Pterygoid Hamulus: Morphological Analysis and Clinical Implications.

INTRODUCTION:  The pterygoid hamulus (PH), as a small and curved projection of the sphenoid bone, occupies a unique position at the skull base. Given its functional relation with the surrounding anatomical structures, the study of this rather underrepresented structure in the literature assumes paramount importance. MATERIALS AND METHODS: We examined a total of 87 pterygoid hamuli (50 right-sided and 37 left-sided) out of a sample of 114 dry skulls. We measured the length, width, and angle of each PH and the interpterygoid distance in skulls with both pterygoid hamuli intact, and we calculated the mean, maximum, and minimum values. RESULTS: Our statistical analysis revealed the mean length (0.9 cm), width (0.3 cm), and angle (47.8°) of the PH, as well as the mean interpterygoid distance (3.31 cm). We recorded the longest-ever documented PH (1.64 cm). The obtained length values were higher than those provided by radiological studies. We also investigated possible associations between anatomy and pathological conditions related to the PH morphology, including pterygoid hamular elongation syndrome, hamular fracture, middle ear disorders, and obstructive sleep apnea syndrome. CONCLUSION: Our study uses precise measurement techniques to detail the anatomy of the PH in dry skulls. This research can be a valuable resource for future studies, advancing our understanding of the PH's structure and its clinical significance.

A Cone-beam Computed Tomography Evaluation of External Invasive Resorption of Unerupted Teeth. Report of Three Cases.

Tooth resorption can occur either physiologically or pathologically and can be classified as internal or external. The term "external invasive resorption" (EIR) has been used to describe lesions originating from any surface defect exposing dentin. The absence of bacterial contamination, an intact pulp space, and a lesion consisting mainly of fibrovascular tissue characterize EIR. This study presents three cases of invasive resorption in unerupted teeth, emphasizing the importance of cone-beam computed tomography (CBCT). In two cases, the primary defect localized on the enamel surface, while in the third case, the focal point of the defect was not clear. CBCT provided detailed visualization of the resorption lesion's size and its relationship with surrounding structures, enhancing the diagnosis of EIR. Histological analysis of the third case confirmed the initial diagnosis. Invasive resorption can occur due to any surface defect in the case of unerupted teeth. Further research and correlation between radiographic and histological analysis are essential for the detection and classification systems in unerupted teeth.

Odontoid Process and Femur: A Novel Bond in Anatomy.

Objective The morphology and quantitative anatomy of the axis vertebra (C2) attracts a lot of attention between anatomists, surgeons and radiologists. However, no report exists in the literature correlating the height of the dens with the length of the femur. Our paper aims to determine such a correlation. Material and methods An examination of forty-five adult dry skeletons (twenty-three male and twenty-two female) was conducted. The height of the odontoid process of the axis and the maximum length of the femur were measured and statistically analyzed. Results The mean values for the height of the dens were 19.13±2.74 mm and 16.83±2.45 mm concerning the male and female dry skeletons respectively. The mean maximum length of the right femur bone was 43.04±2.32 cm for male and 39.90±2.40 cm for female skeletons. Data analysis revealed a statistically significant correlation (r=0.709, p <0.001) between the height of the odontoid process and the maximum length of the femur bone. A linear regression model expressing this association was created: Femur max length (in cm) = 32.874 + 0.531 x Dens height (in mm). Conclusion We present a new mathematical equation correlating one of the most studied long bones of the skeleton, the femur, with another "long" part of the bony structure of the human body- the C2 odontoid process.

A rare triple skeletal bone variation, including a median cleft of the posterior arch of the atlas, a sternal foramina and a bifid xiphoid process.

Bone variations are usually a result of abnormal ossification during embryonic life. Separately or in combination, sternal foramina and bifid xiphoid process are well documented skeletal alternations, as well as the median cleft of the posterior arch of the atlas. However, their appearance in combination is not yet celebrated in the literature. Our post-mortem examination unearthed such a triple variant of an adult male skeleton, which included no other skeletal variations. The fact that all variants are depicted in the median line of ossification implies a hypothesis of a triggered midline bone defect process. The awareness among clinicians of such variations during interventional and imaging procedures is of great importance.

Machaon, Son of Asclepius, the Father of Surgery.

