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Practical relevance: Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice. Clinical approach: Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient’s ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries. Treatment goals and techniques: A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal’s oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain. Aim: This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

Learning objectives After studying this article, the participant should be able to: 1. Define and classify different types of cranial defects 2. Compare both autologous and alloplastic options for reconstruction 3. Develop an optimal approach for cranial vault reconstruction in various clinical scenarios. Summary Defects of the cranium result from various causes, including traumatic loss, neurosurgical intervention, skull tumors, and infection. Cranial vault reconstruction aims to restore both the structural integrity and surface morphology of the skull. To ensure a successful outcome, the choice of appropriate cranioplasty reconstruction will vary primarily based on the cause, location, and size of the defect. Other relevant factors that must be considered include adequacy of soft-tissue coverage, presence of infection, and previous or planned radiation therapy. This article presents an algorithm for the reconstruction of various cranial defects using both autologous and alloplastic techniques, with a comparison of their advantages and disadvantages.

Traumatic brain injury (TBI) is characterized by a complex pattern of abnormalities in resting-state functional connectivity (rsFC) and network dysfunction, which can potentially be ameliorated by rehabilitation. In our previous randomized controlled trial, we found that a 3-month neurological music therapy intervention enhanced executive function (EF) and increased grey matter volume in the right inferior frontal gyrus (IFG) in patients with moderate-to-severe TBI (N=40). Extending this study, we performed longitudinal rsFC analyses of resting-state fMRI data using a ROI-to-ROI approach assessing within-network and between-network rsFC in the frontoparietal (FPN), dorsal attention (DAN), default mode (DMN), and salience (SAL) networks, which all have been associated with cognitive impairment after TBI. We also performed a seed-based connectivity analysis between the right IFG and whole-brain rsFC. The results showed that neurological music therapy increased the coupling between the FPN and DAN as well as between these networks and primary sensory networks. By contrast, the DMN was less connected with sensory networks after the intervention. Similarly, there was a shift towards a less connected state within the FPN and SAL networks, which are typically hyperconnected following TBI. Improvements in EF were correlated with rsFC within the FPN and between the DMN and sensorimotor networks. Finally, in the seed-based connectivity analysis, the right IFG showed increased rsFC with the right inferior parietal and left frontoparietal (Rolandic operculum) regions. Together, these results indicate that the rehabilitative effects of neurological music therapy after TBI are underpinned by a pattern of within- and between-network connectivity changes in cognitive networks as well as increased connectivity between frontal and parietal regions associated with music processing.

The aim of this study was to verify whether L-lactide/DL-lactide copolymer 80/20 (PLDLLA) and platelet-rich plasma (PRP) trigger bone formation within critical-sized calvarial defects in adult sheep (n=6). Two craniectomies, each ca. 3 cm in diameter, were created in each animal. The first craniectomy was protected with an inner polylactide membrane, filled with PRP-polylactide granules, and covered with outer polylactide membrane. The second control craniectomy was left untreated. The animals were euthanized at 6, 7, 17, 19, 33, and 34 weeks after surgery, and the quality and the rate of reossification were assessed histomorphometrically and microtomographically. The study demonstrated that application of implants made of PLDLLA 80/20 combined with an osteopromotive substance (e.g., PRP) may promote bone healing in large calvarial defect in sheep. These promising proof-of-concept studies need to be verified in the future on a larger cohort of animals and over a longer period of time in order to draw definitive conclusions.

Objectives This study aims to identify the patterns and prevalence of violence-related skull trauma (including the cranium and mandible) among a large sample of skeletons from medieval London (1050–1550 AD). Materials and Methods In total, data from 399 skulls, representing six different sites from across medieval London, were analyzed for evidence of trauma and assessed for the likelihood that it was caused by violence. The sites include the three parish cemeteries of St Nicholas Shambles (GPO75), St Lawrence Jewry (GYE92), and St Benet Sherehog (ONE94); the two monastic houses of London Blackfriars (PIC87) and St Mary Graces (MIN86); and the early inmate cemetery from the medieval hospital of St Mary Spital (NRT85). Results The overall findings suggest that violence affected all aspects of medieval London society, but how that violence was characterized largely depended on sex and burial location. Specifically, males from the lay cemeteries appear to have been the demographic most affected by violence-related skull injuries, particularly blunt force trauma to the cranial vault. Discussion Using both archaeological and historical evidence, the results suggest that violence in medieval London may have been more prevalent than in other parts of medieval England, particularly rural environments, but similar to other parts of medieval Europe. However, more studies focusing on medieval trauma, and violence specifically, need to be carried out to further strengthen these results. In particular, males from the lay cemeteries were disproportionately affected by violence-related trauma, especially blunt force trauma. It perhaps indicates a means of informal conflict resolution as those of lower status did not always have the newly established medieval legal system available to them.

