• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.305-307
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• 2012

Oblique basal skull fractures resulting from lateral crushing injuries involving both clivus and occipital condyle are rare due to their deep locations. Furthermore, these fractures may present clinically with multiple cranial nerve injuries because neural exit routes are restricted in this intricate region. The authors present an interesting case of basal skull fractures involving the clivus and occipital condyle and presenting with sixth and contralateral twelfth cranial nerve deficits. Clinico-anatomic correlations and the courses of cranial nerve deficits are reiterated. To the authors' knowledge, no other report has been previously issued on concomitant sixth and contralateral twelfth cranial nerve palsies following closed head injury.

• Imaging Science in Dentistry
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• v.49 no.3
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• pp.251-256
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• 2019

Jugular bulb diverticulum is an irregular extension of the jugular bulb into the temporal bone that may be symptomatic or asymptomatic. The jugular bulb has rarely been reported to extend into the occipital condyle; such extension is termed a condylar jugular diverticulum and is characterized as a defect in the occipital condyle contiguous with the jugular bulb. This report details 3 cases of condylar jugular diverticulum. Extension of the jugular bulb into the ipsilateral occipital condyle was noted as an incidental finding on cone-beam computed tomographic (CBCT) images of 3 patients. All 3 patients were asymptomatic, and this finding was unrelated to the initial area of interest. CBCT use is becoming ubiquitous in dentistry, as it allows 3-dimensional evaluation, unlike conventional radiography. Proper interpretation of the entire CBCT is essential, and recognition of the indicators of condylar jugular diverticulum may prevent misdiagnosis of this rare entity.

• Anatomy and Cell Biology
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• v.56 no.1
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• pp.61-68
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• 2023

Anatomical knowledge of the occipital condyle (OC) and its relationships to surrounding structures is important for avoiding injury during craniovertebral junction (CVJ) surgeries. This study was conducted to evaluate the morphology and morphometry of OC and its relationship to foramen magnum, jugular foramen (JF), and hypoglossal canal (HC). Morphometric parameters including length, width, height, and distances from the OC to surrounding structures were measured. The oval-like condyle was the most common OC shape, representing for 33.0% of all samples. The mean length, width and height of OC were 21.3±2.4, 10.5±1.4, and 7.4±1.1 mm, respectively. Moreover, OC was classified into three types based on its length. The most common OC length in both sexes was moderate length or type II (62.5%). The mean distance between anterior tips and posterior tips of OC to basion, and opisthion were 11.5±1.4, 39.1±3.3, 25.2±2.2, and 27.4±2.7 mm, respectively. The location of intracranial orifice of HC was commonly found related to middle 1/3 of OC in 45.0%. JF was related to the anterior 2/3 of OC in 81.0%, the anterior 1/3 of OC in 12.5%, and the entire OC length in 6.5%. These morphological analysis and morphometric data should be taken into consideration before performing surgical operation to avoid CVJ instability and neurovascular structure injury.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.14 no.1
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• pp.81-87
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• 1984

This study was performed to observe the secondary images and to analyse the relationships between the primary and secondary images in panoramic radiograph. Using the Moritta's Panex-EC panoramic x-ray machine and the human dry skull, the author analysed 17 radiographs which were selected from 65 radiographs of the dry skull that attached the radiopaque materials, and the attached regions of the radiopaque materials were the normal anatomical structures which were important and selected as a regions for the evaluation of the secondary images effectively. The results were as follows; 1. The cervical vertebrae showed three images. The midline image was the most distorted and less clear, and bilateral images were slightly superimposed over the posterior border of the mandibular ramus. 2. In mandible, the secondary image of the posterior border of the ramus was superimposed on the opposite ramus region, and this image was elongated from the anterior border of the ramus to the lateral side of the posterior border of the ramus. The secondary image of the condyle was observed on the upper area of the coronoid process, the sigmoid notch and the condyle in opposite side. 3. In maxilla, the posterior region of the hard palate showed the secondary image on the lower part of the nasal cavity and the medial wall of the maxillary sinus. 4. The primary images of the occipital condyle and the mastoid process appeared on the same region, and only the secondary image of the occipital condyle was observed symmetrically on the opposite side with similar shape to the primary one. 5. In the cranial base, the anatomical structures of the midsagittal portions like a inferior border of the frontal sinus, sella turcica, inferior borderr of the sphenoid sinus and inferior border of the posterior part of the occipital bone showed the simillar shape between the primary and secondary images symmetrically. 6. The petrous portion of the temporal bone showed the secondary image on the lateral side of the sella-turcica, and the secondary images of the posterior border of lesser wing, superior border of greater wing of the sphenoid bone and posterior border were observed on the anterior-superior and inferior region of the sella-turcica.

