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Wiechens B, Klenke D, Quast A, Santander P, Skorna I, Meyer-Marcotty P. Radiodiagnostics of standard orthodontic radiographs-dental and extradental incidental findings : Do we see everything we should see? J Orofac Orthop 2024; 85:1-11. [PMID: 37401944 PMCID: PMC11371876 DOI: 10.1007/s00056-023-00483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The extent of undetected incidental findings in routine orthodontic radiographs is still unknown. However, incidental findings that are not in the primary focus of orthodontic diagnostics may be of high medical relevance. Therefore, this study aimed to analyse whether incidental findings are reliably detected and which parameters influence the orthodontist's assessment. METHODS In a clinical cross-sectional study 134 orthodontists evaluated two orthopantomogram (OPT) and two lateral cephalogram (LC) radiographs each via a standardised online survey. The radiographs were previously examined by three dentists and one radiologist-in a pilot phase-regarding the number of incidental findings and subsequently defining as gold standard in a consensus procedure. The radiographs were presented consecutively, the number of incidental findings detected were noted and the individual findings could be described in free text form. RESULTS Overall, 39.1% of the incidental findings were detected. The orthodontists' focus was primarily on the dental region. Here, 57.9% of incidental findings were detected, while 20.3% were detected in extradental regions (p < 0.001). A highly relevant finding of suspected arteriosclerotic plaque was detected in 7.5% of cases (OPT). Significantly more incidental findings were detected on OPTs than on LCs (OPT 42.1%, LC 36.0%, p < 0.001). As participants' length of professional experience increased, significantly more time was spent on the assessment (p < 0.001), correlating positively with the detection of incidental findings. CONCLUSIONS Even in daily routine practice, attention must be paid to a thorough assessment of all radiographed regions. The factors time and professional experience can prevent practitioners from overlooking findings outside the orthodontic focus.
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Affiliation(s)
- Bernhard Wiechens
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Daniela Klenke
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Petra Santander
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Ida Skorna
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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Alhazmi DM, Shi W, Allareddy V, Anamali S, Allareddy TV, Rengasamy Venugopalan S. A cone beam computed tomographic analysis of cervical vertebral nonsegmentation. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:67-72. [PMID: 37635010 DOI: 10.1016/j.oooo.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Using cone beam computed tomography (CBCT), this study aimed to investigate the radiologic features of cervical vertebral nonsegmentation (CVN) in patients with no known syndromes or pathoses. STUDY DESIGN In this retrospective study, we examined CBCT scans of patients with CVN for the following parameters: type of nonsegmentation (partial or complete); laterality of partial nonsegmentation; level of vertebrae affected in nonsegmentation; anatomic parts of the vertebrae involved; and the presence or absence of degenerative joint disease (DJD). RESULTS From the structured reports of 13,458 CBCT scans, we found 110 CBCT scans (0.82%) with CVN. Of this total, 77.3% were partial and 22.7% were complete. Most were located at the level of the C2 and C3 vertebrae. The transverse process alone and the transverse process and body were most frequently involved in partial CVN, whereas most complete types occurred in the transverse process and body. Degenerative joint disease was present in 45.9% of partial CVN (clearly distinguishable from nonsegmentation in 36.5%) and 20% of complete CVN, with all cases clearly distinguishable. CONCLUSIONS Cervical vertebral nonsegmentation has a low prevalence. It is mostly partial, occurs most commonly in C2-C3, and usually involves the transverse process and body. Identification of CVN on CBCT images is important because this condition can lead to DJD in older age and may increase the risk for muscle weakness, head and neck pain, limited movement, and neurologic complications.
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Affiliation(s)
- Daniah M Alhazmi
- University of Iowa College of Dentistry; Department of Oral Pathology, Radiology and Medicine; Iowa City, IA, USA; Oral Diagnostic Sciences Department, Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wei Shi
- University of Iowa College of Dentistry, Iowa Institute for Oral Health Research, Iowa City, IA, USA
| | | | - Sindhura Anamali
- University of Iowa College of Dentistry; Department of Oral Pathology, Radiology and Medicine; Iowa City, IA, USA
| | - Trishul V Allareddy
- University of Iowa College of Dentistry; Department of Oral Pathology, Radiology and Medicine; Iowa City, IA, USA.
| | - Shankar Rengasamy Venugopalan
- University of Iowa, College of Dentistry, Department of Orthodontics, Iowa City, IA, USA; Tufts University School of Dental Medicine, Department of Orthodontics, Boston, MA, USA.
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Klenke D, Santander P, Vehring C, Quast A, Sommerlath Sohns J, Krohn S, Meyer-Marcotty P. Prevalence of incidental findings in adult vs. adolescent patients in the course of orthodontic X-ray diagnostics. J Orofac Orthop 2023; 84:298-310. [PMID: 35585297 PMCID: PMC10462506 DOI: 10.1007/s00056-022-00399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Due to increasing numbers of adult patients presenting to orthodontic practices, an increase in incidental findings on diagnostic X‑rays, which are the cornerstone of orthodontic diagnostics, is expected. This raises the clinically relevant question of whether an age effect exists regarding prevalence, localisation and severity of incidental findings on orthodontic diagnostic X‑rays. MATERIALS AND METHODS The clinical, primarily retrospective study examined pathological incidental findings from 600 orthopantomograms (OPT) and lateral cephalogram (LC) images in two groups of orthodontic patients (group I: 150 children/adolescents, age 11.89 ± 2.47 years; group II: 150 adults, age 27.03 ± 10.42 years). Prevalence, localisation and severity of the findings were recorded based on a classification sheet. The assessment was done by three experienced examiners following a systematic approach along the nine locations: mandible, maxilla, dentition, paranasal sinuses, temporomandibular joint, cranial base, orbit, cervical spine, soft tissues. RESULTS In all, 1458 incidental findings were detected, with 66% of the findings having occurred away from the dentition. There was a significant age effect (p < 0.001) with respect to the prevalence of incidental findings (group II-adults 1026 findings-OPT: 566/LC 460 vs. group I-children/adolescents 432 findings-OPT: 221/LC 211). Regarding localisation, incidental findings in adults commonly occurred in the dentition, paranasal sinuses and mandibular regions. Furthermore, analysis of the LC images revealed significantly more incidental findings in the area of the cranial base and cervical spine in adults (p < 0.001, p = 0.003). Categorisation according to the severity of the incidental findings showed that 33% of the incidental findings needed further diagnostic investigation and possibly treatment by other specialities. CONCLUSION Diagnostic assessment using orthodontic diagnostic X‑rays results in a high prevalence of incidental findings away from the dentition. Particularly in adults, a large number of incidental findings outside the dental/alveolar region may be expected on orthodontic diagnostic X‑rays. Thus, a structured approach during diagnostic assessment is required to minimise the extent to which incidental findings of clinical relevance are overlooked.
