From anatomic and functional aspects the stomatognathic system and the upper cervical spine are closely interlinked. Together with complex neuromuscular relationships, this gives rise to an important field of cooperation between orthodontics and orthopedics. The literature appeals for close interdisciplinary cooperation for patients with syndromes and for those with torticollis and scoliosis. Since orthopedic points of contact are obvious in these special cases, orthopedic aspects are now being taken increasingly into account in farther-reaching studies. With the rising popularity of manual medicine, these aspects are being recognized from the orthopedic point of view too in terms of functional correlations and are being increasingly debated at international congresses and in the literature. Although relevant publications were initially confined to studies of moderate scientific interest or case reports, potential correlations have undergone scientific investigation in recent interdisciplinary studies. Despite the many clinical studies, no unequivocal recommendation can be given for basic conditions under which an orthopedist is bound to be consulted on patients with orthodontic findings. This literature review is aimed at providing an introduction to this still hotly debated issue.
The objective of the present study was to detect possible associations between unilateral crossbite and orthopaedic disturbances in children with asymmetry of the upper cervical spine. Fifty-five children aged 3-10 years (22 girls and 33 boys) with a unilateral crossbite and 55 gender- and age-matched children with a symmetric occlusion but no crossbite, who served as the control group, were selected from an orthopaedic cohort of 240 patients. In all children, asymmetry of the upper cervical region was confirmed by radiographs and palpation. The following orthopaedic aspects were investigated: oblique shoulder and pelvis, scoliosis, functional leg length difference, and laxity of ligaments of the foot. The differences between the groups were analysed by means of an unpaired t-test. An increased occurrence of orthopaedic parameters in the frontal plane was observed in children with a unilateral malocclusion. A unilateral crossbite was not necessarily combined with a pathological orthopaedic variable, but statistically, children with a unilateral malocclusion showed more often an oblique shoulder (P = 0.004), scoliosis (P = 0.04), an oblique pelvis (P = 0.007), and a functional leg length difference (P = 0.002) than children with symmetry. The results suggest that a unilateral crossbite in children with asymmetry of the upper cervical spine is associated with orthopaedic disturbances. There is no evidence of a causal link.
We report our clinical experiences in the diagnosis and treatment of four patients with synovial hemangiomata. Synovial hemangiomata are rare causes of recurrent, nonspecific joint complaints and occur most often at the knee joint. Nontraumatic joint swelling combined with recurrent, possibly hemorrhagic joint effusions must be considered signs of a synovial hemangioma. Although no preoperative diagnostic tool enables confirmation of the diagnosis, and MRI seems to be the diagnostic procedure of first choice, it is most important fact for the clinician to be aware of the existence of this disease. Early surgical treatment with excision of the tumor within wide margins of noninvolved normal synovial tissue as partial or total synovectomy is the therapy of choice and avoids degenerative changes as demonstrated with the four cases reported here.
Pigmented villonodular synovitis (PVS) is a rare disease of the synovial layer in joints, seen particularly in children. Early diagnosis allows treatment with resection of the affected synovial tissue, avoiding secondary osteoarthritic lesions of the normally unaffected joint structures. In this article, symptoms, clinical findings, and the diagnosis procedure are reported in a rare case of diffuse PVS in an 11-year-old girl. Diagnostic procedures are of differing value, and it seems that the most important factor is suspicion of this disease even in children. Since preoperative verification of the histological diagnosis is impossible, early invasive investigation such as arthroscopy are recommended to confirm the histological character of the lesion. Arthrotomy or arthroscopy followed by total synovectomy is recommended as the surgical treatment of first choice. Our patient was treated by total synovectomy via an arthrotomy of the affected knee joint after histological diagnosis has been confirmed by arthroscopic excision and histological analysis. Follow-up examinations 4 and 6 months postoperatively revealed no signs of recurrence.
The compression characteristics of 25 fresh cadaveric vertebrae of different height had been analysed in static compression tests and related to CAT densitometry values. A relationship between fracture load and CAT densitometry values of the vertebral body (spongiosa and corticalis) had been found, which can be described as a logarithmical function (r2 = 0.91). Separated CAT measurements of spongiosa also showed a logarithmical function (r2 = 0.89). Consequently, the thin corticalis of vertebral waist is of subordinate importance in correlation to fracture load. An analogously explored average CAT densitometry value showed no definite dependence on corticalis capacity. The graphic description of analysed spongiosa areas in absorption profile (CAT histogram) almost resulted in a Gauss distribution.
Characteristic for a trigger-hallux is a thickening of the m. flexor hallucis longus tendon combined with partial rupture of the central fibers proximal to the tarsal tunnel. Division of the retinaculum flexorum leads to free tendon movement and prevents further tendon degeneration. The course of an 11-years old girl is reported. An effective treatment is established by a simple surgical procedure.
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