Analysis of the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma (ACC), and to analyze the prognostic factors. Methods: Data of 82 patients (43 females and 39 males, at a median age of 49 years old) with sinonasal and skull base ACC who were admitted to XuanWu Hospital, Capital Medical University between June 2007 and June 2021 were analyzed retrospectively. The patients were staged according to American Joint Committee on Cancer (AJCC) 8th edition. The disease overall survival(OS) and disease-free survival(DFS) rates were calculated by Kaplan-Meier analysis. Cox regression model was used for multivariate prognostic analysis. Results: There were 4 patients with stage Ⅱ, 14 patients with stage Ⅲ, and 64 patients with stage Ⅳ. The treatment strategies included purely endoscopic surgery (n=42), endoscopic surgery plus radiotherapy (n=32) and endoscopic surgery plus radiochemotherapy (n=8). Followed up for 8 to 177 months, the 5-year OS and DFS rates was 63.0% and 51.6%, respectively. The 10-year OS and DFS rates was 51.2% and 31.8%, respectively. The multivariate Cox regression analysis showed that late T stage and internal carotid artery (ICA) involvement were the independent prognostic factors for survival in sinonasal and skull base ACC (all P<0.05). The OS of patients who received surgery or surgery plus radiotherapy was significantly higher than that of patients who received surgery plus radiochemotherapy (all P<0.05). Conclusions: Endoscopic transonasal surgery or combing with radiotherapy is an effective procedure for the treatment of sinonasal and skull base ACC. Late T stage and ICA involvement indicate poor prognosis.

Influence of the cranial base flexion on Class I, II and III malocclusions: a systematic review

ABSTRACT Objective: The aim of this study was to perform a systematic review on the morphological characteristics of the skull base (flexion, anterior length and posterior length) and the concomitant development of malocclusions, by comparing differences in dimorphism, ethnicity and age. Methods: The articles were selected by means of electronic search on BBO, MEDLINE and LILACS databases from 1966 to 2016. A qualitative evaluation of the methodologies used on the articles was also performed. Results: Although the literature on this topic is abundant, only 16 articles were selected for the present systematic review. The cranial base angle itself does not seem to play a significant role in the development of malocclusions. In fact, the cranial base angle is relatively stable at the ages of 5 to 15 years. Conclusions: A more obtuse angle at the skull base, in association or not with a greater anterior length of the cranial base, can contribute to the development of Class II division 1 malocclusions. On the other hand, a more acute angle at the skull base can contribute to a more anterior positioning of the mandible and to the development of Class III malocclusions.

RESUMO Objetivo: o objetivo desse estudo foi realizar uma revisão sistemática sobre as características morfológicas da base do crânio (flexão, comprimento anterior e comprimento posterior) e o desenvolvimento concomitante da má oclusão, comparando as diferenças do dimorfismo, etnia e idade. Métodos: os artigos foram selecionados por meio de busca eletrônica nas bases de dados BBO, MEDLINE e LILACS, de 1966 a 2016. Uma avaliação qualitativa da metodologia dos artigos também foi executada. Resultados: ainda que a literatura seja abundante nesse assunto, somente 16 artigos foram selecionados para a presente revisão sistemática. O ângulo da base do crânio, por si só, não parece desempenhar papel significativo no desenvolvimento das más oclusões. De fato, o ângulo da base do crânio é relativamente estável dos 5 aos 15 anos. Conclusões: um ângulo mais obtuso na base do crânio, associado ou não a um comprimento maior, pode contribuir para o desenvolvimento da má oclusão de Classe II, divisão 1. Por outro lado, um ângulo mais agudo na base do crânio pode contribuir para um posicionamento mais anterior da mandíbula e para o desenvolvimento da má oclusão de Classe III.

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.

