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A saliva collection device is described that can be used in the presence of anatomical variations such as tilted teeth and lingual tori. The integrity of the seal can be tested by monitoring pH and flow rates and also by noting the viscosity of the secretions collected.
Previous studies in man have relied only on electromyographic (EMG) activity patterns and anatomical landmarks to confirm electrode placement in the superior head of the lateral pterygoid. Computed tomography (CT) was used here to determine whether indwelling fine wires could be visualized in that muscle head in man and thus provide evidence for correct placement before EMG. Two imaging sessions were conducted in six individuals. First, a series of contiguous axial CT slices was obtained to calculate the trajectory of insertion of fine wire electrodes into the superior head. For each individual, the trajectories for the location of the fine wires in the approximate mediolateral and anteroposterior centre of the superior head were different. Further axial CT slices were taken after electrode insertion; in each case, these slices clearly showed the wire ends located within the muscle. It was concluded that fine wires in the lateral pterygoid can be imaged by CT. Furthermore, imaging is necessary to accommodate interindividual anatomical variations and to confirm the position of the electrodes within the muscle.
To test the hypothesis of anomalous anatomy in posterior brain regions associated with language and reading, the corpus callosum was imaged in the midsagittal plane with magnetic resonance. The areas of the anterior, middle, and posterior segments were measured in 21 dyslexic men (mean age 27 yrs, SD 6) and in 19 matched controls. As predicted, the area of the posterior third of the corpus callosum, roughly equivalent to the isthmus and splenium, was larger in dyslexic men than in controls. No differences were seen in the anterior or middle corpus callosum. The increased area of the posterior corpus callosum may reflect anatomical variation associated with deficient lateralization of function in posterior language regions of the cortex and their right-sided homologues, hypothesized to differ in patients with dyslexia.
The radial forearm flap derives its blood supply from the radial artery. Anatomical variations of this vessel are uncommon. This report describes an anomaly which has relevance for the radial forearm flap.
The serratus anterior free muscle flap is useful in lower limb reconstruction, as it combines a moderate quantity of muscle with a long vascular pedicle. There are known vascular anatomical variations, for example the blood supply may come from the thoracodorsal pedicle, directly from the subscapular pedicle or from the axillary artery and vein. We present a case with a totally independent arterial supply to the flap from the first intercostal artery, while venous return from the flap went back as usual to the subscapular pedicle.
An anomolous branch of the cat medial gastrocnemius nerve was found to travel with the combined lateral gastrocnemius and soleus nerves in the popliteal fossa before innervating muscle fibers in the medial gastrocnemius. The innervation pattern was confirmed by EMG recording, elicitation of contraction in the medial gastrocnemius by stimulating the branch, isolation of a single motor unit innervating the medial gastrocnemius whose axon traveled in the branch, and glycogen depletion of medial gastrocnemius muscle fibers by stimulating the branch. Awareness of such anatomic variation is important, for example, in interpreting studies of synaptic connections and of mechanical properties during reinnervation of muscle.
Eight women with cervical atresia were evaluated and treated for symptoms of pelvic pain. Two distinct anatomic variations of cervical atresia were observed among these patients. A fibrous cord, with islands of endocervical glands, was noted in two patients surgically treated with the creation of a cervicovaginal fistula through the fibrous cord. Alternatively, a complete absence of the cervical stroma required a uterovaginal anastomosis in two women. One of the two women with the cervicovaginal fistula continues to menstruate. Both women, after the anastomosis, required additional surgery to maintain menstrual flow and ultimately received hysterectomy. Subsequently, four women with complete congenital absence of the cervical stroma were treated primarily with the removal of the uterine fundus. Although menstrual function may be maintained in patients with some cervical stroma, no pregnancies have occurred. Thus, removal of the uterine fundus remains the treatment of choice, relieving symptoms and avoiding additional surgery to maintain uterovaginal patency.
OBJECTIVES: Our purpose was to detect anatomic variations in postmenopausal bone loss and to determine the risk factors most affecting bone mass in Japanese women. METHODS: One hundred sixty-six Japanese women (54 premenopausal and 112 postmenopausal), aged 40-68 years, were enrolled in the study. Bone mineral densities (BMD) of the lumbar spine (L2-4) and total body were measured by dual energy X-ray absorptiometry and the results were subjected to statistical analysis. RESULTS: Among the various sites studied, the lumbar spine (L2-4) showed the fastest bone loss after menopause. Multiple regression analysis indicated that two factors, number of years since the menopause and body mass index (BMI), affected lumbar spine (L2-4) BMD. CONCLUSION: Measurement of lumbar spine (L2-4) BMD is suitable for evaluating postmenopausal osteoporosis. The risk factors for postmenopausal bone loss were a long period after menopause and a low BMI.
A strain transducer was developed which employs a magnetic field sensing device to detect linear displacement. The transducer was attached to the medial collateral ligament (MCL) of human autopsy specimens, minimally influencing their physiologic behavior. A strain 'map' of the MCL as a function of knee flexion (full extension to 120 degrees) both with and without abduction force was obtained. Our investigation revealed consistent differences in the strain patterns between proximal, middle and distal segments of the anterior and posterior borders of the MCL. Anatomic variations in the pattern of collagen fibers within the MCL, interactions between posterior oblique capsular fibers and the MCL, and the skeletal configuration may account for these varied strain patterns.
The practitioner who treats patients with MPD should be aware that certain anatomic variations may predispose a patient to developing the syndrome. We feel that the newly described entity, the short-face syndrome, is such an example. Patients exhibiting short-face syndrome are overclosed. Their condition appears to be improved by establishing an increased vertical dimension of occlusion. This is first accomplished with the use of a processed acrylic resin occlusal splint. If a patient has been asymptomatic at the new occlusal relationship, a maxillary osteotomy is recommended to achieve a more permanent functional and cosmetic result.
