2018 y 2019. Se realizaron doce dimensiones craneométricas, incluida la relación del proceso odontoides con la base del cráneo, el intervalo atlantodental (ADI), la longitud del clivus y el ángulo clivus-canal (CCA).

Identificación del biotipo facial mediante fotografía vs. radiografías laterales de cráneo. Revisión de literatura / Identification of the facial biotype by photography versus lateral skull radiography. Literature review

Objetivo: reconocer la eficacia de la identificación del biotipo facial mediante fotografía vs. radiografías laterales de cráneo. Materiales y métodos: se realizó un estudio de tipo descriptivo, retrospectivo de la literatura. Para ello se consultaron bases de datos electrónicas, como PubMed, ScienceDirect, Lilacs, Epistemonikos, Sage, Healey Library, Scielo y Google Scholar. Las palabras clave utilizadas fueron: photographs; extraoral photographs; cephalometry; lateral cephalograms; facial biotypes; brachyfacial; mesofacial; dolichofacial. La búsqueda se restringió a artículos en inglés, español y portugués publicados desde el año 2017 hasta el año 2022. Resultados: el biotipo facial permite determinar las características morfológicas y funcionales relacionadas con la dirección en la cual el macizo craneofacial crece y se desarrolla. Existen varios métodos que posibilitan la identificación del biotipo facial. En la actualidad hay diversos tipos de software que, mediante fotografías digitales de las dimensiones y proporciones faciales, permiten identificar el biotipo facial; no obstante, el estándar de oro para la determinación del biotipo facial son las radiografías laterales de cráneo, en las que, por medio de un sistema de trazos, se logra la identificación del biotipo. Este es un método que demanda mayores conocimientos teóricos-anatómicos, por lo que, en la mayoría de los casos, los resultados son más precisos. Sin embargo, al ser ambas técnicas "operador-dependiente", la veracidad de los resultados dependerá en gran medida de los conocimientos, las habilidades y las destrezas de cada profesional. Conclusión: tanto las fotografías digitales como las radiografías laterales del cráneo permiten la identificación del biotipo facial. La precisión de su resultado dependerá, en gran medida, de las habilidades, las destrezas y los conocimientos del profesional, tanto de la técnica como de sus conocimientos básicos de anatomía y radiología.

Objective: To recognize the efficacy of facial biotype identification by photography vs. lateral skull radiographs. Materials and methods:A descriptive, retrospective study of the literature was carried out, for which electronic databases such as PubMed, Science Direct, Lilacs, Epistemonikos, Sage, Healey Library, Scielo and Google Scholar were consulted. The keywords used were: photographs; extraoral photographs; cephalometry; lateral cephalograms; facial biotypes; brachyfacial; mesofacial; dolichofacial. The search was restricted to articles in English, Spanish, and Portuguese published from 2018 to 2022. Results: The facial biotype allows the determination of the morphological and functional characteristics related to the direction in which the craniofacial massif grows and develops. There are several methods that allow the identification of the facial biotype, currently there are different types of software that allow the analysis through digital photographs of the dimensions and facial proportions that allow the identification of the facial biotype; However, the gold standard for determining the facial biotype are lateral skull radiographs, in which biotype identification is achieved by means of a trace system, being a method that demands greater theoretical-anatomical knowledge, therefore that the results in most cases are more precise, however, as both techniques are "operator dependent", the veracity of the results found to a great extent on the knowledge, abilities and skills of each professional. Conclusion: Both digital photographs and lateral skull radiographs allow the identification of the facial biotype, the accuracy of the result will depend mainly on the skills, abilities, and knowledge of the professional, both the technique and of his basic understanding of anatomy and radiology.

Development of craniofacial superimposition: a review / Desarrollo de la superposición craneofacial: una revisión

SUMMARY: Craniofacial superimposition is a method for identifying individuals by using secondary data in order to identify a target group of persons before a DNA process can be used, or to identify an individual instead of using primary data in cases where DNA, fingerprint or dental records are not found. Craniofacial superimposition has continued to evolve, with various techniques, including computer-assisted and photography techniques, to help the operation be more convenient, faster and reliable. The knowledge of forensic anthropology is applied, with a comparison between anatomical landmarks. The study of developments in craniofacial superimposition using computer-assistance has yielded satisfactory results.

