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At least 415 records · Page 23Linked to original sources

PubMed2000

Displacement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality of nasopalatine nerve and vessels: a novel surgical approach.

Accurate implant placement in the anterior maxilla is essential in achieving optimal prosthetic rehabilitation with proper function and acceptable esthetic and phonetic demands. One of the preferable prosthetic solutions to restore a missing maxillary incisor in young adults is by an implant-supported crown. Bone resorption together with an enlarged incisive foramen, challenge proper implant placement. A simultaneous procedure where the implant osteotomy site penetrated the incisive canal is presented. A configurated cortico-cancellous block graft core was adjusted to fit the foramen while its soft tissue content was pushed back posteriorly but not removed. This procedure was followed by an immediate implant placement. Re-entry at 9 months revealed solid bone support embracing the implant body. Although the size of the incisive foramen diminished significantly, the nasopalatine branches were still evident. No complications and/or loss of sensation were observed.

Adult↗

PubMed2002

Prenatal morphogenesis of the human mental foramen.

The mental foramen, at first glance, merely looks like a hole where the mental nerve and the vascular bundle runs through. From a morphogenetic point of view, however, the mental foramen is a suitable model to study the development of a structure where different components are involved. To understand this developmental process, a three-dimensional description at different developmental stages first has to be given. From histological serial sections of human embryos and fetuses, ranging in size from 19 to 117 mm crown rump length (CRL), three-dimensional reconstructions of the foraminar regions were made. Outline and form of the developing foramen, size, course of the mental nerve and the adjacent blood vessels could be shown in detail. In this way, the formation of these structures became concrete in three dimensions. In the future, to understand the mechanisms regulating this complex system, where a nerve and blood vessels became successively surrounded by bone, molecular biological data have to be correlated with morphological findings.

Chin↗

PubMed2003

Morphological features pertinent to interventional closure of patent oval foramen.

Despite the growing trend of device closure for patent ovale foramens (PFO), the morphology of these lesions is much neglected. A better understanding of the morphological aspects is needed for developing lesion-specific devices. We reviewed ten heart specimens and distinguished two forms of PFO: valve competent and valve incompetent. In the valve-competent form, the thin valve of the oval foramen adequately overlaps the firmer muscular rim of the foramen, leaving a crevice-like aperture sandwiched between the two structures. In contrast, the valve-incompetent form results from aneurysmal ballooning of the valve, or stretching of the muscular rim, creating an interatrial communication in a previously competent flap valve. Distinguishing between the two forms can help in designing and selecting the most appropriate device for implantation.

Aortic Valve Insufficiency↗

PubMed2001

[Multiple paradoxical emboli in patent foramen ovale].

HISTORY AND CLINICAL FINDINGS: A 38-year-old man was admitted because of angina pectoris with concomitant dyspnoea. Three months previously he had suffered an ischaemic stroke of the right middle cerebral artery and was treated in a neurological department. At that time, no aetiologic diagnosis was possible. There was no history of other diseases. Pulse rate was 100 beats per minute with a blood pressure of 140/60 mm Hg. The left calf had a 4 cm greater circumference without any symptoms. The rest of the physical examination in the markedly overweight patient was normal. INVESTIGATIONS: The ECG showed sinus rhythm and negative T-waves in leads V1-V4 and a slightly elevated ST-segments in II, III and aVF. An acute coronary thrombosis was ruled out by left heart catheter-angio. DIAGNOSIS, TREATMENT AND COURSE: Within the following hours, embolic occlusion of the left popliteal artery developed and was treated with a Fogarty catheter. On the first postoperative day, the patient complained about mild dysaesthesia of his right arm. Duplex sonography showed a floating thrombus in the left carotid bifurcation. The thrombus was removed surgically. Later a pulmonary embolism due to deep vein thrombosis in the left thigh and calf was found. Transoesophageal echocardiography performed in another hospital previously was repeated and a patent foramen ovale (PFO) with a middle-sized shunt was found. The patent foramen ovale was closed percutaneously by implanting a Cardioseal-Starflex occluder. There was neither a complication nor a residual shunt. Neurological symptoms disappeared completely within the next few months. The patient has now been free from new neurological events for 11 months. CONCLUSION: In patients with PFO, paradoxical embolism remains a challenging diagnosis that can be made highly probable by documentation of venous thromboses, pulmonary embolism, missing evidence of atherosclerosis in the vessels of the embolized organ and exclusion of other cardiovascular sources of emboli and prothrombotic coagulation disorders. Interventional closure of a patent foramen ovale appears to be the treatment of choice in proven paradoxical embolism.

