Three-layered osteodural plasty for severe anterior skull base and facial injuries. Report of eleven cases

Background and purpose The upper cranial trauma of high force and wide area of application leads to fractures of calvaria, the skull base, and the viscerocranium. The aim of the study was to present eleven patients treated for severe anterior skull base and facial defects by means of three-layered osteodural plasty. Materials and methods The operative tactics consisted of bicoronal incision, bifrontal craniotomy, closure of the dura mater damage with a pericranium, reconstruction of bone defects with autologous bone grafts and plasty with anteriorly pedicled pericranial flap on the supratrochlear and supraorbital vessels. Results During follow-up, which lasted 2–7 years, none of the patients developed any early or late postoperative complications. Conclusions The three-layer osteodural plasty of severe anterior skull base injuries with the use of autologous bone grafts for the reconstruction of craniofacial skeleton resulted in a good final functional, morphological and aesthetic outcome in all patients

The comparative analysis of magnetic resonance imaging and arthroscopy of the temporomandibular joints

Background: The aim of the study was to correlate arthroscopic and MRI image of temporomandibular joints (TMJ) dysfunction on the clinical basis. Material/Methods: The study sample comprised 44 patients. All subjects underwent bilateral MRI and unilateral arthroscopy of TMJ to evaluate disc structure, position and function, bone structure abnormalities, joint effusion localization and entity according to Wilkes classification. Results: In 31 patients (70,5%) MRI allowed diagnosing the morphological and functional changes with the arthroscopic confidence. In 13 (29,5%) cases the differences between both images were noted. The stage of the disease was over- or underestimated at one grade level. Conclusions: The present study contributes to an improved understanding of TMJ changes in MRI. The MRI analysis of craniomandibular disorders is extremely helpful as the primary imaging preceding arthroscopy

Metoda elementów skończonych do oceny naprężeń kości czaszki powstających po obciążeniu zewnętrznym w złamaniach czaszkowo-oczodołowych

Background and purpose The craniofacial skeleton remains not fully recognised as far as its mechanical resistance properties are concerned. Heretofore, the only available information on the mechanism of cranial bone fractures came from clinical observations, since the clinical evaluation in a living individual is practically impossible. It seems crucial to implement computer methods of virtual research into clinical practice. Such methods, which have long been used in the technical sciences, may either confirm or disprove previous observations. The aim of the study was to identify the areas of stress concentrations caused by external loads, which can lead to cranio-orbital fractures (COF), by the finite element method (FEM). Material and methods For numerical analysis, a three-dimensional commercially available geometrical model of the skull was used which was imported into software of FEM. Computations were performed with ANSYS 12.1 Static Structural module. The loads were applied laterally to the frontal squama, the zygomatic process and partly to the upper orbital rim to locate dangerous concentration of stresses potentially resulting in COF. Results Changes in the area of force application revealed differences in values, quality and the extent of the stress distribution. Depending on the area of force application the following parameters would change: the value and area of stresses characteristic of COF. Conclusion The distribution of stresses obtained in this study allowed definition of both the locations most vulnerable to fracture and sites from which fractures may originate or propagate.Wstęp i cel pracy Szkielet czaszkowo-twarzowy nie jest obszarem rozpoznanym do końca pod względem jego mechanicznych właściwości wytrzymałościowych. Informacje dotyczące mechanizmu złamań kości czaszki uzyskiwano dotychczas na podstawie pourazowych obserwacji, ponieważ w warunkach klinicznych ocena odporności szkieletu czaszkowo–twarzowego żywego człowieka na zewnętrzne obciążenia nie jest praktycznie możliwa. Słuszne wydaje się zatem wdrożenie do praktyki klinicznej komputerowych metod badań wirtualnych, od dawna stosowanych w technice, które mogą potwierdzić lub zanegować dotychczasowe obserwacje kliniczne. Celem pracy była ocena za pomocą metody elementów skończonych (MES) miejsc koncentracji maksymalnych naprężeń sprowokowanych przez różnorodne zewnętrzno-boczne obciążenia szkieletu czaszkowo-twarzowego, które potencjalnie mogą prowadzić do złamania czaszkowo-oczodołowe-go (ZCO). Materiał i metody Do numerycznych analiz użyto trójwymiarowego, dostępnego komercyjnie geometrycznego modelu czaszki zaimportowanego do oprogramowania metody elementów skończonych. Do obliczeń wykorzystano moduł Static Structural komercyjnego oprogramowania ANSYS wersja 12.1. Obciążeniom poddano boczną powierzchnię łuski czołowej obejmującą guz czołowy, wyrostek jarzmowy kości czołowej i częściowo górny brzeg oczodołu, aby zlokalizować niebezpieczne naprężenia mogące prowokować ZCO. Wyniki Zmiany powierzchni przyłożenia siły ujawniły różnice w wartości, jakości i obszarze rozkładu naprężeń. W zależności od powierzchni przyłożenia siły zmieniały się wartości oraz obszary charakterystycznych dla ZCO naprężeń. Wnioski Uzyskane w badaniach rozkłady naprężeń pozwoliły określić najbardziej narażone na zniszczenie obszary oraz miejsca mogące być początkiem pęknięć lub ich propagacji. Wyniki analizy numerycznej potwierdziły wieloletnie obserwacje kliniczne dotyczące ZCO

