DOCSLIB.ORG

Occipitocervical Junction: Imaging, Pathology, Instrumentation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Occipitocervical Junction: Imaging, Pathology, Instrumentation A Review Paper Occipitocervical Junction: Imaging, Pathology, Instrumentation Michael Benke, MD, Warren D. Yu, MD, Sean C. Peden, MD, and Joseph R. O’Brien, MD, MPH ANATOMY Abstract The occiput, a wide, flat bone at the posteroinferior aspect The occipitocervical junction (OCJ) is a highly special- of the skull, encases the cerebellum, the pons, and the ized area of the spine. Understanding the unique anato- medulla in the posterior fossa. The sphenoid bone also my, imaging, and craniometry of this area is paramount makes up part of the posterior fossa as it articulates with in recognizing and managing the potentially devastating the anterior border of the occiput. The clivus (Latin for effects that pathology has on it. Instrumentation tech- niques continue to evolve, the goal being to safely obtain “slope”) is the superior portion of the sphenoid bone that durable, rigid constructs that allow immediate stability, meets the portion of the occiput anterior to the foramen anatomical alignment, and osseous fusion. This article magnum (Figure 1). Through the foramen magnum, a large, reviews the pathologic conditions at the OCJ and the oval aperture in the occiput, the cranium communicates current instrumentation and fusion options available for with the vertebral canal. The foramen magnum is bound treatment. The general orthopedist needs to recognize anteriorly by the basion, posteriorly by the opisthion, and the pathology common in this region and appropriately laterally by the convex occipital condyles; it transmits the refer patients for treatment. medulla oblongata, the spinal accessory nerves (CN11), the vertebral arteries, the anterior and posterior spinal arteries, he occipitocervical junction (OCJ) is the unique set the tectorial membrane, and the alar ligaments. The hypo- of articulations among the occipital bone or occiput glossal nerve (CN12) courses through the hypoglossal canal (C0), the atlas (C1), and the axis (C2). This anatom- in the base of each occipital condyle.2 ical area is also known as the craniovertebral junc- The atlas (C1) is a ring-shaped vertebra composed of Ttion; in the literature, the 2 terms are used interchangeably. right and left lateral masses connected by anterior and pos- The OCJ lacks intervertebral disks and depends on strong terior arches. The atlas has no vertebral body. The C1 lateral capsular and ligamentous attachments for stability.1 This masses articulate superiorly with the occipital condyles and region affords a large degree of mobility, with about half of inferiorly with the C2 superior articular facets. The dens all cervical flexion-extension coming from C0–C1 and half (a.k.a. odontoid process) of C2 articulate with the posterior of all cervical rotation occurring at C1–C2.1 Recognition and surface of the anterior arch of C1 and is held in place by treatment of OCJ pathology require a thorough understand- strong ligamentous attachments to the atlas and the skull ing of osseous, ligamentous, and neurovascular anatomy. (Figure 2). Craniocervical instability can originate at the Understanding imaging and associated craniometry of the C0–C1 and C1–C2 joints.3 OCJ is paramount. General orthopedists needs to recognize The unique combination of motion and stability at the the pathology common in this region and appropriately refer OCJ is provided by its strong ligamentous structures.4-6 patients for treatment. Dr. Benke is Resident, Department of Orthopaedic Surgery, George Washington University, Washington, DC. Dr. Yu is Chief, Spine Section, Department of Orthopaedic Surgery, George Washington University Hospital, and Associate C Professor of Orthopaedic Surgery and Neurosurgery, George Washington University School of Medicine, Washington, DC. Dr. Peden is Resident, Department of Orthopaedic Surgery, O George Washington