La superposición craneofacial es un método para identificar individuos mediante el uso de datos secundarios, se utiliza para identificar un grupo objetivo de personas, antes de que se pueda utilizar un proceso de ADN, o para identificar a un individuo en lugar de utilizar datos primarios en los casos en que no se cuenta con registros de ADN, huellas dactilares o dentales. La superposición craneofacial ha seguido evolucionando, con diversas técnicas, incluidas las técnicas fotográficas y asistidas por computador, para ayudar a que la operación sea más conveniente, rápida y confiable. Se aplica el conocimiento de la antropología forense, con una comparación entre hitos anatómicos. El estudio de la evolución de la superposición craneofacial con asistencia informática ha arrojado resultados satisfactorios.

Anatomical description of the skulls of peccaries (Tayassu tajacu, Linnaeus 1758) by computed tomography / [Descrição anatômica de crânio de catetos (Tayassu tajacu, Linnaeus, 1758) por tomografia computadorizada]

The aim of this study was to evaluate the anatomical structures of the skulls of peccaries to establish the basis for their clinical study and future preclinical research. Ten skulls of adult peccaries were subjected to tomographic examination. The data obtained were processed via three-dimensional image reconstruction software (3D images). The reconstructions obtained from the neurocranium of the studied specimens allowed the identification and description of the following structures: nasal bone, frontal bone, parietal bones, incisor bone, maxillary bone, zygomatic bone, temporal bone, palatal bone, occipital bone, vomer bone, pterygoid bone, sphenoid bone, paranasal sinuses and orbit. Computed tomography proved to be an important diagnostic tool in the investigation of the skull of this species, allowing the acquisition of anatomical values not yet documented for the species in the literature.(AU)

O objetivo deste estudo foi avaliar as estruturas anatômicas dos crânios de catetos, a fim de se estabelecerem as bases para seu estudo clínico e futuras pesquisas pré-clínicas. Dez crânios de catetos adultos foram submetidos a exame tomográfico. Os dados obtidos foram introduzidos em um software de reconstrução de imagens tridimensionais (imagens em 3D). As reconstruções obtidas do neurocrânio dos espécimes estudados permitiram a identificação e a descrição das seguintes estruturas: osso nasal, osso frontal, ossos parietais, osso incisivo, osso maxilar, osso zigomático, osso temporal, osso palatino, osso occipital, osso vômer, osso pterigoide, osso esfenoide, seios paranasais e órbita. A tomografia computadorizada mostrou-se como uma ferramenta diagnóstica importante na investigação do crânio dessa espécie, permitindo a aquisição de valores anatômicos ainda não documentados para a espécie na literatura.(AU)

Anatomy of the skull of saanen goat: an anesthesiology and stereology approach / Anatomía del cráneo de la cabra saanen: un enfoque desde la anestesiología y la estereología

SUMMARY: The Saanen goat is known as the greatest milk producer among small ruminat breeds. However, its morphometric features still remain unclear. Therefore, the present work aimed to investigate the functional anatomy of the upper and lower jaws as well as the volumetric properties of the male and female Saanen goat for clinical applications. The heads of 20 adult animals (10 males and 10 females) were included. Totally, 22 morphometric parameters were measured on three dimensional computed tomographic images using RadiAnt DICOM Viewer software and some parameters were measured on hot macerated sample. The mean volume of paranasal sinuses as well as conchal sinuses were estimated using stereological method. Based on the results, the differences between males and females were not significant (p>0.05) in all desired parameters.The frontal and lacrimal sinuses were the largest and smallest paranasal sinus in both sexes. Also, the dorsal and middle conchal sinuses were the largest and smallest ones, respectively. The common nasal meatus was the smallest and ventral meatus was the largest meatus in the nasal cavity. In conclusion, these findings provide a basic data that would be useful in blocking terminal branches of the cranial nerves in this breed for surgical purpose or teeth injuries treatment.