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Affiliation(s)
- Daniela Klenke
- Department of Orthodontics, University Medical Centre Göttingen, Göttingen, Germany.
| | - Petra Santander
- Department of Orthodontics, University Medical Centre Göttingen, Göttingen, Germany
| | - Charlotte Vehring
- Department of Orthodontics, University Medical Centre Göttingen, Göttingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Sebastian Krohn
- Department of Prosthodontics, University Medical Centre Göttingen, Göttingen, Germany
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Hlongwa P, Moshaoa MAL, Musemwa C, Khammissa RAG. Incidental Pathologic Findings from Orthodontic Pretreatment Panoramic Radiographs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3479. [PMID: 36834172 PMCID: PMC9966392 DOI: 10.3390/ijerph20043479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Panoramic radiography is frequently performed for new patients, follow-ups and treatment in progress. This enables dental clinicians to detect pathology, view important structures, and assess developing teeth. The objective of the study was to determine prevalence of incidental pathologic findings (IPFs) from orthodontic pretreatment panoramic radiographs at a university dental hospital. A retrospective cross-sectional review was conducted of pretreatment panoramic radiographs, using data collection sheets with predefined criteria. Demographic data and abnormalities (impacted teeth, widening of periodontal ligament, pulp stones, rotated teeth, missing teeth, unerupted teeth, crowding, spacing, supernumerary teeth, and retained deciduous teeth) were reviewed. SPSS 28.0 was used to analyze data with statistical tests set at a 5% significance level. Results: One hundred panoramic radiographs were analyzed with an age range of 7 to 57 years. The prevalence of IPFs was 38%. A total of 47 IPFs were detected with altered tooth morphology predominantly (n = 17). Most IPFs occurred in males (55.3%), with 44.7% in females. A total of 49.2% were in the maxilla and 50.8% in the mandible. This difference was statistically significant (p < 0.0475). Other abnormalities were detected in 76% of panoramic radiographs; 33 with IPFs and 43 without. A total of 134 other abnormalities detected showed predominantly impacted teeth (n = 49). Most of these abnormalities were in females (n = 77). Conclusions: The prevalence of IPFs was 38%, predominated by altered tooth morphology, idiopathic osteosclerosis, and periapical inflammatory lesions. Detection of IPFs from panoramic radiographs underscored the importance for clinicians to examine them for comprehensive diagnosis and treatment planning, especially in orthodontics.
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Affiliation(s)
- Phumzile Hlongwa
- Department of Orthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Mpule Annah Lerato Moshaoa
- Department of Orthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Charity Musemwa
- Department of Orthodontics, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - Razia Abdool Gafaar Khammissa
- Department of Periodontology and Oral Medicine, School of Dentistry, Faculty of Health Science, University of Pretoria, Pretoria 0001, South Africa
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Subbaramaiah M, Archana R, Jagannatha SR. A case series of synostosis/blocks observed in Indian human vertebra: Clinical and developmental perspective. NATIONAL JOURNAL OF CLINICAL ANATOMY 2023. [DOI: 10.4103/njca.njca_231_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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MacDonald D, Patel A, Zou B, Yen E, Vora SR. A retrospective study of incidental findings occurring in a consecutive case series of lateral cephalograms of 12- to 20-year-old patients referred for routine orthodontic treatment. Imaging Sci Dent 2022; 52:295-302. [PMID: 36238700 PMCID: PMC9530292 DOI: 10.5624/isd.20220402] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Lateral cephalograms of orthodontic patients may contain incidental findings that could potentially lead to harm. Materials and Methods The lateral cephalograms of 1765 consecutive 12- to 20-year-old patients, being considered for routine orthodontic treatment, were retrospectively reviewed. These patients were considered normal, because no abnormalities were found either in their medical history or on their clinical examination. Results The overall prevalence of incidental findings was 18.8%, of which 10.3% were ponticulus posticus and 4.2% were bridging of the sella turcica. Although occipital spurs and ponticulus posticus were more prevalent in males, the size of the sella turcicas did not differ between sexes. Of the 1156 patients completing treatment about 2 years later, only one lateral cephalogram displayed progression of the ponticulus posticus in that time. Conclusion The prevalence of incidental findings on lateral cephalograms of otherwise normal orthodontic 12- to 20-year-old patients was almost a fifth, of which ponticulus posticus, vertebral fusion, and enlarged parietal foramina were clinically significant.
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Affiliation(s)
- David MacDonald
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Akash Patel
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bingshuang Zou
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edwin Yen
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siddharth R. Vora
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Are Congenital Cervical Block Vertebrae a Risk Factor for Adjacent Segment Disease? A Retrospective Cross-Sectional CT and MR Imaging Study. Diagnostics (Basel) 2021; 12:diagnostics12010090. [PMID: 35054258 PMCID: PMC8774787 DOI: 10.3390/diagnostics12010090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Adjacent segment disease (ASDI) is a well-described complication of spinal fusion surgery that may ultimately lead to spinal stenosis and repeated surgical intervention. Although congenital block vertebrae also present with degenerative changes in the adjacent segments, this has not yet been systematically investigated. The aim of this study was to assess the presence and degree of ASDI in congenital cervical block vertebrae. Methods: A total of 51 patients with congenital vertebral fusion in one cervical segment were analysed in this IRB-approved retrospective cross-sectional study using available CT/MR imaging. Exclusion criteria were prior spinal surgery and the presence of additional hereditary abnormalities. We assessed the severity of degenerative changes using a sum score. The sum score for adjacent and non-adjacent segments was then divided by the highest possible degeneration score, which resulted in a ratio of severity for adjacent and remaining segments (ranging from 0 to 1). Results: Overall, 35 of 51 patients (68.6%) showed evidence of ASDI, and 34 of 51 patients (66.7%) also showed degenerative changes in the remaining segments. The severity score was significantly higher (p = 0.025) in the segments adjacent to the congenital block vertebrae (mean value 0.307) compared to the non-adjacent segments (mean value 0.188). Conclusions: Our results suggest that ASDI is also caused by congenital block vertebrae of the cervical spine.