University. Dr. O’Brien is Associate Director of Spine Surgery, George Washington University Hospital, and Assistant Professor, George Washington University School of Medicine. Figure 1. Coned-down cross-section of skull shows important anatomical structures and their relationships in occipitocervical Address correspondence to: Sean C. Peden, MD, 2150 junction. Clivus (C) is posterior portion of sphenoid bone, with Pennsylvania Avenue NW, 7th Floor, Washington, DC 20037 (tel, smooth inferior slope. Occipital bone (occiput) makes up pos- 203-918-0409; e-mail, [email protected]). terior rim of foramen magnum. The anterior point of occiput— posterior margin of foramen magnum at its midpoint—is opis- Am J Orthop. 2011;40(10):E205-E215. Copyright Quadrant thion (O). Courtesy of Gray’s Anatomy of the Human Body. 20th HealthCom Inc. 2011. All rights reserved. US ed. Public domain. www.amjorthopedics.com October 2011 E205 Occipitocervical Junction B A C D E F Inferior body C3 Figure 2. Sketch of odontoid peg and its major ligaments attaching to occiput (C0) and atlas (C1). Posterior elements have been removed. The tectorial membrane, a continuation of the posterior longitudinal ligament, has been removed to better expose these ligaments. Figure 4. Midline sagittal computed tomography of normal anatomy. Hard palate is commonly not well visualized on neck CT. Wackenheim clivus baseline (A), posterior axial line or pos- terior vertebral line (B), and angle that they form, clivus–canal angle (a), are shown. McRae line (C), Chamberlain line (D), and McGregor line (E) are also shown. Lines are drawn to demon- strate Redlund-Johnell criterion. Distance from inferior body of axis (C2) to McGregor line (F) should be less than 29 mm in women or less than 34 mm in men. apical ligament (connects dens to basion). The posterior stabilizing structures are the ligamentum nuchae, the inter- spinous ligament, the posterior atlanto-occipital membrane, the ligamentum flavum, and the cervical musculature.4-6 OCCIPITOCERVICAL CRANIOMETRY Pathologic conditions at the OCJ may be evaluated with conventional radiography, computed tomography (CT), Figure 3. Cross-sectional view of occipitocervical junction (OCJ). and magnetic resonance imaging (MRI). Anatomical land- The following parameters are often used when interpreting sagit- marks, parameters, and relationships that were originally tal computed tomography scan or lateral radiograph for signs of described on conventional radiography,7-9 and that form the pathology at OCJ. Dens should remain below Wackenheim line, basis for occipitocervical craniometry, have been extrapo- which is drawn as tangent to posterior slope of clivus. McRae line lated for use with CT and MRI (Table). connects tip of clivus to opisthion, and protrusion of dens above it is abnormal. Chamberlain and McGregor lines use hard palate The Wackenheim clivus baseline is a tangent along the as reference point for 2 additional lines, and protrusion of dens superior surface of the clivus10 (Figure 3). Extension of the 3 mm above Chamberlain line and 4.5 mm above McGregor line tip of the dens above or posterior to this line is abnormal is abnormal. Atlantodental interval (ADI; sometimes anterior ADI and indicates basilar invagination. The clivus–canal angle is [AADI]), is usually less than 3 mm in adults and 5 mm in children. formed by the Wackenheim clivus baseline and the posterior At this spinal level, minimum space available for cord (SAC) to avoid compression is 14 mm. vertebral body line. The normal range is 180° in extension to 150° in flexion. Ventral spinal cord compression may occur Anteriorly, the OCJ is stabilized by 5 ligaments—the ante- when the angle is less than 150°.11 rior atlanto-occipital membrane (continuation of anterior The McRae line runs from the basion to the opisthion longitudinal ligament), the tectorial membrane (continua- (protrusion of tip of dens above line is abnormal12,13), the tion of posterior longitudinal ligament), the transverse liga- Chamberlain