• Title/Summary/Keyword: Cranial base

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Modified Orbitozygomatic Approach without Orbital Roof Removal for Middle Fossa Lesions

  • Lopez-Elizalde, Ramiro;Robledo-Moreno, Edgar;O'Shea-Cuevas, Gabriel;Matute-Villasenor, Esmeralda;Campero, Alvaro;Godinez-Rubi, Marisol
    • Journal of Korean Neurosurgical Society
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    • v.61 no.3
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    • pp.407-414
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    • 2018
  • Objective : The purpose of the present study was to describe an OrBitoZygomatic (OBZ) surgical variant that implies the drilling of the orbital roof and lateral wall of the orbit without orbitotomy. Methods : Design : cross-sectional study. Between January 2010 and December 2014, 18 patients with middle fossa lesions underwent the previously mentioned OBZ surgical variant. Gender, age, histopathological diagnosis, complications, and percentage of resection were registered. The detailed surgical technique is described. Results : Of the 18 cases listed in the study, nine were males and nine females. Seventeen cases (94.5%) were diagnosed as primary tumoral lesions, one case (5.5%) presented with metastasis of a carcinoma, and an additional one had a fibrous dysplasia. Age ranged between 27 and 73 years. Early complications were developed in four cases, but all of these were completely resolved. None developed enophthalmos. Conclusion : The present study illustrates a novel surgical OBZ approach that allows for the performance of a simpler and faster procedure with fewer complications, and without increasing surgical time or cerebral manipulation, for reaching lesions of the middle fossa. Thorough knowledge of the anatomy and surgical technique is essential for successful completion of the procedure.

Rapid Development of Brain Abscess Caused by Streptococcus Pyogenes Following Penetrating Skull Injury via the Ethomoidal Sinus and Lamina Cribrosa

  • Gulsen, Salih;Aydin, Gerilmez;Comert, Serhat;Altinors, Nur
    • Journal of Korean Neurosurgical Society
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    • v.48 no.1
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    • pp.73-78
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    • 2010
  • Objective : Streptococcus pyogenes is a beta-hemolytic bacterium that belongs to Lancefield serogroup A, also known as group A streptococci (GAS). There have been five reported case in terms of PubMed-based search but no reported case of brain abscess caused by Streptococcus pyogenes as a result of penetrating skull injury. We present a patient who suffered from penetrating skull injury that resulted in a brain abscess caused by Streptococcus pyogenes. Methods : The patient was a 12-year-old boy who fell down from his bicycle while cycling and ran into a tree. A wooden stick penetrated his skin below the right lower eyelid and advanced to the cranium. He lost consciousness on the fifth day of the incident and his body temperature was measured as $40^{\circ}C$. While being admitted to our hospital, a cranial computed tomography revealed a frontal cystic mass with a perilesional hypodense zone of edema. There was no capsule formation around the lesion after intravenous contrast injection. Paranasal CT showed a bone defect located between the ethmoidal sinus and lamina cribrosa. Results : Bifrontal craniotomy was performed. The abscess located at the left frontal lobe was drained and the bone defect was repaired. Conclusion : Any penetrating lesion showing a connection between the lamina cribrosa and ethmoidal sinus may result in brain abscess caused by Streptococcus pyogenes. These patients should be treated urgently to repair the defect and drain the abscess with appropriate antibiotic therapy started due to the fulminant course of the brain abscess caused by this microorganism.

A CEPHALOMETRIC STUDY ON FACIAL MORPHOLOGY IN ANGLE'S CLASS III MALOCCLUSION PATIENTS WITH FACIAL ASYMMETRY (안면비대칭을 동반한 Angle III급 부정교합자의 안모형태에 관한 두부방사선계측학적 연구)

