Hyperostosis associated with orbital vascular malformation

A previously healthy adult male presented with a slowly enlarging orbital mass associated with 5 mm of non-pulsatile proptosis. On imaging, a soft tissue lesion with avid contrast enhancement and associated bony hyperostosis was noted. The lesion and hyperostotic bone were surgically debulked, and significant arterial bleeding was noted intraoperatively consistent with an arteriovenous malformation. Histopathologic analysis revealed a vascular malformation with enhanced microvasculature infiltrating the periosteum. While vascular lesions elsewhere in the body can be associated with skeletal changes, bony hyperostosis is a rare feature of orbital vascular malformations.

[Domestic software, medical devices and materials in surgery for hyperostotic craniofacial meningiomas]

OBJECTIVE

The modern concept of resection of hyperostotic craniofacial meningiomas involves the desire for one-stage surgery with excision of tumor and simultaneous extensive skull defect closure.

MATERIAL AND METHODS

The authors present skull defect closure with an individual implant after resection of cranioorbital meningioma in a 61-year-old man. The neoplasm was accompanied by exophthalmos and eyelid edema. The patient underwent simultaneous microsurgical resection and skull reconstruction with an individual implant. At discharge (7 days after surgery), exophthalmos regressed to 3 mm. After 3 months, ophthalmologist revealed complete regression of exophthalmos.

RESULTS

Domestic software and 3D printers were used for implant modeling and preparing the necessary physical models and molds. We intraoperatively used domestic polymer and titanium fixation systems for manufacturing and fixation of implant.

CONCLUSION

This clinical case confirms that resection of hyperostotic craniofacial meningioma with simultaneous bone defect closure using domestic analogues of software, technical equipment, materials and methods is possible at all stages of this procedure.

Surgical nuances of the expanded endoscopic anterior skull base craniectomy for hyperostotic meningioma resection

BACKGROUND

The rostral expanded endoscopic approach (EEA) to anterior cranial fossa (ACF) has several advantages over transcranial/craniofacial surgery, providing early access to the vascular supply of tumors and reducing morbidities of craniotomy especially that of brain retraction. This article presents endoscopic landmarks and nuances for a wide ACF corridor, with stepwise image-guided dissections highlighting surgical tricks and techniques to enhance surgical safety.

METHODS

We describe an expanded endoscopic endonasal anterior skull base craniectomy for a recurrent large olfactory groove hyperostotic meningioma, with correlated cadaveric dissections.

CONCLUSION

The widening of rostral EEA can provide a safe and feasible route to access ACF. This article highlights the specific landmarks in endoscopic anatomy with reference to the angle of visualization and bayonetted instruments.

Peri-implant bony overgrowth as a cause of revision surgery in auditory osseointegrated implantation

Implantation of auditory osseointegrated implants, also known as bone-anchored hearing systems (BAHS), represents a surgical option for select pediatric patients aged 5 years or older with hearing loss. Functional indications in this patient population include conductive or mixed hearing loss. Common complications of implantation include skin infections, chronic skin irritation, hypertrophic skin overgrowth, and loose abutments. In a case series of 15 pediatric patients, we discovered an unexpectedly high skin-related complication rate requiring surgical revision of 53%. During revision surgery, we discovered 5 patients who exhibited significant bony overgrowth at the abutment site, a complication infrequently noted in past literature.

Tumoral calcinosis: a dental literature review and case report

Tumoral calcinosis (TC) is a rare familial disease characterized by abnormal peri-articular calcification in affected joints, without any associated renal, metabolic or collagen vascular disease. It is characterized by usual hyperphosphataemia with normal serum calcium and alkaline phosphatase values. There are only a few reported cases ofTC patients with dental findings. This article reviews the dental literature and describes progressive gingival, alveolar and mandibular tori enlargement in a 41-year-old female from Zimbabwe with tumoral calcinosis.

CLINICAL RELEVANCE

Tumoral calcinosis is a rare disorder of mineral metabolism with oral manifestations.

[Evaluation of the effect of intranasal corticosteroid sprays on radiofrequency tissue ablation in the treatment of hypertrophied inferior turbinate]

OBJECTIVES

This study aims to evaluate the effect of combining the confidingly preferred modality of radiofrequency (RF) application with intranasal corticosteroid spray treatment on the efficacy of RF and on the number of sessions in patients with hypertrophy of inferior turbinate.