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Kawanishi M, Ito Y, Tanaka H, Yokoyama K, Yamada M, Sugie A. Resolution of retro-odontoid cyst in a patient with atlanto-occipital assimilation after occipitocervical fixation. Surg Neurol Int 2021; 12:34. [PMID: 33598350 PMCID: PMC7881517 DOI: 10.25259/sni_688_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Fusion of the atlas with the lower part of the occiput is clinically known as atlanto-occipital assimilation (AOA) or atlas occipitalization. This can be either partial or complete depending on the extent of fusion. AOA is one of the most common congenital anomalies of the craniovertebral junction and is usually asymptomatic. Case Description: An 80-year-old female presented with a retro-odontoid cyst in conjunction with AOA. Following posterior occipitocervical fixation without resection of the cyst, the patient improved, and the postoperative MR documented cyst resolution. Conclusion: Patients with AOA and a retro-odontoid cyst may be successfully managed with occipitocervical fixation without resection of the cyst. However, we would recommend preoperative computed tomography angiography to document whether the vertebral artery follows an anomalous course to avoid an intraoperative neurovascular injury.
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Affiliation(s)
- Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, Fushimiku, Kyoto, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Fushimiku, Kyoto, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Fushimiku, Kyoto, Japan
| | - Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimiku, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Fushimiku, Kyoto, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, Fushimiku, Kyoto, Japan
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Morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces. Surg Radiol Anat 2020; 43:865-872. [PMID: 33128647 DOI: 10.1007/s00276-020-02599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The prolonged change in the head posture alters the morphological characteristics of cervical vertebrae. The difference in the head posture among subjects with short, normal, and long anterior facial heights might have a significant influence on the morphological characteristics of cervical vertebrae. Thus, the present study was conducted to evaluate the morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces. METHODS Based on Frankfort mandibular plane angle (FMA) on lateral cephalograms, 135 subjects were equally divided into three groups, i.e. Group I [Short face], II [Normal face], and III [Long face]. The angular variables like Atlas-dens angle (ADA), Pars interarticularis-dens angle (PDA), Pars interarticularis-vertebrae angle of C3 vertebrae (PVA3), Pars interarticularis-vertebrae angle of C4 vertebrae (PVA4), Lamina-Pars interarticularis angle of C2 vertebrae (LP2), Lamina-Pars interarticularis angle of C3 vertebrae (LP3), and Lamina-Pars interarticularis angle of C4 vertebrae (LP4) in the first four cervical vertebrae were measured, analyzed, and compared. Descriptive statistics, analysis of variance, Bonferroni, and Pearson's correlation coefficient tests were used. The P value of 0.05 was considered as the level of significance. RESULTS All parameters except PDA and PVA3 were comparable among the groups. The PDA was 54.350 ± 1.870, 57.890 ± 1.550, and 60.290 ± 2.830 in Group I, II, and III, respectively; these differences were statistically significant [P < 0.001]. The PVA3 was 42.700 ± 5.640 in Group I, 45.850 ± 3.820 in Group II, and 45.590 ± 5.530 in Group III subjects that were also statistically significant [P < 0.01]. A fairly strong positive correlation was observed between FMA and PDA. CONCLUSION A significant difference was found in the PDA among subjects with short, normal, and long faces. The vertical height of the face had a strong correlation with the morphology of axis vertebra.
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Anusuya V, Sharan J, Jena AK. A study of cervical vertebra anomalies among individuals with different sagittal and vertical facial growth patterns. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:75-80. [PMID: 32904940 PMCID: PMC7462128 DOI: 10.4103/jcvjs.jcvjs_51_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective was to evaluate the prevalence of cervical vertebra anomalies (CVA) in individuals with different sagittal and vertical skeletal growth patterns of jaws and also to establish the associations of anomalies with the type of growth, if any. Materials and Methods: A total of 293 lateral cephalograms were evaluated for CVA. Based on the Frankfort mandibular plane angle, cephalograms were categorized into three groups: Group I, II, and III. Based on the ANB angle, cephalograms were classified into three classes, Class 1, 2, and 3. Six types of CVA such as partial cleft (PC), block fusion (BF), dehiscence (D), fusion between C2 and C3 (F23), occipitalization (OC), and spina bifida (SB) were identified on lateral cephalograms. Descriptive statistics were applied along with multinomial logistic regression analysis. P = 0.05 was considered as the level of statistical significance. Results: PC was most common in the overall samples (36%). BF was the least common (3.2%) CVA. The frequency of various CVA was comparable between males and females in all the three classes of individuals. The association of vertical growth patterns with CVA was found to be statistically nonsignificant (P > 0.05). Class 2 malocclusion was found to be statistically significantly associated with the D (P = 0.043). Conclusions: PC, fusion, and D were the most frequently found CVA, and SB was found only among the hypodivergent growth pattern individuals. The association of CVA with vertical facial growth patterns was not significant, somewhat influenced by age, sex, and sagittal skeletal malocclusions.