Autologous bone grafts remain the gold standard for craniofacial reconstruction despite limitations of donor-site availability and morbidity. A myriad of commercial bone substitutes and allografts are available, yet no product has gained widespread use because of inferior clinical outcomes. The ideal bone substitute is both osteoconductive and osteoinductive. Craniofacial reconstruction often involves irregular three-dimensional defects, which may benefit from malleable or customizable substrates. "Hyperelastic Bone" is a three-dimensionally printed synthetic scaffold, composed of 90% by weight hydroxyapatite and 10% by weight poly(lactic-co-glycolic acid), with inherent bioactivity and porosity to allow for tissue integration. This study examines the capacity of Hyperelastic Bone for bone regeneration in a critical-size calvarial defect.Eight-millimeter calvarial defects in adult male Sprague-Dawley rats were treated with three-dimensionally printed Hyperelastic Bone, three-dimensionally printed Fluffy-poly(lactic-co-glycolic acid) without hydroxyapatite, autologous bone (positive control), or left untreated (negative control). Animals were euthanized at 8 or 12 weeks postoperatively and specimens were analyzed for new bone formation by cone beam computed tomography, micro-computed tomography, and histology.The mineralized bone volume-to-total tissue volume fractions for the Hyperelastic Bone cohort at 8 and 12 weeks were 74.2 percent and 64.5 percent of positive control bone volume/total tissue, respectively (p = 0.04). Fluffy-poly(lactic-co-glycolic acid) demonstrated little bone formation, similar to the negative control. Histologic analysis of Hyperelastic Bone scaffolds revealed fibrous tissue at 8 weeks, and new bone formation surrounding the scaffold struts by 12 weeks.Findings from our study suggest that Hyperelastic Bone grafts are effective for bone regeneration, with significant potential for clinical translation.

WOS: 000386352100126, PubMed ID: 27513784, The purpose of this study was to histologically evaluate the effects on bone healing of nigella sativa seed extract applied on calvarial defects in an ovariectomized rat model. The study included 32 female rats weighing 280 to 310g with an average age of 3 months. A defect was created with a trephine burr on each rat calvarium. The rats were divided into 2 groups (control and study) of 8 animals each. All the defects were grafted with a gelatin sponge mixed with normal saline. In the study group, nigella sativa seed extract was applied systemically using an oro-gastric tube. Half of the animals in each group were sacrificed after 2 weeks, and the others after 4 weeks. In the control groups, the defects were not completely filled with regenerated bone. Osteoblast cells were observed more in the study groups. A higher rate of osteoclasts was determined in the control groups. In addition, the nigella sativa group had a statistically greater amount of bone formation than the others group at both 2 weeks and 4 weeks (P

Although bone morphogenetic protein-2 (BMP-2) is a potent growth factor, the appropriate and effective dosages for ideal bone formation according to defect size and type remain to be established. This study was designed to measure the effects of BMP-2 on calvarial defects in the beagle dog, by means of three-dimensional computed tomographic imaging.Eight beagles of equal age and weight were divided into one control and three experimental groups. After creating four circular 20-mm diameter defects, a BMP-2/tricalcium phosphate scaffolding mixture with concentrations of BMP-2 was introduced. The defect filling response was assessed until 16 weeks by three-dimensional computed tomograpy for the thickness, area, and density of the regenerating bone.Statistically significant responses to BMP-2 were observed. The mean thicknesses of the regenerated bone were 1.6 mm for the control group and 1.6, 2.1, and 2.8 mm for 10, 50, and 200 µg/ml, respectively. As the original mean thickness of the calvarial bone in the beagles was 2.0 mm, a 50-µg quantity of BMP-2 proved to be ideal for 2-cm calvarial defects. The original surface area of the defect created was 314 mm. The mean surface areas of the regenerated bone were 181.94 mm for the control group, and 237, 276, and 288 mm for 10, 50, and 200 µg/ml.BMP-2 promotes anatomically significant bone regeneration in critical-size cranial defects in this model, with an optimal dose-response at 50 µg/ml and without hyperosteogenesis or hypo-osteogenesis.

Background:Increasing literature data suggest that cranioplasty at early stage of skull defects may lead to better rehabilitation outcome. This study was conducted to explore the relationship between the timing of cranioplasty and neurological rehabilitation in patients with traumatic skull injury (

The purpose of this investigation was to examine the effect of resorbable collagen plug (RCP) on bone regeneration in rat calvarial critical-size defects.About 5-mm-diameter calvarial defects were created in forty 12-week-old male Sprague-Dawley rats and implanted with or without RCP. Animals were killed at 1, 2, 4, and 8 weeks postoperatively. After being killed, specimens were collected and subjected to micro-computed tomography (μCT) and histological analysis.The μCT showed a significant increase of newly formed bone volume/tissue volume in RCP-implanted defect compared with controls at all designated time points. After 8 weeks, the defects implanted with RCP displayed almost complete closure. Hematoxylin and eosin staining of the decalcified sections confirmed these observations and evidenced active bone regeneration in the RCP group. In addition, Masson's trichrome staining demonstrated that RCP implantation accelerated the process of collagen maturation.The RCP enhances bone regeneration in rat critical-size cranial defects, which suggest it might be a desired material for bone defect repair.

