Cervical vertebral maturation method: growth timing versus growth amount

Brown-Séquard syndrome caused by multiple knife trauma gunshot with late debridement: Two cases report and literature review

INTRODUCTION AND IMPORTANCE

Brown-Séquard syndrome (BSS) is a rare syndrome consequence of interruption in the spinal cord following traumatic or non-traumatic injuries. Although, based on the previous literature, BSS has a good prognosis, some reports do not complete recovery following BSS.

CASES PRESENTATION

In this current survey, we present two aggressive BSSs with complete recovery. One case involved a man aged 23 years without any underlying disease with multiple traumas with a knife who was transferred to the level 1 trauma center knife. Case two was a man 36 years with a gun shutting in C6 level.

CLINICAL DISCUSSION

C5 total laminectomy and C4 and C6 partial laminectomy were done due to the sharp knife. Three months later, the patient achieved full recovery. After C6 total laminectomy in case 2, the patient was discharged without defect.

CONCLUSION

Incomplete spinal cord injuries are challenging to diagnose and treat. Due to esophageal rupture and late debridement, full recovery was not expected. Despite neurological impairments, full recovery was achieved over three months in two cases. Also, many factors can aggravate the initial trauma in gunshot spine injury patients.

Interceptive Dentofacial Orthopedics (Growth Modification)

Although all dentofacial deformities involve deviation of skeletal and dental units that require correction, the timing and method of treatment can vary considerably. Growth is a key consideration when managing dentofacial deformities, because it has a direct impact on the timing and method of management. Some deformities may be intercepted and managed during growth, whereas others can only be definitively managed after cessation of growth. This article focuses on clinical considerations of growth in managing dentofacial deformities, and discusses methods of growth evaluation and interceptive orthodontic management strategies in different types of dentofacial deformities.

Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion.

Facial soft tissue changes during the pre-pubertal and pubertal growth phase: a mixed longitudinal laser-scanning study

BACKGROUND/OBJECTIVES

Facial soft tissues changes during growth roughly tend to mimic the underlying hard tissues, but not completely. The aim of this mixed longitudinal study was to assess facial growth among pre-pubertal and pubertal subjects without malocclusion using a non-invasive three-dimensional laser scanning system.

SUBJECTS/METHODS

Fifty-nine subjects (30 females and 29 males) aged at baseline 5.4-8.9 years with normal occlusion were clustered into the younger, older pre-pubertal, and pubertal groups according to age and the absence/presence of a standing height growth spurt. Three-dimensional facial images were obtained using laser scanners for five consecutive years. Several transversal, sagittal, and vertical parameters were assessed for between and within group comparisons.

RESULTS

Significant overall changes of almost all parameters were seen within each group (P < 0.05) without any group differences (P > 0.05). The younger pre-pubertal group showed greater annual growth rates of lip prominence; both pre-pubertal groups showed greater rates in facial middle third height. The pubertal group showed greater annual rates in facial profile angle changes during the growth peak.

LIMITATIONS

A high standing height increment (7cm) was used as the threshold for subject allocation in the pubertal group.

CONCLUSIONS

Soft tissue facial growth has generally similar amounts and rates irrespective of the pubertal growth spurt. Pre-pubertal subjects show greater annual rates of facial middle third height changes while pubertal subjects show greater annual rates of chin protrusion.

Ultrasonographic localization of the thyroid gland for its optimal shielding prior to lateral cephalometric radiography: a pilot study

OBJECTIVES

Lateral cephalometric radiography is a common radiographic examination technique in children. The exclusion of the thyroid gland from the primary X-ray beam is important especially with children. However, patient treatment might require displaying the four most cranial cervical vertebrae (C1-C4) for the assessment of cervical vertebral maturation. Our aim was to present a safe way to display C1-C4 and exclude the thyroid gland from the X-ray beam during lateral cephalometric radiography.

METHODS

The thyroid glands of 25, 7- to 12-year-old patients were localized by ultrasound examination and shielded prior to lateral cephalometric radiography. A roentgen-positive mark was taped on the patient's skin at the level of most cranial level of the thyroid gland in the midsagittal plane. After exposure, each lateral cephalometric radiograph (LCR) was analyzed for the visibility of the cervical vertebrae. The distance between the ear post and the highest edge of the thyroid shield (TS) at the lateral part of the neck was measured and compared with the distance between the centre of the radiological external auditory meatus, and a roentgen-positive mark was made on the LCR.

RESULTS

68% of the LCRs displayed C1-C4, and the rest of them displayed C1-C3. In all of the patients, the highest edge of the TS in the lateral parts of the neck was located in a higher position than the actual most cranial level of the thyroid gland.

CONCLUSIONS

Despite localizing the thyroid gland prior to lateral cephalometric radiography, simultaneous visualization of C1-C4 and exclusion of the thyroid gland from the primary X-ray beam during lateral cephalometric radiography might not be completely possible in children because of the design and poor fitness of the TS.