Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death

The Incidence and Aetiology of Maxillofacial Trauma and Concomitant Traumatic Brain Injury in a Johannesburg Tertiary Hospital

OBJECTIVE

To investigate the incidence and etiology of maxillofacial trauma (MFT) and its association with traumatic brain injury (TBI).

BACKGROUND

Anecdotal evidence suggests that there is an association between MFT and TBI and that higher incidences of TBI are associated with frontal bone and mid-facial fractures. Despite the large volume of maxillofacial facial fractures treated in the authors' unit, no study has been undertaken to establish the relationship between TBI and maxillofacial fractures.

METHODS

This was a retrospective single-center cross-sectional study that was conducted on patients who presented at Charlotte Maxeke Academic Hospital emergency department with MFT and concomitant TBI over a period of 1 year (January 2019-January 2020). The primary predictor was maxillofacial fractures, which were classified into upper, middle, and lower thirds. The primary outcome variable was TBI indicated by the Glasgow Coma Scale (GCS) and Marshall computed tomography (CT) classification (radiological finding in CT).Variables such as age, etiology, fracture type, and neurological injury indicated by the recorded GCS and Marshall CT classification (I-IV) were collected. Maxillofacial fractures were classified based on the anatomical location. The level of significance was set at P <0.05.

RESULTS

A total of 112 patients (102 males, 10 females) presented with MFT and concomitant TBI. The age group 30 to 39, followed by 20 to 29 years, was most affected. Respectively assault (n = 67), gunshots (n = 16), and falls (n = 16) were the main causes of injury. Supra-orbital rim fractures (P = 0.00193), frontal sinus fractures (P < 0.001,), and panfacial fractures (P < 0.001) were significantly associated with TBI. Severe TBI (GCS: 3-8) was associated with higher Marshall CT grading.

CONCLUSIONS

Facial fractures affecting the upper third and panfacial fractures pose a significant risk for TBI. To identify TBIs, a multidisciplinary evaluation of facial fractures is recommended, especially in high-risk groups.

The gender-related volumetric side asymmetries in sphenoid sinuses and their clinical significance

BACKGROUND

The sphenoid sinus (SS) is important in neurosurgical practice because it is surrounded by numerous critical neurovascular structures. Using helical computerized tomography (CT) scanning, we investigated the gender-related volumetric asymmetric nature of the SS.

MATERIALS AND METHODS

CT scans of SS of 49 (21 females, 28 males) patients admitted to the hospital between 1 October 2018 and 1 June 2019 were analyzed retrospectively. The volumes of SSs were calculated using a secondary reconstruction tool.

RESULTS

The mean age was 33,81 for females, 41,107 and in males patients which was not statistically significant. The mean right and left SS volume was 3,03 cm3 and 3,.57cm3 in females, but 4,28cm3 and 4,70cm3 in males, respectively. The difference in side asymmetry between men and women was statistically significant (p < 0.05).

CONCLUSION

In this study, the gender-related side differences of the SS have been the first time reported in this study. The reason for this gender-related asymmetric size of the SSs may be related to the pneumatization process.

The relationship between mean platelet volume and the mortality of patient severe head trauma; first study

BACKGROUND

Prediction of mortality in a patient with head trauma is essential. In this study, the effect of mean platelet volume (MPV) on the mortality rate of patients with severe head trauma was studied.

MATERIAL AND METHODS

The relationship between mortality and mean platelet volumes of patient with cranial trauma was retrospectively analyzed.

RESULTS

43 patients with head trauma were admitted to the intensive care unit during the study period. While 17 patients died (Group I), 26 patients survived (Group II). Cox regression analysis showed that late MPV (at exitus or discharged date), WBC at admission, and age increase the mortality rate 1,770, 1,202, 1,052 times, respectively.

CONCLUSIONS

The present study shows that MPV may be a useful predictor of mortality in patients with severe head trauma.

From Nose to Lumbar Spinal Cord - Reduced Sperm Numbers Occur by Olfactory Bulbectomy-Related Onuf's Nucleus Degeneration: New Experimental Evidence for Kallmann Syndrome

INTRODUCTION

Olfaction and its relation to human health is an area of growing interest. Although olfaction disorders have been considered a part of Kallmann syndrome, the role of olfactory dysfunction on spermatogenesis has not been studied yet. We studied if olfactory bulbectomy (OBX) causes dysfunction in spermatogenesis as a result of Onuf's nucleus damage.