The earliest cranial surgery (trepanation) has been attested since the Mesolithic period. The meaning of such a practice remains elusive but it is evident that, even in prehistoric times, humans from this period and from the Neolithic period had already achieved a high degree of mastery of surgical techniques practiced on bones. How such mastery was acquired in prehistoric societies remains an open question. The analysis of an almost complete cow cranium found in the Neolithic site of Champ-Durand (France) (3400-3000 BC) presenting a hole in the right frontal bone reveals that this cranium underwent cranial surgery using the same techniques as those used on human crania. If bone surgery on the cow cranium was performed in order to save the animal, Champ-Durant would provide the earliest evidence of veterinary surgical practice. Alternatively, the evidence of surgery on this cranium can also suggest that Neolithic people practiced on domestic animals in order to perfect the technique before applying it to humans.

Objective: Penetrating skull injury (PSI) is a neurosurgical emergencies. Most PSI cases reported were caused by gunshot wounds. Although the diagnosis and management of those cases has been described, the actual cases, especially in our center, were quite rare. Methods: A craniectomy debridement with a supine position was performed and removal of the object was achieved. Intraoperatively, we succed control the bleeding as expected. Results: The patient was operated and hospitalized in our center; physical examination revealed neurologically intact before and after the removal of the object. The patient was sent home without any neurological deficits or other complications. Conclusions: We reported a case of penetrating skull injury in a 5-year-old girl caused by a scissors. Penetrating skull injuries were interesting due to its mechanism, management and complications. Early diagnosis and appropriate treatment should resulted in good outcomes. Keywords: Penetrating skull injury, a sharp metal object DOI: 10.15850/ijihs.v3n2.588

Objectives: In the Netherlands, cyclists continue to outnumber other road users in injuries and deaths. The wearing of bicycle helmets is not mandatory in the Netherlands even though research has shown that wearing bicycle helmets can injuries and helmet protection. Methods: Three patients who had been involved in a bicycle accident while wearing a helmet were subjected to multi-detector row computed tomography (MDCT) imaging after trauma. The helmets were separately scanned using the reduce head and brain injuries by up to 88%. Therefore, the aim of this study was to assess the feasibility of using 3D technology to evaluate bicycle-related head same MDCT scanner with tube voltages ranging from 80. kVp to 140. kVp and tube currents ranging from 10. mAs to 300. mAs in order to determine the best image acquisition parameters for helmets. The acquired helmet images were converted into virtual 3D surface hence Standard Tessellation Language (STL) models and merged with MDCT-derived STL models of the patients' skulls. Finally, all skull fractures and corresponding helmet damage were visualized and related. Results: Imaging bicycle helmets on an MDCT scanner proved to be feasible using a tube voltage of 120. kVp and a tube current of 120. mAs. Merging the resulting STL models of the patients' skull and helmet allowed the overall damage sustained by both skull and helmet to be related.Conclusion: Our proposed 3D method of assessing bicycle helmet damage and corresponding head injuries could offer valuable information for the development and design of safer bicycle helmets.

Assorted projectiles including shrapnel, sling shots, stones, metal and rock fragments and other missiles cause fatal penetrating skull injuries. In this case, a 34-year-old foreman suffered a fatal penetrating orbito-cerebral injury while lubricating a hydraulic rock-splitting machine with industrial grease viscous.

Background Bone transport osteogenesis (BTO), distraction of a free portion of bone across a defect, offers an autologous solution to large cranial defects that may allow treatment without permanent hardware implantation. This study establishes a sheep model to evaluate the feasibility and distraction kinetics of BTO. Methods Subtotal cranial defects (3.5 × 3.5 cm) were created in 10 young adult sheep and a transport segment (3.5 × 2 cm) traversed the defect at varying distraction rates (0, 0.5, 1.0, and 1.5 mm/day) using semi-buried cranial distractors. After a 6-week consolidation period, sheep were euthanized and the resultant bone was analyzed by CT, histology, and mechanical testing. Results Gross examination, histology, and 3D CT revealed that control animals had fibrous nonunion whereas distraction animals had ossified defects with fibrous nonunion at the distal docking site. There was one premature consolidation in the 0.5 mm/day group. The volume of bony regenerate in the 0.5, 1.0, and 1.5 mm/day distraction rate groups was statistically indistinct (P = 0.16). The mean flexural moduli (MPa) of non-decalcified samples from the control cranium, transport segment, and bone regenerate were found to be 4.50 ± 4.9, 6.17 ± 2.1, and 4.14 ± 4.8, respectively (P = 0.24). Conclusions This experiment provides proof of concept for BTO for large calvarial defects in a sheep model. Distraction at a rate of 0.5 mm per day may place individuals at higher risk for premature consolidation, but distraction rates did not have significant effects on regenerate quantity or quality. Future work will include the use of curvilinear distraction devices for 3-dimensional contour.

Wounds involving the calvarium secondary to trauma or burns are rare. However, they can present with challenging potential clinical sequelae. A wide variety of reconstructive options have evolved over the last century. Technical aspects have progressively improved as well over time. For proper surgical restoration of function and cosmesis reconstructive surgeons must have a detailed understanding of both the scalp and skull anatomy. Several factors such as etiology of the injury, including whether or not calvarial bone defects exists or simply soft tissue loss, as well as size, local tissue environment and patient comorbidities play major roles in appropriate choice for reconstruction. Currently, there is no single treatment option for scalp or calvarial reconstruction after trauma or burns. However, reconstructive alternatives are constantly emerging with promising results.

