Extreme sensitivity of hearing to decreases of ICP in Menière's disease

We report the case of a Menière's disease patient affected by normal pressure hydrocephalus (NPH) who presented a cerebrospinal fluid (CSF) pressure-dependent hearing impairment after shunting. This side-effect was not only reversible and reproducible but occurred at a high opening pressure when the valve setting was lowered by only 0.7mmHg (10mmH2O). This observation suggests that hearing in Menière's disease might be very sensitive to small reductions of intracranial pressure (ICP) and that these patients should be informed of this potential risk, which can compromise the efficacy of the shun

Removal of unusual, large high-velocity metallic maxillary sinus foreign bodies by a modified free bone flap technique

Metallic foreign bodies are rarely found in the maxillary sinus, and usually they have a dental origin. Potential complications related to foreign bodies include recurrent sinusitis, rhinolith formation, cutaneous fistula, chemical poisoning, facial neuralgic pain and even malignancies. Two main surgical approaches are currently used for the removal of foreign bodies in the maxillary sinus: the bone flap and the endoscopic sinus techniques. We are reporting two unusual cases of large high-velocity foreign bodies removed by a modified maxillary lateral antrotomy, with free bone flap repositioning and fixation with a titanium miniplat

Reconstruction orbitaire post traumatique par grilles en titane préformées et non préformées

Introduction. Nous avons comparé cliniquement et radiologiquement la précision et la fiabilité de deux types de grilles en titane utilisées pour les reconstructions orbitaires. Les premières étaient des grilles non préformées (GNP) et les secondes étaient préformées industriellement dans les trois axes (GP). Patients et méthodes. Les deux groupes étaient constitués de 15 patients. Le volume de chaque orbite a été calculé à partir de coupes TDM coronales à l'aide du logiciel d’analyse d’image OsiriX Medical Image software (version 3.3.2, www.osirixviewer.com). Les autres paramètres étudiés rétrospectivement ont été : le sexe, l’âge, la distribution des fractures et les complications (diplopie et enophtalmie). Résultats. Le volume orbitaire entre le côté reconstruit et le côté sain n’était pas significativement différent dans chaque groupe (GP : p = 0,200, GNP : p = 0,991). La moyenne des volumes orbitaires reconstruits n’était pas significativement différente dans chaque groupe (GNP = 21,76 cm3, GP = 20,28 cm3, p = 0,441). Un patient a été réopéré à cause d'une diplopie postopératoire. Il n'y a pas eu d'enophtalmie clinique postopératoire. Discussion. La restauration du volume orbitaire, mesurée par le logiciel OsiriX, est la même avec des plaques en titane préformées ou non

Computer-aided volumetric comparison of reconstructed orbits for blow-out fractures with nonpreformed versus 3-dimensionally preformed titanium mesh plates: a preliminary study

OBJECTIVES: To compare and evaluate, using computer-aided volumetric measurements, the accuracy and reliability of nonpreformed mesh plates (NPMPs) versus 3-dimensionally preformed titanium mesh plates (PMPs) in posttraumatic orbital volume restoration. PATIENTS AND METHODS: Facial coronal computed tomographic scan slices from 20 patients (10 in the NPMP and 10 in the PMP group) were used to measure bony orbital volume using OsiriX Medical Image software (version 3.3.2, www.osirix-viewer.com). The procedure was performed on both orbits; thereafter, the volume of the contralateral health orbit was used as a control for comparison in the 2 groups of patients. The difference in orbital volume between the 2 groups and between the reconstructed versus uninjured side in both groups have been statistically correlated. RESULTS: The mean orbital volume between the reconstructed (19.215 mL in NPMP and 21.791 mL in PMP) and the contralateral uninjured side (18.955 mL in NPMP and 21.710 mL in PMP) was not statistically significant (P > 0.05). The mean orbital volumes of the reconstructed orbits were 19.215 mL in the NPMP and 21.791 mL in the PMP group, with no statistically significant difference (P > 0.05). The volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with an accuracy of a maximum of 1.85 mL in the NPMP group and 2.5 mL in the PMP group. CONCLUSIONS: The current study demonstrated that there were no significant differences in the orbital volume restoration using either technique. In fact, both techniques allow for close reproduction of natural orbital volume and shape, and its use in posttraumatic orbital wall reconstruction was successful