The first description of organized surgical care is given in Homer's epic poem "Iliad'', even though evidence of performing surgical operations can be traced back to the history of ancient civilizations. Machaon (ca. 1300 BC), the son of Asclepius, was described as a skillful and confident therapist, whose lineage ensured a unique training. He lived in an era when the reality was shaped by myths, and natural phenomena were ruled by the will of the Olympian gods. It was at that time when philosophers and scientists rediscovered the world that surgery was born. We review and present Machaon's story, as he is not only the first documented surgeon ever mentioned in written records in Greek history, but he also proved himself to be a valiant soldier at the battlefield, during the Trojan War. It is no wonder that the life of such a charismatic man, living in a place and time of prosperity and steady evolution of both the scientific and the spiritual world, became a demigod patron of surgical treatment and a landmark in the history of medicine.

Osteochondroma of the talus in a 19-year-old female: A case report and review of the literature.

CASE: Osteochondroma is a benign bone tumor usually affecting areas around the knee, pelvis, neck and tibia. This disease rarely affects the talus. A case of a 19-years-old female with anteromedial ankle impingement with 8 years follow-up is reported. Surgery removal was the treatment of choice and histopathology examination revealed a benign solitary osteochondroma. CONCLUSION: Osteochondromas in the anterior and anteromedial side of talus are rarer and can cause multiple clinical manifestations including important ones such as limitation of ankle movement and pain. Different locations of solitary osteochondromas can influence both patients' symptoms and clinical examination findings.

A Case of Early FAP Diagnosis with Extraintestinal Manifestations on the Face.

OBJECTIVE: Gardner's syndrome is a variant of familial adenomatous polyposis, characterized by gastrointestinal polyps, multiple osteomas, and skin and soft tissue lesions. Diagnosis by means of an understanding of its various symptoms is of great importance. CASE REPOSRT: This report presents the case of a 32-year-old man with obvious asymmetry and disfigurement on his face, due to multiple osteomas and soft tissue lesions. These clinical signs prompted us to further investigation, leading to the diagnosis of a case of Gardner's syndrome, with asymptomatic polyposis of the colon. Polyps have virtually an almost 100% risk of undergoing malignant transformation. CONCLUSION: Early diagnosis and treatment of this pathological entity are crucial, while the presence of osteomas should alert us to this diagnosis.

The Greek Surgeon-Gynecologist Savvas Georgiadis (1857-1942) and the First Vaginal Reconstruction in Smyrna.

The Greek surgeon-gynecologist Savvas Georgiadis from Phocaea in Asia Minor had performed in 1897 an innovative surgical operation in a young female patient, reconstructing her vagina. Having been educated both in Greece and France, specialized in gynecology, he became a famous surgeon in the Hellenic Hospital of Smyrna "Agios Charalampos," where the operation was masterfully executed. Although among the pioneers in neovagina techniques, Georgiadis still is searching his place among the important figures in the history of plastic surgery.

Situs inversus Totalis: Always recall the uncommon.

Situs inversus totalis has been reported as a rare entity. The detailed knowledge of the human structure and its anatomical variations is of great importance for the daily clinical practice and even more critical in emergency medicine. Such a condition may elude in routine patient evaluation or an urgent interventional procedure, with potentially fatal results.

Rotated mesiodens in children. An immediate surgical removal or active monitoring?

Rotated mesiodentes impaction is a rare variant of dental anatomy which may cause a cluster of symptoms damaging nearby structures. Although some recommend a delayed approach, after the end of teeth development, it seems that an immediate surgical removal would be of great benefit for the patients involved.

The Hippocratic Method for the Reduction of the Mandibular Dislocation, an Ancient Greek Procedure Still in Use in Maxillofacial Surgery.

Mandibular dislocation remains an acute medical condition in maxillofacial surgery. Since the Hippocratic era its reduction has been performed exactly in the same way it is now performed in modern surgery. We report an example of an elderly female patient with bilateral mandibular dislocation, who came to our department and was treated under sedation using the Hippocratic bimanual intraoral technique by two medical personnel, depicting the timeless usage of the method. Although some characteristics of the procedure were wrongfully attributed to others, such as Barton and Lewis, after a thorough examination of the ancient Greek medical texts, its originality should in fact be attributed solely to the Hippocratic School of Medicine. Furthermore, we recommend the use of the term "mandibular dislocation" instead of the "temporomandibular joint dislocation", as a more accurate medical definition.

In vivo estimation of normal amygdala volume from structural MRI scans with anatomical-based segmentation.