PATIENTS AND METHODS

Fifty patients (37 males, 13 females; mean age 42.9 years; range 15 to 74 years) who admitted with the complaint of nasal obstruction and were detected to have hypertrophied inferior turbinate by nasal endoscopy were enrolled in the study. The patients were divided into two groups, each consisting of 25 patients. Before the treatment, the severity of nasal obstruction was evaluated and scored by a visual analogue scale (VAS). Radiofrequency was applied to every patient. Control group received no medical treatment following RF application. Drug group received mometasone furoate nasal spray (MFNS) at a dose of 200 mcg once daily into both nasal passages for eight weeks following surgery. All patients were asked to return for a control visit at week eight after treatment. Radiofrequency application was repeated in patients who continued to have complaints of nasal blockage. At the end of treatment, patients were reevaluated and VAS scores were recorded.

RESULTS

The improvement in VAS scores following treatment was statistically significant in both groups (p<0.05). When the two groups were compared, there was no statistical difference between the two groups before treatment; however there was an improvement in the post-treatment corticostreoid group (p<0.05). The mean session number was calculated to be 1.16 in the control group and 1.08 in the corticosteroid treatment group. The difference between the two groups was not statistically significant (p>0.05).

CONCLUSION

We recommend the use of intranasal corticosteroids with RF applications to increase the efficacy of radiofrequency.

Radiofrequency treatment for inferior turbinate hypertrophy

Radiofrequency ablation (RFA) is a technique which causes a reduction in tissue amount using ablation by high-frequency current. Beside other surgical tools, RFA has become quite popular over the past decade. Hypertrophy of the inferior turbinate is a common cause of chronic nasal obstruction. There is no agreement on how to deal with this problem. An ideal procedure for turbinate reduction should be performed with minimal discomfort or adverse reactions and should preserve the physiologic function of the turbinate, such as regulation of humidification and temperature of inspired air. All the current techniques have potential short and long-term complications such as bleeding and atrophic rhinitis. No technique is perfect, and the main goal of turbinate surgery should be the preservation of mucosal surfaces with reduction of submucosal tissue. The variety of surgical techniques available indicates the lack of consensus on the optimal technique. Radiofrequency tissue reduction is a surgical procedure that uses radiofrequency heating to induce submucosal tissue destruction, leading to the reduction of tissue volume. This energy induces ion agitation within the tissue, which increases the local temperature and causes a thermal lesion that should occur in the deep mucosa without damaging the surface. The healing process secondarily induces fibrosis with wound contraction, leading to tissue volume reduction. Radiofrequency ablation is an efficient, easily applicable technique, which does not lead to serious complications in the treatment of the nasal obstruction caused by inferior turbinate hypertrophy.

Aspergillus infection of supramid orbital implant and hyperostosis of orbital bone: report of a unique case

PURPOSE

The authors report the clinical findings in a patient who developed proptosis fourteen years after an orbital floor fracture repair with a Supramid orbital implant due to hyperostosis of the orbital floor and lateral orbital wall bone secondary to aspergillus infection.

METHODS

Clinical, radiological, microbiological and histological findings and the management of this patient are presented.

RESULTS

A 25-year-old male was referred with proptosis and lower lid retraction, fourteen years after a traumatic orbital floor fracture repair with a Supramid implant. Orbital exploration revealed a thick irregular sheet of bone covering the orbital floor implant and extending laterally along the lateral orbital wall. Aspergillus fumigatus was grown from the Supramid implant as well as from the bone and histology showed chronic inflammatory process with reactive bone formation. Patient was treated with a course of oral Voriconazole and post-operatively the patient is asymptomatic with reduction in proptosis.

CONCLUSION

To the best of our knowledge, this is the first case of Apergillus fumigatus infection secondary to a Supramid orbital floor implant, associated with hyperostosis of orbital bone.

Inferior turbinate hypertrophy radiofrequency management for children with cystic fibrosis

OBJECTIVE

To evaluate, using radiofrequency techniques, the relevance and effectiveness of treatment of inferior turbinate hypertrophy in children with cystic fibrosis.

MATERIALS AND METHODS

A study of patients with cystic fibrosis with hypertrophy of inferior turbinate who were being treated at Lisieux Hospital In-Patient Paediatric and ENT- Head and Neck Surgery Department. 41 patients were included in the study and followed over 2 years. We analyzed the postoperative phase and the effectiveness of treatment, through clinical and radiological examination.

RESULTS

A clinical improvement of symptoms is observable from the third month after surgery in 100% of cases. However, we noted a loss in the effectiveness of radiofrequency on the turbinate tissue one year following operation, which worsens with time. However, the postoperative results remain satisfactory at 1 year and 2 years.