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Affiliation(s)
| | - Jitendra Sharan
- Department of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashok Kumar Jena
- Department of Dentistry, Central Sterile Services Department, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Traumatic Craniocervical Dissociation in Patients with Congenital Assimilation of the Atlas to the Occiput. Case Rep Orthop 2020; 2019:2617379. [PMID: 31934479 PMCID: PMC6942727 DOI: 10.1155/2019/2617379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
Traumatic atlantooccipital dissociation (AOD) is a severe and usually fatal injury. Patients with assimilation of the atlas to the skull are exposed to a higher risk of injury and delay diagnosis due to the abnormal anatomy. We report two cases of acute traumatic craniocervical dislocation in patients with baseline congenital assimilation of the atlas to the skull. Computer tomography (CT) was used to identify the injury. Computer tomography angiography (CTA) showed variations of the vertebral arteries' location on both patients. Assimilation of the atlas was complete in patient one and partial in patient two. Emergent surgical instrumentation and fusion were performed with a very careful and meticulous posterior dissection. As general rule, most of the patients with CCD will undergo occiput to C2 posterior segmental instrumentation and fusion. In the presented cases, a more extensive fusion was necessary based on the type and severity of the CCJ injury and the anatomical anomalies associated. Postoperatively, patient one remained neurologically intact and patient two died. Alternative fixation techniques should be used to minimize risk of VA injury during the surgical procedures.
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12
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Goel S, Neshar A, Chhabra H. A rare case of surgically managed multiple congenital thoraco-lumbar and lumbar block vertebrae with kypho-scoliosis and adjacent segment disease with myelopathy in a young female. J Clin Orthop Trauma 2020; 11:291-294. [PMID: 32099296 PMCID: PMC7026526 DOI: 10.1016/j.jcot.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 10/27/2022] Open
Abstract
Spinal block vertebrae is a rare condition reported in 0.25% of South Asian population. This condition may not only result in deformity of lower back but also alter the bio-mechanics of spine leading to adjacent level degeneration and spinal canal stenosis. There is little literature evidence on surgical management of such a condition. Here we report a case of multiple congenital thoraco-lumbar and lumbar block vertebrae with lumbar kypho-scoliosis, adjacent segment disease and myelopathy in a young Asian female. She was operated with minimal possible instrumentation and decompression. Patient is pain free now and is able to walk without support, one year following the primary treatment.
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Affiliation(s)
- ShaktiA. Goel
- Orthopaedic Spine Surgeon and Researcher, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, 110070, India
| | - AnsariMD. Neshar
- Spine Fellow, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, 110070, India
| | - H.S. Chhabra
- Medical Director and Chief of Spine Services, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, 110070, India,Corresponding author.
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Paraskevas GK, Noussios G, Koutsouflianiotis KN, Iliou K. Congenital Synostosis of Cervical Vertebrae: An Osteological Study and Review of the Literature. Cureus 2019; 11:e6015. [PMID: 31815079 PMCID: PMC6881090 DOI: 10.7759/cureus.6015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction The possible appearance of congenital fusion of the second cervical vertebra with adjacent cervical vertebrae, along with its epidemiology, embryological development, and clinical manifestations, was the aim of the current study. Methods The osteological material of 93 dried second cervical vertebrae of both sexes were examined in order to identify the likely presence of congenital fusion with the neighboring vertebrae. Results Among 93 axes, we identified one case of a congenitally fused second cervical vertebrae with the third and fourth cervical vertebrae, which accounted for a frequency of 1.08%. There was an incomplete fusion of the vertebral bodies and almost complete fusion of the laminae and facet joints. Conclusion The knowledge of such rare vertebral synostosis is crucial for the neurosurgeon, orthopedist, and physician dealing with the cervical spine, as well as the anesthetist when performing procedures, such as endotracheal intubation.
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Affiliation(s)
| | - George Noussios
- Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | - Kalliopi Iliou
- Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, GRC
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14
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Fida M, Tahir Kamal A. Authors' response. Am J Orthod Dentofacial Orthop 2019; 156:439-440. [PMID: 31582113 DOI: 10.1016/j.ajodo.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022]
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N V A, Avinash M, K S S, Shetty AP, Kanna RM, Rajasekaran S. Congenital Osseous Anomalies of the Cervical Spine: Occurrence, Morphological Characteristics, Embryological Basis and Clinical Significance: A Computed Tomography Based Study. Asian Spine J 2019; 13:535-543. [PMID: 30866614 PMCID: PMC6680038 DOI: 10.31616/asj.2018.0260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/14/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Observational retrospective computed tomography (CT) based study. Purpose To analyze the congenital anomalies of the cervical spine, their morphological variations and their clinical significance. Overview of Literature Studies published to date have focused mainly on upper cervical anomalies; no study has comprehensively reported on anomalies of both the occipitocervical and subaxial cervical spine. Methods Nine hundred and thirty cervical spine CT scans performed in Ganga Hospital, Coimbatore, India between January 2014 and November 2017 were screened by two independent observers to document anomalies of both the upper and lower cervical spine. CT scans conducted for infection, tumor, and/or deformity were excluded. Different morphological variations, embryological basis, and clinical significance of the anomalies were discussed. Results Of the 930 CT scans screened, 308 (33.1%) had congenital anomaly. Of these, 184 (59.7%) were males and 124 (40.2.7%) were females, with a mean age of 44.2 years (range, 14-78 years). A total of 377 anomalies were identified, with 69 cases (7.4%) having more than one anomaly. Two hundred and fifty (26.8%) anomalies of the upper cervical region (occiput to C2-C3 disk space) were identified, with the most common upper cervical anomalies being high-riding vertebral artery (108 cases, 11.6%) and ponticulus posticus (PP) (75 cases, 8%). One hundred and twenty seven (13.6%) anomalies of the lower cervical spine (C3-C7) were noted, of which double foramen transversarium was the most common anomaly observed in 46 cases (4.8%). Conclusions We found that 33.1% of CT scans had at least one congenital anomaly. Some anomalies, such as abnormal facet complex and arch anomalies, have to be differentiated from fractures in a trauma patient. Other anomalies, like PP, have to be looked for during preoperative planning to avoid complications during surgery. Therefore, knowledge of these anomalies is important as different anomalies have different clinical courses and management.