PURPOSE: Literature includes a number of studies using structural MRI (sMRI) to determine the volume of the amygdala, which is modified in various pathologic conditions. The reported values vary widely mainly because of different anatomical approaches to the complex. This study aims at estimating of the normal amygdala volume from sMRI scans using a recent anatomical definition described in a study based on post-mortem material. METHODS: The amygdala volume has been calculated in 106 healthy subjects, using sMRI and anatomical-based segmentation. The resulting volumes have been analyzed for differences related to hemisphere, sex, and age. RESULTS: The mean amygdalar volume was estimated at 1.42 cm3. The mean right amygdala volume has been found larger than the left, but the difference for the raw values was within the limits of the method error. No intersexual differences or age-related alterations have been observed. CONCLUSION: The study provides a method for determining the boundaries of the amygdala in sMRI scans based on recent anatomical considerations and an estimation of the mean normal amygdala volume from a quite large number of scans for future use in comparative studies.

Aspiration and Brushing Cytology in tumors and tumor-like conditions of the tongue: A Study of 27 Cases.

BACKGROUND: Lesions of the tongue have a broad differential diagnosis ranging from benign idiopathic processes to infections, cancers, and infiltrative disorders. An important thing to remember is that most tongue lesions will resolve spontaneously or with simple therapy within a week, if not, they should be biopsied or evaluated further for a definitive diagnosis of a potentially serious disorder. Some tongue lesions may be clues to other underlying illnesses which require further evaluation Tongue lesions are traditionally evaluated by surgical biopsy. Most of them, however, are easily accessible by fine-needle aspiration (FNA) or brushing. STUDY DESIGN: Fifteen males and twelve females aged from 15 to 72 were examined in our institution over a period of 15 years and 27 lesions, were evaluated by fine-needle aspiration cytology (FNAC) or brushing cytology. RESULTS: The lesions were located at the mobile aspect of the tongue.10 malignant tumors were diagnosed: 9 cases of squamous cell carcinoma (SCC), and 1 non-Hodgkin lymphoma (NHL). In addition, 13 benign tumors (7 cases of papillomas / fibromas, 3 cases of hemangiomas, 2 cases lymphangiomas, and 1 case of lipoma), and 4 nonneoplastic benign conditions (3 traumatic ulcers and 1 hematoma) were found. There were no false-positive diagnoses. There were no clinical complications resulting from FNA or brushing. CONCLUSION: Cytologic examination is rapid, safe, accurate, inexpensive, and patient-friendly for establishing preoperative diagnosis in tumors and tumor-like conditions of the tongue, and we recommend this method as the first diagnostic step in the evaluation of these lesions.

Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies.

AIMS AND BACKGROUND: Evidence from the literature suggests that osteonecrosis of the jaw is emerging as a serious complication of treatment with bisphosphonates for patients with advanced prostate cancer. METHODS AND STUDY DESIGN: This study is a series of 60 patients with osseous metastases from prostate cancer under complete androgen deprivation therapy. All patients also received bisphosphonates intravenously every 3 to 4 weeks. Over a period of 3 and a half years, we recorded the incidence, presenting signs and symptoms of osteonecrosis of the jaw among those patients and the diagnostic workup required. RESULTS: Nine of the 60 patients with metastatic prostate cancer were found to be affected with osteonecrosis of the jaw secondary to bisphosphonate administration at the Urology Department at the University Hospital of Alexandroupolis between January 2006 and August 2009. For diagnostic reasons, all 9 patients underwent computed tomography scan and magnetic resonance imaging of the maxillary region, as well as a three-phase whole body bone scan. CONCLUSIONS; There is evidence that administration of bisphosphonates in patients with advanced prostate cancer may increase the risk of osteonecrosis of the jaw. Guidelines regarding the diagnosis and management of those patients are needed.

Application of PRP gel alone or in combination with guided bone regeneration does not enhance bone healing process: An experimental study in rabbits.

INTRODUCTION: The aim of this study was to assess the hypothesis that application of platelet-rich plasma (PRP) gel in mandibular defects in rabbits, alone or in combination with guided bone regeneration (GBR) techniques, could enhance the bone healing process. MATERIALS AND METHODS: Thirty New Zealand white rabbits were used. Three groups of 10 animals each were assigned, and the animals were sacrificed after 12 weeks. During the operation, a rotating trephine bur was used to create circular defects 10-mm in diameter in the region anterior to the jaw angles. In group human fascia lata (HFL), a human fascia lata membrane was used. In group PRP, PRP gel was used to fill the defect, and in group HFL+PRP, PRP was used to fill the defect which after that was covered with a human fascia lata membrane. RESULTS: In general, none of the control sides and the PRP treated sides had full development of bone or filling of the defect through bone bridging. Conversely, the sides on which the fascia lata membrane or the combination of membrane and PRP had been applied were characterized mostly by development of newly formed bone that bridged the gap. CONCLUSIONS: Our results suggest that the application of PRP gel alone or in combination with GBR does not enhance bone healing process.