RESUMEN: La cabra Saanen es conocida como la mayor productora de leche entre las razas de pequeños ruminos, sin embargo, sus características morfométricas aún permanecen sin revelar. Por lo tanto, el presente trabajo tuvo como objetivo investigar la anatomía de los huesos del cráneo y cara, así como sus propiedades volumétricas, en la cabra Saanen, tanto del macho como de la hembra con la finalidad de contribuir con las aplicaciones clínicas. Se incluyeron las cabezas de 20 animales adultos (10 machos y 10 hembras). Se midieron 22 parámetros morfométricos en imágenes de tomografía computarizada tridimensionales utilizando el software RadiAnt DICOM Viewer; algunos parámetros se midieron en muestra macerada en calor. El volumen medio de los senos paranasales y concales se estimó mediante método estereológico. En base a los resultados, las diferencias entre machos y hembras no fueron significativas (p> 0.05) en todos los parámetros deseados. Los senos frontal y lagrimal eran de mayor y menor volumen en ambos sexos, respectivamente. Además, los senos conchal dorsal y medio eran los más grandes y los más pequeños, respectivamente. El meato nasal común fue el más pequeño y el meato ventral el más grande en la cavidad nasal. En conclusión, estos hallazgos brindan un dato básico que sería útil en el bloqueo de las ramas terminales de los nervios craneales en esta raza, con fines quirúrgicos o tratamiento de lesiones dentales.

3D CT Soft Tissue Craniofacial Analysis and Lip Morphology

ABSTRACT Objctive: To assess the soft tissue characteristics of Bangladeshi adults to formulate soft tissue 3D CT standards using Holdaway's (HA) and lip morphology (LM) analyses. Another aim of this study was to assess the gender dimorphism of Bangladeshi population. Material and Methods: One hundred and seventeen (Eighty-five men and Thirty-two women) Bangladeshi adults have obtained their computed tomography (CT) scan at the Radiology Department for normal diagnosis. Craniofacial deformities were undetected in all cases. The CT images were prepared by a 3D imaging programming software (Mimics 11.02 Materialise). Parameters from the identified landmark points were measured in 3D through this software. Results: Upper lip thickness (ULT) (vermillion UL-A point) measurement was significant in HA and in LM analyses, upper lip protrusion (ULP) (Ls to Sn-SPog) measurement has demonstrated significant difference among both genders, where p-value was less than 0.05. Mean measurements of Bangladeshi adults were relatively comparable except the face convexity (FC) when compared with the HA cephalometric soft tissue values. Conclusion: By using HA and LM analyses, 3D CT soft tissue standards were established for Bangladeshi adults. Measurements for all parameters have remained equivalent with the HA standard data apart from the FC measurement. This consequently may demonstrate that the Bangladeshi population retains a convex shape with a slight protrusive lip or retruded chin.

Age-Related Changes of Material Mechanics and Bone Material Parameters of Rat Skulls / 法医学杂志

Objective To study the relationship between material mechanics and bone material parameters of rat skulls and their correlation with age by examination of the parameters. Methods Forty-eight healthy male SD rats were divided into 2, 4, 6, 8, 17, 26, 52 and 104 week groups according to their age. Each group had six rats. The right cranium was compressed by KD Ⅱ-0.2 microcomputer controlled electronic universal testing machine, and material mechanics parameters （ultimate load, compression strength and compression modulus） were measured, then the skull slices were cut off and scanned by Micro-CT system to detect bone material parameters （skull thickness, bone mineral density, bone volume, and trabecular thickness）. Results The differences in ultimate load, compression strength and compression modulus among all groups had statistical significance （P<0.05）, and were positively correlated with age within 26 weeks （P<0.05）. The differences in skull thickness, bone mineral density, bone volume and trabecular thickness among all groups had statistical significance （P<0.05）, and were positively correlated with age within 52 weeks （P<0.05）. All material mechanics parameters were positively correlated with bone material parameters （P<0.05）. Conclusion There is a positive correlation between bone material parameters （skull thickness, bone mineral density, bone volume, trabecular thickness）, material mechanics parameter （skull ultimate load, compression strength, compression modulus） and age in a certain range, which can be used to infer age.