line from the hard palate to the opisthion (pro- ment (secures dens to anterior arch of C1), the alar liga- trusion of dens more than 3 mm above line is abnormal8), ments (connect dens to occipital condyles and are the main and the McGregor line from the hard palate to the most restraints to axial rotation and lateral bending4,5), and the caudal aspect of the occiput on midsagittal images (protru- E206 The American Journal of Orthopedics® www.amjorthopedics.com M. Benke et al Table. Radiographic Parameters of Occipitocervical Junction Eponym Parameters Pathology Wackenheim clivus baseline Tangent drawn along superior surface of Dens should be below line clivus Clivus–canal angle Angle formed by Wackenheim line and Normal range is 180° in extension to 150° posterior vertebral body line in flexion; angle of <150° is abnormal McRae line From basion to opisthion Protrusion of dens above line is abnormal Chamberlain line From hard palate to opisthion Protrusion of dens >3 mm above line is abnormal McGregor line From hard palate to most caudal point on Protrusion of dens >4.5 mm above line is midline occipital curve abnormal Ranawat criterion Distance from center of pedicle of C2 to <15 mm in men or <13 mm in women is transverse axis of C1 abnormal Redlund-Johnell criterion Distance from inferior C2 body to <34 mm in men or <29 mm in women is McGregor line abnormal Welcher basal angle Tangent to clivus as it intersects tangent to Normal range is 125°-143°; platybasia sphenoid bone occurs when basal angle is >143° Basion–dens interval From tip of basion to tip of dens >12 mm is abnormal Basion–atlanto interval From tip of basion to posterior axial line of >12 mm is abnormal C2 Powers ratio Ratio of line from basion to posterior arch >1.0 is abnormal of C1 (BP) to line from opisthion to anterior arch of C1 (OA) Anterior atlantodental interval From anterior arch of C1 to dens >3 mm in adults or >4.5-5 mm in children is abnormal Posterior atlantodental interval From dens to posterior arch of C1 <14 mm is abnormal Atlanto-occipital joint axis angle Angle formed by lines drawn parallel to Normal range is 124°-127° atlanto-occipital joints on coronal images sion of dens more than 4.5 mm above line is abnormal9).
Load more

Recommended publications
  • Copyrighted Material
    C01 10/31/2017 11:23:53 Page 1 1 1 The Normal Anatomy of the Neck David Bainbridge Introduction component’ of the neck is a common site of pathology, and the diverse forms of neck The neck is a common derived characteristic disease reflect the sometimes complex and of land vertebrates, not shared by their aquatic conflicting regional variations and functional ancestors. In fish, the thoracic fin girdle, the constraints so evident in this region [2]. precursor of the scapula, coracoid and clavi- Unlike the abdomen and thorax, there is no cle, is frequently fused to the caudal aspect of coelomic cavity in the neck, yet its ventral part the skull. In contrast, as vertebrates emerged is taken up by a relatively small ‘visceral on to the dry land, the forelimb separated from compartment’, containing the larynx, trachea, the head and the intervening vertebrae speci- oesophagus and many important vessels, alised to form a relatively mobile region – the nerves and endocrine glands. However, I neck – to allow the head to be freely steered in will not review these structures, as they do many directions. not represent an extension of the equine ‘back’ With the exception of the tail, the neck in the same way that the more dorsal locomo- remains the most mobile region of the spinal tor region does. column in modern-day horses. It permits a wide range of sagittal plane flexion and exten- sion to allow alternating periods of grazing Cervical Vertebrae 3–7 and predator surveillance, as well as frontal plane flexion to allow the horizon to be scan- Almost all mammals, including the horse, ned, and rotational movement to allow possess seven cervical vertebrae, C1 to C7 nuisance insects to be flicked off.