CONCLUSION

Radiofrequency is, in our opinion, the treatment of choice for inferior turbinate hypertrophy in children with cystic fibrosis. It combines a simple and low-risk effect with effective preservative treatment. However, the benefits of radiofrequency fade with time. Nonetheless, this technique yields postoperative results that remain satisfactory beyond 2 years. It is often useful to consider a new session after this date.

Hemifacial spasm associated with focal bone hyperostosis

We present a very rare case of hemifacial spasm in a 58-year-old patient who was predisposed by focal temporal bone hyperostosis. The patient presented with a 6-year history of progressive left hemifacial spasm, unresponding to the conservative treatment. She underwent a typical microvasular decompression procedure, during which an unusual local hyperostosis of the interior surface of the left temporal bone was found, distorting the adjacent AICA and causing significant pressure on the facial nerve. The postoperative course was uneventful and in the 24-month follow up, the patient is spasm free.

Isolated costal hyperostosis: a rare cause of severe hemothorax

Chest pain due to hemothorax is rare. However, the possibility of traumatic hemothorax must always be suspected. We report a case of a 15-year-old girl with hemothorax after erosion of the intercostal artery of the left seventh rib by a histological proved solitary costal hyperostosis. She presented with a 2-month history of intermittent left-sided chest pain and 3 episodes of acute chest pain followed by dizziness and loss of consciousness. The chest radiograph revealed a large left pleural effusion and a thin-section chest computed tomography scan that was performed after drainage of the hemothorax indicated a spicule projecting inward into the chest from the left seventh rib. After thoracotomy, a solitary costal hyperostosis causing a traumatic pseudoaneurysm of the intercostal artery was removed by partial resection of the left seventh rib, the intercostals vessels were ligated, and the pseudoaneurysm excised.

Aesthetic correction of a hypertrophic sinus frontalis: a long-term follow-up evaluation and refinement of the method

Two cases treated for hypertrophy of the frontal sinus are presented. In both patients, the excised frontal bone was inverted, and the resultant cavity was filled with either bone dust from the parietal region or Medpor. The first patient is shown with an excellent result after a follow-up period of 16 years. The second patient, who also achieved an excellent result, is presented after a follow-up period of 5 years. Using Medpor instead of bone dust resulted in the advantage that the operation could be performed with the patient under local anesthesia with sedation and prevention of an additional donor site. The use of Medpor has certain advantages over the use of hydroxyapatite, not least of which is its significant lower cost.

Giant calvarial hyperostosis with biparasagittal en plaque meningioma

We report a patient with an uncommon presentation in the form of massive bilateral calvarial hyperostosis with bi-parasagittal en plaque meningioma. The tumour was removed by bilateral fronto-parieto-occipital craniotomies. The patient was subjected to post operative radiotherapy to reduce the chances of recurrance. The management of such a case is a surgical challenge.

[Evaluation of temporomandibular joint function after condylectomy for condylar hyperplasia]

OBJECTIVE

To investigate the temporomandibular joint (TMJ) function of the condylar hyperplasia patients after condylectomy.

METHODS

Twelve patients with condylar hyperplasia were included in this study. Before and after condylectomy, they were examined and the Fricton' s Craniomandibular Index (CMI) was calculated to assess the functional disorder of TMJ.

RESULTS

(1) The facial asymmetry was improved after condylectomy. The morphological symmetry of the bilateral condyle and ramus was displayed by X-ray examinations. There was new cortex formed on the surface of the operated condyle. (2) The TMJ function was improved in terms of Fricton's DI and CMI, which decreased from 0.131 and 0.066 to 0.042 and 0.021 respectively (P < 0.05).

CONCLUSIONS

Condylectomy is an effective method to remedy facial asymmetry and, at the same time, improve the TMJ function of the condylar hyperplasia patients.

Long-term results of inferior turbinate hypertrophy with radiofrequency treatment: a new standard of care?

OBJECTIVE

The objective of this study was to report the long-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) and to compare this with other accepted surgical treatments of inferior turbinate hypertrophy.

STUDY DESIGN AND SETTING

Prospective, 2-year follow-up of 19 patients originally enrolled in a prospective, randomized, single blinded, placebo controlled trial for treatment of inferior turbinate hypertrophy with RFVTR. Patients evaluated their severity of obstruction, frequency of obstruction, and overall ability to breathe by way of a 10 cm visual analogue scale.

RESULTS

RFVTR for inferior turbinate hypertrophy showed continued benefit at 2 years posttreatment, with no indication of increasing symptomatology. The benefit demonstrated in frequency of obstruction, severity of obstruction, and overall ability to breathe (P < .05) was maintained at 2 years. No complications occurred. Review of the literature shows lower short- and long-term complications for RFVTR compared with other surgical methods

CONCLUSION

RFVTR is effective in treating inferior turbinate hypertrophy with sustained benefit at 2 years follow-up while resulting in fewer complications than other surgical methods.