Comparative anatomy of blue-and-yellow macaw (Ara ararauna) and toco toucan (Ramphastos toco) beaks using macroscopic analysis and computerized tomography / Anatomía comparada de los picos de guacamayo azul y amarillo (Ara ararauna) y de tucán toco (Ramphastos toco) mediante análisis macroscópico y tomografía computarizada

SUMMARY: Clinically, avian medicine still finds it very difficult to treat wild patients due to the lack of reliable information about their anatomy and physiological parameters that make comparative analyzes possible. Considering that computed tomography (CT) is one of the most viable alternatives in radiography of the head, we describe the comparative anatomy of the beak in the Ara ararauna and the Ramphastos toco through this imaging modality and macroscopy analysis, providing additional information about their conformation and topography for clinical exams. Adult specimens of each were dissected after the CT and beaks were removed for macroscopic analyses. The macroscopic and tomographic findings for both species confirm the similarities in beak morphology and the dietary peculiarities of each.The CT scan proved to be a useful tool to visualize internal structures of the skull through a detailed virtopsy of regions that are difficult to access by the usual necropsy with a scalpel.

RESUMEN: Debido a la escasa información de la anatomía y de los parámetros fisiológicos que hacen posible los análisis comparativos en la medicina aviar, clínicamente resulta muy difícil el tratamiento de estos animales. Considerando que la tomografía computarizada es una buena alternativa, estudiamos la anatomía comparativa del pico en Ara ararauna y Toco Toucan utilizando imágenes y un análisis de macroscopía. Estos métodos proporcionaron información adicional referente a su conformación y topografía para el trabajo clínico. Después de analizar la tomografía se disecaron las muestras de especímenes adultos y se retiraron los picos para un análisis macroscópico. Los hallazgos macroscópicos y tomográficos para ambas especies corroboraron la relación morfológica entre los picos y las peculiaridades dietéticas de cada uno. Se demostró además, que la tomografía computarizada es una herramienta útil para visualizar las estructuras internas del cráneo de las aves, a través de una virtopsia detallada en áreas de difícil acceso durante una necropsia habitual.

Variaciones anatómicas de los senos frontales en radiografías de cráneo de pacientes con cráneos braquicéfalos / Anatomical variations of frontal sinuses in skull radiographs of patients with brachycephalic skulls

Introducción: La anatomía ósea de las cavidades paranasales presenta múltiples variantes, que pueden ser causa o factor predisponente de enfermedad rinosinusal, entre las que se encuentran las asimetrías y las agenesias. Éstas pueden ser reparos de gran importancia en la cirugía endoscópica nasal y demandan atención médica con frecuencia. Objetivo: Determinar las variaciones anatómicas de los senos frontales en los pacientes con cráneos braquicéfalos y que no presentaron diagnóstico de enfermedad rinosinusal. Métodos: Se realizó un estudio observacional, descriptivo y transversal, donde fueron estudiados los diámetros transversales y longitudinales de los senos frontales a través de radiografías de cráneo AP en 28 pacientes con cráneos braquicéfalos, en el servicio de imagenología del Hospital Juan Bruno Zayas Alfonso en los meses de enero y febrero de 2019. Resultado: Se identificaron las principales variaciones de los senos frontales a través de radiografías de cráneo y su comportamiento según variables epidemiológicas. Conclusiones: Predominó los enfermos (9) en el rango etáreo de 19-29 años, lo que representa un 32,1 por ciento, hubo un ligero predominio de los hombres con respecto a las mujeres, 10 (35,7 por ciento) pacientes presentaron agenesia bilateral y 3 (10,7 por ciento) agenesia unilateral izquierda. Las magnitudes de las cavidades derechas fueron mayores que las izquierdas y los senos frontales estudiados son asimétricos por su tamaño y posición(AU)