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Affiliation(s)
- Ankith N V
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - M Avinash
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Srivijayanand K S
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
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Kharbanda OP, Qureshi T, Kandasamy D. Prevalence of cervical vertebrae anomalies in patients with cleft lip and palate. AUSTRALASIAN ORTHODONTIC JOURNAL 2019. [DOI: 10.21307/aoj-2020-032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Abstract
Objective
To investigate the prevalence of cervical vertebral anomalies (CVA) in a group of patients presenting with cleft lip and palate (CLP) and to compare with a non-cleft population.
Material and methods
The sample comprised of 150 lateral cephalograms of non-syndromic patients with CLP and 150 non-cleft age-matched controls. The age range of both groups covered 6 to 20 years. An expert radiologist blinded to the cleft status evaluated the cephalograms for CVA and categorised them into normal, fusion, dehiscence and multiple cervical anomalies. The cleft group was subdivided according to the types of cleft (UCLP/ BCLP/ CPO) and gender (male/female). The CVA prevalence was compared between the cleft and non-cleft patients.
Results
The prevalence of CVA was 37.7% and 20.7% in cleft and non-cleft patients, respectively. The difference was statistically significant with a p-value <0.01. Of the types of clefts, a left UCLP had the highest prevalence of CVA (47.2%), with fusion (35.8%) most commonly seen. On comparing CLP with CPO, no significant variation was observed between the types of anomalies.
Conclusions
A high prevalence of CVA was observed in cleft patients compared with non-cleft subjects. The prevalence of CVA was similar between males and females. The practitioner should carefully evaluate the lateral cephalogram of CLP patients for CVA, which otherwise may remain undetected and lead to neurological symptoms later in life.
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Affiliation(s)
- Om Prakash Kharbanda
- * Centre for Dental Education and Research , All India Institute of Medical Sciences , New Delhi , India
- † Division of Orthodontics and Dentofacial Deformities , All India Institute of Medical Sciences , New Delhi , India
| | - Tabassum Qureshi
- † Division of Orthodontics and Dentofacial Deformities , All India Institute of Medical Sciences , New Delhi , India
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Sharma DK, Sharma D, Sharma V. Atlantooccipital Fusion: Prevalence and its Developmental and Clinical Correlation. J Clin Diagn Res 2017; 11:AC01-AC03. [PMID: 28764139 DOI: 10.7860/jcdr/2017/26183.9999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atlantooccipital fusion or occipitalization of atlas or assimilation of atlas is a rare or uncommon abnormality recorded in anatomical, morphological and radiological studies. It is usually associated with reduction in dimensions of foramen magnum leading to acute or chronic neurovascular compression and clinical manifestations of varying severity. Though, atlantooccipital fusion is rare but it is important and significant for the physicians and surgeons for their diagnostic and therapeutic approach. AIM To know the prevalence of atlantooccipital fusion in South Asian population predominantly in Central India and its embryological and clinical correlation by reviewing literature and earlier studies. MATERIALS AND METHODS This study included careful examination for the atlantooccipital fusion on total 192 human skulls of both genders, available in the Department of Anatomy AIIMS Raipur, Chhattisgarh, India, Department of Anatomy and Forensic Medicine of Gandhi Medical Colledge, Bhopal, Madhya Pradesh, India and Pt. Jawahar Lal Nehru Memorial Medical College, Raipur. Morphometric measurements of the abnormal skulls were done, analysed and recorded. Observations and findings of this study were correlated embryologically and clinically with the results and claims of previous studies and literature, and accordingly the conclusions were drawn. RESULTS We found only two skulls with atlantooccipital fusion, in overall study of 192 skulls. The first skull showed incomplete atlantooccipital fusion on the left side with little right lateral inclination and missing posterior tubercle/spinous process and adjoining part of posterior arch of atlas, whereas the second skull showed complete atlantooccipital fusion. CONCLUSION We conclude that the prevalence of atlantooccipital fusion including complete and incomplete fusion was 1.04%, which is higher than the proclaimed prevalence rate of 0.12% to 0.72%, by the previous studies. In accordance with the fact that the atlantooccipital fusion represents a synostosis between the atlas and the occipital bone due to developmental abnormal segmentation of cranial part of paraxial mesoderm and abnormal fusion between segments of caudal occipital and cranial cervical sclerotomes, we would like to thereby assert that the fusion associated with the reduction in dimensions of foramen magnum (reduction also seen in our study) is definitely significant for diagnostic and therapeutic purposes to clinicians.
