Jarosław Wysocki

Vascularization of the mandibular condylar head with respect to intracapsular fractures of mandible.

BACKGROUND Causes of mandibular condylar (condylar) head necrosis as a consequence of intracapsular mandibular fractures are still a subject of controversy. OBJECTIVES To investigate why in some cases of intracapsular fractures condylar head necrosis occurs. MATERIAL 58 human heads from the collection of Head and Neck Clinical Anatomy Laboratory, from the Institute of Physiology and Pathology of Hearing, Warsaw, Poland, constituted the material. STUDY Head arterial tree injections, anatomical preparation with the use of standard set of microsurgical equipment and an operating microscope. RESULTS The main source of condylar head vascularization is the inferior alveolar artery, supplying bone marrow of the whole mandible as well as its cortical layer. Additional arterial blood supplying comes from a various number (2-7) of branches supplying the temporomandibular joint capsule. They originate directly from the maxillary artery or from its primary branches: masseteric artery, external pterygoid artery or superficial temporal artery. Two rare variants of accessory mandibular head vascularization were encountered. The first (2 cases) was an arterial branch from the maxillary artery and the second (1 case) was a branch from the external pterygoid artery. In these cases the arterial supply of lateral part of temporomandibular joint capsule from other sources was reduced. CONCLUSION Fractures resulting in the lateral part of the condylar head in isolation could be potentially threatened by necrosis because of poor vascularization.

Patency of nasopharynx and a cephalometric image in the children with orthodontic problems

OBJECTIVES To study a possible impact of adenoidectomy on malocclusion on the base of cephalometry. METHODS Retrospective analysis of 148 patients qualified into the orthodontic treatment (77 girls and 71 boys) at the age of 9-11 years (an average age: 10 years and 3 months). Material was divided into three groups, equalized regarding sex and age. The first one consisted of the patients after adenoidectomy, at the moment of orthodontic assessment without any organic pathology within a nasal cavity or nasopharynx. To the second group were included children who for different reasons were not a subject of adenoidectomy despite clinical diagnosis of adenoid hypertrophy. In the third group were patients whose only problem was malocclusion. X-ray pictures taken on a cephalostate were scanned and given to cephalometric assessment. In statistics Bartletts test, Tukeys test and Pearsons correlation coefficients were used. RESULTS The significant differences with respect to many skull parameters appeared among the groups. The inappropriate respiratory habits find their reflection mainly within anterior and lower anterior facial height, angle of mandibular plane, nasopharyngeal flow and dental parameters. An evident beneficial influence of adenoidectomy is observed within a period of 36-41 months after an operation. Nasopharyngeal flow is the most sensitive parameter indicating the respiratory conditions, and is strongly connected with the key cephalometric parameters. CONCLUSIONS In cases of malocclusion of skeletal character, coexisting with adenoid hypertrophy, adenoidectomy should be carried out as early as possible.

Identification and location of the cocaine and amphetamine regulated transcript (CART) in the abomasum of cattle.

The cocaine and amphetamine regulated transcript (CART) belongs to the group of peptides with anorexigenic properties and is present in many areas of the central and peripheral nervous systems of numerous mammalian species. Research has suggested an effect on the feeling of appetite and satiety; however, there are no clear clues as to the role of CART in specific organs, including the stomach. Considering the specificity of cattle feeding and digestion, CART may play a highly significant role possibly associated with the option of administering greater amounts of high-volume feeds. Based on the results of immunohistochemical staining of abomasum samples prepared from hybrid bulls, the presence of CART-positive structures and CART distribution were determined in the mucosa, submucosa and muscularis layers of the stomach. Abundant sites of CART were found in the myenteric plexus, nerve fibers innervating the myocytes of the myenteron, neuroendocrine cells of the diffuse neuroendocrine system and the submucous plexus. The preliminary stage of abomasal CART detection suggests that CART is an agent that strongly affects the regulation of motor activity involved in stomach emptying and in secretory functions of the stomach. However, further research is necessary to explain the relationship.