METHODS

Twenty-eight male rats were divided into three groups: six as the control (G-1; n = 6), six as the only frontal burr hole applied animals SHAM (G-2; n = 6), and 16 as the study group (G-3; n = 16) in which OBX was performed. The animals were followed for 2 months. After the decapitation of the animals, olfactory bulb (OB) volumes (mm3), the neuron density of the Onuf's nucleus (n/mm3), and sperm density (n/mm3) were estimated stereologically and analyzed.

RESULTS

OB volumes (mm3), degenerated neuron density of Onuf's nucleus (n/mm3), and sperm numbers of control, SHAM, and study groups were estimated as: 4 ± 0.5; 6 ± 2 and 103.245 ± 10.841 in G-1; 3.5 ± 0.7; 14 ± 4 and 96.891 ± 9.569 in G-2; and 1.3 ± 0.3; 91 ± 17 and 73.561 ± 6.324 in G-3. The statistical results of degenerated neuron density of Onuf's nucleus and sperm numbers between groups are p < 0.005 for G-1/G-2; p < 0.0005 for G-2/G-3; and p < 0.00001 for G-1/G-3.

DISCUSSION

This study first time indicates that Onuf's nucleus degeneration secondary to OBX seems to be responsible for reduced sperm numbers.

Orthodontic Treatment Does Not Affect Frontal Sinus Development in Female Adults: A Clinical Study

Frontal sinus growth is gradual and lasts until post-puberty. However, the influence of biomechanical stimuli, such as orthodontic treatment, on frontal sinus development after the growth period has ended remains unclear. This study was designed to elucidate the impact of orthodontic treatment on the frontal sinus morphology of adult females. Sixty women were included and divided into three groups, based on the Frankfort mandibular plane angle. All participants underwent computed tomography and lateral cephalometry before and after treatment. Although two participants exhibited frontal sinus agenesis, most exhibited a bilaterally symmetric frontal sinus without fusion. The frontal sinus width and height were almost similar, irrespective of the vertical skeletal pattern, where the frontal sinus depth was significantly larger in the average mandibular plane angle group than in the low- and high-angle groups. Furthermore, the sinus volume in the low-angle group was likely smaller than that in the average and high-angle groups. On comparing pre-treatment and post-treatment measurements, minimal or no changes to the frontal sinus dimension were detected after treatment. In conclusion, orthodontic treatment did not affect frontal sinus development after the end of growth.

Age- and gender-related radiological changes of the cervical spine: A study with largest magnetic resonance imaging database of 5672 consecutive patients

Background

The morphological features of the cervical spine are an essential issue. This retrospective study aimed to investigate the structural and radiological changes in the cervical spine.

Materials and Methods

A total of 250 patients with neck pain but no apparent cervical pathology were selected from a database of 5672 consecutive patients undergoing magnetic resonance imaging (MRI). MRIs were directly examined for cervical disc degeneration. These include Pfirrmann grade (Pg/C), cervical lordosis angle (A/CL), Atlantodental distance (ADD), the thickness of transverse ligament (T/TL), and position of cerebellar tonsils (P/CT). The measurements were taken at the positions of T1- and T2-weighted sagittal and axial MRIs. To evaluate the results, patients were divided into seven age groups (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70, and over).

Results

In terms of ADD (mm), T/TL (mm), and P/CT (mm), there was no significant difference among age groups (P > 0.05). However, in terms of A/CL (degree) values, a statistically significant difference was observed among age groups (P < 0.05).

Conclusions

Intervertebral disc degeneration was more severe in males than in females as age increased. For both genders, cervical lordosis, decreased significantly as age increased. T/TL, ADD, and P/CT did not significantly differ with age. The present study indicates that structural and radiological changes are possible reasons for cervical pain at advanced ages.