    [Show full text]
  • Gross Anatomy Assignment Name: Olorunfemi Peace Toluwalase Matric No: 17/Mhs01/257 Dept: Mbbs Course: Gross Anatomy of Head and Neck
    GROSS ANATOMY ASSIGNMENT NAME: OLORUNFEMI PEACE TOLUWALASE MATRIC NO: 17/MHS01/257 DEPT: MBBS COURSE: GROSS ANATOMY OF HEAD AND NECK QUESTION 1 Write an essay on the carvernous sinus. The cavernous sinuses are one of several drainage pathways for the brain that sits in the middle. In addition to receiving venous drainage from the brain, it also receives tributaries from parts of the face. STRUCTURE ➢ The cavernous sinuses are 1 cm wide cavities that extend a distance of 2 cm from the most posterior aspect of the orbit to the petrous part of the temporal bone. ➢ They are bilaterally paired collections of venous plexuses that sit on either side of the sphenoid bone. ➢ Although they are not truly trabeculated cavities like the corpora cavernosa of the penis, the numerous plexuses, however, give the cavities their characteristic sponge-like appearance. ➢ The cavernous sinus is roofed by an inner layer of dura matter that continues with the diaphragma sellae that covers the superior part of the pituitary gland. The roof of the sinus also has several other attachments. ➢ Anteriorly, it attaches to the anterior and middle clinoid processes, posteriorly it attaches to the tentorium (at its attachment to the posterior clinoid process). Part of the periosteum of the greater wing of the sphenoid bone forms the floor of the sinus. ➢ The body of the sphenoid acts as the medial wall of the sinus while the lateral wall is formed from the visceral part of the dura mater. CONTENTS The cavernous sinus contains the internal carotid artery and several cranial nerves. Abducens nerve (CN VI) traverses the sinus lateral to the internal carotid artery.
    [Show full text]
  • M ONITOR a Semi-Annual Data and Research Update Texas Department of Health, Bureau of Epidemiology
    Texas Birth Defects M ONITOR A Semi-Annual Data and Research Update Texas Department of Health, Bureau of Epidemiology VOLUME 10, NUMBER 1, June 2004 FROM THE DIRECTOR The web site also has a useful glossary linked to risk factor summaries for a number of birth defects. INTERACTIVE WEB PAGE ALLOWS EASY RESEARCH SYMPOSIUM ACCESS TO TEXAS BIRTH DEFECTS DATA Birth defects data were recently highlighted at the Texas In partnership with Texas Department of Health's Center for Birth Defects Research Symposium on April 9 in San Anto- Health Statistics, birth defects data are now available on the nio. The following speakers provided insight into the causes Texas Health Data web site. Visitors to the site (http://soup- of birth defects: fin.tdh.state.tx.us/) will be able to query data from the Texas Birth Defects Registry. Linking Birth Defects and the Environment, with Prelimi- nary Findings from an Air Pollution Study in Texas (Peter The Registry uses active surveillance to collect information Langlois, Ph.D., TBDMD and Suzanne Gilboa, M.H.S., U.S. about infants and fetuses with birth defects, born to women Environmental Protection Agency) residing in Texas. Data are presented for 49 defect catego- ries, plus a category for “infants and fetuses with any moni- Neural Tube Defects: Multiple Risk Factors Among the tored birth defect” beginning with deliveries in 1999, when Texas-Mexico Border Population (Lucina Suarez, Ph.D., the Texas Birth Defects Registry became statewide. Texas Department of Health) The Embryonic Consequences of Abnormal
    [Show full text]
  • Evaluation and Treatment of Selected Sacral Somatic Dysfunctions
    Evaluation and Treatment of Selected Sacral Somatic Dysfunctions Using Direct and HVLA Techniques including Counterstrain and Muscle Energy AND Counterstrain Treatment of the Pelvis and Sacrum F. P. Wedel, D.O. Associate Adjunct Professor in Osteopathic Principles and Practice A.T. Still University School of Osteopathic Medicine in Arizona, and private practice in Family Medicine in Tucson, Arizona Learning Objectives HOURS 1 AND 2 Review the following diagnostic and treatment techniques related to sacral torsion Lumbosacral spring test Sacral palpation Seated flexion test HOURS 3 AND 4 Counterstrain treatments of various low back pathologies Sacral Techniques Covered : 1. Prone, direct, muscle energy, for sacral rotation on both same and opposite axes 2. HVLA treatment for sacral rotation on both same and opposite axes 3. Counterstain treatment of sacral tender points and of sacral torsion Counterstrain Multifidi and Rotatores : UP5L Gluteii – maximus: HFO-SI, HI, P 3L- P 4L ,medius, minimus Piriformis Background and Basis The 4 Osteopathic Tenets (Principles) 1. The body is a unit; the person is a unit of body, mind, and spirit. 2. Structure and function are reciprocally inter-related. 3. The body is capable of self- regulation, self-healing, and health maintenance. 4. Rational treatment is based upon an understanding of these basic principles. Somatic Dysfunction - Defined • “Impaired or altered function of related components of the somatic (body framework) system: • Skeletal, arthrodial, and myofascial structures, • And… • Related vascular, lymphatic, and neural elements” Treatment Options for Somatic Dysfunctions All somatic dysfunctions have a restrictive barrier which are considered “pathologic” This restriction inhibits movement in one direction which causes asymmetry within the joint: The goal of osteopathic treament is to eliminate the restrictive barrier thus restoring symmetry….