Reconstruction of the 3D Geometry of the Ossicular Chain Based on Micro-CT Imaging

Modelling of the sound transmission process from the externai ear canal through the middle ear structures to the cochlea is often performed using the finite element method. This requires knowledge of the geometry of the object being modelled. The paper shows the results of reconstruction of the 3D geometry of the ossicular chain. The micro-CT images of a cadaver’s temporal bone were used to carry out the reconstruction process. The obtained geometry may be used not only for modelling of the middle ear mechanics before and after ossicular replacement but also for production of anatomical middle ear prostheses, calculation of inertial properties of the ossicular bones or educating radiologist and otolaryngologist.

Comparison of round‐window membrane mechanics before and after experimental stapedotomy

Surgical intervention within the area of the middle ear always leads to alteration of conditions in its biomechanical system. This fact may provide an explanation for the lack of expected auditory outcome, although an apparently good anatomic outcome was obtained. In the case of stapedotomy, the majority of patients report lack of satisfactory results for frequencies above 2,000 Hz. The effect has not been experimentally investigated yet.

Relative nasopharyngeal patency index as possible objective indication for adenoidectomy in children with orthodontic problems.

OBJECTIVES Although the harmful influence of nasopharyngeal obstruction on the facial skeleton has been demonstrated, clear criteria to qualify children with adenoid hypertrophy and malocclusion for adenoidectomy have not been established yet. METHODS Retrospective analysis of 148 patients qualified for orthodontic treatment (77 females and 71 males) at the age of 9-11 years (the average age was 10 years and 3 months). X-ray images performed with the use of a cephalostat were scanned and submitted for cephalometric assessment. The study investigated the correlation between standard cephalometric parameters and the value of relative nasopharyngeal flow defined as the ratio of the nasopharyngeal flow to the dimension of the entire nasopharynx. In statistics Bartletts test, Tukeys test and Pearsons correlation coefficients were used. RESULTS The value of relative nasopharyngeal lumen ranged from 0.0943 to 0.5532 with no significant differences between genders. The subjects were divided into decile groups for investigating the correlation with cephalometric parameters. The study demonstrated statistically significant negative correlations between relative nasopharyngeal flow and the following parameters: the angle between lines NA and NB (ANB), the angle between lines SN and ML (SN/ML), the posterior/anterior facial height ratio (Post.Fac.H./Ant.Fac.H.), the difference between the maxillary and mandibular length (difference maxillary/mandibular), the mandibular length (Co-Gn) and the lower anterior facial height (Sn-Me). The correlations generally referred to middle deciles: from the 40th to 80th decile. An apparent lack of significant correlations in patients located below the 40th decile, which corresponded to the value of relative nasopharyngeal flow up to 18%, may indicate, that this value constitutes a threshold and further decreasing it exceeds adaptive capabilities of the body. CONCLUSIONS Relative nasopharyngeal flow below 38% should constitute an indication for adenoidectomy, due to the exceeded adaptive capabilities of the body.

The correlation of the results of the survey SNOT-20 of objective studies of nasal obstruction and the geometry of the nasal cavities.

INTRODUCTION In this paper were verified the correlation between the results of the survey SNOT-20 and the results of the objective tests of nasal obstruction which are rhinomanometry and acoustic rhinometry before and after surgical treatment, such as septoplasty, septoconchoplasty, ethmoidectomy and septoethmoidectomy. MATERIAL AND METHODS The material used in this study was 233 patients diagnosed routinely in the Rhinomanometry Laboratory of the Department of Otolaryngology at the Medical University of Warsaw, reporting rhinological problems. Data were obtained from 70 women (31,4%) ranging in ages from 18 to 81 years of age and 153 men (68,6%) ranging in ages from 16 to 81 years of age. The researches presented in the study were made using the device RhinoMetrics SRE 2100 which combines the Rhinomanometer (RhinoStream) and Acoustic Rhinometer (RhinoScan) Interacoustics AS (Denmark). Survey SNOT-20 (Sino-Nasal Outcome Test-20) in Polish was completed by patients before surgery and during the postoperative control visits. RESULTS The calculated correlations between the objective parameter, which was the resistance to the flow of air through the nasal cavity , and the subjective feelings of respondents expressed in the survey SNOT-20 were generally weak, and statistical significance was achieved with respect to the first question survey (the severity of the nose obstruction) for all components of resistance flow. DISCUSSION The feeling of nasal obstruction is the most reproducible and reliable complaint reported by the patient with rhinological problems.