  • Kim, Mee-Kyung;Kang, Jeung-Suk;Kim, Jong-Ryoul;Son, Woo-Sung
    • The korean journal of orthodontics
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    • v.24 no.4 s.47
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    • pp.787-798
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    • 1994
  • The purpose of this study was three-fold: i) to investigate the degree of asymmetry in Angle's Class III malocclusion patients and normal adults; ii) to determine the nature of difference existed between two groups; and iii) to investigate the correlationship between the degree of asymmetry and ANB and overbite in Angle's Class III malocclusion patients. The subjects consisted of 25 Angle's Class III malocclusion patients and 25 normal adults and the mean ages were 22.0 and 24.5 years, respectively. Their posteroanterior and lateral cephalograms were traced and analysed with three-dimensional approach. The results were as follows: 1. Asymmetry of Angle's Class III malocclusion group was significant in all regions except cranial base. Their horizontal asymmetry was seen in mandibular angle, maxillary and mandibular 1st molar, mandibular midline and menton. Vertical asymmetry was observed in maxillary 1st molar and mandibular shape and anteroposterior asymmetry in mandibular angle. 2. Nine variables indicating asymmetry were selected and each variable had similar discriminant score. 3. There was a little correlationship between An and asymmetric variable(MSR-B6) and its correlation coefficients was 0.3564. 4. There was no significant correlationship between overbite and asymmetric variables.

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ROENTGENOCEPHALOMETRIC STUDY ON THE TEETH AND SKULL (치아 및 두개골에 대한 두부방사선 계측학적 연구)

  • Son, Byung Hwa
    • The korean journal of orthodontics
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    • v.5 no.1
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    • pp.57-63
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    • 1975
  • For the purposes of augmentation of the aid for case analysis and diagnosis of malocclusion, a roentgenocephalometric study was made from 84 Korean adolescences. The Subjects consist of 42 males and 42 females aged from 17 to 20 years with normal occlusion and acceptable facial appearance. The author measured 18 angles and 14 linear distances as suggested by Jarabak. The following results were obtained. 1) Each linear measurement of the males' skull was greaten than that of the females. 2) The posterior to anterior facial height was $69.2\%$ in the males and $67.1\%$ in the females. 3) In the relationship of upper lip to esthetic line, the lip of females was more behind than that of males. 4) Saddle angle was $124.7^{\circ}$, articular angle was $148.7^{\circ}$, genial angle was $119.4^{\circ}$ and upper and lower genial angles were $45.1^{\circ}\;(N-Go-a^{\circ})$ and $74.2^{\circ}\;(N-Go-Me^{\circ})$. 5) The ratio of mandibular body to anterior cranial base was about 1:1. 1. 6) The angulations of $SNA^{\circ},\;SNB^{\circ}\;and\;SNP^{\circ}$ were as follows; $SNA^{\circ},\;80.3^{\circ},\;SNB^{\circ},\;79.8^{\circ},\;SNP^{\circ},\;81.1^{\circ}$. 7) The angle of the sella-nasion plane to the mandibular plane $(SNG^{\circ}Me^{\circ})$ was $32.0^{\circ}$ and that of the occlusal plane to the mandibular plane was $18.2^{\circ}$. 8) The angle of the maxillary central incisor to the sellanasion plane $(1-SN^{\circ})$ was $105.6^{\circ}$. That of the mandibular central incisor to the mandibular plane $(1-GoMe^{\circ})$ was $94.0^{\circ}$, and the interincisal angle $(1\;to\;1^{\circ})$ was $127.6^{\circ}$. 9) The linear distance from incisal edge of upper central incisor to facial plane was 8.0mm and that of lower central incisor was 4.6mm. 10) In the relationship of the lower lip to the esthetic line, the lower lip was 0.2mm front of the esthetic line.

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ROENTGENOCEPHALOMETRIC STUDY FOR THE CHILDREN IN THE PRIMARY DENTITION OF KOREAN (한국인 유치열기 아동의 두부방사선 계측학적 연구)