Introduction: The bone anatomy of paranasal cavities presents a large number of variants which may be the cause of or predisposing factor for rhinosinus disease, among which are asymmetry and agenesis. These may be very important hurdles in nasal endoscopic surgery and often require medical care. Objective: Determine the anatomical variations in the frontal sinuses of patients with brachycephalic skulls not diagnosed with rhinosinus disease. Methods: A cross-sectional observational descriptive study was conducted of frontal sinus longitudinal and transverse diameters of frontal sinuses based on AP skull radiographs of 28 patients with brachycephalic skulls attending the imaging service of Juan Bruno Zayas Alfonso Hospital from January to February 2019. Result: Identification was made of the main frontal sinus variations in skull radiographs and their behavior according to epidemiological variables. Conclusions: The 19-29 years age group prevailed, with 9 patients (32.1 percent). There was a slight predominance of men versus women. Ten (35.7 percent) patients had bilateral agenesis and 3 (10.7 percent) had unilateral left agenesis. The magnitudes for right cavities were greater than those for left cavities. The frontal sinuses studied were asymmetrical in terms of size and position(AU)

Application of magnetic resonance imaging-compatible incubator in cranial magnetic resonance imaging for neonates: a multicenter prospective randomized clinical trial / 中国当代儿科杂志

OBJECTIVE@#To study the safety and efficacy of magnetic resonance imaging (MRI)-compatible incubator in cranial MRI examination for neonates.@*METHODS@#A total of 120 neonates who were hospitalized in three hospitals and needed to undergo MRI examination were randomly divided into a control group and an experimental group, with 60 neonates in each group. The neonates in the experimental group were transferred with MRI-compatible incubator and underwent cranial MRI examination inside the MRI-compatible incubator, and those in the control group were transferred using a conventional neonatal transfer incubator and then underwent MRI examination outside the incubator. The two groups were compared in terms of the primary efficacy index (total examination time), secondary efficacy indices (times of examination, MRI completion rate on the first day of use), and safety indices (incidence rate of adverse events and vital signs).@*RESULTS@#There were no significant differences in total examination time, times of examination, and MRI completion rate on the first day of use between the two groups (@*CONCLUSIONS@#The use of MRI-compatible incubator does not significantly shorten the examination time of cranial MRI, but it does provide a relatively stable environment for examination with acceptable safety. There is a need for further studies with a larger population.

Evaluation of bone availability for grafts in different donor sites, through computed tomography

Abstract Objective To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. Methodology For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. Results The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. Conclusions Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

Analysis of Influencing Factors of Single Camera Photogrammetry in Forensic Three-Dimensional Reconstruction / 法医学杂志

Objective To evaluate the influence of factors such as the selection of equipment, focal length and the selection of reconstruction quality in the reconstruction software on the reconstruction results of single camera photogrammetry and provide reference for the forensic application of single camera photogrammetry. Methods The 19 skulls were measured by traditional measurement method and single camera photogrammetry. The differences between the two measurement methods and within the group with same equipment but different focal length were analyzed. One skull and one corpse were selected as the research objects. According to the reconstruction quality selection conditions in the photogrammetric software, the experimental group was divided into five grades. The model reconstructed by optical scanner was defined as reference model, while the model reconstructed by single camera photogrammetry was defined as test model. The test model was aligned with the reference model, 3D deviation analysis was carried out and the mean error and root mean square （RMS） values were calculated. Results The differences between EOS 7D zoom group and traditional measurement, and within the group with same equipment had statistical significance （P<0.05）. The mean error value and minimum RMS value of the skull reconstructed by single camera photogrammetry and the three-dimensional model of the corpse existed in the medium quality group, and the trend was basically the same. Conclusion The equipment and focal length has no obvious influence on the results of single camera photogrammetry. Lower reconstruction quality can easily cause distortion, while higher reconstruction quality can easily generate noise, so medium quality is preferred.

Empiema subdural recidivante secundário à sinusite bacteriana frontal em um adolescente imunocompetente: relato de caso / Relapsing subdural empyema secondary to frontal bacterial sinusitis in an immunocompetent adolescent: case report

A sinusite é uma causa rara de infecção intracraniana, sendo responsável por 2,4% dos casos em pacientes jovens, e tem como a complicação intracraniana mais frequente o empiema subdural (ESD). Descrevemos um caso raro de um adolescente imunocompetente de 16 anos que evoluiu com confusão mental, rebaixamento do nível de consciência, anisocoria, hemiparesia à direita, afasia e febre. Tomografa computadorizada confirmou ESD, e paciente foi submetido à avaliação laboratorial e abordagem clínico-cirúrgica para tratamento do quadro.

