Effects of a Verbal Intervention for Head and Neck Posture on Lumbar Lordosis Angles in Healthy Young and Older Adults: a Preliminary Study

Background Postural rehabilitation plays an important role in the treatment of non-specific low back pain. Although pelvic inclination has been widely used to improve lumbar lordosis, the effect of cervical anterior inclination on lumbar lordosis in young and older adults, in sitting and standing posture is still unclear. This preliminary study was designed to examine the influence of changing the cervical anterior angle on the lumbar lordosis angle, through alterations of the head position under the natural sitting and standing conditions, aiming to provide a basis for establishing a new postural rehabilitation strategy.Methods Thirty-eight older (68.4 ± 5.9 years old) and 36 young (24.0 ± 2.2 years old) healthy adults participated in this study. The four spinal regional angles - cervical anterior angle, thoracic kyphosis angle, lumbar lordosis angle, and pelvic foreword inclination angle were measured in standing and relaxed sitting postures to determine the effects of a postural cueing, “inclining head backward and performing chin tuck”, for the head and neck posture on lumbar lordosis angle.Results In the standing posture, the pelvic foreword inclination angle in the older group was significantly smaller (P <0.001) than that in the young group, and increased significantly (P <0.001) post the postural cueing. In addition, the thoracic kyphosis angle in the standing (P = 0.001) and sitting (P = 0.003) positions was significantly reduced post the postural cueing. However, the lumbar lordosis angle post postural cueing increased significantly in both the standing position (P <0.001) and sitting position (P <0.001).Conclusion The results suggest that increasing the cervical anterior angle can indeed increase the lumbar lordosis angle, and the cervical anterior inclination can be used as an alternative to pelvic foreward inclination to improve the lumbar lordosis angle. Furthermore, the change of head and neck posture can reduce the thoracic kyphosis angle, making it possible to establish a new non-invasive body posture rehabilitation strategy.(approval number TJUS2019032)

Axenfeld-Rieger Syndrome: A Case Report with Literature Review

Axenfeld–Rieger syndrome (ARS) is a rare autosomal dominant disorder that has both systemic and ocular anterior segment dysgenesis. The ocular manifestations include posterior embryotoxon, iris and anterior angle abnomalies with a high risk of glaucoma and blindness. The systemic manifestations can include craniofacial abnomalies such as maxillary hypoplasia, hypodontia, oligodontia and microdont.

Comparative analysis of the combined petrosal and the pretemporal transcavernous anterior petrosal approach to the petroclival region

OBJECTIVE The combined petrosal (CP) approach has been traditionally used to resect petroclival meningioma (PCM). The pretemporal transcavernous anterior petrosal (PTAP) approach has emerged as an alternative. A quantitative comparison of both approaches has not been made. This anatomical study compared the surgical corridors afforded by both approaches and identified key elements of the approach selection process. METHODS Twelve cadaveric specimens were dissected, and 10 were used for morphometric analysis. Groups A and B (n = 5 in each) underwent the CP and PTAP approaches, respectively. The area of drilled clivus, lengths of cranial nerves (CNs) II–X, length of posterior circulation vessels, surgical area of exposure of the brainstem, and angles of attack anterior and posterior to a common target were measured and compared. RESULTS The area of drilled clivus was significantly greater in group A than group B (mean ± SD 88.7 ± 17.1 mm2 vs 48.4 ± 17.9 mm2, p < 0.01). Longer segments of ipsilateral CN IV (52.4 ± 2.33 mm vs 46.5 ± 3.71 mm, p < 0.02), CN IX, and CN X (9.91 ± 3.21 mm vs 0.00 ± 0.00 mm, p < 0.01) were exposed in group A than group B. Shorter portions of CN II (9.31 ± 1.28 mm vs 17.6 ± 6.89 mm, p < 0.02) and V1 (26.9 ± 4.62 mm vs 32.4 ± 1.93 mm, p < 0.03) were exposed in group A than group B. Longer segments of ipsilateral superior cerebellar artery (SCA) were exposed in group A than group B (36.0 ± 4.91 mm vs 25.8 ± 3.55 mm, p < 0.02), but there was less exposure of contralateral SCA (0.00 ± 0.00 mm vs 7.95 ± 3.33 mm, p < 0.01). There was no statistically significant difference between groups with regard to the combined area of the exposed cerebral peduncles and pons (p = 0.75). Although exposure of the medulla was limited, group A had significantly greater exposure of the medulla than group B (p < 0.01). Finally, group A had a smaller anterior angle of attack than group B (24.1° ± 5.62° vs 34.8° ± 7.51°, p < 0.03). CONCLUSIONS This is the first study to quantitatively identify the advantages and limitations of the CP and PTAP approaches from an anatomical perspective. Understanding these data will aid in designing maximally effective yet minimally invasive approaches to PCM.

Rieger anomaly and Axenfeld-Rieger syndrome: a rare anterior segment dysgenesis

Axenfeld Rieger Syndrome is anterior segment dysgenesis characterized by posterior embryotoxon and dysgenesis of the anterior chamber. Developmental abnormalities of the anterior angle cause increased resistance to outflow. Ocular hypertension is a complication in almost 50% of the cases. It is an autosomal dominant disease and its prevalence is between 50,000 and 100,000 newborns per year. The main associated affected genes are FOXC1 and PITX2, occurring in 40% of the cases. Axenfeld Rieger Syndrome can be associated with systemic manifestations such as dental anomalies (hypodontia and microdontia), facial anomalies (maxillary hypoplasia, telecanthus and hypertelorism), redundant paraumbilical skin, hypospadia, auditory and cardiac alterations. Within this syndrome, we distinguish different phenotypes, being the Rieger anomaly the one with least systemic affectation. We present three cases in different stages of the disease, which allow us to understand the development and management of this disorder.