    [Show full text]
  • Saethre-Chotzen Syndrome
    Saethre-Chotzen syndrome Authors: Professor L. Clauser1 and Doctor M. Galié Creation Date: June 2002 Update: July 2004 Scientific Editor: Professor Raoul CM. Hennekam 1Department of craniomaxillofacial surgery, St. Anna Hospital and University, Corso Giovecca, 203, 44100 Ferrara, Italy. [email protected] Abstract Keywords Disease name and synonyms Excluded diseases Definition Prevalence Management including treatment Etiology Diagnostic methods Genetic counseling Antenatal diagnosis Unresolved questions References Abstract Saethre-Chotzen Syndrome (SCS) is an inherited craniosynostotic condition, with both premature fusion of cranial sutures (craniostenosis) and limb abnormalities. The most common clinical features, present in more than a third of patients, consist of coronal synostosis, brachycephaly, low frontal hairline, facial asymmetry, hypertelorism, broad halluces, and clinodactyly. The estimated birth incidence is 1/25,000 to 1/50,000 but because the phenotype can be very mild, the entity is likely to be underdiagnosed. SCS is inherited as an autosomal dominant trait with a high penetrance and variable expression. The TWIST gene located at chromosome 7p21-p22, is responsible for SCS and encodes a transcription factor regulating head mesenchyme cell development during cranial tube formation. Some patients with an overlapping SCS phenotype have mutations in the FGFR3 (fibroblast growth factor receptor 3) gene; especially the Pro250Arg mutation in FGFR3 (Muenke syndrome) can resemble SCS to a great extent. Significant intrafamilial
    [Show full text]
  • The Influence of the Rib Cage on the Static and Dynamic Stability
    www.nature.com/scientificreports OPEN The infuence of the rib cage on the static and dynamic stability responses of the scoliotic spine Shaowei Jia1,2, Liying Lin3, Hufei Yang2, Jie Fan2, Shunxin Zhang2 & Li Han3* The thoracic cage plays an important role in maintaining the stability of the thoracolumbar spine. In this study, the infuence of a rib cage on static and dynamic responses in normal and scoliotic spines was investigated. Four spinal fnite element (FE) models (T1–S), representing a normal spine with rib cage (N1), normal spine without rib cage (N2), a scoliotic spine with rib cage (S1) and a scoliotic spine without rib cage (S2), were established based on computed tomography (CT) images, and static, modal, and steady-state analyses were conducted. In S2, the Von Mises stress (VMS) was clearly decreased compared to S1 for four bending loadings. N2 and N1 showed a similar VMS to each other, and there was a signifcant increase in axial compression in N2 and S2 compared to N1 and S1, respectively. The U magnitude values of N2 and S2 were higher than in N1 and S1 for fve loadings, respectively. The resonant frequencies of N2 and S2 were lower than those in N1 and S1, respectively. In steady-state analysis, maximum amplitudes of vibration for N2 and S2 were signifcantly larger than N1 and S1, respectively. This study has revealed that the rib cage improves spinal stability in vibrating environments and contributes to stability in scoliotic spines under static and dynamic loadings. Scoliosis, a three-dimensional deformity, prevents healthy development.