SIGNIFICANCE

RFVTR is a relatively new procedure, and therefore there are few long-term evaluations of its effectiveness; this is the first prospective study to document successful outcomes at 2 years follow-up.

Die Behandlung hypertropher distaler Tibiapseudarthrosen mit perkutan eingebrachten winkelstabilen Implantaten

Hypertrophic nonunions of the distal, dia-/metaphyseal tibial shaft are still considered to be a problematic challenge. The use of a locking plate system (LCP) as an alternative treatment option was evaluated in these nonunions. This retrospective, nonrandomized study included four male patients (mean age 52.5 years) with hypertrophic nonunions of the distal dia-/metaphyseal tibial shaft treated with a locking compression plate (LCP) by percutaneous technique. The following parameters were evaluated: fracture type (AO), primary fracture care, operation technique of the nonunion, healing of the nonunion, ability to work, complications, and clinical result (function of the upper ankle joint). Primarily, there were 3 cases of open fractures. Three fractures were located in the dia-/metaphyseal region and primarily treated with an unreamed tibial nail (UTN), while 1 open metaphyseal fracture was treated with an external fixator. The mean interval between injury and operation of the nonunion was 9.1 (4.4-12) months. All nonunions healed within 3 (2-4) months. The mean clinical and radiological follow-up was 11.5 (9-14) months. All patients were able to work within an average of 2.3 months. The function of the upper ankle joint was unrestricted in 3 cases, and in 1 case there was a mild functional deficit. The use of an interlocking plate for the management of hypertrophic nonunions of the distal tibial shaft represents a reliable, new treatment option.

Entrapment neuropathy of the optic nerve due to hyperostosis associated with congenital anemia

The authors report on the case of a 14-year-old boy who presented with bilateral visual impairment due to optic canal stenosis caused by hyperplasia of the bone marrow arising from anemia. The patient had hereditary hemolytic anemia with unstable hemoglobin of the Christchurch type. This congenital form of anemia caused hyperplasia of the bone marrow as well as hyperostosis of the entire calvarial bone, which in turn led to optic canal stenosis. The patient underwent surgical decompression of the optic canal, resulting in significant improvement in visual acuity. Pathological findings in the calvarial bone indicated hypertrophic bone marrow with no other specific features such as neoplastic pattern or fibrous dysplasia. With the exception of objective hearing impairment, no other significant cranial neuropathy has been detected thus far. On reviewing the published literature, this case was found to be the first in which hyperostosis due to congenital anemia resulted in symptomatic entrapment neuropathy of the optic nerve. The authors concluded that surgical decompression effectively improves visual acuity.

[Case report of Ito-syndrome associated with congenital hemihypertrophy from the orthopaedic point of view]

We report on the orthopaedic treatment of a patient with the very rare Ito syndrome and congenital hemihypertrophy. The leading symptom is the lamellar depigmentation of the skin for which it is synonymously called incontinantia pigmenti acromians. Further anomalies are found in the central nervous system, as well as the ocular and the musculoskeletal systems. The treatment of the hemihypertrophy and the coexistent dysplasia of the hip with a combination of intertrochanteric shortening osteotomy and a triple osteotomy are specified and further methods are discussed.

Aggressive Cranial Vault Decompression for Cranial Hyperostosis: Technical Case Report of Two Cases

OBJECTIVE AND IMPORTANCE:

Camurati-Engelmann's disease, also known as progressive diaphysial dysplasia, is a disorder of the bone metabolism. Neurological manifestations of progressive diaphysial dysplasia include cranial nerve dysfunction, generalized weakness, cerebellar herniation, and increased intracranial pressure. In the past, surgical intervention has been of limited and temporary benefit. We present two patients with cranial hyperostosis secondary to Camurati-Engelmann's disease who were treated successfully with a single surgery involving a combination of multiple craniotomies for cranial vault decompression.

CLINICAL PRESENTATION:

Two patients presented with signs and symptoms of increased intracranial pressure secondary to Camurati-Engelmann's syndrome. Radiological workup revealed marked cranial hyperostosis.

INTERVENTION:

The patients underwent aggressive cranial vault decompression. Multiple craniotomies were performed, and the inner table was then drilled down until the bone was 1 cm thick.

CONCLUSION:

Effective surgical options are needed for clinically significant cranial hyperostosis. In an effort to further define operative management in these patients, we describe a single, aggressive surgical procedure that may be used for successful cranial decompression.