Sinusitis is a rare cause of intracranial infection, accounting for 2.4% of cases in young patients. The most frequent intracranial complication is subdural empyema (SDE). We describe a rare case of a 16-year-old immunocompetent adolescent who developed mental confusion, lowered consciousness, anisocoria, right hemiparesis, aphasia, and fever. Computed tomography confirmed SDE, and the patient underwent laboratory evaluation and clinical-surgical approach for treatment of the condition.

Análisis craneocervical en sujetos con respiración oral y nasal / Craneocervical analysis in subjects with oral and nasal breathing

La influencia de la función respiratoria en el desarrollo de estructuras orofaciales y postura craneocervical ha sido ampliamente discutida. El objetivo del estudio fue comparar valores cefalométricos de la región craneocervical e hioidea en sujetos con respiración nasal y oral. Se incluyeron sujetos de entre 18 y 27 años, de ambos sexos, donde 20 presentaban diagnóstico de respiración oral y 20 no presentaban esta alteración; mediante telerradiografía lateral de cabeza y cuello se realizó análisis cefalométrico craneocervical de Rocabado y aplicación de la técnica de Penning, obteniendo medidas craneocervicales e hioideas, dimensión anterior nasofaríngea y curvatura cervical. Para el análisis estadístico se utilizó la prueba de normalidad Shapiro-Wilk y la prueba T para muestras independientes, considerando un valor de p <0,05 para obtener diferencias significativas; en aquellos parámetros en donde no se presentó distribución normal se aplicó la prueba U de Mann-Whitney. No se encontraron diferencias significativas entre los grupos de estudio y los valores cefalométricos analizados, a excepción de la distancia entre la base del hueso occipital y el arco posterior del atlas (p=0,03). Existen limitadas diferencias cefalométricas entre sujetos con respiración oral y respiración nasal, no asociándose el espacio aéreo nasofaríngeo con las modalidades de respiración estudiadas. Deben ser consideradas condiciones de morfología facial o mandibular, para determinar más adecuadamente la influencia de los parámetros cefalométricos en el diagnóstico del modo respiratorio en estudios futuros.

The influence of respiratory function on the development of orofacial structures and craniocervical posture has been widely discussed. The objective of the study was to compare cephalometric values of the craniocervical and hyoid region in subjects with nasal and oral respiration. Subjects between 18 and 27 years of age, of both sexes, were included, where 20 presented oral breathing diagnosis and 20 did not present this alteration; using lateral telerradiography of the head and neck, craniocervical cephalometric analysis was performed of Rocabado and Penning technique was applied, obtaining craniocervical and hyoid measurements, anterior nasopharyngeal dimension and cervical curvature. For the statistical analysis we used the Shapiro-Wilk normality test and the T test for independent samples, considering a value of p <0.05 to obtain significant differences; in those parameters where no normal distribution was presented, the MannWhitney U test was applied. No significant differences were found between the study groups and the cephalometric values ??analyzed, except for the distance between the base of the occipital bone and the posterior arch of the atlas (p=0.03). There are limited cephalometric differences between subjects with oral breathing and nasal breathing, with no association of the nasopharyngeal air space with the breathing modalities studied. Conditions of facial or mandibular morphology should be considered in order to determine more adequately the influence of cephalometric parameters in the diagnosis of the respiratory mode in future studies.