Signal-intensity contrast of T1-weighted magnetic resonance imaging scans has been associated with tissue integrity and reported as a sign of neurodegenerative changes in diseases such as Alzheimer's disease. After severe traumatic brain injury (TBI), progressive structural changes occur in white (WM) and gray matter (GM). In the current study, we assessed the signal-intensity contrast of GM and WM in patients with diffuse TBI in the chronic stage to (1) characterize the regional pattern of WM/GM changes in intensity contrast associated with traumatic axonal injury, (2) evaluate possible associations between this measure and diffusion tensor image (DTI)/fractional anisotropy (FA) for detecting WM damage, and (3) investigate the correlates of both measures with cognitive outcomes. Structural T1 scans were processed with FreeSurfer software to identify the boundary and calculate the WM/GM contrast maps. DTIs were processed with the FMRIB software library to obtain FA maps. The WM/GM contrast in TBI patients showed a pattern of reduction in almost all of the brain, except the visual and motor primary regions. Global FA values obtained from DTI correlated with the intensity contrast of all associative cerebral regions. WM/GM contrast correlated with memory functions, whereas FA global values correlated with tests measuring memory and mental processing speed. In conclusion, tissue-contrast intensity is a very sensitive measure for detecting structural brain damage in chronic, severe and diffuse TBI, but is less sensitive than FA for reflecting neuropsychological sequelae, such as impaired mental processing speed.

Suicide by power saws (bland, chain, circular or router saw) are an extreme exception. A few case reports are published in forensic literature regarding it. We report the case of a 30-year-old carpenter found dead lying on the floor next to a router saw in his carpenter workshop, with two gaping and deep wounds in his head. We summarize the findings of the death scene examination, the forensic autopsy, and the world literature concerning suicide committed with power saws.

In cranial firearm trauma, where soft tissues have decomposed, determining the manner of death can pose difficultly for a forensic anthropologist. Detailed analysis of skeletal wounds may lead to reconstruction of the events surrounding death, however considerable research has been conducted on soft tissue details and less has focused on skeletal wounds alone. Macroscopic descriptive observations were carried out on thirteen skulls from the Hamman-Todd Human Osteological Collection at the Cleveland Museum of Natural History, Ohio which had documented cranial projectile trauma to analyse wound location, shape, size, beveling and projectile paths. This sample of skeletons provides a non-arbitrary selection of individuals which were unclaimed bodies from a disturbed social environment. Nine entry wounds were located on the right side of the skull, 3 located on left side of skull and one had entry under the right side of the skull. Entry wounds were often oval or round in shape. Exit wounds were not present in all cases; however, when present they were of irregular shape. Radiating fractures occurred in 8 entry wounds and 8 exit wounds. Concentric fractures accompanied 3 exit wounds. Three entry wounds had clear internal beveling. Three cases had exit wounds with external beveling. One showed signs of combination beveling on the entry wound. Beveling, if present, can lead to identifying the entry/exit wound. Radiating fractures form when the intracranial pressure is too great and if the pressure is not relieved, concentric fractures form secondarily. Based on the characteristics of the cranial projectile trauma one can suggest manner of death, however, it is not possible to reach a firm decision.

Most penetrating skull injuries are caused by gun shot wounds or missiles. The compound depressed skull fracture represents an acute neurosurgical emergency. Management and diagnosis of such cases have been described, but its occurence following a fall onto a piece of wood is quite unusual. A 75-year-old female fell onto a piece of wood that penetrated her skull on the left frontal region and was treated in our department. The patient had no neurological deficits during presentation. She was managed surgically and removal of the wooden object was performed to prevent early or late infection complications. Wooden foreign bodies often pose a different set of challenges as far as penetrating injuries to the brain are concerned. Radiological difficulties and increased rates of infection due to its porous nature make these types of injuries particularly interesting. Their early diagnosis and appropriate treatment can minimize the risk of complications.

Objectives The objective of this study was to evaluate the physical properties of synthetic hydroxyapatite (sHA) and hydroxyapatite from eggshells (eHA) by Fourier-transform infrared (FT-IR) and x-ray diffraction (XRD) and to compare the regenerative ability of the bone using sHA and eHA in a rabbit calvarial defect model. Study Design FT-IR and XRD were used to compare the physical properties of sHA and eHA. sHA was purchased from Sigma, and eHA was kindly donated from the Hungarian academy of science. Sixteen New Zealand white rabbits were used for the animal study. After the formation of a bilateral parietal bony defect (diameter 8.0 mm), either sHA or eHA was grafted into the defect. The defect in the control was left unfilled. Bone regeneration was evaluated by histomorphometry at 4 and 8 weeks after the operation. Results The peak broadening of the XRD experiments were in agreement with scanning electron microscope observation; the sHA had a smaller granule size than the eHA. The eHA had impurities phases of CaO (International Center for Diffraction Data (ICDD) 075-0264) and Ca(OH) 2 (ICDD 072-0156). Total new bone was 17.11 ± 10.24% in the control group, 28.81 ± 12.63% in sHA group, and 25.68 ± 10.89% in eHA group at 4 weeks after the operation. The difference was not statistically significant ( P > .05). Total new bone at 8 weeks after the operation was 27.50 ± 10.89% in the control group, 38.62 ± 17.42% in sHA group, and 41.99 ± 8.44% in the eHA group. When comparing the sHA group to the control group, the difference was not statistically significant ( P > .05). However, the eHA group was significantly different from the control group ( P = .038). When comparing the eHA group to the sHA group, the difference was not statistically significant ( P > .05). Conclusions Both types of HA showed higher bone formation than the unfilled control. However, eHA had significantly higher bone formation than the unfilled control at 8 weeks after operation.