Hyperostosis as a late sequel of parasymphyseal mandibular fractures in 2 children

BACKGROUND

The potential problem of growth anomalies affecting a mandible following a fracture of a mandibular condyle in childhood is well established. However, there have been no previous reports of this phenomenon affecting other fracture sites in the mandible.

PATIENTS

Two patients who had parasymphyseal fractures treated in childhood presented at skeletal maturity with hyperostosis at the fracture site, producing chin asymmetry in their teens.

RESULTS

In both cases the hyperostosis produced significant chin asymmetry without disturbance of the occlusion. Both patients were managed with corrective genioplasty.

CONCLUSION

These cases reinforce the previous recommendations regarding the need for long-term follow-up of children who sustain facial fractures of the mandible, and that the protocol should be expanded to include parasymphyseal fractures as well as fractures of the condyle.

A new retractor for surgical removal of mandibular torus

INTRODUCTION

A newly devised retractor for mandibular torus is presented. It has a half-spoon-shaped head and was applied to various cases of mandibular torus for its evaluation.

RESULTS

It was found that the elevated mucoperiosteum flap was safely protected lingually by using this retractor. Various mandibular tori were completely resected without damaging the surrounding tissues.

[Morphological changes in tissues of extremities in military personnel with overload disease]

Extremely high physical activity results in anatomic-functional discordance in muscle compartments of segments of extremities. It leads to compartment syndrome consisting in compromised microcirculation, blood plasma infiltration of intercellular space, increased subfascial pressure at the same time we see intraosseous microcirculation disturbance and pathological alterations of bone tissue (hyperostosis, pathological reorganization, fractures), muscles, nerves and fasciae, that is confirmed by morphological alterations. Facsiotomy is of pathogenetic nature in patients with this pathology. Connective tissue replaces the site subjected to facsiotomy thus enabling to extend muscle compartment, normalizing in them intracompartment pressure under exercise stress, improving muscles, nerves, bones microcirculation, that enables elimination of anatomic-functional discordance of blood circulation and size of a muscle compartment under physical load and speeds up reparative processes in bones.

Abnormal bony protuberance of anterior atlas causing dysphagia. A rare congenital anomaly

STUDY DESIGN

A Case report.

OBJECTIVE

To report an exceedingly rare case of dysphagia caused by abnormal bony protuberance of anterior atlas.

SETTING

Kocaeli University Faculty of Medicine, Departments of Neurosurgery and Otorhinolaryngology.

METHOD

Radiological examinations revealed a large anterior abnormal bony tuberance of atlas in an 11-year-old boy who complained of dysphagia of 5 years donation.

RESULT

The anterior bony tuberance of the atlas was resected by a transoral approach. Histopathological examination of the surgical specimens showed normal bone tissue. Resection resulted in complete resolution of the dysphagia.

CONCLUSIONS

Dysphagia can be caused by disorders of the cervical spine. These disorders are usually seen in elderly adults. In the pediatric population, spinal abnormality is an exceedingly rare cause of dysphagia. Abnormal inductive signals from the adjacent notocord and ventral neural tube may play role in the pathogenesis of this abnormal bony protuberance.

Argon plasma surgery for treatment of inferior turbinate hypertrophy: a long-term follow-up in 157 patients

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophic inferior turbinates. In cases of nonresponse to conservative medical management, the surgical reduction of the inferior turbinates is often required. Surgical techniques for the reduction of hyperplastic nasal turbinates include monopolar or bipolar coagulation, partial or total reduction of the turbinates with a conchotome or scissors and laser surgery with Nd:YAG, CO(2) or KTP. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngology which is based on high-frequency electrocoagulation with an argon gas source. The fast and short surgery times, the absence of hemorrhagic complications and, in rhinosurgery, the complete abstention from any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgery Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t test was used for statistical data. After 24 months, 87% (p < 0.001) of the patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. The indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery are reviewed and discussed.

[Diagnosis and treatment of Klippel-Trenaunay syndrome]

OBJECTIVE

To investigate the diagnostic criteria and therapeutic method of the Klippel-Trenaunay syndrome.

METHODS

Among 5 cases, there were 2 males and 3 females aged from 11 days to 73 years. Vasography was carried out in all five patients and MRA was performed in one patients.

RESULTS

After operation, the symptoms improved in 4 cases: the portine-like erythemas on their limbs got unclear; the focuses diminished obviously; the circumferences of the suffered limbs shrank and the ulcer healed. For following-up period was not long enough, the long term therapeatic result was still uncertain.