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Affiliation(s)
- D K Sharma
- Additional Professor, Department of Anatomy, AIIMS, Raipur, Chhattisgarh, India
| | - Deepak Sharma
- Demonstrator, Department of Anatomy, Gandhi Medical Colledge, Bhopal, Madhya Pradesh, India
| | - Vandana Sharma
- Associate Professor, Department of Anatomy, Gandhi Medical Colledge, Bhopal, Madhya Pradesh, India
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Giri J, Pokharel PR, Gyawali R. How common is ponticulus posticus on lateral cephalograms? BMC Res Notes 2017; 10:172. [PMID: 28454552 PMCID: PMC5410104 DOI: 10.1186/s13104-017-2494-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ponticulus posticus is an anomaly of first cervical vertebra visible on lateral cephalogram and has some serious medical and surgical implications. Unfortunately, it is often overlooked or undetected by orthodontists. The general objective of this study is to sensitize orthodontists about this anomaly by depicting its prevalence among a group of Nepalese orthodontic patients. Methods Four hundred and fourteen digital lateral cephalograms of orthodontic patients were retrieved from the archives of the department. The lateral cephalograms were carefully assessed for the presence of ponticulus posticus in the posterior spine of atlas vertebra by two investigators independently and the findings were recorded. Results Ponticulus posticus was observed in 35.7% of the cases, of which 30.9% had partial ponticulus posticus and 4.8% had complete ponticulus posticus. Even though there was some female predilection, no statistically significant association was found between gender of the patient and presence of ponticulus posticus. Conclusion Ponticulus posticus is a fairly common anomaly with more than one-third (35.7%) of a group of Nepalese orthodontic patients affected and is independent of gender. Since, this anomaly is associated with numerous medical conditions and has surgical implications, orthodontists should use lateral cephalogram as screening radiograph for this anomaly. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2494-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jamal Giri
- Department of Orthodontics, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Prabhat Ranjan Pokharel
- Department of Orthodontics, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajesh Gyawali
- Department of Orthodontics, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Alsufyani NA. Cone beam computed tomography incidental findings of the cervical spine and clivus: retrospective analysis and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e197-e217. [PMID: 28411008 DOI: 10.1016/j.oooo.2017.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to analyze and describe incidental findings in the cervical spine (C-spine) and the clivus encountered in cone beam computed tomography (CBCT) imaging. The wide range of possible anatomic variants and pathoses is discussed in the context of the medical and dental literature to clarify their radiographic appearance and clinical implications as a guide for the oral and maxillofacial radiologist. STUDY DESIGN A retrospective analysis of radiographic reports was conducted based on CBCT images from 2 oral and maxillofacial imaging centers. Reports documenting incidental findings in the C-spine or the clivus were selected. Data on patient age and sex were collected, and each incidental finding was categorized as degenerative, congenital, or developmental/pathologic. Each finding is discussed with clinical importance and is pictorially presented. RESULTS From a total of 7689 CBCT reports, there were 732 incidental findings (9.5%) in the C-spine or the clivus. Most findings were in the C-spine (92.3%), were degenerative in nature (78.7%), and occurred in females in their sixth decade. Logistic regression analysis showed that the odds of presenting with a degenerative incidental finding in the C-spine or the clivus did not differ based on sex but were 5.5 times (95% confidence interval, 3.77-8.04) higher if the patient was aged 50 years or older. CONCLUSIONS This review is the largest and the first to characterize incidental findings in the C-spine and the clivus. Such findings were reported in 9.5% of radiographic reports. Several presented as uncommon congenital variants that are not usually spotlighted during oral and maxillofacial radiology training.
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Affiliation(s)
- Noura A Alsufyani
- Assistant Professor, Oral & Maxillofacial Radiology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada; Assistant Professor, College of Dentistry, King Saud University, Saudi Arabia.
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Sarah Samson R, Varghese E, Kumbargere SN, Chandrappa PR. Fused cervical vertebrae: a coincidental finding in a lateral cephalogram taken for orthodontic diagnostic purposes. BMJ Case Rep 2016; 2016:bcr-2016-217566. [PMID: 27688149 DOI: 10.1136/bcr-2016-217566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Renu Sarah Samson
- Faculty of Dentistry, Department of Orthodontics, Melaka-Manipal Medical College, Bukit Baru, Malaysia
| | - Eby Varghese
- Faculty of Dentistry, Department of Paediatric Dentistry, Melaka-Manipal Medical College, Bukit Baru, Malaysia
| | | | - Pramod Redder Chandrappa
- Department of Oral Pathology and Microbiology, College of Dental Surgery, Davangere, Davangere, Karnataka, India
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Incidental Findings on Cone Beam Computed Tomography Studies outside of the Maxillofacial Skeleton. Int J Dent 2016; 2016:9196503. [PMID: 27462350 PMCID: PMC4947649 DOI: 10.1155/2016/9196503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To define the presence and prevalence of incidental findings in and around the base of skull from large field-of-view CBCT of the maxillofacial region and to determine their clinical importance. Methods. Four hundred consecutive large fields of view CBCT scans viewed from January 1, 2007, to January 1, 2014, were retrospectively evaluated for incidental findings of the cervical vertebrae and surrounding structures. Findings were categorized into cervical vertebrae, intracranial, soft tissue, airway, carotid artery, lymph node, and skull base findings. Results. A total of 653 incidental findings were identified in 309 of the 400 CBCT scans. The most prevalent incidental findings were soft tissue calcifications (29.71%), followed by intracranial calcifications (27.11%), cervical vertebrae (20.06%), airway (11.49%), external carotid artery calcification (10.41%), lymph node calcification (0.77%), subcutaneous tissue calcification and calcified tendonitis of the longus colli muscle (0.3%), and skull base finding (0.15%). A significant portion of the incidental findings (31.24%) required referral, 17.76% required monitoring, and 51% did not require either. Conclusion. A comprehensive review of the CBCT images beyond the region of interest, especially incidental findings in the base of skull, cervical vertebrae, pharyngeal airway, and soft tissue, is necessary to avoid overlooking clinically significant lesions.
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Natsis K, Lyrtzis C, Totlis T, Anastasopoulos N, Piagkou M. A morphometric study of the atlas occipitalization and coexisted congenital anomalies of the vertebrae and posterior cranial fossa with neurological importance. Surg Radiol Anat 2016; 39:39-49. [PMID: 27192980 DOI: 10.1007/s00276-016-1687-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Our study highlights the morphometry of the partial and complete atlas occipitalization (AOZ), its coexistence with fusions of the 2nd and 3rd cervical vertebrae and morphological and morphometric abnormalities of the posterior cranial fossa that are of paramount neurological importance. METHODS One hundred and eighty adult dry skulls, the atlas and axis vertebrae were examined. RESULTS Four skulls (2.2 %) showed AOZ. Two of them (1.1 %) presented a partial AOZ, one male skull (0.6 %) a complete AOZ and a female skull (0.6 %) had a fused left hemiatlas with the occipital bone and a fusion of the 2nd and 3rd cervical vertebrae. The inner anteroposterior and transverse diameters of the foramen magnum (FM) in the control group were 34.6 ± 3.46 and 29.3 ± 3.47 mm. Only the skull with the complete AOZ had a reduced outer anteroposterior diameter of the FM (29.8 mm), while no specimen was found with a reduced transverse diameter. A wide total decrease (range 13.1-50.9 %) in the surface area of the FM in skulls with AOZ was detected. Extracranial, the clivus length in two skulls with AOZ was smaller than the normal range. No skull was detected with a reduction in the intracranial length of the clivus. All skulls with the AOZ had a vermian fossa. CONCLUSIONS The study adds important morphometric details about the partial and complete AOZ and correlates the phenomenon of synostosis with the narrowing of the FM, particularly in the case of complete AOZ. Awareness of the AOZ and other fusions of the upper cervical vertebrae and their topographical relations and attendant problems are of paramount importance to surgeons, when operate to the craniocervical junction, or interpret imaging studies to plan a safe surgery for nerve or spinal tissue decompression.