This article addresses the bioarchaeological evidence for Inca warfare through an analysis of 454 adult skeletons from 11 sites in the Inca capital region of Cuzco, Peru. These 11 sites span almost 1000 years (AD 600-1532), which allows for a comparison of the evidence for warfare before the Inca came to power (Middle Horizon AD 600-1000), during the time of Inca ascendency in the Late Intermediate Period (AD 1000-1400), and after the Inca came to power and expanded throughout the Cuzco region and beyond (Inca Imperial Period, AD 1400-1532). The results indicate that 100 of 454 adults (22.0%) showed evidence of cranial trauma. Of these, 23 individuals had major cranial injuries suggestive of warfare, consisting of large, complete, and/or perimortem fractures. There was scant evidence for major injuries during the Middle Horizon (2.8%, 1/36) and Late Intermediate Period (2.5%, 5/199), suggesting that warfare was not prevalent in the Cuzco region before and during the Inca rise to power. Only in the Inca Imperial Period was there a significant rise in major injuries suggestive of warfare (7.8%, 17/219). Despite the significant increase in Inca times, the evidence for major cranial injuries was only sporadically distributed at Cuzco periphery sites and was entirely absent at Cuzco core sites. These findings suggest that while the Inca used warfare as a mechanism for expansion in the Cuzco region, it was only one part of a complex expansion strategy that included economic, political, and ideological means to gain and maintain control.

Today, there is increasing use of CT scanning on a clinical basis, aiding in the diagnosis of diseases or injuries. This exam also provides important information that allows identification of individuals. This paper reports the use of a CT scan on the skull, taken when the victim was alive, for the positive identification of a victim of a traffic accident in which the fingerprint analysis was impossible. The authors emphasize that the CT scan is a tool primarily used in clinical diagnosis and may contribute significantly to forensic purpose, allowing the exploration of virtual corpses before the classic autopsy. The use of CT scans might increase the quantity and quality of information involved in the death of the person examined.

This review paper gives an overview and summarizes the different methods of cranioplasty for reconstruction of the bony skull. There are various origins of cranial defects including trauma, tumours, congenital deformities or postoperative defects due to the surgical procedure itself. The overall goal of skull reconstruction is, on the one hand, appropriate closure, and on the other hand, the perfect cosmetic result. The cranioplasty should be safe, fast and easy to handle. Cost-effectiveness of the procedure represents a further important point. To solve these complex and multimodal problems, different techniques and also various materials for the reconstruction are available. This report details the usual procedures for skull reconstruction, as well as the advantages and limitations of the different materials and operative strategies.

The skull vault consists of a multitude of flat bones held together by the cranial sutures. Radiologists encounter a vast array of calvarial pathologies that tend to cause abnormalities in thickness, abnormalities in density, focal defects, or an excess of soft tissue or bone tissue. Further anomalies related to the cranial sutures and fontanelles occur in the dynamic pediatric skull. The imaging features of the host of conditions resulting in these commonly detected calvarial abnormalities are reviewed and illustrated.

Background: Osteopathic physicians believe that the birthing process causes cranial dysfunction that may be manifested in somatic symptoms, one of which is excessive crying of infancy. Cra...

The authors made an attempt to verify if a coconut can be used as a model of human skull to determine the homicide weapon. During our experiment 27 strike attempts were performed with the use of 9 different tools. Among them there were authentic murder weapons and instruments which had been used in similar experiments conducted on human skulls in 1955. Depending on the size of an area in contact with a coconut, weapons caused dents corresponding to the shape of a weapon, irregular fractures or long linear cracks. Our results have shown that coconut can be used as an inexpensive screening model of human skull, but only to determine fractures made by tools with small striking surface.

Some sports' accidents are responsible for inflicting traumatic brain injuries and mandibular bone fractures when impacts occur to the chin. It is often thought that mouth guards can prevent many of these injuries. However, such assertions may be insufficient without adequate research. It is therefore necessary to establish a systematic method of investigation to solve this problem. In the present laboratory study, tests were performed using pendulum impact equipment and an artificial skull model connected to strain gages and accelerometers to simulate and measure the surface distortions related to bone deformation or fractures and the acceleration of the head related to concussions. As impacts, direct blows to the mandibular undersurface were applied. As a result, wearing a mouth guard decreased (P < 0.01) the distortion to the mandibular bone and the acceleration of the head significantly compared with not wearing a mouth guard (54.7%: to the mandible -- measured at a total of three different points, 18.5%: to the head measured at a total of three different points). Within the limits of this study, the following conclusions were drawn: The present measuring system in this study was able to evaluate the distortion to the mandibular and the acceleration of the head from the direct blow to the mandibular undersurface. Mouth guards can reduce distortion to the mandibular and the acceleration of the head from the same blow. So mouth guards might have the possibility to prevent mandibular bone fractures and concussions. However, further well-designed and exhaustive studies are vital to show that mouth guards reduce the incidence of concussions and mandibular bone fractures.