Adult↗

PubMed2004

Vascular anatomy of the foramen of Vicq d'Azyr: a microsurgical perspective.

INTRODUCTION: The foramen of Vicq d'Azyr, is a triangular-shaped area located rostral to the ventral median fissure of the medulla oblongata. Its importance relies on the fact that it is penetrated by small vessels from the vertebrobasilar axis that nourish vital pontine nuclei and tracts. We described the microvascular anatomy of the perforating vessels of the foramen of Vicq d'Azyr (FVA). MATERIALS AND METHODS: The vertebrobasilar junction arteries and the perforating arteries of the foramen of Vicq d'Azyr were examined using a surgical microscope in 21 formalin-fixed brain stems. RESULTS: The total number of perforating branches found was 286 in the 21 brains, an average of 13.6 perforators per brain, range 7 to 22. They arose as distal branches of 73 main trunks, average of 3.5 per brain, range 2 to 5, originating mainly from the basilar artery in 41 (56.1 %); the left ventral spinal artery in 12 (16.4 %), and the left vertebral artery in 8 (11 %). The average outer diameters of the left and right vertebral arteries were 3.2 mm and 2.9 mm, 4.1 mm for the basilar artery, and 0.6 mm for the right and left ventral spinal arteries. The branching pattern and interesting anatomic variations of the main vessels of the vertebro-basilar junction are also described. DISCUSSION: The vascular anatomy of the infratentorial compartment is highly variable. These variations should be kept in mind to avoid pitfalls during vascular or tumor surgery. In contrast, the entering locations of perforating vessels remain constant, referring to these zones as key areas when planning or doing surgical procedures in this region.

Basilar Artery↗

PubMed1990

Transient transcatheter balloon closure of patent foramen ovale following surgical repair of critical pulmonary stenosis.

Severe cyanosis resulting from postoperative atrial right-to-left shunt is a life-threatening complication. We present a technique of transient transcatheter balloon closure of a patent foramen ovale in a newborn operated on for critical pulmonary stenosis, where the foramen ovale had been left open intraoperatively. Cardiac catheterization was performed under echocardiographic control in the intensive care unit and the foramen ovale was occluded with a water-filled balloon-catheter. Significant improvement of arterial oxygen tension allowed delayed definitive surgical closure in a second step. Unfortunately, the child developed right-sided pneumothorax postoperatively and died of cardiopulmonary failure. Nevertheless, this procedure seems a suitable way to relieve atrial right-to-left shunt temporarily until definitive surgical closure can be performed.

Anastomosis, Surgical↗

PubMed1986

[Diagnosis and therapy of obstructions of the foramen of Monro].

Occlusions or obstructions in the region of the interventricular foramen (also known as foramen of Monro) can be due to a variety of causes. Among these are lesions of the hypothalamus that can be operated on under present-day conditions and in certain cases. This article draws attention to the possibility of choosing between several surgical approaches. Analysis of our own material (27 cases) during the past ten years shows that good results can be obtained when using modern methods of diagnosis and treatment. Four case reports are presented of four typical patients with occlusion of the foramen of Monro. If there is an associated hydrocephalus, the transcortico-transventricular approach appears to be the most appropriate one. It seems it is not always possible to effect exact type-specific separation of the diseases in the third ventricle. The presence of blood in the CSF can be a pointer toward a tumour in the third ventricle.

Aged↗

PubMed2001

Patent foramen ovale presenting as platypnea-orthodeoxia: diagnosis by transesophageal echocardiography.

Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a patent foramen ovale or atrial septal defect. We describe the case of a 65-year-old woman with progressive dyspnea and hypoxia when standing and walking, which was relieved by assuming the recumbent position. The diagnosis was confirmed by tilt-table transesophageal echocardiography demonstrating a large right-to-left shunt through a patent foramen ovale while the patient was in a semiupright position and no significant shunt while in a recumbent position. This case demonstrates that platypnea-orthodeoxia caused by a patent foramen ovale can be clearly demonstrated by the technique of contrast transesophageal echocardiography performed on a tilt table.

Aged↗

PubMed1993

Inter- and intra-observer variability in detection of patent foramen ovale with contrast echocardiography.