Lack of periradicular healing and gradually increasing swelling two years after intentional extrusion of calcium hydroxide into periapical lesion: report of a case.

A 40-year-old female patient with noncontributory medical history presented to the postgraduate clinic of the Department of Endodontology, Aristotle University of Thessaloniki, Greece. Her chief complaint was a gradually increasing swelling in the left side of her maxilla, during the preceding 2 months. After clinical examination, the radiologic and computerized tomographic scan examinations revealed the presence of a radiopaque foreign material in contact with the apex of tooth #22, confined within the limits of a radiolucent area. On dental anamnesis and after communication with her dentist, it was concluded that calcium hydroxide was deliberately extruded for the healing of the large lesion. The patient was scheduled for periapical surgery. The histopathologic features of the lesion revealed the presence of a periapical cyst and the absence of foreign body giant cells. After an observation period of 1 year, healing was uneventful.

Epidemiology of surgical treatment of nonmelanoma skin cancer of the head and neck in Greece.

BACKGROUND: Nonmelanoma skin cancer (NMSC) constitutes the most common malignancy in Caucasians. Epidemiological data derive, mainly, from studies in the United States, Australia, and Northern Europe, whereas data from Mediterranean Europe are scarce. OBJECTIVE: To provide information on the epidemiology of surgically treated NMSC of the head and neck in the region of Thrace, Northern Greece, and to evaluate the surgical treatment given. METHODS: A retrospective review of patients surgically treated from 2004 to 2006 was conducted. Data on demographics, histology and skin cancer characteristics, and treatment efficacy and recurrence rate were extracted and analyzed. RESULTS: One hundred seventy-nine NMSCs of the head and neck were excised and histopathologically confirmed in 160 patients, with the majority (58.7%) classified as Fitzpatrick skin type III. Histology included 125 basal cell carcinomas (BCCs) and 54 squamous cell carcinomas (SCCs). The mean age was 70.6 +/- 10.1 (range 38-97). Tumor size ranged between 2 and 50 mm. Excision with 5-mm margins was performed in every case, and the defects were closed mainly using local flaps. Incomplete excision was limited to 3.9% of cases, and the recurrence rate was 1.7%. The study revealed similar characteristics between BCC and SCC regarding age and sex but significant differences in terms of location and size. CONCLUSIONS: Surgical resection achieves a satisfactory NMSC clearance rate in the head and neck.

Jaw bone metastases: four cases.

OBJECTIVE: Metastatic tumors make up approximately one percent of all oral malignancies. Such tumors may present in the jaw bones and oral soft tissues. The commonest oral site is the mandible. PATIENTS AND METHODS: This is a retrospective study of four cases of metastatic tumors of the jaws seen at the Oral-Maxillofacial Department, General University Hospital of Alexandroupolis, Thrace, Greece from 1989 to 2005, representing 1% of all histologically confirmed malignant tumors at the hospital. RESULTS: Two cases originated from the thyroid gland, one was from the esophagus, and one from the liver. Three metastases occurred in the mandible and one in the maxilla. The oral symptoms were similar to odontogenic infections or to benign neoplasms. CONCLUSIONS: In view of the resemblance in the presentation of metastases and other tumors affecting the jaws, a high index of clinical suspicion is advocated to ensure early, multidisciplinary care of hosts.

Polymorphous low grade adenocarcinoma of the parotid gland. Cytological, histological and immunohistochemical features and review of the literature.

AIM: Polymorphous low grade adenocarcinoma of the salivary glands (PLGA) is a low grade neoplasm that predominantly occurs in the minor salivary glands. In this site is amenable to biopsy and histologic diagnosis. However, experience with cytological findings in these tumors is limited. We describe the cytology of this entity. EXPERIMENTAL DESIGN: Touch imprint cytology of a primary parotid PLGA is specified and correlated with histology. RESULTS: Smears were hypercellular showing branching papillae, sheets and clusters of uniform cells with bland nuclei, dispersed chromatin and no nucleoli. The cells had a scant to moderate amount of eosinophilic cytoplasm. They formed tubular structures containing hyaline globules. CONCLUSIONS: The cytologic differential diagnosis of PLGA includes adenoid cystic carcinoma, pleomorphic adenoma, and monomorphic adenoma. PLGA should be considered in the differential diagnosis of head and neck tumors, where the cytology suggests on of the above mentioned tumors, even when the clinical findings (involvement of a major salivary gland, lymph node metastasis) is not typical of PLGA.