Evaluation of the Sensory Organization Testto differentiate non-fallers from single- and multi-fallers

BACKGROUND Among the elderly, instability leading to falls (and consequences of them) is one of the most important problems. The etiology of falls is usually complex, but balance, posture and gait problems are considered to be the most important risk factors. OBJECTIVES The objective of this study was to assess the usefulness of the Sensory Organization Test (SOT) in differentiating multi-fallers from single-fallers. MATERIAL AND METHODS The studied group included 92 patients aged >60 years with balance disorders and falls in their history. The patients were divided into 2 groups: multi-fallers and single-fallers. The control group (non-fallers) included 21 individuals. The SOT was performed on the 1st day (SOT1) and on the last day (SOT2) of rehabilitation. Mean equilibrium score (ES) of 1-3 and 4-6 sensory conditions and composite score (CS) of the SOT1 and SOT2 were analyzed. The falls were analyzed as a total number of falls while performing SOT and a number of falls in all 3 repetitions of both conditions 5 and 6 separately. In SOT conditions 1-4 there were no falls observed. RESULTS The importance of SOT to differentiate fallers from non-fallers and single-fallers from multi-fallers is ambiguous. CONCLUSIONS The SOT may or may not indicate the differences between the groups - it does not fully explain those differences. It shows only postural dysfunction without indicating any localization in particular part of vestibular organ. The basic diagnostic evaluation in the elderly with a proneness to falls should include clinical examination and the Dix-Hallpike maneuver, supplemented with a videonystagmography (VNG), which would assess the structure of damage in vestibular organ. Posturography is of less validity in the differentiation of fallers from non-fallers.

Location of the narrowest area of the pharynx regarding body mass index and obstructive sleep apnoea severity

BACKGROUND Among authors studying morphological determinants of the obstructive sleep apnoea (OSA) controversies exist on the location of the narrowest area within the pharynx, critical for development of obstruction. Those disagreements primarily revolve around differences between obese and nonobese OSA patients. Determination whether the location and size of the narrowest area within the pharynx differentiates the obese and nonobese OSA patients. MATERIALS AND METHODS A population of 55 subjects was investigated after being diagnosed with OSA in the Polysomnography Laboratory of the Department and Clinic of Otolaryngology in the Medical University of Warsaw, Poland. Additionally a head computed tomography (CT) was performed in all the subjects. The CT images were used to do several crucial measurements which described the geometry of the facial skeleton as well as soft tissues of the head. The obtained results were correlated with apnoea-hypopnoea index (AHI) and body mass index (BMI) values. The data were statistically analysed. RESULTS The distance between the hard palate and posterior pharyngeal wall parallel to the horizontal plane as well as the shortest distance between the soft palate and posterior pharyngeal wall significantly differentiated patients in the subgroups by AHI but not by BMI. CONCLUSIONS Pharyngeal obstruction at the level of the hard and soft palate differentiates patients with severe OSA from patients with mild and moderate OSA regardless of BMI.

Morphological predictors of sleep apnoea severity

BACKGROUND Obstructive sleep apnoea (OSA) does not always depend on obesity but on a certain morphological configuration. The study objective was to verify a hypothesis about a relation between anthropometric features and OSA occurrence and severity. MATERIALS AND METHODS The study involved 138 patients, who had reported in Department and Clinic of Otolaryngology, Warsaw Medical University, due to suspected OSA. Each patient underwent morphological evaluation according to visual analogue scales. The assessment involved nasal septum morphology evaluation according to a 4-grade scale, palate morphology evaluation according to the 4-grade Friedman scale, whereas the facial profile, oropharyngeal isthmus, and the shape of the nasopharynx were assessed according to our own 3-grade scale. RESULTS Statistical analysis confirmed the high concordance of the basic polysomnographic parameters with the Friedman scale and the shape of the oropharyngeal isthmus. CONCLUSIONS 1. The modified Mallampati score as well as evaluation of the shape of the oropharyngeal isthmus demonstrated high concordance with the basic polysomnographic parameters. 2. The neck circumference is a significant predictor of the apnoea-hypopnoea index value in males suffering from the OSA syndrome.