Patent foramen ovale is detected in-vivo using the technique of contrast echocardiography. A positive test depends on the ability of an observer to recognise micro-bubbles passing from the right to the left heart, and to differentiate them from background noise and/or chordae tendinae. To assess the inter- and intra-observer variability of this technique four observers reviewed independently, and on two separate occasions, 100 consecutive contrast studies stored on video tape. The proportions of agreement (95% CI) for each separate observer on the two occasions for the presence of patent foramen ovale were 0.91 (0.76-0.98), 0.88 (0.73-0.92), 0.80 (0.63-0.92) and 0.78 (0.60-0.91), and for its absence were 0.96 (0.88-0.99), 0.95 (0.87-0.99), 0.90 (0.81-0.96) and 0.91 (0.82-0.96), respectively. The proportions of agreement (95% CI) between all observers on the first viewing were 0.78 (0.72-0.84) for the presence and 0.91 (0.87-0.93) for the absence of patent foramen ovale. For the second viewing these were 0.81 (0.75-0.86) and 0.91 (0.88-0.94), respectively (P = NS, Chi-squared test). These results indicate that contrast echocardiography is subject to clinically acceptable inter- and intra-observer variability.

Adolescent↗

PubMed1985

Hypoxemia from right to left shunting through patent foramen ovale.

We report a patient with severe hypoxemia from a large (41%) right to left shunt through a patent foramen ovale after right ventricular myocardial infarction, and review 18 previous descriptions of patients with right to left shunting through patent foramen ovale. These shunts occur when right atrial pressure is elevated above left atrial pressure, or when the anatomic relationship of the interatrial septum to the inferior vena cava is altered. Since 15-35% of the population have a potentially patent foramen ovale, interatrial right to left shunting may occur more frequently than had previously been recognized, and should be considered in a differential diagnosis of hypoxemia.

Adult↗

PubMed2003

The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy.

The cemento-dentino-canal junction, the apical constriction, and the apical foramen are the principal reference points used to determine the apical limit for instrumentation and root canal filling. For a better understanding of these structures, the objective of this study was to evaluate histologically the localization of the cemento-dentino-canal junction and the diameters of the apical foramen and root canal at the cemento-dentino-canal junction. Eighteen anterior maxillary teeth (canines, central, and lateral incisors) were used, from which 269 histological sections were obtained and evaluated by optical microscopy. The results indicated that the longest extension of the cementum into the root canal was observed in the canines, this value decreasing in the lateral incisors, and even more so in the central incisors. The widest diameter of the apical foramen corresponded to the lateral incisors, followed by the canines and the central incisors. The diameter of the root canal at the cemento-dentino-canal junction was greatest in the canines and lowest in the central and lateral incisors. Great variability was observed in the measurements of the extension of the cementum into the root canal. AQ: 1.

Adult↗

PubMed1998

Osteologic classification of the sphenopalatine foramen.

Textbook descriptions and illustrations of the opening of the sphenopalatine foramen (SPF) into the nasal cavity place it above and behind the posterior end of the middle turbinate (i.e., within the superior meatus). Although true for some skulls, this is not the situation for the majority and may be of importance, because the major blood supply to the nasal cavity enters via this route. Having studied 238 lateral nasal walls, the authors propose a classification of the osteology of the sphenopalatine foramen. In class I (35%) the opening of the SPF is purely into the superior meatus with a notch or foramen in the middle turbinate/ethmoidal crest of the palatine bone. In class II (56%) the SPF spans the ethmoidal crest (i.e., opens into both the superior and middle meati). In class III (9%) there are two separate openings into the superior and middle meati. These findings may explain the route of the artery to the inferior turbinate and indicate the need for care in dealing with the posterior end of the middle turbinate. They may also suggest a potential site for dealing with "difficult" epistaxis via an intranasal route.

Cadaver↗

PubMed2001

A hearing preservation technique for the resection of extensive jugular foramen tumors.

OBJECTIVE: To describe a modified surgical approach for patients who maintain hearing function with jugular foramen tumors that extend to the posterior cranial fossa and the neck. STUDY DESIGN: A retrospective review of 6 patients with jugular foramen tumors that were resected by a combined suboccipital and infralabyrinthine-transcervicomastoid approach. METHODS: A combined suboccipital and infralabyrinthine-transcervicomastoid approach is characterized as follows: 1) There is no ablation of ear structures except the infralabyrinthine mastoid bone; the auricle is retracted anteriorly while preserving the bony wall and skin of the ear canal. 2) After superficial parotidectomy, a limited length of nerve VII from the intratemporal vertical segment is rerouted to divisions of the parotid portion. 3) The tumor is removed along with the internal jugular vein and sigmoid sinus, then the extended intracranial mass is resected through an additional suboccipital approach. RESULTS: Five of the 6 patients had complete removal of all gross tumors. There were no major complications or mortalities. The preoperative levels of hearing were preserved in 5 of the 6 patients. Favorable facial function in the immediate postoperative period was noted in 4 of the 6 patients. Incomplete paralysis of 2 patients recovered eventually. CONCLUSION: We propose that a combined suboccipital and infralabyrinthine-transcervicomastoid approach to the jugular foramen can provide sufficient exposure to resect most dumbbell-shaped tumors, and it could be the initial treatment of choice for patients with remnant hearing.