    [Show full text]
  • Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement
    Universität Ulm Zentrum für Chirurgie Institut für Unfallchirurgische Forschung und Biomechanik Direktor: Prof. Dr. A. Ignatius Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement Dissertation zur Erlangung des Doktorgrades der Medizin der Medizinischen Fakultät der Universität Ulm vorgelegt von: Konrad Appelt geboren in: Pforzheim 2012 Amtierender Dekan: Prof. Dr. Thomas Wirth 1. Berichterstatter: Prof. Dr. H.-J. Wilke 2. Berichterstatter: Prof. Dr. Tobias Böckers Tag der Promotion: 06.06.2013 Index List of abbreviations ......................................................................................IV 1 Introduction .............................................................................................. 1 1.1 Background ............................................................................................................. 1 1.2 State of Research .................................................................................................... 4 1.3 Objectives ............................................................................................................... 6 2 Material and methods .............................................................................. 7 2.1 Testing machines and devices ................................................................................. 7 2.1.1 Spine loading simulator ................................................................................... 7 2.1.2 Vicon – MX Motion Capture System
    [Show full text]
  • CASE REPORT Congenital Posterior Atlas Defect Associated with Anterior
    Acta Orthop. Belg., 2007, 73, 282-285 CASE REPORT Congenital posterior atlas defect associated with anterior rachischisis and early cervical degenerative disc disease : A case study and review of the literature Dritan PASKU, Pavlos KATONIS, Apostolos KARANTANAS, Alexander HADJIPAVLOU From the University of Crete Heraklion, Greece A rare case of a wide congenital atlas defect is report- diagnosed posterior atlas defect coexisting with an ed. A 25 year-old woman was admitted after com- anterior rachischisis, presenting with radicular arm plaints of radicular pain in the right arm. pain resistant to conservative therapy. In addition, a Radiographs incidentally revealed aplasia of the pos- review of the literature is presented with emphasis terior arch of the atlas together with anterior rachis- on the possibility of the association between the chisis. A review of the literature is presented and a atlas defect and early disc degeneration. possible association with early disc degeneration is discussed. CASE REPORT Keywords : spine ; congenital disorders ; computed tomography ; MR imaging ; disc degeneration. A 25 year-old woman presented with neck pain radiating to the right arm over the last 5 days. She also reported intermittent neck and arm pain for the INTRODUCTION past 4 years. The patient had consulted in our hos- pital for an episode of cervical pain one year previ- Malformations of the atlas are relatively rare and ously without arm pain but was discharged from exhibit a wide range including aplasia, hypoplasia the emergency department without any radiological and various arch clefts (2, 15). The reported inci- examination. Her symptoms deteriorated with neck dence in a large study of 1,613 autopsies with flexion, with pain referred to the upper thoracic regard to presence of congenital aplasia is 4% for the posterior arch and 0.1% for the anterior arch (5- 8).
    [Show full text]
  • Oral Surgery Procedures in a Patient with Hajdu-Cheney Syndrome Treated with Denosumab—A Rare Case Report
    International Journal of Environmental Research and Public Health Article Oral Surgery Procedures in a Patient with Hajdu-Cheney Syndrome Treated with Denosumab—A Rare Case Report Magdalena Kaczoruk-Wieremczuk 1,†, Paulina Adamska 1,† , Łukasz Jan Adamski 1, Piotr Wychowa ´nski 2 , Barbara Alicja Jereczek-Fossa 3,4 and Anna Starzy ´nska 1,* 1 Department of Oral Surgery, Medical University of Gda´nsk,7 D˛ebinkiStreet, 80-211 Gda´nsk,Poland; [email protected] (M.K.-W.); [email protected] (P.A.); [email protected] (Ł.J.A.) 2 Department of Oral Surgery, Medical University of Warsaw, 6 St. Binieckiego Street, 02-097 Warsaw, Poland; [email protected] 3 Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20-112 Milan, Italy; [email protected] 4 Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20-141 Milan, Italy * Correspondence: [email protected] † Co-first author, these authors contributed equally to this work. Abstract: Background: Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the NOTCH2 gene. This disorder affects the connective tissue and is characterized by severe bone resorption. Hajdu-Cheney syndrome most frequently affects Citation: Kaczoruk-Wieremczuk, M.; the head and feet bones (acroosteolysis). Case report: We present an extremely rare case of a 34- Adamska, P.; Adamski, Ł.J.; Wychowa´nski,P.; Jereczek-Fossa, year-old male with Hajdu-Cheney syndrome. The patient was admitted to the Department of Oral B.A.; Starzy´nska,A. Oral Surgery Surgery, Medical University of Gda´nsk,in order to perform the extraction of three teeth.