CONCLUSION

Once the diagnosis of the Klippel-Trenaunay syndrome was made, operation should be performed as early as possible. If the surgical time is selected in prepuberty, optimal result can be expected.

[Mandibular hyperostosis. A case report]

A case of hyperostosis of the left hemimandible medial face in a young patient is reported. This in an interesting case both for the remarkable size and the location of the lesion and because it was unique and asymmetrical; as a matter of fact this pathology, frequent on the jaws, is usually symmetrical and bilateral. The most probable etiopathogenetic hypothesis for the case presented to our observation seems to be an unknown localized stimulation of osteoblastic cells. Considering its size, the lesion was removed.

Incidence of chronic hyperostotic rhinosinusitis in patients undergoing primary sinus surgery compared to revision surgery

HYPOTHESIS

The incidence of chronic hyperostotic rhinosinusitis has been underreported due to poor recognition of the disease process. The surgical management of chronic hyperostotic rhinosinusitis with prolonged pre and post-operative antibiotic therapy can alter clinical course of the disease process.

STUDY DESIGN

A prospective study of 40 patients based at two teaching tertiary care institutions.

MATERIAL AND METHODS

CT scans of twenty patients (ten undergoing primary sinus surgery and ten undergoing revision sinus surgery) were randomly selected from each institution and reviewed by an independent radiologist for evidence of hyperostosis and compared to original reading of the CT scans.

RESULTS

The finding of sinus hyperostosis is rarely reported by the radiologist on the sinus CT scan where the focus is always on mucosal disease. The incidence of sinus hyperostosis is higher, in patients undergoing revision sinus surgery than patients undergoing primary sinus surgery.

CONCLUSION

Sinus hyperostosis is not an uncommon finding in chronic refractory sinusitis which may require long term intravenous antibiotic therapy in conjunction with surgery to provide symptomatic relief.

Autosomal dominant craniometaphyseal dysplasia with atypical features

Craniometaphyseal dysplasia (CMD) is a rare genetic disorder of bone modelling characterised by hyperostosis and sclerosis of the craniofacial bones, and abnormal modelling of the metaphyses. Clinically, autosomal dominant (AD) CMD is characterised by facial distortion and cranial-nerve compression. The goals of surgical treatment for AD CMD are cosmetic recontouring of the sclerotic craniofacial bones, correction of nasal obstruction and correction or prevention of neurological manifestations. We describe the successful correction of AD CMD craniofacial manifestations in an individual with atypical findings, and outline an approach for correcting the craniofacial deformities associated with this rare disorder.

Osseous overgrowth in congenital amputations of the upper limb: report of 3 cases treated with autologous stump plasty

Osseous overgrowth is an important problem after traumatic or surgical amputations in children. It is rather exceptional in congenital amputations. We report three cases of congenital amputation of the humerus with osseous overgrowth. They were treated with an autologous stump plasty according to Marquardt's technique.

[Parosteal lipoma]

Paraosteal lipoma is a rare benign tumour of the musculoskeletal system. It's features consist of a fatty component seated on a hypersotosis i.e. an exostose-like bone prominence. This tumor has a high tendency of metaplasia. Therefore chondroid elements may be present in addition to the fatty and bony components. Therapy of choice is complete surgical removal including the hyperostosis. Presenting this case the clinical and morphological characteristic of this rare tumour are discussed.

The Er:YAG laser in ear surgery: first clinical results

BACKGROUND AND OBJECTIVE

The goal of this study was to gain experiences about the possibilities and limits of the Er:YAG laser for ear operations.

STUDY DESIGN/PATIENTS AND METHODS

Eighty-three ear operations were performed with the aid of an Er:YAG laser: 32 stapedotomies, 15 tympanoplasties type III, 10 tympanoplasties type I, 18 ear operations in cholesteatoma, and 8 removals of hyperostosis in the outer ear canal.

RESULTS

The Er:YAG laser facilitated stapedotomies and removal of hyperostosis from the outer ear canal. In cases of beginning cholesteatoma, the Er:YAG laser allowed matrix removal of the ear ossicles left in situ. Furthermore, in tympanoplasty it was possible to achieve an osteosynthesis of the auditory ossicles, which was done for the first time during this study. No hearing loss attributable to laser dose was found during postoperative hearing tests.

CONCLUSION

The Er:YAG laser seems to become a useful tool in middle ear surgery.

[Torus mandibularis. Apropos a case]

One case of mandibular torus is described. It was an hyperostosis of the lower jaw, of big size, condition scarcely presented, and characterized by its long course and slight local feeling of discomfort. Total removing of the mass is the indicated surgical treatment.

Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion

OBJECTIVE

Hyperostosis associated with intracranial meningiomas is a well-described entity. The cause, management, and prognosis of these bony changes have long been a point of controversy. Some authors have postulated that hyperostotic changes are secondary to the formation of the tumor and do not constitute invasion of the tumor into the bone. Determining this point has direct implications in the treatment of these patients, especially regarding surgical considerations. To more thoroughly evaluate this question, a study correlating the morphology to the radiology is necessary.

METHODS

In this study, 51 patients underwent resection for meningiomas involving the cranial base. Preoperative radiographic evaluation using magnetic resonance imaging and/or computed tomography was performed, and areas of hyperostosis were identified. During the resection of the tumor, biopsies from these hyperostotic regions were sent for histological evaluation regarding the presence or absence of tumor invasion of the bone.

RESULTS

Preoperative neuroradiological assessment identified 26 patients with radiographic evidence of hyperostosis. Histological examination of the resected bone showed tumor invasion in 35 patients, including the area of radiographically identified hyperostosis in 25 of the 26 patients. The floor of the middle fossa was a specific area of low sensitivity for preoperative assessment of associated hyperostosis.

CONCLUSION

These results indicate that hyperostosis associated with meningiomas involving the cranial base are caused by tumor invasion of the bone histologically.

[Anterior hyperostosis of the cervical spine: diagnostic studies and surgical therapy]

BACKGROUND

Dysphagia due external compression by anterior hyperostosis of the cervical spine is rare. The diagnosis may be established by conventional X-ray of the spine, esophagogram, and CT.

PATIENTS

We operated on three patients with large anterior osteophytes from C3 to C7. In two cases morphologic changes of the cervical spine were the main cause of dysphagia. One patient with progressive hypopharynx cancer had hyperostosis of cervical spine as secondary findings.

RESULTS

The patients were asymptomatic, post-operatively.

CONCLUSIONS

Cervical osteophytes can be detected in 20-30% of the population in asymptomatic patients. The therapeutic approach depends on the extent of dysphagic complaints. Painful dysphagia is a indication for surgery. The anterolateral extrapharyngeal approach is commonly preferred with anterior hyperostosis between C4 and C7. The transoral intrapharyngeal approach has been used in patients with hyperostosis of cervical vertebra C2/C3. Interdisciplinary orthopedic and ENT surgical treatment is without complications and yields good functional results.

Thallium-201 single photon emission computed tomography imaging of meningioma cells in hyperostosis

Hyperostosis is a well-known bony reaction associated with meningioma. However, it is difficult to determine preoperatively whether meningioma cells have invaded the bone, and if so, the extent of tumor invasion. Preoperative thallium-201 chloride single photon emission computed tomography (201Tl SPECT) was performed in four patients with meningioma and hyperostosis. The presence of meningioma cells in bone biopsy specimens was also investigated using standard histological techniques. 201Tl SPECT revealed increased uptake in three of the four patients. Biopsy specimens from these three patients revealed invasion of the bony lesions by meningioma cells in accordance with the 201Tl SPECT findings. 201Tl SPECT found no abnormal uptake in the other patient, in which there was also no histological evidence of tumor invasion of bone. Preoperative 201Tl SPECT can provide information on bone invasion by meningioma, which will facilitate preoperative planning of the extent of bony resection required at meningioma surgery.

Subpontic osseous hyperplasia: a five-patient report

Thirty-four cases of benign osseous proliferation beneath the pontics of mandibular posterior fixed partial dentures have been reported in the dental literature. This report describes subpontic osseous hyperplasia in the posterior regions of five additional patients. Within this population, recurrence following surgical excision was documented in one patient. Continued osseous proliferation following pontic modification occurred in a second patient. Chronic irritation and functional stresses are discussed as possible etiologies. Clinical significance and treatment considerations are presented.

[Giant cervical hyperostosis of the prevertebral space: presentation of two cases and review of the literature]