Dentists must base their technique on an understanding of the biologic aspects of the relationship between the denture base and supporting tissues. Those tissues must be able to tolerate functional stresses without promoting patient discomfort and should be recorded in such a manner that these areas provide complete denture support. Anatomic regions that satisfy the requirements for providing primary support should make positive contact with the denture base under functional loading. Those that are less resistant to long-term changes or are unable to tolerate stress should be relieved of excessive contact with the denture base. Selection of those regions that should provide primary and secondary support depends on the anatomic variations unique to each patient.
Hereditary spastic paraparesis (HSP) is a neurodegenerative disorder, of which progressive spastic paraparesis is the clinical hallmark. Given the neuropathological evidence of degeneration of pyramidal tracts, dorsal columns, and dorsal spinocerebellar tracts, it is surprising that sensory symptoms are so indistinct compared to motor symptoms. We investigated the involvement of peripheral conduction and spinal proprioceptive pathways by nerve conduction studies, somatosensory evoked potentials of the median and tibial nerves, and quantitative assessment of the vibration perception thresholds of the hands and feet respectively in 32 patients suffering from HSP and healthy control groups. We did not find peripheral conduction abnormalities in HSP patients. Log-transformed vibration perception thresholds of the feet were abnormal in 13/32 HSP patients and in 0/64 controls (p < 0.00001), while tibial nerve somatosensory evoked potentials were abnormal in 20/32 patients and in 1/17 controls (p = 0.00001). The values for the upper extremities were within normal limits for nearly all subjects. In the HSP group, the neurophysiological disturbances did not correlate significantly with duration or severity of the disease, when age was controlled for, except for median nerve SSEP latency, which was affected by severity (p = 0.0072). We conclude that neurophysiological methods detected proprioceptive, subclinical abnormalities in several HSP patients, which may reflect degeneration of the dorsal columns, and/or dorsal spinocerebellar tracts. Since we found no correlation with several disease variables, the fact that not all HSP patients displayed these abnormalities may be caused by anatomical variations in proprioceptive pathways, rather than by phenotypical heterogeneity.
A case of coronoid process hyperplasia is presented. The primary presenting complaint and clinical feature was restriction of opening, although there was marked facial asymmetry in the area of the right zygoma. Presurgical documentation of this anatomic variation by routine radiography and computed tomography with sagittal reconstruction is presented.
Bis-dequalinium acetate (BDA), a quaternary ammonium compound, was introduced as a bactericidal and chemotherapeutic agent for endodontic use. This study was undertaken to compare the efficacy of this compound to 5.25% sodium hypochlorite in the cleansing and shaping of root canals. One hundred twenty freshly extracted teeth were divided into three groups. Each group was treated with the aid of the test material; saline solution was used as a control. After completion of the endodontic preparation, a silicone imprint of the canals was performed and the teeth were decalcified. The imprints were examined three-dimensionally to determine the amount of debris and canal configuration due to defective preparation and anatomic variation. No significant difference could be observed between the tested materials with respect to cleanliness and the shape of the canals. At the apical third, however, the BDA-treated canals showed more favorable results with respect to cleanliness. On the basis of the present and previous findings, it was concluded that BDA might be a favorable replacement for sodium hypochlorite as an irrigation solution.
The prevalence of an anatomic variation, called retrocuspid papilla, was determined in Israeli Jews. The distribution of the retrocuspid papillae, according to two age groups, and symmetry within the dental arch and in relation to ethnic origin were examined. Results showed that retrocuspid papillae were observed in 38.5% of the young group and in 11.3% of the adult group. Greater occurrence of bilateral than unilateral retrocuspid papillae was observed in each age group and in both sexes. No significant ethnic trend was found when the prevalence of retrocuspid papillae was examined in relation to the ethnic origin of the study sample.
This article deals with the incidence of anatomic variations in the styloid process and stylohyoid ligament as found in panoramic radiographs. Also, the accuracy was determined for measuring the length of styloid processes from panoramic radiographs, the variation in length of the styloid process with age, and the relationship of elongated styloid processes and ossified stylohyoid ligaments to symptoms of styloid-stylohyoid syndrome. Variations in styloid process and stylohyoid ligaments are not uncommon, especially segmentation of the process in young subjects. The apparent length of the styloid process was magnified approximately 1.37 times and was never diminished by panoramic radiographs. A steady increase in styloid process length was observed to age 30 years, with another slight increase starting at age 60 years. Subjects with elongated styloid processes (greater than 40 mm) had the highest incidence of discomfort on swallowing, whereas subjects with ossification of the stylohyoid ligament had the highest incidence of discomfort on turning the head from side to side.
A significant proportion (31%) of southern (Hong Kong) Chinese patients who received therapeutic transcutaneous electrical stimulation with the Myo-Monitor experienced uncomfortable twitching of the muscles of facial expression of the upper and middle portions of the face. This can be attributed, at least in part, to anatomic variation in the position and branching pattern of the upper (temporofacial) division of the facial nerve in the sample population. Our observations of living patients support the contention that muscular contraction resulting from Myo-Monitor stimulation is neurally mediated.
Twelve patients undergoing bilateral osteotomy of the ramus of the mandible were examined with CT preoperatively and postoperatively. The maximum area of the cheek and oropharynx was measured together with the thickness of the masseter muscle and the overlying subcutaneous tissue. The preoperative CT examinations showed wide anatomic variations. The postoperative examinations showed a diminished oropharynx lumen of approximately 43%. Swelling of the cheek averaged 61% and was associated with the well-vascularized masseter muscle. The TMJs were measured and a slight widening of the joint space was found postoperatively.