Downstairs falls frequently occur within domestic environments and are mainly associated with elderly and intoxicated individuals, often feature multiple injuries on various parts of the body. In most cases it is not possible to determine the cause of the fall and/or death solely by means of external examination. In this retrospective study, which covers a period of 11 years, all cases of death which included a fall downstairs in their case history, were collected from the Forensic Institutes of the Universities of Bonn and Greifswald, Germany. Falls downstairs made up to 2% (166 cases) of all postmortem examinations carried out within this period. Interestingly, almost double of the amount of such falls applied to males as to females. The primary cause of death was cranio-cerebral trauma and the vast majority of skull injuries associated with falls downstairs were found above ‘the hat brim line’. Injuries were also often found on several other parts of the body at once. Nineteen of the 116 examined individuals exhibited agonal injuries. In these cases, postmortem examination revealed pre-existing disease or intoxication to be the cause of death and thus, cause of the fall. The injury pattern only allows a tendency towards vital or agonal incident as a conclusion. # 2004 Elsevier Ireland Ltd. All rights reserved.

The objective of this study was to evaluate the optimal thickness and porosity of novel titanium mesh membranes to enhance bone augmentation, prevent soft tissue ingrowth, and prevent membrane exposure.Six types of novel titanium meshes with different thicknesses and pore sizes, along with three commercially available membranes, were used to cover surgically created calvarial defects in 6-week-old Sprague-Dawley rats. The animals were killed after 4 or 8 weeks. Microcomputed tomographic analyses were performed to analyze the three-dimensional bone volume and bone mineral density. Soft tissue ingrowth was also evaluated histologically and histomorphometrically.The novel titanium membranes used in this study were as effective at augmenting bone in the rat calvarial defect model as the commercially available membranes. The greatest bone volume was observed on 100-μm-thick membranes with larger pores, although these membranes promoted growth of bone with lower mineral density. Soft tissue ingrowth when 100-μm membranes were used was increased at 4 weeks but decreased again by 8 weeks to a level not statistically significantly different from other membranes.Membrane thickness affects the total amount of new bone formation, and membrane porosity is an essential factor for guided bone regeneration, especially during the initial healing period, although the final bone volume obtained is essentially the same. Newly developed titanium mesh membranes of 100 μm in thickness and with large pores appear to be optimal for guided bone regeneration.

Specific features usually allow recognition of entrance and exit wounds in bones. Exits are often more irregular, and usually larger than entrances. The aim of this paper is to compare the size of 17 entrance and exit gunshot wounds from a series of 13 forensic cases. The results of this work confirm the usually accepted fact that exit wounds in bones tend to be larger than the entrances resulting from the same shot. In all but one case the exits were larger than the entrances in this study. Though the bullet loses velocity after penetrating, the ballistic behavior (deformation and instability of the projectile) explains this tendency.

Experimental gunshots were made with 9 x 19 mm (9-mm Luger) Frangible ammunition using skin, gelatin, and bones as targets. Direct gunshots penetrated 50 cm into gelatin blocks without mushrooming or fragmentation. Skull bone was easily perforated. Head models were penetrated by the bullets, which broke down to myriad fragments within or outside the head. Gunshots through windshields and steel plates led to dangerous bullet fragmentation with a high risk of injury. Gunshots perforating tibias produced comminuted fractures. In all soft tissues, except the direct gunshots into gelatin, high-resolution radiography revealed many metallic fragments along the bullet path. Clinical radiography can show the larger copper fragments, but the explosion-like distribution of metallic foreign bodies in soft tissue is a serious surgical problem.

The 18th century was the time when trauma neurosurgery began to develop into the modern discipline. Before this, the management had, for the most part, changed little from the days of Hippocrates, Celsus, and Galen. Attention was directed to skull injuries, and the brain was treated as the seat of the rational soul but without other function. Symptoms after trauma were attributed to injuries to the bone and meninges. Following the lead of the Royal Academy of Surgery in Paris, it was accepted from the 1730s that the brain was the seat of symptoms after cranial trauma. During the 18th century, at least 12 surgeons published articles on cranial injury, 6 describing significant clinical series on this topic. They were Henri-Francois Le Dran (1685-1770) of Paris, Percival Pott (1714-1788) of London, James Hill (1703-1776) from Dumfries, Sylvester O'Halloran (1728-1807) of Limerick (Ireland), William Dease (1750-1798) of Dublin, and John Abernethy (1764-1831) of London. This article analyzes these series. Each individual made a different contribution. It is suggested that the relatively lesser-known James Hill in Scotland demonstrated the greatest understanding of the management of brain trauma and achieved the best results. A product of the Scottish Enlightenment, he adapted his management to his own experience and was not tied to the accepted authorities of his day, but he improved the management of each case following his experience with previous patients. He deserves to be remembered.