Incidence of basilar invagination in patients with tonsillar herniation ? a case control craniometrical study / Incidência da invaginação basilar com heriação tonsilar ? estudo da craniometria do tipo caso-controle

A retrospective case-control study based on craniometrical evaluation was performed to evaluate the incidence of basilar invagination (BI). Patients with symptomatic tonsillar herniation treated surgically had craniometrical parameters evaluated based on CT scan reconstructions before surgery. BI was diagnosed when the tip of the odontoid trespassed the Chamberlain’s line in three different thresholds found in the literature: 2, 5 or 6.6 mm. In the surgical group (SU), the mean distance of the tip of the odontoid process above the Chamberlain’s line was 12 mm versus 1.2 mm in the control (CO) group (p<0.0001). The number of patients with BI according to the threshold used (2, 5 or 6.6 mm) in the SU group was respectively 19 (95%), 16 (80%) and 15 (75%) and in the CO group it was 15 (37%), 4 (10%) and 2 (5%).

Realizamos estudo retrospectivo tipo caso-controle baseado na avaliação craniométrica para avaliar a incidência da Invaginação Basilar (IB). Pacientes com herniação tonsilar sintomática tratada cirurgicamente foram avaliados quanto a parâmetros craniométricos obtidos em reconstrução de TC antes da cirurgia. IB foi diagnosticada quando a ponta do odontóide passava acima da linha de Chamberlain em 2, 5 ou 6,6 mm. No grupo cirúrgico (CI), a distância média da ponta do odontóide acima da linha de Chamberlain foi de 12 mm versus 1,2 mm no grupo controle (CO) (p<0.0001). O número de pacientes com IB conforme o critério diagnóstico usado (2, 5 ou 6,6 mm) foi de 19 (95%), 16 (80%) e 15 (75%) no grupo CI, respectivamente, contra 15 (37%), 4 (10%) e 2 (5%) no grupo CO. Pacientes com herniação tonsilar tinham maior incidência de IB comparados ao grupo controle.

Advances in Magnetic Resonance Imaging of the Skull Base

Introduction: Over the past 20 years, magnetic resonance imaging (MRI) has advanced due to new techniques involving increased magnetic field strength and developments in coils and pulse sequences. These advances allow increased opportunity to delineate the complex skull base anatomy and may guide the diagnosis and treatment of the myriad of pathologies that can affect the skull base. Objectives: The objective of this article is to provide a brief background of the development of MRI and illustrate advances in skull base imaging, including techniques that allow improved conspicuity, characterization, and correlative physiologic assessment of skull base pathologies. Data Synthesis Specific radiographic illustrations of increased skull base conspicuity including the lower cranial nerves, vessels, foramina, cerebrospinal fluid (CSF) leaks, and effacement of endolymph are provided. In addition, MRIs demonstrating characterization of skull base lesions, such as recurrent cholesteatoma versus granulation tissue or abscess versus tumor, are also provided as well as correlative clinical findings in CSF flow studies in a patient pre- and post-suboccipital decompression for a Chiari I malformation. Conclusions: This article illustrates MRI radiographic advances over the past 20 years, which have improved clinicians' ability to diagnose, define, and hopefully improve the treatment and outcomes of patients with underlying skull base pathologies...

Tomographic assessment of the spine in children with spondylocostal dysotosis syndrome

OBJECTIVE: The aim of this study was to perform a detailed tomographic analysis of the skull base, craniocervical junction, and the entire spine in seven patients with spondylocostal dysostosis syndrome. METHOD: Detailed scanning images have been organized in accordance with the most prominent clinical pathology. The reasons behind plagiocephaly, torticollis, short immobile neck, scoliosis and rigid back have been detected. Radiographic documentation was insufficient modality. RESULTS: Detailed computed tomography scans provided excellent delineation of the osseous abnormality pattern in our patients. CONCLUSION: This article throws light on the most serious osseous manifestations of spondylocostal dysostosissyndrome.

Dental findings in GAPO syndrome: case report

This article reports the case of a young female adult with GAPO syndrome who presented as a peculiar dental finding unerupted primary and permanent dentitions, which resembled total anodontia on clinical examination. A cephalometric analysis was performed to investigate the alterations in facial bone development. This is the 9th GAPO syndrome case reported in a Brazilian patient.