Posterior reduction and fixation of an unstable Jefferson fracture with C1 lateral mass screws, C2 isthmus screws, and crosslink fixation: technical case report

OBJECTIVE: We sought to describe a modified technique for the reduction and stabilization of unstable Jefferson fractures. CLINICAL PRESENTATION: We present the case of an isolated unstable Jefferson fracture in a 33-year-old woman. The patient was the victim of a motor vehicle accident. Her neurological examination was normal. A cervical computed tomographic scan revealed an isolated Jefferson fracture that we thought to be unstable when we applied the Spence criteria. TECHNIQUE: The fracture was treated by a technical variant of C1-C2 posterior fixation with compression on the rods by means of a crosslink connector, allowing the reduction of the atlantoaxial lateral mass overhanging. C1-C2 fusion with posterior iliac crest bone graft was added. CONCLUSION: The 1-year radiological follow-up evaluation showed a complete consolidation of the fracture lines and atlantoaxial stability. This technique could be an option for the reduction and stabilization of the unstable Jefferson fractures

Reconstruction orbitaire post-traumatique par grilles en titane préformées versus non préformées

We compared, clinically and radiologically, the accuracy and reliability of two types of titanium mesh plates used for orbital reconstruction. The first were non-preshaped mesh plates (NPMP) and the second were three-dimensionally preformed mesh plates (PMP)

Dentofacial deformities treated according to a dentoskeletal analysis based on the divine proportion: are the resulting faces de facto "divinely" proportioned?

The aim of this study was to retrospectively evaluate the accuracy and reliability of a skeletal cephalometric analysis based on the divine proportion (Sassouni's analysis) in predicting "divinely proportioned" faces in the treatment of dentofacial deformities. Preoperative and postoperative frontal photographs of 50 patients were analyzed, and the following 5 proportions were measured: (1) TR-AL:AL-ME, (2) ME-AL:AL-LC, (3) LC-CH:CH-ME, (4) LC-AL:AL-CH, and (5) ME-CH:CH-AL (TR indicates trichion; AL, alar rim; ME, menton; LC, lateral canthus; CH, cheilion). For each proportion, the effect of the treatment on the absolute difference between the proportions and the golden number (Φ) (1.618) was statistically analyzed. Analyses were adjusted for sex, age, type of dentofacial deformity (anteroposterior and/or vertical), and surgical technique (1-jaw vs 2-jaw surgery with or without a genioplasty). In all of the cases, the facial proportions analyzed were not significantly changed by the surgical treatment except for the proportion ME-CH:CH-AL (lower facial third), which was significantly moved toward 1.618 (P < 0.01). The current study demonstrated that (1) facial divine proportion can be closely approximated and predicted only by a specific cephalometric analysis in the lower facial third and (2) parameters such as age, sex, type of dentofacial deformities, type of surgery, and so on, could potentially and significantly influence the final results toward the divine proportion

Evaluation of condylar morphology following orthognathic surgery on digital panoramic radiographs. Could methodology influence the range of "normality" in condylar changes?

To evaluate the morphological condylar changes following orthognathic surgery by using a rapid and reliable computational method on panoramic radiographs

Removal of unusual, large high-velocity metallic maxillary sinus foreign bodies by a modified free bone flap technique.

Metallic foreign bodies are rarely found in the maxillary sinus, and usually they have a dental origin.Potential complications related to foreign bodies include recurrent sinusitis, rhinolith formation, cutaneous fistula,chemical poisoning, facial neuralgic pain and even malignancies.Two main surgical approaches are currently used for the removal of foreign bodies in the maxillary sinus: the bone flap and the endoscopic sinus techniques. We are reporting two unusual cases of large high-velocity foreign bodies removed by a modified maxillary lateral antrotomy,with free bone flap repositioning and fixation with a titanium miniplate