Background Alloplastic materials are increasingly being used in augmentation of craniofacial defects because of its ready availability, good aesthetic outcome and absence of donor site morbidity. This paper highlights experience in the use of heat-cured acrylic in augmentation cranioplasty. Subjects and methods The management of three patients with anterior skull defect who presented at the Dental and Maxillofacial Surgery Clinic of the Aminu Kano Teaching Hospital over a five-year period is presented. Results There was good aesthetic outcome in all the patients and no complications were recorded. Conclusion Augmentation of craniofacial defects using customized prefabricated heat-cured acrylic provides patients with a durable, stable and structural repair of craniofacial defects with good aesthetic outcome.

This article presents the examination of 78 accidents in horseback riding, referring to their origin and kind of injury. It was found that 76% of all injuries did not occur during the active phase of riding, but in the time just before and right after it. Children without any experience in horseback riding were most susceptible to injuries. Referring to lesions occurring before and after the active phase, the longer extremity was predominantly involved (40%); furthermore, the skull was injured in 18% and the hand in 14% of all lesions. During the active phase of horseback riding, skull injuries increased to 34%. Thoracic and spinal lesions occurred in 15% each. The frequency of all lesions shows a reversed proportional dependence on the amount of experience in this sport. Severity of the accidents increases significantly with increasing demand on performance. In consideration of these studies the thesis can be advanced that coordinated prevention directly before and after the active riding phase can decrease the frequency of all accidents and especially the involvement of the lower extremity and the skull. Language: de

Exit gunshot wounds of the skull generally have external beveling while entrance wounds show internal beveling. With rare exceptions, entrance gunshot wounds show external beveling, usually of two types: the asymmetric 'keyhole' type and the symmetric 'non-keyhole' type. In exit gunshot wounds of the skull, only the keyhole type has been reported. This report shows that symmetric internal beveling from an exit gunshot wound to the skull may confuse medical personnel.

The objective of this study was to report outcomes after initiation of an algorithmic approach (Bethesda protocol) using intracranial free flaps, cranial bone autografts, and dermal/fat grafts to treat warfare-related cranial frontofacial defects after war-related decompressive craniectomy.A retrospective review of personnel undergoing complex cranial defect reconstruction that required free flap interpositions for dead space obliteration, cranial bone grafting, or dermal/fat grafting for orbital defects was performed over a 52-month period.From March of 2003 to July of 2011, 13 patients were identified who underwent complex craniofacial defect reconstruction. All patients were male (average age, 25 years). Average follow-up was 3.6 years. Glasgow Coma Scale score was 7 initially and 9 on arrival to the continental United States. Average evacuation time was 4.2 days. Forty-six percent of injuries were blast injuries. Nine patients (69 percent) underwent hemicraniectomies and four (31 percent) underwent bifrontal craniectomies. Two patients required free flaps and four required free flaps and cranial bone grafts for skull base reconstruction. Five patients required cranial bone grafts and two required cranial bone grafts with dermal fat grafts for reconstruction. All patients were complication free at conclusion of the study. The initial free flap success rate was 86 percent (six of seven flaps). Successful frontal bar/free flap reconstruction was present in 100 percent and the secondary cranioplasty rate was 77 percent.Decompressive craniectomy defects associated with orbital, sinus, and skull base defects can be successfully reconstructed using an algorithmic approach with low morbidity and high secondary cranioplasty retention rates.Therapeutic, IV.

