1/20. Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes.Idiopathic condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. This article presents the diagnostic criteria for idiopathic condylar resorption and a new treatment protocol for management of this pathologic condition. Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years. These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite. Imaging usually demonstrates small resorbing condyles and TMJ articular disk dislocations. A specific treatment protocol has been developed to treat this condition that includes: (1) removal of hyperplastic synovial and bilaminar tissue; (2) disk repositioning and ligament repair; and (3) indicated orthognathic surgery to correct the functional and esthetic facial deformity. patients with this condition respond well to the treatment protocol presented herein with elimination of the disease process. Two cases are presented to demonstrate this treatment protocol and outcomes that can be achieved. Idiopathic condylar resorption is a progressive disease that can be eliminated with the appropriate treatment protocol.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/20. 99mTc-HDP pinhole SPECT findings of foot reflex sympathetic dystrophy: radiographic and MRI correlation and a speculation about subperiosteal bone resorption.reflex sympathetic dystrophy (RSD) is a common rheumatic disorder manifesting painful swelling, discoloration, stiffening and atrophy of the skin. Radiographic alterations include small, spotty subperiosteal bone resorption (SBR) and diffuse porosis, and MR imaging shows bone and soft-tissue edema. The purposes of current investigation were to assess 99mTc HDP pinhole SPECT (pSPECT) findings of RSD, to correlate them with those of radiography and MRI and to speculate about causative mechanism of SBR which characterizes RSD. pSPECT was performed in five patients with RSD of the foot. pSPECT showed small, discrete, spotty hot areas in the subperiosteal zones of ankle bones in all five patients. Diffusely increased tracer uptake was seen in the retrocalcaneal surface where the calcaneal tendon inserts in two patients with atrophic RSD. pSPECT and radiographic correlation showed spotty hot areas, that reflect focally activated bone turnover, to closely match with SBR. Further correlation with MRI showed both spotty hot areas and SBR to coincide in location with the insertions of ligaments and tendons, onto which pulling strain is constantly exerted. In contrast, the disuse osteoporosis in unstrained bones did not show any more significantly increased tracer uptake than normal cancellous bones.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/20. Atypical keratosis obturans.keratosis obturans is a rare condition characterized by the accumulation of desquamated keratin material in the bony portion of the external auditory canal. Classically, it is reported to present with severe otalgia, conductive deafness and global widening of the canal. A case of keratosis obturans is described in which the principal symptom was a metallic taste and the main finding was extensive erosion of the hypotympanum with exposure of the facial nerve and the annulus of the tympanic membrane. This presenting symptom and resorption pattern are atypical of keratosis obturans and have not been documented previously.- - - - - - - - - - ranking = 0.016681037019569keywords = membrane (Clic here for more details about this article) |
4/20. Mandibular resorption in progressive systemic sclerosis: a report of three cases.Progressive systemic sclerosis is a generalized collagen disorder, which is characterized by fibrosis that involves skin, muscles and other organ systems like the gastrointestinal tract, lungs, heart and kidneys. Its oral manifestations include features like restricted mouth opening, widening of periodontal ligament space, pseudoankylosis, malocclusion and mandibular resorption. Mandibular resorption in systemic sclerosis is relatively uncommon and is reported only in 10% of cases. The purpose of reporting these three cases is to highlight the importance of screening all patients with advanced systemic sclerosis with panoramic radiographs. Panoramic radiographs are essential for early detection of resorption in the mandible to prevent possible consequences like pathological fractures, osteomyelitis and neuropathies.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/20. Pelvic insufficiency fracture related to autosomal dominant polycystic kidney disease.We report the case of a patient with autosomal dominant polycystic kidney disease (ADPKD) and an insufficiency-type fracture of the pelvis. A 60-year-old Japanese woman was admitted because of pain in the right ischium and pubis that began suddenly with no precipitating cause. Computed tomography showed the bony pelvis to be compressed by enlarged dependent kidneys and an enlarged liver. We relieved compression on the pelvic bones by means of transarterial embolization (TAE) to the kidneys and liver after initiation of hemodialysis therapy. The fracture healed gradually after TAE, and the patient could walk 4 months later. In an iliac bone specimen obtained before TAE, cancellous bone was intact, but periosteal and endosteal surfaces of cortical bone showed marked resorption and were irregular. Normally, many ligaments are connected tightly to the periosteal surface, supporting the cortical bone. However, because of extensive surface resorption associated with pressure from enlarged kidneys, connections between ligaments and the periosteal surface presumably became fragile, promoting an insufficiency fracture from unapparent external forces. Thus, ADPKD is a potential cause of insufficiency fracture owing to abnormalities of cortical bone.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