Este artigo relata o caso de um jovem paciente, gênero feminino, portadora da síndrome de GAPO, apresentando impacções dos dentes decíduos e permanentes, sugerindo anodontia total no exame clínico. Foi realizada uma análise cefalométrica para investigar as alterações no desenvolvimento ósseo facial. Este é o nono caso descrito no Brasil

rare presentation of rosai-dorfman syndrome: first reported case in Iran

A case of intracranial Rosai-Dorfman syndrome is presented that was initially diagnosed and treated as meningioma, and was complicated due to a wrong diagnosis of coexistent lung sarcoidosis. Intracranial lesions appeared as dura-based parasellar and anterior fossa enhanc-ing lesions on magnetic resonance images. Excellent result was obtained from whole brain radiotherapy, which can be used as a guideline for treating similar cases

Dentofacial morphology of mouth breathing children

The relationship between dentofacial morphology and respiration has been debated and investigated from various approaches. The aim of this study was to verify the skeletal and dental relationship of mouth and nose breathing children. Thirty-five children, 7 to 10 years of age, were submitted to orthodontic and otorhinolaryngologic evaluations and were separated into 2 groups: 15 nose breathers and 20 mouth breathers. Each subject underwent a cephalometric radiograph analysis. Statistical analysis (Mann-Whitney U test) indicated that changed mode of breathing was associated with 1) maxillo-mandibular retrusion in relation to the cranial base in the mouth breathers; 2) the SNGoGn and NSGn angles were greater in the mouth breathing group; 3) incisor inclination in both jaws and the interincisal angle were not different between groups. There was no statistically significant difference in the maxillary and mandibular molar heights between the nose breathers and mouth breathers.

Effects of variation in the timing of palatal repair on sagittal craniofacial morphology in complete cleft lip and palate children.

The complete cleft lip and palate children, ranging from 6-14 years of age were studied to evaluate the effect of variation in the timing of palatal repair on craniofacial morphology and compared to the noncleft children. It was observed that all the groups early (8 to < or = 24 months), medium (> 24 to < or = 36 months) and late repair (> 36 to < or = 78 months) had significantly larger cranial base, retruded maxillomandibular relations, skeletodental and incisal relationships compared to the noncleft children. However, intercomparison among the cleft groups showed insignificant difference amongst them suggesting that the timing of palatal repairs does not effect the anterioposterior (sagittal) relationship.

Pure extradural approach for skull base lesions.

Lesions in the parasellar and paracavernous regions can be removed by various skull base approaches involving basal osteotomies. A major complication of intradural skull base approaches is CSF leak and associated meningitis. We have managed 5 patients with skull base lesions with a pure extradural approach using wide basal osteotomies. The operative techniques are described.

Estudio morfológico y morfométrico de la epidermis de fetos de ratas intoxicadas con plomo durante la preñez / Morphologic and morphometric study of the fetal epidermis after lead intoxication of rats during pregnancy

Fueron estudiados los efectos que la intoxicación prenatal con plomo produce en la histología y en los parámetros morfométricos de la epidermis de la región occipitofrontal de la bóveda del cráneo fetal. El plomo, administrado intraperitonealmente en forma de acetato en el 10º día de preñez en ratas Wistar, en dosis de 25 mg por kg de peso corporal, causó retardo del crecimiento intrauterino en fetos y placentas. Se demostró que la epidermis de la bóveda del cráneo es más delgada en los fetos intoxicados por plomo. Los resultados del análisis morfométrico sugieren que el plomo induce retardo en el crecimiento y en la diferenciación de las células epidérmicas de la bóveda craneal de los fetos

Efectos del etanol sobre la epidermis de fetos de rata: estudio morfológico y morfométrico / Ethanol effects on the epidermis of rat fetuses: morphologic and morphometric study

Fueron estudiados los efectos de la intoxicación prenatal con etanol sobre la histología y los parámetros morfométricos de la epidermis de la región occipitofrontal de la bóveda del cráneo fetal. Una solución de etanol al 25 por ciento, administrada intraperitonealmente en dosis de 0,03 mllg de peso corporal, en los días 9, 10 y 11 de embarazo, en ratas Wistar, causó retardo en el crecimiento intrauterino de fetos y placentas. Fue demostrado que la epidermis de la bóveda del cráneo es más delgada en los fetos del grupo intoxicado. Los resultados del análisis morfométrico sugieren que el etanol causa retardo de crecimiento (hipoplasia) en las células epidérmicas de la bóveda craneal en los fetos de ratas intoxicadas con etanol