Volumetric Assessment of the Frontal Sinus in Female Adolescents and Its Relationship with Craniofacial Morphology and Orthodontic Treatment: A Pilot Study

The present study aimed to evaluate the correlation between frontal sinus morphology and craniofacial morphology, and to investigate the effects of orthodontic treatment on the development of the frontal sinus in female adolescents (mean age: 13.9 ± 1.3 years). In total, 53 patients were recruited and underwent cephalography and computed tomography before and after orthodontic treatment. Of these patients, most had a bilaterally symmetrical fan-shaped frontal sinus without any fusion. The average size and volume of the frontal sinus before orthodontic treatment were 45.8 ± 12.3 mm in breadth, 29.8 ± 7.3 mm in height, 22.7 ± 5.1 mm in depth, and 5151.6 ± 2711.4 mm² in volume. Sinus volume in patients with skeletal Class III malocclusion tended to be larger than that in patients with skeletal Class I and II malocclusion. Upon comparison with the pretreatment measurements, the sizes and volumes of the frontal sinus were significantly larger following orthodontic treatment, regardless of the skeletal pattern; however, since these changes were small, the increases in the size and volume of the frontal sinus may have been caused by pubertal growth and not orthodontic treatment. The clinical relevance of the frontal sinus remains controversial.

Introducing a new possible predisposing risk factor for odontoid type 2 fractures after cervical trauma; Ponticulus posticus anomaly of C1 vertebra

OBJECTIVE

Ponticulus posticus is an anomaly of the atlas. Odontoid fracture type 2 fracture occurs by hyperflexion, hyperextension, lateral flexion, and a combination of these movements. The presence of Ponticulus Posticus anomaly may affect the occurrence of odontoid fractures of the C2 vertebra. In this study, the relationship between the presence of PP anomaly and occurring of the odontoid type 2 fracture was investigated.

PATIENTS AND METHODS

Cervical CTs of a total of 14 patients with odontoid type 2 fracture were retrospectively evaluated for PP, and compared with 13 patients with cervical trauma without odontoid type 2 fracture.

RESULTS

Ponticulus posticus anomaly was noted in 7 of 14 patients with odontoid type 2 fractures on the upper cervical CT; therefore, the prevalence was 50.%, but only 3 cases (23.07%) were seen in 13 patients of the control group. In binominal regression analysis showed that the presence of PP anomaly increases 12,075 times to occur odontoid type 2 fracture after cervical trauma.

CONCLUSION

Ponticulus posticus is often not recognized, but this study shows that ponticulus posticus is a risk factor for odontoid type 2 fracture after cervical trauma.

First histopathological bridging of the distance between Onuf's nucleus and substantia nigra after olfactory bulbectomy-new ideas about the urinary dysfunction in cerebral neurodegenerative disease: an experimental study

OBJECTIVES

Olfactory bulbectomy (OBX) in experimental studies induces neurochemical, neurodegenerative changes in various parts of the body. But no information is available about how OBX affects the spinal cord in rats. Our study aims to investigate this question.

METHODS

Twenty-eight male rats were used. The rats were divided into three groups: six as the control, six as the SHAM, and 16 as the study group in which OBX was performed. The animals were followed for 10 weeks. After decapitation of the animals, olfactory bulb (OB) volumes, the olfactory glomerulus (OG), and the neuron density of the ON (Onuf nucleus) per cubic centimeter at the L4-S4 level were examined histopathologically and analyzed stereologically.

RESULTS

The mean OB volume, remaining normal OG density, and degenerated neuron density (DND) of the ON was measured as 4.32 ± 0.21/mm³ , 1842 ± 114/mm³ , and 4 ± 1 /mm³ in the control (group I); 3.3 ± 0.14/mm³ , 1321 ± 114/mm³ , and 43 ± 8/mm³ in the SHAM (group II); and 1.672 ± 0.12/mm³ , 852 ± 93/mm³ , and 154 ± 11/mm³ in the study group (group III). There was a statistically significant difference between the SHAM and the study group (P < .05).

CONCLUSIONS

In this study, histopathological bridging between ON-related lower urinary tract symptoms (LUTS) and OBX was shown the first time. According to the findings, LUTS may be reversed by the protection of the affected spinal cord through the correction of olfaction impairment in neurodegenerative disease.