Microsurgical Treatment of Ruptured True Posterior Communicating Artery Aneurysm in the Distal Portion of the Posterior Communicating Artery

The true posterior communicating artery (PCoA) aneurysms in the distal portion of the posterior communicating artery are rare. The authors describe a 63-year-old woman with 1 true PCoA aneurysms in the distal portion of the PCoA, which was treated surgically through modified pterional approach. No neurologic deficit was present at the postoperative period. Although endovascular intervention is more and more widely used in the treatment of aneurysms, the authors have also emphasized that true PCoA aneurysms in the distal portion of the PCoA can also be surgically treated in suitable patients. Address correspondence and reprint requests to Yonglin Yang, PhD, Wandong Su, Department of Neurosurgery, People's Hospital of Rizhao, Rizhao 276826, China; E-mail: yyl197705@126.com, 76667503@qq.com Received 8 February, 2018 Accepted 3 June, 2018 Funding: Jining Medical University (award number: JY2017FS025). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Can Volumetric and Morphological Variants of Sphenoid Sinuses Influence Sinuses Opacification?

Improvements in computed tomography and in functional endoscopic sinus surgery have recently increased interest toward paranasal sinus anatomy and anatomic variations that can be observed in patients affected by sinusitis. Isolated sphenoid sinusitis is a relatively rare pathology, often related to nonspecific symptoms, therefore making diagnosis difficult. The correlation between this type of sinusitis and anatomical variants remains unclear. The authors' aim was to retrospectively revise paranasal sinuses computed tomography scans of patients affected by sphenoid sinusitis, compared with a control group, analyzing the types of sphenoid sinus and the presence of aberrant pneumatization, and performing a segmentation of the sphenoid sinuses to calculate the volumes. Sphenoid sinuses of 60 patients affected by sinus opacification, compared with a control group, were segmented. Type of sinus (sellar, presellar, postsellar) and presence of aberrant pneumatization were assessed as well. Possible statistically significant differences in volumes according to sex and group were assessed through 2-way ANOVA test (P 

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Reconstruction of Wegener Granulomatosis Nose Deformity Using Fascia Lata Graft

Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose. The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment. Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse. The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result. Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation. Address correspondence and reprint requests to Esther Deleyto La Cruz, MD, Department of Plastic and Reconstructive Surgery, Hospital Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain; E-mail: esdelac@gmail.com Received 25 January, 2018 Accepted 3 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Incidence of Foramen Tympanicum (of Huschke): Comparing Cadaveric and Radiologic Studies

Purpose: The foramen tympanicum (FT) represents a developmental anomaly that forms due to incomplete fusion of processes of the tympanic ring. Its presence in the population is controversial and it has been associated with a number of otologic complications. The aim of this study was to systematically analyze the prevalence, anatomical characteristics, and ethnic variations of the FT and compare these parameters in cadaveric and radiologic studies. Methods: An extensive search was conducted through the major electronic databases, and identified articles were separated into 2 groups based on their methodology: cadaveric and radiologic studies. Data extracted included study modality, prevalence data, ethnicity, gender, side, laterality, and diameter. Results: A total of 8 studies (n = 2671 patients) were included into our meta-analysis. The main findings revealed that the prevalence of the FT in the population is 14.9%, it is more often unilateral (62.5%) than bilateral (37.5%), it is most often reported in Asia (21.4%), and it is more prevalent in cadavers (21.2%) than in radiologic studies (8.8%) (not statistically significant). Conclusion: As the FT is present in more than one-tenth of the population, it is important to consider the possibilities of its presence when undertaking surgical procedures in the temporomandibular joint and ear region and plan accordingly to avoid injuries. Clinicians should keep it as one of the possible diagnoses while confronted with patients presenting with otologic complications. The use of newer imaging techniques was recommended, such as cone-beam computer tomography to detect the FT prior to surgery. Address correspondence and reprint requests to Krzysztof A. Tomaszewski, MSPC, MBA, MSc (Edin), MD, PhD, Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034 Krakow, Poland; E-mail: krtomaszewski@gmail.com Received 3 January, 2018 Accepted 29 May, 2018 Krzysztof A. Tomaszewski was supported by the Polish Ministry of Higher Education grant for young scientists. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Maxillary Alveolar Ridge Atrophy Reconstructed With Autogenous Bone Graft Harvested From the Proximal Ulna