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Affiliation(s)
- Konstantinos Natsis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloniki, Greece.
| | - Christos Lyrtzis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloniki, Greece
| | - Trifon Totlis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloniki, Greece
| | - Nikolaos Anastasopoulos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 M. Asias Street, 11527, Athens, Greece
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Sundareswaran S, James J, S P, V P L, S S. Unusual foreign body in a routine lateral cephalogram. J Clin Diagn Res 2015; 9:ZD10-1. [PMID: 25859532 DOI: 10.7860/jcdr/2015/11438.5584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/08/2015] [Indexed: 11/24/2022]
Abstract
Routine radiographs made in the orthodontic office can often give way to detection and diagnosis of unusual syndromes, signs or foreign bodies. A case report of one such accidental detection of a very unusual foreign body within the nasal cavity of an orthodontic patient has been presented here to emphasize the importance of routine radiographic views, which over and above aiding in Orthodontic diagnosis, can also often detect potentially life threatening problems in the Oro-facial region.
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Affiliation(s)
- Shobha Sundareswaran
- Professor and Head, Department of Orthodontics, Government Dental College , Calicut, Kerala, India
| | - Jean James
- Junior Resident, Department of Orthodontics, Government Dental College , Calicut, Kerala, India
| | - Praveen S
- Associate Professor, Department of Orthodontics, Government Dental College , Calicut, Kerala, India
| | - Latheef V P
- Associate Professor, Department of Orthodontics, Government Dental College , Calicut, Kerala, India
| | - Sreehari S
- Associate Professor, Department of Orthodontics, Government Dental College , Calicut, Kerala, India
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Ríos-Rodenas M, de Nova J, Gutiérrez-Díez MP, Feijóo G, Mourelle MR, Garcilazo M, Ortega-Aranegui R. A cephalometric method to diagnosis the craniovertebral junction abnormalities in osteogenesis imperfecta patients. J Clin Exp Dent 2015; 7:e153-8. [PMID: 25810828 PMCID: PMC4368004 DOI: 10.4317/jced.52126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/12/2014] [Indexed: 01/29/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a hereditary bone fragility disorder that in most patients is caused by mutations affecting collagen type I. Their typical oral and craneofacial characteristics (Dentinogenesis imperfecta type I and class III malocclusion), involve the dentist in the multidisciplinary team that treat these patients. It is usual to perform lateral skull radiographs for the orthodontic diagnosis. In addition, this radiograph is useful to analyse the junctional area between skull base and spine, that could be damaged in OI. Pathology in the craneovertebral junction (CVJ) is a serious complication of OI with a prevalence ranging from rare to 37%. To diagnosis early skull base anomalies in these patients, previously the neurological symptoms have been appear, we make a simple cephalometric analysis of the CVJ. This method has four measurements and one angle. Once we calculate the values of the OI patient, we compare the result with the mean and the standard deviations of an age-appropriate average in healthy controls. If the patient has a result more than 2,5 SDs above the age-appropriate average in healthy controls, we should to refer the patient to his/her pediatrician or neurologist. These doctors have to consider acquiring another diagnostic images to be used to determine cranial base measurements with more reliability. Thereby, dentists who treat these patients, must be aware of the normal radiological anatomy of the cervical spine on the lateral cephalogram. Key words:Osteogenesis imperfecta, craniovertebral junction, cephalometric.
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Affiliation(s)
- Mercedes Ríos-Rodenas
- Profesora asociada de Odontopediatría (Universidad Alfonso X El Sabio). Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Joaquín de Nova
- Profesor Titular de Odontopediatría (Universidad Complutense de Madrid (UCM)). Responsable Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - María-Pilar Gutiérrez-Díez
- Especialista en Endocrinología Pediátrica. Unidad de Osteogénesis Imperfecta (Hospital Universitario de Getafe (Madrid)). Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Gonzalo Feijóo
- Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Maria-Rosa Mourelle
- Profesora Contratada Doctora de la UCM. Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Mario Garcilazo
- Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Ricardo Ortega-Aranegui
- Profesor asociado (UCM). Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
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Mudit G, Srinivas K, Satheesha BH R. Retrospective analysis of ponticulus posticus in Indian orthodontic patients-a lateral cephalometric study. Ethiop J Health Sci 2014; 24:285-90. [PMID: 25489191 PMCID: PMC4248026 DOI: 10.4314/ejhs.v24i4.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The lateral cephalogram is the most common diagnostic radiograph used in clinical orthodontics. Significant cervical spine pathology can be detected on the routine lateral cephalogram. The aim of this study is to sensitize clinicians for examining the cervical area of lateral cephalogram carefully and thus record anatomical variations. MATERIALS AND METHODS The presence and types of ponticuli posticus were investigated on 650 lateral cephalograms which were randomly selected from archived records at AECS Maaruti College of Dental Sciences & Research Centre, Bangalore. RESULTS The prevalence rate of Ponticulus Posticus in our study was found to be 11.1%. Though there was slight female predominance of 11.7% as compared to 10.4% in males, difference was not statistically significant. CONCLUSION Ponticulus posticus is a common anomaly in the Indian population. If any such anomaly is detected or suspected, it must be documented in the patient's health record and specialist consultation must be sought. The lateral cephalogram must thus be considered as one of the baseline screening tool for detecting anomalies and pathology in the cervical spine region.