  • Kim, Dong-Joon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.5 no.1
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    • pp.64-75
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    • 1978
  • In order to know cephalometric norms for the preschool children, this roentgeno cephalometric study was undertaken in each 50 Korean male and female children of primary dentition age from 4 to 5 year. The following results were obtained. 1. In the skeletal analysis, there was no significant difference between male and female in angular measurement and the linear measument of the male was generally greater than that of the female. 2. Saddle angle was $122.3^{\circ}$, articular angle was $147.6^{\circ}$, gonial angle was $119.4^{\circ}$ and the sum of each angle was $396.1^{\circ}$ in male and $396.6^{\circ}$ in female. 3. The ratio of mandibular body to anterior cranial base was about 1 : 0.91. 4. In the primary dentition, suggested that the nasion and point A move forward relative to sella turcica in a fashion, pogonion and point B are equal in angular position relative to plan S-N, bony chin and chin button was yet underdeveloped, and the forward growth of mandible was seen rapid than maxilla after 4 years. 5. Suggested that the percentage of anterior facial height to the posterior facial height were 64.4% in male and 64.1% in female. 6. Maxillary primary incisors was more upright than the permanent incisors, mandibular primary incisors was inclined lingually relative to the permanent incisor, and primary incisors was more upright than the permanent incisors. 7. Maxillary primary incisors in female was inclined labially than male. 8. In the the relationship of the upper lip and lower lip to the esthetic line, the upper lip was 2.11mm and the lower lip was 2.33mm front of the esthetic line.

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Treatment in Bimaxillary Prognathism with Anterior Open Bite: A Case Report (전치부 개방교합을 지닌 상악골 및 하악골 전돌증의 치료: 증례 보고)

  • Chun, Sang-Deuk;Chin, Byung-Rho
    • Journal of Yeungnam Medical Science
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    • v.21 no.2
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    • pp.242-250
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    • 2004
  • In general, the skeletal class III has the characteristics of mandibular overgrowth with a normal maxillary growth or maxillary undergrowth with a normal mandibular growth And clinical and radiographic evaluations of the patient are needed. However, the treatment plan is not dependent on these evaluations alone, because patient's general condition and hope for aesthetics varies. The aim of this report is to consider the treatment of a medically compromised patient with an anterior open bite and skeletal class III, which showed a severe mandibular overgrowth. In 2003, a 17-year-old boy with epilepsy, mental retardation presented at our clinic complaining of concave profile. A clinical examination showed severe mandibular prognathism with an anterior open bite. The radiographic examination revealed a short cranial base, a moderate maxillary overgrowth, severe mandibular overgrowth and skeletal open bite tendency. In 2004, he was verified to have no potential of growth by hand-and-wrist radiographs and an endocrine examination. He completed the preoperative orthodontic treatment and orthognathic surgery (sagittal split ramus osteotomy, genioplasty). He was evaluated on the first visit, the preoperative period and the postoperative period with a clinical and radiographic examination. At the first visit, the patient showed moderate overgrowth of the maxilla, severe overgrowth of the mandible, and a subsequential skeletal open bite. After the preoperative orthodontic treatment (preoperative period), the patient showed the same skeletal problem as before and a decompensated dentition for orthognathic surgery. After orthognathic surgery, his profile had improved, but he had still a skeletal openbite tendency because the maxillary orthognathic surgery was not performed. Severe mandibular prognathism with a maxillary overgrowth and anterior open bite should be treated by bimaxillary orthognathic surgery. However, one-jaw orthognathic surgery on the remaining the skeletal open bite tendency was performed for his medical problem and facial esthetics. This subsequential open bite should be resolved with a postoperative orthodontic treatment.

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Femoral Nerve Injury after Rectus Abdominis Muscle Slap Harvesting: A Case Report (복직근 유리피판 거상 후 합병된 대퇴 신경손상 1례)

  • Kim, Jino;Lew, Dae Hyun;Tark, Kwan Chul
    • Archives of Plastic Surgery
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    • v.33 no.4
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    • pp.510-513
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    • 2006
  • Purpose: The Rectus abdominis muscle free flap is utilized in various reconstruction surgeries due to easiness in harvesting, consistency of vascular pedicle and reduced donor site morbidity. But rarely, femoral nerve injury during rectus abdominis harvesting can be resulted. We report a case of femoral nerve injury after rectus muscle harvesting and discuss the injury mechanism with the follow-up process of this injury. Methods: To reconstruct the defect of middle cranial base after wide excision of cystic adenocarcinoma of the external ear, rectus muscle free flap was havested in usual manner. To achieve a long vessel, inferior epigastric artery was dissected to the dividing portion of femoral artery and cut. Results: One week after the surgery, the patient noted sensory decrease in the lower leg, weakness in muscle strength, and disabilities in extension of the knee joint resulting in immobilization. EMG and NCV results showed no response on stimulation of the femoral nerve of the left leg, due to the defects in femoral nerve superior to the inguinal ligament. With routine neurologic evaluations and physical therapy, on the 75th day after the operation, the patient showed improvement in pain, sensation and muscle strength, and was able to move with walking frame. In 6 months after the operation, recovery of the muscle strength of the knee joint was observed with normal flexion and extension movements. Conclusion: Rarely, during dissection of the inferior epigastric artery, injuries to the femoral nerve can be resulted, probably due to excessive traction or pressure from the blade of the traction device. Therefore, femoral nerve injury can be prevented by avoiding excessive traction during surgery.