Evaluation of alternative halo ring positions in children using tomography

OBJECTIVES: The halo ring can be applied in children, through skeletal traction or a halo vest device, to treat many cervical spine pathologies, including traumatic injuries and pathologies related to deformities. However, the procedure is associated with various complications, such as infection, pin loosening, and respiratory and neurological problems. Although widely studied in adults, the best pin insertion site in children and the correlations of pin insertion sites with outcomes and complications have not been completely elucidated. This study aimed to determine alternative pin placement sites based on a morphological analysis of the infant skull by computerized tomography (CT). METHODS: An analytical-descriptive study was performed using 50 CT scans from children. The Wilcoxon and Friedman tests were used. RESULTS: A linear and directly proportional relation was found between cranial thickness and patient age. The average thicknesses of the anterior points across all ages analyzed ranged from 4.16 mm to 4.98 mm. The thicknesses of the posterior points varied from 3.94 mm to 4.27 mm. Within each age range, points 1 cm above the standard insertion sites had thicknesses similar to those of the standard sites, and points 2 cm above the standard insertion sites had thicknesses greater than those of the standard sites. CONCLUSIONS: The cranial thickness at all points increases linearly with age. Points 1 and 2 cm above the standard insertion sites are viable alternatives for the placement of halo pins. Preoperative CT can aid in choosing the best positioning sites for pins in the skull.

Sex Recognition of Skulls in Chinese Uygur / 法医学杂志

Objective Logistic regression method was used to establish a multiple regression sex discriminant function to discriminate the complete skull model and the incomplete skull model without frontal bone, occipital bone and mandible of Uygur adults in Turpan, Xinjiang. Methods A total of 117 （60 male and 57 female） three-dimensional skull models were collected by CT. Sixteen cranial measurement indexes were measured and calculated by computer software. The multivariate regression sex discriminant function was established with Logistic regression method and retrospectively tested. Results Among the 16 measurement indexes, except for nose width （x7） and maximum frontal breadth （x13）, the remaining 14 indexes had statistical significance of differences between male and female （P<0.05）. For the discriminant function of complete skull established by eyebrow arch convexity （x4）, mastoid width （x6）, maximum cranial length （x12）, cranial base length （x15）, cranial circumference （x16）, the male and female discrimination accuracy was 90.0% and 94.7%, respectively. For the sex discriminant function of incomplete skull without frontal bone established by mandibular angle width （x10）, mandibular height （x11） and cranial circumference （x16）, the discrimination accuracy of male and female was 85.0% and 84.2%, respectively. For the sex discriminant function of incomplete skull without occipital bone established by the index of eyebrow arch convexity （x4）, the discrimination accuracy of male and female was 80.0% and 73.7%, respectively. For the sex discriminant function of incomplete skull without mandible established by frontal chord （x5） and occipital protrusion angle （x9）, the discrimination accuracy of male and female was 85.0% and 78.9%, respectively. Conclusion The computer software and system developed in our study can achieve sex discrimination of complete skulls and incomplete skulls without frontal bone, occipital bone or mandible.

Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls

ABSTRACT Objective: To evaluate topographic and temporal aspects of premaxillary bone and premaxillary-maxillary suture, since they are fundamental anatomical elements little explored clinically. Methods: 1,138 human dry skulls were evaluated, of which 116 (10.19%) of the specimens were children, and 1,022 (89.81%) were adults. The skulls were photographed and the percentage of premaxillary-maxillary suture opening was determined. Subsequently the data were tabulated and submitted to statistical analysis, adopting a level of significance of 5%. Results: The progression of premaxillary suture closure from birth to 12 years of age was 3.72% per year. In 100% of the skulls up to 12 years, the premaxillary-maxillary suture open in the palatal region was observed, while 6.16% of adults presented different degrees of opening. Conclusions: The premaxilla exists in an independent way within the maxillary complex and the presence of the premaxilla-maxillary suture justifies the success of anteroposterior expansions to stimulate the growth of the middle third of the face, solving anatomical and functional problems.

RESUMO Objetivo: avaliar aspectos topográficos e temporais do osso pré-maxilar e da sutura pré-maxilar/maxilar, por serem elementos anatômicos fundamentais pouco explorados clinicamente. Métodos: foram avaliados 1.138 crânios secos humanos, sendo 116 (10,19%) dos espécimes crianças e 1.022 (89,81%) adultos. Os crânios foram fotografados e determinou-se a porcentagem de abertura da sutura pré-maxilar/maxilar. Posteriormente, os dados foram tabulados e submetidos a análise estatística, adotando-se nível de significância de 5%. Resultados: a progressão de fechamento da sutura pré-maxilar/maxilar do nascimento aos 12 anos de idade foi de 3,72% ao ano. Em 100% dos crânios até 12 anos, observou-se a sutura pré-maxilar/maxilar aberta na região palatina, enquanto 6,16% dos adultos apresentavam diferentes graus. Conclusões: a pré-maxila existe de forma independente dentro do complexo maxilar e a presença da sutura pré-maxilar / maxilar justifica o sucesso de expansões anteroposteriores para estimular o crescimento do terço médio da face, solucionando problemas anatômicos e funcionais.