RAGE and HMGB1 Expression in Orbital Tissue Microenvironment in Graves’ Ophthalmopathy

Graves’ ophthalmopathy (GO) is a chronic autoimmune inflammatory disorder involving orbital tissues. A receptor for advanced glycation end products (RAGE) and its ligand high mobility group box 1 (HMGB1) protein trigger inflammation and cell proliferation and are involved in the pathogenesis of various chronic inflammatory diseases. This study was aimed to evaluate RAGE and HMGB1 expression in GO to determine its potential clinical significance. To the best of our knowledge, this is the first study showing RAGE and HMGB1 expression in orbital tissue using immunohistochemistry. Sections of orbital adipose tissue obtained from patients diagnosed with GO (23 patients; 36 orbits) and normal controls (NC) (15 patients; 15 orbits) were analyzed by immunohistochemistry for RAGE and HMGB1 expression. Expression profiles were then correlated with clinical data of the study group. RAGE and HMGB1 expression were elevated in GO patients in comparison with NC (p=0.001 and p=0.02, respectively). We observed a correlation between RAGE expression and occurrence of dysthyroid optic neuropathy (DON) (p=0.05) and levels of TSH Receptor Antibodies (TRAb) (p=0.01). Overexpression of RAGE and HMGB1 might be associated with GO pathogenesis. In addition, RAGE and HMGB1 proteins may be considered as promising therapeutic targets, but this requires further research

RAGE and HMGB1 Expression in Orbital Tissue Microenvironment in Graves’ Ophthalmopathy

Graves' ophthalmopathy (GO) is a chronic autoimmune inflammatory disorder involving orbital tissues. A receptor for advanced glycation end products (RAGE) and its ligand high mobility group box 1 (HMGB1) protein trigger inflammation and cell proliferation and are involved in the pathogenesis of various chronic inflammatory diseases. This study was aimed to evaluate RAGE and HMGB1 expression in GO to determine its potential clinical significance. To the best of our knowledge, this is the first study showing RAGE and HMGB1 expression in orbital tissue using immunohistochemistry. Sections of orbital adipose tissue obtained from patients diagnosed with GO (23 patients; 36 orbits) and normal controls (NC) (15 patients; 15 orbits) were analyzed by immunohistochemistry for RAGE and HMGB1 expression. Expression profiles were then correlated with clinical data of the study group. RAGE and HMGB1 expression were elevated in GO patients in comparison with NC (p = 0.001 and p = 0.02, respectively). We observed a correlation between RAGE expression and occurrence of dysthyroid optic neuropathy (DON) (p = 0.05) and levels of TSH Receptor Antibodies (TRAb) (p = 0.01). Overexpression of RAGE and HMGB1 might be associated with GO pathogenesis. In addition, RAGE and HMGB1 proteins may be considered as promising therapeutic targets, but this requires further research