Adult↗

PubMed2004

Meningioma of the jugular foramen: glomus jugulare mimic and surgical challenge.

OBJECTIVES: Meningiomas involving the jugular foramen are rare lesions, with approximately 34 cases reported in the English literature. Clinically, these tumors mimic the more common glomus jugulare tumor. After surgical resection, meningiomas have worse cranial nerve outcomes and higher recurrence rates than glomus tumors. There is controversy regarding the selection of surgical approach, particularly with regard to management of the facial nerve. A reliable means of accurate preoperative diagnosis would help surgical planning and patient counseling. STUDY DESIGN: We present a series of six consecutive large jugular foramen meningiomas resected by a single surgeon from 1996 to 2002. METHODS: Retrospective case series (chart review). RESULTS: The preoperative diagnosis was correct in nearly all (6/7) cases on the basis of the characteristic imaging findings seen with a combination of temporal bone dedicated computed tomography and high-resolution enhanced magnetic resonance imaging. Five of six patients had lateral facial nerve rerouting (infratemporal fossa Fisch type A), and three patients also had posterior rerouting (transcochlear approach with division of greater superficial petrosal nerve). Total tumor removal was accomplished in 83%. One patient suffered recurrence over a mean follow-up period of 2.5 years. New postoperative vocal cord palsies occurred in 50% of patients, and all required vocal cord medialization. At 1 year, 50% of patients had normal or near normal (House-Brackmann I or II) facial function. Postoperative cerebrospinal fluid leaks occurred in two patients, and both eventually required ventriculoperitoneal shunts. CONCLUSIONS: Meningiomas involving the jugular foramen are surgically challenging tumors that pose unique diagnostic issues. The majority of these lesions can be completely resected. A relatively high postoperative complication rate, which can be controlled with appropriate intervention, is seen with these surgeries.

Cranial Nerve Diseases↗

PubMed2002

Peripheral primitive neuroectodermal tumor of the jugular foramen: case report.

OBJECTIVE AND IMPORTANCE: Peripheral primitive neuroectodermal tumor (pPNET) is a rare type of tumor, most commonly found in the limbs of children and young adults. The authors report an extremely rare case of pPNET located at the jugular foramen whose clinical course demonstrated rapid progression. CLINICAL PRESENTATION: A 23-year-old man presented with a 2-month history of progressive hoarseness and dysphagia. The neuroradiological appearance of the lesion was a jugular foramen tumor. INTERVENTION: The patient underwent a partial resection of the tumor through a far lateral suboccipital craniotomy. After surgery, the patient experienced an unexpected deterioration in consciousness. Magnetic resonance images on postoperative Day 18 revealed rapid and large expansion of the residual tumor into the posterior fossa. No adjuvant therapy was administered, and the patient died 6 weeks after diagnosis. CONCLUSION: The pathological diagnosis of the surgical specimen was pPNET, according to the findings of hematoxylin and eosin and immunohistochemical stainings. To the best of our knowledge, this is the first reported case of pPNET at the jugular foramen.

Adult↗

PubMed2001

Canal and intervertebral foramen encroachments of a burst fracture: effects from the center of rotation.

STUDY DESIGN: The neural spaces of thoracolumbar burst fractures were investigated in an in vitro biomechanical study. OBJECTIVE: To evaluate encroachments of spinal canal diameter and intervertebral foramen area as functions of where the center of rotation is located during flexion and extension. SUMMARY OF BACKGROUND DATA: Decompression of the neural spaces is important for the recovery of neural function in a patient with a burst fracture injury. A few biomechanical studies have documented the decompression of the neural elements by adjustment of posterior fixation devices. However, the device adjustments have been device specific and ill defined. No study has investigated the neural decompression phenomenon with precisely defined multiple adjustments. METHODS: Burst fractures were produced at L1 vertebra in nine T11-L3 human spinal segments. Specimens were flexed and extended around five different centers of rotation located in the mid-L1 plane. The spinal canal diameter and intervertebral foramen area encroachments were quantified in maximum flexion and extension around each center of rotation using lateral radiographs. RESULTS: The average canal encroachment of 42.6% changed in flexion (32.2-48.5%) and extension (36.3-44.2%) by location of the center of rotation. The average intervertebral foramen area encroachment was decreased to a greater extent more often in flexion than in extension because of where the center of rotation was located. CONCLUSIONS: Both flexion and extension can decompress canal and foramina, depending on the choice for the location of the center of rotation. If lordotic posture is preferred clinically, then the optimal choice may be extension around the center of rotation located at the tip of the spinous process of the burst vertebra.