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Affiliation(s)
- Gupta Mudit
- Uttaranchal Dental & Medical Research Institute, Oral Medicine & Radiology, Dehradun, Uttarakhand, India
| | - Kandula Srinivas
- Best Dental Science College, Oral Medicine & Radiology, Madurai, Tamil Nadu, India
| | - Reddy Satheesha BH
- Maaruti College of Dental Sciences & Research Centre, Oral Medicine & Radiology, Bangalore, Karnataka, India
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Edwards R, Alsufyani N, Heo G, Flores-Mir C. The frequency and nature of incidental findings in large-field cone beam computed tomography scans of an orthodontic sample. Prog Orthod 2014; 15:37. [PMID: 25033888 PMCID: PMC4884029 DOI: 10.1186/s40510-014-0037-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/09/2014] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study is to evaluate the nature and frequency of incidental findings in large-field maxillofacial cone beam computed tomography (CBCT). Methods A total of 427 consecutive CBCT radiologic reports obtained for orthodontic purposes were retrospectively reviewed. Findings were summarized and categorized into six anatomic categories. Results A total of 842 incidental findings were reported in the 427 CBCT scans (1.97 findings/scan). The most prevalent findings were those located in the airway (42.3%), followed by the paranasal sinuses (30.9%), dentoalveolar (14.7%), surrounding hard/soft tissues (4.0%), temporomandibular joint (TMJ) (6.4%), and cervical vertebrae (1.3%) regions. Non-odontogenic findings, defined as those located outside the dentition and associated alveolus, represented 718 of the 842 (85.3%) findings. Conclusions This study confirms the high occurrence of incidental findings in large-field maxillofacial CBCT scans in a sample of orthodontically referred cases. The majority are extragnathic findings, which can be normally considered outside the regions of interest of many dental clinicians. Specifically, incidental findings in the naso-oropharyngeal and paranasal air sinuses are the most frequent. This underscores the need for comprehensive review of the entire data volume and the requisite to properly document all findings, regardless of the region of interest. Electronic supplementary material The online version of this article (doi:10.1186/s40510-014-0037-x) contains supplementary material, which is available to authorized users.
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Incidental findings of C1, C2 and C3 fused vertebrae. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ohnmeiß M, Kinzinger G, Wesselbaum J, Korbmacher-Steiner HM. Therapeutic effects of functional orthodontic appliances on cervical spine posture: a retrospective cephalometric study. Head Face Med 2014; 10:7. [PMID: 24661951 PMCID: PMC3998510 DOI: 10.1186/1746-160x-10-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Interactions between the cervical spine and the stomatognathic system have been discussed in literature. The present study was conducted to investigate whether, and to what extent, orthodontically induced mandibular advancement produces changes in cervical spine posture. Furthermore, possible appliance-specific effects should be distinguished. MATERIAL AND METHODS The cephalograms of 64 patients with skeletal class II were analysed before and after mandibular advancement. Linear and angular cephalometric parameters were identified to define the position of the atlanto-occipital and atlantoaxial joints. The total example was divided into two subgroups (comprising 32 individuals each) according to the employed appliance: activator versus bite-jump appliance (BJA). Student's t-test and analysis of covariance were used for statistical analysis. RESULTS Overall, a significant straightening of the cervical spine was observed during the treatment. This conclusion is based on changes of Chamberlain (p = 0.0055), CVT (p = 0.0003), OPT (p < 0.0001), Redlund-Johnell/Petersson (p < 0.0001), McGregor-mC2 (p = 0.0333) and AT-FH (p = 0.0445). Improvements in occipitoatlantal dislocation were also observed in the total sample. Appliance-specific changes were found in the activator subgroup for a number of linear parameters (Chamberlain, McGregor, CVT, OPT, Redlund-Johnell/Petersson). In contrast, only two linear parameters (OPT and Powers ratio) revealed statistically significant changes in the BJA subgroup. CONCLUSIONS During skeletal class II treatment the position of upper cervical spine changes. In the activator subgroup the observed effects were more pronounced than those in the BJA subgroup. Further studies including a control group comprised with non-treated class II patients are needed to assess whether these effects may be caused directly by the appliances irrespective of growth.
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Affiliation(s)
| | | | | | - Heike M Korbmacher-Steiner
- Department of Orthodontics, University Hospital Giessen and Marburg, Georg-Voigt-Strasse 3, Marburg 35039, Germany.
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Miyamoto JJ, Yabunaka T, Moriyama K. Cervical characteristics of Noonan syndrome. Eur J Orthod 2013; 36:226-32. [DOI: 10.1093/ejo/cjt019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE To determine the frequency of significant pathologies on lateral cephalograms discovered by orthodontists during their careers. MATERIALS AND METHODS A five-statement survey was sent to the 417 active and affiliate members of the Edward H. Angle Society of Orthodontists. The survey asked orthodontists to identify any significant radiographic pathology that they had discovered on lateral cephalograms during their careers to date. The data were analyzed statistically. RESULTS Of the 417 surveys, 201 were returned for a 48% response rate. Ninety-nine respondents or 49.3% of the sample had discovered at least one significant pathology. Of the 1.3 million patients observed by the orthodontists in the sample, 268 patients (0.02%) with significant pathologies had been identified. Younger orthodontists had a statistically greater potential to discover pathologies than older orthodontists. The general types of pathologies discovered were musculoskeletal (38%), glandular (28%), and dental groups (12%). CONCLUSIONS About 50% of orthodontists will likely discover a significant, potentially life-affecting pathology on a lateral cephalogram.
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Sharma V, Chaudhary D, Mitra R. Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol 2010; 39:277-83. [PMID: 20587651 DOI: 10.1259/dmfr/16271087] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the prevalence of complete ponticulus posticus in Indian orthodontic patients. METHODS The presence and types of ponticuli posticus were investigated on 858 lateral cephalograms. RESULTS Complete ponticulus posticus was found in 4.3% of the subjects studied with a male (5.33%) predominance over female in the population (3.76%). CONCLUSIONS Ponticulus posticus is not a rare anomaly and the patient must be told of the implications and importance of detecting ponticulus posticus on a lateral cephalogram. This information can prove beneficial for the diagnosis of head and neck symptoms later.
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Affiliation(s)
- V Sharma
- Division of Orthodontics and Dentofacial Orthopaedics, Department of Dental Surgery, Armed Forces Medical College, Pune - 411040, India.
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Koletsis DD, Halazonetis DJ. Cervical vertebrae anomalies in orthodontic patients: a growth-based superimpositional approach. Eur J Orthod 2009; 32:36-42. [DOI: 10.1093/ejo/cjp049] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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