Swellings of the retropharyngeal area are quite rare and all cases have common symptoms deriving from the site of origin, size, interaction with the surrounding anatomical structures and the presence, or lack thereof, of any associated inflammation. The main symptoms are dysphagia, the feeling of a foreign body in the pharynx and dyspnea. The present work describes two clinical cases of hyperostosis of the cervical column both of which presented discrete dysphagia, intermittent dyspnea and swelling in the area located between the pharynx and the spinal column thus leading to the feeling of having a foreign body in the area. The first case was a hyperostosis of the prevertebral space located on the right side and running medially toward the homolateral palatine tonsil. The pharyngoepiglottic fold area was medialized while the glottic region appeared normal. The second case had an ovoid median swelling in the hypopharynx stemming from the prevertebral space. During normal respiration the upper part of the laryngeal face of the epiglottis came into contact with this swelling while during phonation the glottic plane was normal. CT, MRI and endoscopy all proved able to provide information regarding the anatomy of the neoformation and the relationship with the neighboring structures. Many surgical techniques have been described to gain access to the spinal column osteophytes. The transcervical techniques give better exposure than transoral approaches although they increase the risk of damaging the recurrent laryngeal nerve and the sympathetic nervous system; moreover they require marked retraction of the carotid artery. In the authors' experience surgery was opted for in only one of the cases as the patient was relatively young and in good general health. The transcervical posterolateral approach was chosen as it provided better exposure of the cervical region between C3 and C6 than did the anterolateral approach.

Intracranial and extracranial reduction osteoplasty for craniodiaphyseal dysplasia

Craniodiaphyseal dysplasia is a rare, sporadic form of craniotubular bone dysplasia, characterized by massive generalized hyperostosis and sclerosis, particularly of the skull and facial bones, leading to severe deformity. The clinical course is typically characterized by progressive encroachment of the craniofacial foramina and brain by the relentless deposition of bone. Compression of cranial nerves, the foramen magnum, and intracranial contents commonly leads to blindness, loss of hearing, and death. This report describes a unique case of craniodiaphyseal dysplasia manifesting with asymmetric craniofacial and axial hyperostosis. The tubular bones demonstrated the characteristic diaphyseal endostosis, undertubulation, and relative overgrowth on the involved side. Significant brain compression with signs and symptoms of increased intracranial pressure was managed successfully with decompressing craniectomy at age 12 years, enlarging the anterior and middle fossae. Calvarial thickness measured nearly 4 cm. Further calvarial, midfacial, and mandibular recontouring were performed 6 and 22 months later. Follow-up in our case indicates that close observation is mandatory to manage further progression of the disease.

[Resection of protruding mandibular angle through combined external and intraoral approach]

Mandibular angle protrusion may cause excessive width of the mandible and a disproportion of the face. A new method was introduced to resect the protruding mandibular angle through a combined external and intraoral approach. Good results were received in 5 cases. This operation avoided external scar and the danger of damage to the marginal nerve.

Craniodiaphyseal dysplasia; another cause of difficult intubation

A nine-year-old boy with craniodiaphyseal dysplasia (CDD) presented for mandibular reduction. Patients with CDD present problems to the anaesthetist, specifically difficulties with airway management and tracheal intubation. This child was managed using laryngeal mask airway (LMA) guided fibreoptic intubation. Spontaneous respiration was maintained throughout intubation, following which ventilation was controlled and anaesthesia was provided using nitrous oxide, isoflurane and fentanyl. The perioperative management is described.

Diagnosis and treatment of subpontic osseous hyperplasia. Report of a case

This report describes a case of subpontic osseous hyperplasia that occurred in the posterior mandible of a healthy 67-year-old woman. The two hard masses, which were removed from beneath a fixed partial denture that was placed 35 years ago and spanned the lower left first premolar and the first and second molars, consisted of normal viable dense cortical bone. Only 30 cases of this phenomenon defined as a slow-growing, benign osseous proliferation occurring on the crest of the alveolar ridge beneath the pontic of a fixed partial denture have been described in the literature. Possible causes, including genetic programming, functional stimulus, and mild chronic irritation are discussed, as well as rationale for treatment of this anomaly.

Lumbar spinal stenosis by postdiscectomy hyperostosis

The mesenchymal repair process of the connective tissue in the surgical wound following lumbar laminectomy presents three aspects: postoperative epidural scar, heterotopic bone formation in the epidural scar and vertebral hyperostosis around laminectomy. Twelve cases of lumbar spine hyperostosis consecutive to laminectomy, confirmed by x-ray findings and surgery are presented. The main symptom at presentation was a recurrent sciatic neuritis. Lumbo-sacral spine films showed a "bright" focal condensation in the previous surgical. Lamina inferior and superior and the articular facets were hypertrophic. Surgery confirmed the hyperostosis and compressive lumbar spine stenosis or foramen stenosis.

A giant hyperostosing meningioma in a child

A case of 15-year-old boy with a giant hyperostotic meningioma is presented. The patient had a huge prominence at the posterior parietal region. The CT scan showed a giant intracranial tumor in the left parieto-occipital region under the hyperostotic bone. The tumor and hyperostotic bone were totally resected with the involved portion of the sagittal sinus. Histological study revealed a meningioma. The presence of such a huge hyperostosis and some peculiarities of childhood meningiomas are discussed.