Atrophy of the alveolar ridge requires bone grafting at the implant site for rehabilitation of the masticatory function with dental implants. Despite the advances in the development of bone substitutes, autogenous bone graft remains the "criterion standard" because of its osteogenic, osteoinductive, osteoconductive potential, and non-immunogenic properties. However, harvesting of autogenous bone is not exempt from donor site morbidity. In this context, the use of autogenous bone derived from the proximal ulna might be a viable resource to obtain corticocancellous bone graft, as the harvesting from this donor site is associated with low morbidity. Thus, this article aimed to describe a case in which a maxillary sinus floor augmentation was performed by means of autogenous bone graft harvested from the proximal ulna, as the donor site. An appositional bone block graft harvested from the same region was used to augment the residual alveolar ridge. Clinically, healing proceeded uneventfully with no major complications. After 8 months, a proper amount of bone was found at the implant site, allowing a prosthetically driven implant insertion and subsequent implant-supported rehabilitation. Results were clinically and radiographically stable after a 3-year follow-up. The present case report suggested that proximal ulna as a donor site should be considered as a safe and reliable alternative for alveolar ridge augmentation. Besides the case presentation, a comprehensive review of the literature was also provided. Address correspondence and reprint requests to Prof. Francisley Ávila Souza, MSc, PhD, Department of Surgery and Integrated Clinic, Araçatuba Dental School, São Paulo State University "Júlio de Mesquita Filho" - UNESP, Rua José Bonifácio 1193, Vila Mendonça, 16015–050, Araçatuba, São Paulo, Brazil; E-mail: f.avilasouza@foa.unesp.br Received 9 January, 2018 Accepted 24 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Novel Application of Platelet-Rich Fibrin as a Wound Healing Enhancement in Extraction Sockets of Patients Who Smoke

The objectives of this study were to assess the potential of platelet-rich fibrin (PRF) on acceleration of soft tissue healing after tooth extraction and to evaluate its effectiveness in reducing the prevalence of dry socket among smoker patients. Twenty smoker male patients aged (18–72) years with multiple teeth extraction were participated in this clinical research. They underwent trans-alveolar extraction of 40 teeth. The extraction sockets were divided in each patient into 2 groups: the study group in which extraction sockets were treated with PRF and the control group: in which extraction sockets left to heal naturally without PRF. Platelet-rich fibrin enhanced soft tissue healing and reduced inflammatory process within the study group compared with control group as the 2-tailed P value equaled 0.0035 which was very statistically significant. Pain level according to visual analog scale in control group had average of (1.8), while in the study group had average of (0.65) and the P value equaled 0.1511 which was not statistically significant. Degree of epithelization was recorded by dental caliper for both groups and the 2-tailed P value equaled 0.7134 which was insignificant. The results from this study showed that PRF enhanced the quality of soft tissue healing of extraction socket among smoker patients but it did not show significant difference regarding pain reduction, dry socket prevention, and socket closure. Future clinical trials are required to clearly identify the effectiveness of PRF regarding this subject. Address correspondence and reprint requests to Huda Moutaz Asmael, BDS, MSc, Assistant Lecturer at Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Almoadham, PO Box 1417, Baghdad, Iraq; E-mail: Dr_huda2012@yahoo.com Received 13 March, 2018 Accepted 12 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Achondroplasia: Orocraniofacial Features and Orthodontic-Surgical Management Guidelines Proposal

In this study, the authors aimed to describe orocraniofacial features and to suggest orthodontic-surgical managements in achondroplasia, based on a literature review. The authors focused on skeletal and dentoalveolar malocclusion in order to highlight the place of orthognathic surgery, based on our experience of 3 patients. Maxillary hypoplasia in achondroplasia typically results in an Angle class III malocclusion with an anterior open bite. The other orocraniofacial features include enlarged calvarium, prominent forehead and frontal bossing, midface hypoplasia, elongated lower face and saddle-shaped nose due to lack of development of the nasomaxillary complex. All our patients had a typical facial appearance but each of them had their own particularities regarding medical history and severity of the dentoskeletal dysmorphosis. Two of them were successfully treated by orthognathic surgery; the other declined surgical treatment and underwent orthopedic treatment only (anchorage plates). The treatment failure of this 3rd patient raises the question of the efficiency of anchorage plates in achondroplasia. In the light of the literature and our results, the authors conclude the need for personalized management based on age, medical history, severity of the dentoskeletal dysmorphosis, functional and/or esthetic disorders, and the patient's needs and requests. In any patient, orthodontic management should be initiated at an early age, and orthognathic surgery modalities should be personalized and adapted to each situation. Address correspondence and reprint requests to Dr Mallouel Pineau, MD, Service de Chirurgie Maxillo-Faciale et Stomatologie Hôpital Roger Salengro, Bd du Professeur Emile Laine, 59037 Lille, France; E-mail: mal_well@hotmail.fr Received 27 March, 2018 Accepted 12 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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