PECULIARITIES OF THE MORPHOMETRIC PARAMETERS OF SUPRAHYOID REGION OF THE HUMAN PREFETUSES

The aim: To determine the peculiarities of the morphometric parameters of suprahyoid region of the human prefetuses. Materials and methods: Thirty specimens of human prefetuses of 14.0-80.0 mm parietococcygeal length (PCL) (7-12 weeks of IUD) were studied using a complex of modern methods of morphological research. Results: On the basis of obtained digital indicators of the main morphometric parameters of human SHR in the dynamics of the prenatal period of IUD the critical periods of development of the region were clarified and mathematical functions that describe the normal course of organogenesis of SHR were created, which can be useful for creating diagnostic algorithms for the norm when carrying out prenatal diagnostics and monitoring the state of the fetus. It has been established that the 9-10th week of IUD is a critical period in the development of SHR, since during this time, intensive growth processes occur, which are manifested by a sharp change in the size of the organ, and this can lead to the appearance of variants of the structure and possible congenital defects of the SHR and the dental-maxillary apparatus in general. Conclusions: 1.Age-depended dynamics of changes in the anterior angle of the SHR shows an almost linear decrease in the angle by the end of the 9th week of IUD almost to 76°, after which it increases to almost 90° by the end of the 10th week. From the 11th week of the IUD, the anterior angle decreases again to 77 °, but begins to increase at the 12th week and by the end of the prefeal period. 2.The lateral length of SHR increases almost uniformly until the 9th week of IUD, during which its growth rate slows down. Starting from the end of the 10th week of IUD, this morphometric parameter begins to grow rapidly until the end of the prenatal period of ontogenesis. The growth rate of the lateral length of the SHR is described by the function: L lat = 1.1025 + 0.0015 x + 0.001 x2. 3.The width of the SHR from the 10th week of IUD begins to grow rapidly until the end of the prenatal period of development. The growth rate of the width of SHR is described by the function: W = 1.1025 + 0.0015 x + 0.001 x2. 4.Analysis of the age dynamics of the area of SHR demonstrates the exponential dependence on the age of the prefetuses, which is described by a mathematical function: A = 1,2452exp(0,0424x). Meanwhile, there is a slight slowdown in its growth rate at the 10th week of IUD with subsequent recovery of growth by the end of the prenatal period of ontogenesis. 5.The 9-10th week of IUD is a critical period in the development of SHR, since during this time, intensive growth processes occur, which are manifested by a sharp change in the size of the mandible.

Masseter muscle adaptation following orthognathic surgery - Biomodelling analysis - A pilot study

Purpose: This pilot investigation was designed to apply several, newly developed and more sophisticated methods of measuring muscle structure, function and fibre orientation to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Materials and Methods: Patients attending the combined orthodontic / orthognathic surgery clinic at the Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal were screen using Magnetic Resonance Imaging protocol. Ten patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible were select to form the study group. An Experimental design used to provide information in relation to masticatory muscle adaptation following orthognathic surgery. The study involved the contribution of two independent examiners that measured the changes in fibre orientation at the different jaw positions using AnatomicsTM software, at three different time moments. A combination of different parametric tests has been used to compare the different experimental variables. Results: Statistical differences have been identified between examiners measurements and between operations. There were no significant differences testing different times. Conclusions: The discrepancies between examiners probably arise from small variations in the experimental methodology used by them. The differences between operations reveal the masseter muscle adaptation following orthognathic surgery. The measurement of “P1 masseter muscle/ Zygomatic bone / process mastoid anterior angle” and “P2 masseter muscle / mandibular angle” can therefore be a valuable tool for controlling the reworking of masseter muscle upon orthognathic surgery.

Effects of the upper respiratory tract cross-section on the vertical and sagittal dimension and the facial axis according to Ricketts

This study assesses the effects of the upper respiratory tract width at the level of the adenoid in patients with a normal and abnormal breathing route on basic parameters of the morphology of the facial skeleton. <b>Aim.</b> Comparison of skeletal parameters determining vertical (SNL/ML, NL/ML, NL/ML), sagittal (SNA, SNB) dimensions and type of facial rotation (the angle of the facial axis according to Ricketts) in the study and control groups and determination of the threshold value (a cut-off point) of width according to Holmberg, at which there is a deviation from the average values of basic parameters of morphology of the facial skeleton. <b>Material and methods.</b> The study included 221 patients treated at an orthodontic clinic in Kielce. Based on the medical history taken, clinical examination and subjective evaluation of the upper respiratory tract width according to Holmberg 112 patients were enrolled into the study group and 109 patients into the control group. The width of the upper respiratory tract was measured using the modified Holmberg method and parameters assessing the vertical (SNL/ML, NL/ML) and sagittal (SNA, SNB) dimensions, as well as the anterior angle of the Ricketts’ axis were measured using the analysis of lateral teleroentgenograms of the head. <b>Results.</b> All compared skeletal parameters indicated significant statistical differences between the study and control group. These differences were: Ricketts’ angle 6.5°, SNL/ML 8.5°, NL/ML 9.7°, SNA 2.4°, SNB 1.4°. <b>Conclusions.</b> The width of the upper respiratory tract at the level of the adenoid significantly affects values of skeletal parameters evaluating the vertical (SNL/ML, NL/ML) and sagittal (SNA, SNB) dimensions and the type of rotation of the facial axis. There is a correlation between a gradual decrease in the airway dimension according to Holmberg and an increase in the vertical dimension (SNL/ML, NL/ML) and anterior angle of the Ricketts’ facial axis (posterior rotation of the mandible) and a decrease in the sagittal dimension (SNA, SNB).