• Journal of Korean Neurosurgical Society
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• v.37 no.4
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• pp.310-312
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• 2005

We report a case of endodermal cyst of the posterior fossa. A 44-year-old man presented with headache for three months. Computed tomography and magnetic resonance imaging revealed a $6{\times}2.5{\times}2cm$ sized extra-axial non-enhancing cystic lesion on the ventral aspect to brain stem. To avoid retraction injury to brain stem, far lateral transcondylar approach was selected. Right suboccipital craniotomy and partial removal of occipital condyle with resection of C-1 and C-2 hemilaminae exposed the extra-axial cyst well. The cyst has a whitish thick membrane. It was not adherent to brain stem and lower cranial nerves. Total removal of the cyst was done without difficulty. Histological analysis disclosed a layer of pseudostratified columnar epithelium with basement membrane. The result of immunohistochemical study was consistent with endodermal cyst.

• Journal of Veterinary Clinics
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• v.20 no.4
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• pp.523-526
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• 2003

Three dimensional computed tomographic images were obtained in two cases with trauma. The first case of a 3 year-old male Maltese, with ataxia and head tilting due to head trauma was referred to veterinary medical teaching hospital, Seoul National University. Remarkable findings were not found on survey radiographs. With the help of three-dimensional reconstruction computed tomographic imaging, parietal and occipital bone fracture was identified. The second case of 4 month-old female Yorkshire terrier with left forelimb lameness was referred right after trauma. Survey radiography showed obvious incongruity of the elbow joint. Lateral and medial condyle of the left humerus fracture and lateral displacement of the left ulna were apparent in three-dimensional computed tomographic image. It was considered that three-dimensional computed tomography could be used as an aid modality for the exact evaluation of extends and degree of fracture as well as planning of orthopedic surgery.

• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.10 no.1
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• pp.8-15
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• 2001

The Class III malocclusion classified in two types of Skeletal Class III and Pseudo Class III. In the case of the maxillary deficiency, the protraction H-G(facemask) with Bonded RPE can be used. For children with A-P and vertical maxillary deficiency, the preferred treatment is to move the maxilla into a more anterior and inferior position, which also increases its size as bone is added at the posterior and superior sutures. Successful forward repositioning of the maxilla can be accomplished before age 8. To resist tooth movement as much as possible, the maxillary teeth should be splinted together as a single unit. The maxillary appliance must have hooks for attachment to the facemask that are located in the canine-primary molar area above the occlusal plane. The facemask usually worn until a positive overjet of 2-5mm is achieved interincisally. Occipital chin cup is successful in those patients who can bring their incisors close to an edge-to-edge position when in centric relation. This treatment is particularly useful in patients who begin treatment with a short lower anterior facial height, as this type of treatment can lead to an increase in lower anterior facial height. If the pull of the chin cup is directed below the condyle, the force of the appliance may lead to a downward and backward rotation of the mandible.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.39.1-39.6
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• 2015

Skull-base osteomyelitis is a rare disease affecting the medulla of the temporal, sphenoid, and occipital bones. In general, it occurs due to external ear canal infections caused by malignant external otitis. Skull-base osteomyelitis usually affects elderly diabetic patients. The patient, a 58-year-old man, was referred for evaluation and management of the left jaw. Clinical examination of the patient revealed pain in the left jaw and mouth-opening deflection to the left. The maximum active mouth opening was measured to about 27 mm. Panoramic, CT, and CBCT revealed bone resorption patterns in the left condyle. Through control of diabetes, continued pharmacological treatment, arthrocentesis, and occlusal stabilization appliance therapy were carried out. The extent of active mouth opening was increased to 45 mm, and pain in the left jaw joint was alleviated. This was a case wherein complications caused by failure to control diabetes induced skull-base osteomyelitis. There is a need for continued discussion about the advantages and disadvantages of arthrocentesis with lavage for patients with skull-base osteomyelitis and other treatment options.

• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1094-1102
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• 2001

Objective : During the trans-condylar or trans-jugular approach for the lesion of cranio-cervical junction(CCJ), its necessary to identify the accurate locations of vertebral artery(VA), internal jugular vein(IJV) and its related lower cranial nerves. These neurovascular structures can also be damaged during the operation for vascular tumor or traumatic aneurysm around extra-jugular foramen, because of their changed locations. To reduce the neurovascular injury at the operation for CCJ, morphometric relationship of its surrounding neurovascular structures based on the tip of the transverse process of atlas(C1 TP), were studied. Materials & Methods : Using 10 adult formalin fixed cadavers, tip of mastoid process(MT) and TPs of atlas and axis were exposed bilaterally after removal of occipital and posterior neck muscles. Using standard caliper, the distances were measured from the C1 TP to the following structures : 1) exit point of VA from C1 transverse foramen, 2) branching point of muscular artery from VA, 3) entry point of VA into posterior atlanto-occipital membrane(AOM), 4) branching point of C-1 nerve. In addition, the distances were measured from the mid-portion of the posterior arch of atlas to the entry point of the VA into AOM and to the exit point of the VA from C1 transverse foramen. After removal of the ventrolateral neck muscles, neurovascular structures were exposed in the extra-jugular foraminal region. Distances were then measured from the C1 TP to the following structures : 1) just extra-jugular foraminal IJV and lower cranial nerves, 2) MT and branching point of facial nerve in parotid gland. In addition, distance between MT and branching point of facial nerve was measured. Results : The VA was located at the mean distance of 12mm(range, 10.5-14mm) from the C1 transverse foramen and entered into the AOM at the mean distance of 24mm(range, 22.8-24.4mm) from the C1 TP. The mean distance from the mid portion of the C1 posterior arch was 20.6mm(range, 19.1-22.3mm) to the entry point of the VA into AOM and 38.4mm(range, 34-42.4mm) to the exit point of the VA from C1 transverse foramen. Muscular artery branched away from the posterior aspect of the transverse portion of VA below the occipital condyle at the mean distance of 22.3mm(range, 15.3-27.5mm) from the C1 TP. The C-1 nerve was identified in all specimens and ran downward through the ventroinferior surface of the transverse segment of VA and branched at the mean distance of 20mm(range, 17.7-20.3mm) from the C1 TP. The IJV was located at the mean distance of 6.7mm(range, 1-13.4mm) ventromedially from the lateral surface of the C1 TP. The XI cranial nerve ran downward on the lateral surface of the IJV at the mean distance of 5mm(range, 3-7.5mm) from the C1 TP. Both IX and X cranial nerves were located in the soft tissue between the medial aspect of the internal carotid artery(ICA) and the medial aspect of the IJV at the mean distance of 15.3mm(range, 13-24mm) and 13.7mm(range, 11-15.4mm) from the C1 TP, respectively. The IX cranial nerve ran downward ventroinferiorly crossing the lateral aspect of the ICA. The X cranial nerve ran downward posteroinferior to the IX cranial nerve and descended posterior to the ICA. The XII cranial nerve was located between the posteroinferior aspect of the IX cranial nerve and the posterior aspect of the ICA at the mean distance of 13.3mm(range, 9-15mm) ventromedially from the C1 TP. The distance between MT and C1 TP was 17.4mm(range, 12.5-23.9mm). The VII cranial nerve branched at the mean distance of 10.2mm(range, 6.8-15.3mm) ventromedially from the MT and at the mean distance of 17.3mm(range, 13-21mm) anterosuperiorly from the C1 TP. Conclusion : This study facilitates an understanding of the microsurgical anatomy of CCJ and may help to reduce the neurovascular injury at the surgery around CCJ.