6/20. Clinical and histologic evaluation of the use of mandibular tori as donor site for mandibular block autografts: report of three cases.The present paper reports on three patients who underwent localized alveolar ridge augmentation using block autografts harvested from the mandibular tori. Autogenous particulate bone graft was placed at the periphery of the block. Resorbable collagen membrane was placed above the graft material. Implant placement surgery followed at 6 to 16 months after bone grafting. During implant surgery, a biopsy was taken from the block autograft. Clinical evaluation revealed incorporation of the graft material at the recipient site. No donor site complication was noted. Histologic evaluation suggested that the block autograft was vital and in an active remodeling phase at the time of implant placement. Impressions were made intraorally before and 6 months after bone grafting. Laboratory measurements revealed 13% resorption at 6 months after bone grafting while 0.53 mL of ridge augmentation was achieved 6 months after bone grafting. Linear tomographs indicated 4.33 mm of lateral alveolar ridge augmentation. This report suggests that block autografts harvested from the mandibular tori may have the potential to maintain their vitality after bone grafting, while they may demonstrate resorption rates similar to those of autografts harvested from other intraoral donor sites.- - - - - - - - - - ranking = 0.016681037019569keywords = membrane (Clic here for more details about this article) |
7/20. Distal femur replacement is useful in complex total knee arthroplasty revisions.Revision total knee arthroplasty can be considerably more difficult in cases involving severe bone loss, complete absence of collateral ligaments, and persistent periprosthetic supracondylar femoral fractures. Modular segmental endoprosthetic distal femur replacement is a limb salvage option when other surgical options are unfeasible. The clinical performance of rotating hinge knee prostheses has greatly improved with the evolution of second and third generation designs. The increased freedom of rotation decreases the prosthetic bone stresses and the longevity. While designs have improved, the prostheses still do not match the function and longevity of condylar components with approximately a 90% survivorship at 20 years. The modular endoprosthesis rotating hinge knee prosthesis is useful for total knee arthroplasty revision in patients with inadequate bone stock, ligamentous instability, or difficult supracondylar femur fractures, especially in low demand elderly patients. Level of Evidence: Therapeutic study, level V (expert opinion). See Guidelines for Authors for a complete description of levels of evidence.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
8/20. in vitro bone resorption by isolated multinucleated giant cells from giant cell tumour of bone: light and electron microscopic study.The behaviour of multinucleated giant cells (GCs), obtained from a giant cell tumour of the tibia and cultured on glass coverslips or on devitalized bone slices, was studied using light and electron microscopy. Monitoring the GCs on bone slices by phase-contrast microscopy revealed that they had removed calcified bone matrix resulting in excavation of lacunae, with subsequent lateral extension and perforation of the bone slices. Electron microscopy demonstrated for the first time that the GCs responsible for exavating lacunae had two specific membrane modifications, ruffled border and clear zone, and showed basically similar cytoplasmic fine structures to those of osteoclasts. fluorescence images of the GCs on glass and on bone after rhodamine-conjugated phalloidin staining revealed that most of the GCs had an intensely fluorescent peripheral band composed of a number of F-actin dots called podosomes. Some GCs showed unusual arrangements of podosomes suggesting abortive attempts at GC formation. We have demonstrated that the band structure of the GCs cultured on bone is intimately involved in bone resorption. Two stromal cell types could be recognized. The predominant type, which seemed to be the only neoplastic element because of its proliferative capability, showed quite different fine structural and cytoskeletal features from the GCs. The other type, which was much less frequent and seemed not to proliferate, had morphological similarities to the GCs, and seemed to be their precursor. Importantly GCs cultured on bone and the osteoclasts share common structures for adhesion to and resorption of bone, strongly supporting the view that the GCs of the giant cell tumour of bone are potentially active bone resorbers and can be regarded as osteoclasts.- - - - - - - - - - ranking = 0.016681037019569keywords = membrane (Clic here for more details about this article) |
9/20. bone regeneration adjacent to titanium dental implants using guided tissue regeneration: a report of two cases.The biologic principle of guided tissue regeneration was applied to regenerate alveolar bone in conjunction with the placement of titanium dental implants. In one case, complete osseointegration of an implant was achieved by the placement of a Teflon membrane over an implant that had been inserted into an alveolus immediately following tooth extraction. In a second case, the same biologic principle was used to increase the volume (height and width) of a resorbed, edentulous alveolar ridge to provide adequate bone dimensions for implant installation. In both cases, the membranes appear to have prevented the repopulation of the wound area by cells other than those derived from surrounding bone tissue. These two different applications of the principle of guided tissue regeneration open new avenues for reconstructive osseous surgery.- - - - - - - - - - ranking = 0.033362074039138keywords = membrane (Clic here for more details about this article) |
10/20. fibrin and fibronectin sealing system in a guided tissue regeneration procedure. A case report.A case is reported showing an iatrogenic, chronic abscess of six years' duration associated with a bony defect between the maxillary right central and lateral incisors. The osseous defect was treated by a guided tissue regeneration procedure with the use of a fibrin and fibronectin sealing system. The system was employed to fix the membranes and keep them apart from the root surface, thereby maintaining room for bone regeneration. This operation resulted in a 9-mm clinical attachment gain and in an 11-mm filling of the osseous defect. The second surgical stage after a three-month reentry procedure was strictly for cosmetic improvement by means of a free gingival graft.- - - - - - - - - - ranking = 0.016681037019569keywords = membrane (Clic here for more details about this article) |
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