Tolosa-Hunt Syndrome / Síndrome de Tolosa-Hunt

Abstract We present a case study of Tolosa-Hunt syndrome, a rare idiopathic disease, that is characterized by painful ophthalmoplegia of strong intensity, generally affecting the third cranial nerve, and, less frequently, the fourth or the sixth cranial nerves. Usually, there is no visual impairment. The treatment is based on corticosteroids with satisfactory results in most cases although recurrences can occur at intervals from months to years. In our case, the patient presented sudden pain periorbital associated with cranial nerves involvement, which have an excellent outcome after treatment with corticosteroids, with no relapses until today.

Resumo Nós apresentamos um caso de Síndrome de Tolosa-Hunt, uma doença idiopática rara, caracterizada por oftalmoplegia dolorosa, de forte intensidade, geralmente afetando o terceiro par craniano, e, menos frequentemente, o quarto e/ou o sexto par. Geralmente, não há acometimento visual. O tratamento é feito com base em corticóides com resultados satisfatórios na maior parte dos casos, embora recorrências possam ocorrer após meses a anos. Relatamos caso de paciente masculino de 36 anos, com diagnóstico prévio de sífilis congênita e esquizofrenia, com dor periocular súbita associada com envolvimento de pares cranianos, que teve melhora total após vigência de corticoterapia, sem recorrências até a presente data.

Deformidades craneales sinostósicas y no sinostósicas / Synostosic and non-synostosic cranial deformities

Las alteraciones de la forma del cráneo han aumentado en las últimas décadas a expensas de las plagiocefalias, como consecuencia de las recomendaciones de la Academia Americana de Pediatría de dormir al lactante en decúbito supino. El clínico debe diferenciar entre plagiocefalia posicional y craneosinostosis, ya que la conducta terapéutica será potencialmente neuroquirúrgica de comprobar una sinostosis craneal. Si bien la tomografía de cráneo tridimensional con ventana ósea es el estudio de mayor sensibilidad y especificidad diagnóstica, la mayoría de los casos pueden confirmarse por la clínica, reservando la radiografía simple o de preferencia la ecografía con enfoque de suturas para casos dudosos. Las craneosinostosis deben derivarse tempranamente a un equipo craneofacial para definir la indicación, oportunidad y técnica quirúrgica más adecuada para evitar futuras complicaciones neurocognitivos y psicosociales. Los niños con plagiocefalias posicionales, independientemente del tratamiento de la deformidad craneal, pueden tener más riesgo de retraso del desarrollo motor. Para su corrección se sugiere reposicionamiento y fisioterapia en formas leves a moderadas, reservando el uso de ortésis craneal en formas graves.

In the last decades alterations in the skull shape have increased at the expense of plagiocephaly, as consequence of the American Academy of Pediatrics recommendations to sleep the infant in the supine position. The clinician must differentiate between positional plagiocephaly and craniosynostosis, since if a cranial synostosis is proven, the therapeutic behavior will be potentially neurosurgical. Although three-dimensional skull tomography with bone window is the study of greater sensitivity and diagnostic specificity, the majority of cases can be confirmed by the clinic, reserving the radiography or ultrasound with a suture approach for doubtful cases. Craniosynostosis must be early referral to a craniofacial team to define the indication, opportunity and most appropriate surgical technique, in order to avoid future neurocognitive and psychosocial complications. Children with positional plagiocephaly regardless of the treatment of cranial deformity may have a higher risk of motor development delay. For correction, repositioning and physiotherapy are suggested in mild to moderate forms, reserving the use of cranial orthesis in severe forms.