Adult↗

PubMed2004

Transjugular craniotomy for the management of jugular foramen tumors with intracranial extension.

OBJECTIVES: To elucidate indications and outcomes with the transjugular craniotomy for resection of jugular foramen tumors with intracranial extension. The transjugular approach is a lateral craniotomy conducted through a partial petrosectomy traversing the jugular fossa combined with resection of the sigmoid sinus and jugular bulb, which often have been occluded by disease. STUDY DESIGN: Retrospective review. SETTING: University medical center. PATIENTS: Twenty-eight patients with intracranial jugular foramen tumors who underwent a total of 30 surgical procedures. MAIN OUTCOME MEASURES: Pathologic findings, surgical approach, extent of tumor resection, rate of facial nerve mobilization and ear canal closure, facial and lower cranial nerve outcomes, and hearing preservation. RESULTS: Tumors included schwannoma (37%), meningioma (33%), glomus jugulare (23%), and chordoma (7%). The surgical approaches were tailored to maximize functional preservation, and included the transjugular (53%), translabyrinthine (17%), retrosigmoid (10%), and far lateral (7%) craniotomies. Translabyrinthine (3%) or transcondylarfar lateral (3%) approaches were occasionally used in combination with the trans-jugular approach. Most procedures were managed in a single stage (90%), but three patients with massive tumor in the neck required two stages. Microsurgical gross total and near-total tumor removal (37% each) were commonly achieved, although subtotal resections (27%) were occasionally performed. In only a minority of cases was facial nerve mobilization (7%) or ear canal closure (21%) required. If present preoperatively, Grade I facial nerve function was usually maintained (22 of 24 [92%]) and Hearing Class A or B could always be maintained (9 of 9 [100%]). As expected, new lower cranial nerve dysfunction was common (8 of 30 [27%]), although over half of the patients had complete lower nerve palsy preoperatively (16 of 30 [53%]). CONCLUSION: Most patients with jugular foramen tumors with intracranial extension can be managed with a single-stage transjugular craniotomy. Facial nerve mobilization or ear canal closure is usually not required, permitting conservation of facial function and hearing, when present preoperatively.

Adult↗

PubMed2006

Preservation of conductive hearing in approaches to tumors of the jugular foramen.

OBJECTIVE: Surgical approaches to the jugular foramen, most often used for the resection of glomus jugulare tumors, may include removal of the external auditory canal wall and overclosure of the meatus, resulting in maximal conductive hearing loss. Modifications have been described that maintain hearing by preserving the canal wall at the price of decreased exposure and are, therefore, suitable only for small and favorably located tumors. Our technique for removal and then reconstruction of the canal wall with hydroxyapatite cement allows for complete anterior translocation of the facial nerve as far proximal as the geniculate ganglion, giving uncompromising exposure of even the most extensive tumors, with the potential for preservation of normal hearing. The purpose of this study was to describe and report our experience with this technique. STUDY DESIGN: : Retrospective review. SETTING: Private otology practice. PATIENTS: Between 2000 and 2005, seven patients between the ages of 34 and 77 years were identified who underwent procedures using this technique. INTERVENTION: Surgical management of jugular foramen tumors. MAIN OUTCOME MEASURES: Successful anatomical reconstruction of the external auditory canal and middle ear. Preoperative and postoperative audiograms are compared, and facial nerve function is reported. Complications are discussed. RESULTS: All seven patients had successful reconstruction of the external auditory canal. Complications were minor and did not require additional surgical intervention. Postoperative pure-tone average differed from the preoperative average by a mean of 7.5 dB. Facial nerve function ranged from House-Brackmann Grades I to III when checked at least 7 months after surgery. CONCLUSION: This study reveals that this technique of external auditory canal reconstruction using hydroxyapatite cement allows complete anterior translocation of the facial nerve, while safely and reliably preserving the potential for normal hearing, without any compromise in exposure of the jugular foramen in the setting of an infratemporal fossa approach.

Abdominal Fat↗