    [Show full text]
  • Morfofunctional Structure of the Skull
    N.L. Svintsytska V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 Ministry of Public Health of Ukraine Public Institution «Central Methodological Office for Higher Medical Education of MPH of Ukraine» Higher State Educational Establishment of Ukraine «Ukranian Medical Stomatological Academy» N.L. Svintsytska, V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 2 LBC 28.706 UDC 611.714/716 S 24 «Recommended by the Ministry of Health of Ukraine as textbook for English- speaking students of higher educational institutions of the MPH of Ukraine» (minutes of the meeting of the Commission for the organization of training and methodical literature for the persons enrolled in higher medical (pharmaceutical) educational establishments of postgraduate education MPH of Ukraine, from 02.06.2016 №2). Letter of the MPH of Ukraine of 11.07.2016 № 08.01-30/17321 Composed by: N.L. Svintsytska, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor This textbook is intended for undergraduate, postgraduate students and continuing education of health care professionals in a variety of clinical disciplines (medicine, pediatrics, dentistry) as it includes the basic concepts of human anatomy of the skull in adults and newborns. Rewiewed by: O.M. Slobodian, Head of the Department of Anatomy, Topographic Anatomy and Operative Surgery of Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Doctor of Medical Sciences, Professor M.V.
    [Show full text]
  • Anencephalic Fetus with Craniospinal Rachischisis – Case Report
    Case Study International Journal of Research - GRANTHAALAYAH ISSN (Online): 2350-0530 May 2021 9(5), 24–29 ISSN (Print): 2394-3629 ANENCEPHALIC FETUS WITH CRANIOSPINAL RACHISCHISIS – CASE REPORT 1 Ayse KONAC 1Gelisim University Health Sciences, Istanbul, Turkey ABSTRACT Anencephaly, in which a substantial part of the brain, skull, or scalp is miss- ing, is a lethal neural tube defect (NTD) that occurs during the fourth week of pregnancy after failed cranial neuropore closure. One in every 1,000 births is anencephalic, and newborns with this NTD are not viable or treatable. Associ- ated with anencephaly is rachischisis, or severe incomplete neural tube closure and exposure of the spinal cord. Ultrasonography can quickly diagnose anen- cephaly. Like other NTDs, nutritional and environmental factors both play a role in the development of anencephaly. Here, we report and discuss an unusual case of a 12-week gestation anencephalic fetus with craniospinal rachischisis and its embryological roots. In our case, except from the low socio-economic life of the patient, the Received 18 April 2021 absence of a predisposing factor that could cause such an anomaly, the abor- Accepted 4 May 2021 tion being in the irst trimester and the occurrence in the irst pregnancy of the Published 31 May 2021 patient as a result of 5-year infertility made us think that pathology examination Corresponding Author of the abortus material is important in complet or incomplete abortions. Ayse KONAC, ayse.konac1@gmail. com DOI 10.29121/ Keywords: Anencephaly, Neural Tube Defect, Rachischisis, İncomplet Abortion, granthaalayah.v9.i5.2021.3899 First Trimester Funding: This research received no speciic grant from any funding agency in the public, commercial, or not-for-proit sectors.
    [Show full text]
  • MBB: Head & Neck Anatomy
    MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina
    [Show full text]