A Study on the Correlation between Anterior Tooth Contacts and Cephalometric Profile in Patients with Craniomandibular Disorders (두개하악장애환자의 전치부접촉과 측모두부형태간의 관계에 관한 연구)

  • Byung-Wook Kim;Kyung-Soo Han;Min Shin
    • Journal of Oral Medicine and Pain
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    • v.17 no.2
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    • pp.37-49
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    • 1992
  • 80 patients who presented at Wonkwang University Dental Hospital with craniomandibular disorders were collected for this study. To observe the occlusal contact pattern such as contact numbers, contact force and presence or absence of anterior occlusal contact, the author used T-Scan system (Tekscan, Inc, U.S.A.) with are computerized occlusal analysing system. And to study the correlation between craniofacial profile and occlusal contact pattern, cephalogram were also taken, The cephalometric items related to growth pattern, jaw bone relation and denture pattern were measured and analysed according to routine method by computerized program. The obtained data were statistically processed with SPSS/PC+ package about anterior contact pattern and its craniofacial relationship. The obtained results were as follows : 1. In terms of growth pattern, patients without anterior tooth contacts showed a tendency to downward growth of craniofacial profile. The value in this subjects were significantly different from the value of patients with anterior tooth contacts in items of low gonial angle, Jarabak ratio, SN to GoMe angle, FMA, occlusal plane to mandibular plane angle and ramus height. 2. In terms of jaw bone relationship, patients without anterior tooth contacts showed a tendency to backward growth of craniofacial profile. The value of this patients were significantly different from the value of patients with anterior tooth contacts in items of SNB, ANB, mandibular plane to anterior cranial base ratio, SNPo, NAPo and APDI items. 3. But in denture pattern, no statistically significant difference by the presence or absence of anterior tooth contacts were showed between this patients groups. 4. From this study, it could be proposed that anterior open bite in the patients with craniomandibular disorders would be originated from not dental discrepancy but skeletal discrepancy.

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ANALYSIS OF FAMILIAL TENDENCY IN SKELETAL CLASS III MALOCCLUSION (골격성 하악전돌증 환자의 유전적 경향에 대한 분석)

  • Lee, Chang-Hwan;Lee, Sang-Han;Kim, Hyun-Soo;Kwon, Tae-Geon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.32 no.6
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    • pp.506-513
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    • 2006
  • The purpose of this study was to examine the familial tendency of the patients with mandibular prognathism in three generations and to define the relationship between the familial tendency and the skeletal class III morphology. The probands of this study were 103 orthognathic surgery patients with skeletal Class III malocclusions who had undergone (48 men, 55 women) mandibular set-back surgery. A questionnaire was given to patients who sought surgical treatment for excessive mandibular length, and all answers were confirmed in interviews. Lateral cephalograms were analyzed in cranial base parameters, mandibular positional parameters and mandibular skeletal parameters. In the examined families, 58.3% had at least one member other than the proband who had mandibular prognathism. The affected ratio of total relatives was 4.5%, and the value was higher in first-degree (13.4%) than second-degree (5.9%) and third-degree relatives (1.7%). The affected ratio was 51.9% in the offsprings who had at least one affected father or mother. The comparison of the groups according to the familial tendency showed no significant craniofacial skeletal measurments. In conclusion, skeletal class III malocclusion showed high familial tendency, suggesting a significant genetic influence in the etiology. However, the patient's familial tendency did not show the special craniofacial patterns compare to the subjects without familial tendency.