[spa] La Tesis consta de 5 fases diferenciados de trabajo: una investigación teórica, tres empíricas y un estudio clínico de casos. El objetivo principal dirige las tareas al análisis del perfil cognitivo de pacientes con daño cerebral adquirido, que han recibido un tratamiento de rehabilitación cognitiva de la capacidad de atención mediante la plataforma PREVIRNEC. Otros objetivos conducen a la observación de los efectos del tratamiento de la atención sobre otras funciones cognitivas, y a conocer la relación entre los citados perfiles y el rendimiento en la rehabilitación. La muestra está constituida por pacientes con daño cerebral adquirido que realizaron el tratamiento de rehabilitación cognitiva en el Institut Guttmann. En el primer estudio empírico, se observa el comportamiento de 123 pacientes; en el segundo, la muestra se amplía a 242 pacientes; y en el tercero, se desarrolla un tratamiento específico de atención con dos modalidades de intervención aplicadas a 26 pacientes. Para el análisis de resultados, se aplican técnicas paramétricas o, en su caso, no paramétricas, para comparar el rendimiento en test y retest de exploración neuropsicológica pre- y post-tratamiento. Posteriormente, se llevan a cabo estudios de correlación entre el perfil y el rendimiento en la rehabilitación. Como conclusión general, se pone de manifiesto que, tras la rehabilitación cognitiva mediante la plataforma PREVIRNEC, la mayoría de los pacientes estudiados han obtenido un positivo cambio en su rendimiento cognitivo. Dichos resultados concuerdan con los planteamientos de diferentes autores sobre los efectos de la rehabilitación cognitiva (Cicerone et al. 2011); así como sobre los beneficios de las técnicas informatizadas para la rehabilitación cognitiva (García-Molina, 2011; Westerberg, 2007), y en especial de los tratamientos específicos de rehabilitación de atención (Yun-Hee et al., 2008; Dirette, 2004; Sohlberg y Maater, 2001; Gray et al., 1992; Niemann et al., 1990; Gray y Robertson, 1989). Los resultados obtenidos a lo largo de los tres estudios empíricos confirman el positivo impacto que el tratamiento de atención puede provocar sobre otras funciones cognitivas como la memoria (Poser, Kohler, Sedlmeier y Strätz, 1992; Niemman et al. 1990; Sturm et al. 1983). Finalmente, la relación entre el perfil positivo de atención dividida y el elevado rendimiento en las tareas de rehabilitación sugiere el uso de diferentes estrategias de respuesta, que favorecerían su precisión. Diversos autores han planteado la influencia que pueden provocar dichas estrategias sobre la capacidad cognitiva y funcional de los pacientes (García-Molina, 2011; Dirette, 2004; Ruff et al., 2001), [eng] This thesis is composed of 5 different parts of work: a theoretical investigation, three empirical studies and clinical case studies. The main objective was to analyse the cognitive profile of patients with cerebral damage who received a cognitive rehabilitation on attention ability with the PREVIRNEC platform. Other objectives were to describe the impact of attention training on other cognitive functions, and study the relations between the cognitive profiles of the patients and their performance in the rehabilitation tasks. All the brain injury patients who took part in the cognitive rehabilitation treatment were attending the Guttmann Institute. 123 patients took part in the first empirical study. The second sample contained 242 patients, and the third case study was made with 26 patients. Results were analysed with parametric and non parametric techniques, to compare the performance of the neuropsychological assessment pre- and post-treatment. Secondly, correlation studies were carried out between the cognitive profile and the rehabilitation performance. The general conclusion highlight’s that after the cognitive rehabilitation with the PREVIRNEC platform the majority of the patients studied have obtained a positive change in their cognitive performances. These results were supported with different previous studies by authors about cognitive rehabilitation effects (Cicerone et al. 2011; García-Molina, 2011; Westerberg, 2007), and especially on specific attention rehabilitation treatments (Yun-Hee et al., 2008; Dirette, 2004; Sohlberg and Maater, 2001; Gray et al., 1992; Niemann et al., 1990; Gray and Robertson, 1989). Conclusions after analysing the three empirical studies confirmed the positive impact that the attention treatment could made to other cognitive functions like memory (Poser, Kohler, Sedlmeier and Strätz, 1992; Niemman et al. 1990; Sturm et al. 1983). Finally, relation between the improvement of the divided attention patient profile and the high performance in the of rehabilitation tasks, suggests that the use of different strategies of answer, could improve his accuracy. Several authors supported the conclusion the positive influence that the different answers strategies could have on the cognitive and functional patient’s ability (García-Molina, 2011; Dirette, 2004; Ruff et al., 2001).

Materials used to repair cranial defects have evolved tremendously over the past several decades. Advances in metallurgy, the development of acrylics, and the advent of modern imaging and histologic techniques all have played a role in improving cranioplastic materials. Discussed here is a case report depicting the use of synthetics in cranioplasty, followed by a review of the historical development of these materials.

Conventional radiographs, axial CT with multiplanar 2-D and 3-D-CT reformations were obtained in 20 patients presenting with craniofacial injuries, to evaluate the capabilities of 3-D-CT. The image quality was assessed by two readers. Sagittal and oblique components as well as comminuted fractures could be detected by 3-D-CT reconstructions similarly to axial CT with 2-D reformations. Displacements over 2 mm were confidently documented by 3-D-CT images. 3-D-CT reconstructions allow an improved demonstration of rotational components of fractured fragments. 3-D-CT images are not as accurate as 2-D-CT in the primary detection of fractures in the relevant anatomic regions. Among 3-D-CT reconstructions, the lateral and partly the facial regions are adequately visualised.

Reconstruction of the pediatric calvaria is frequently complicated by a shortage of bone. This problem is most apparent between 2 and 10 years of age, when the osteogenic potential of the dura is diminished and the diploic space has not matured to the point that split-thickness calvarial grafting is practical. In this article, the authors evaluate and compare the relative efficacy of adipose-derived stem cells, bone morphogenetic protein (BMP)-2, and adipose-derived stem cells osteoinduced with BMP-2 in addressing these defects.Cranial defects measuring 15×15 mm were created in New Zealand White rabbits. Five treatment modalities were compared: no repair (surgical control); untreated acellular collagen sponge (vehicle control); BMP-2 on acellular collagen sponge; adipose-derived stem cells on acellular collagen sponge; and osteoinduced adipose-derived stem cells on acellular collagen sponge. Osteogenesis was assessed with radiology and histology. Statistical significance was determined by analysis of variance.No significant difference in osseous healing was observed among empty controls (32.8 percent), acellular collagen sponge alone (34.4 percent), adipose-derived stem cells on acellular collagen sponge (33.9 percent), and osteoinduced adipose-derived stem cells on acellular collagen sponge (40.2 percent). Defects reconstructed with recombinant human BMP-2/acellular collagen sponge were on average 96.9 percent ossified, significantly (p0.05) more than the defects in all other groups.BMP-2-based tissue engineering is a viable approach to craniofacial reconstruction. Adipose-derived stem cells did not significantly augment this process as modeled here. Advances in the understanding of craniofacial biology, and of protein- and cell-based therapies, will enhance the efficacy of tissue-engineering strategies for this problem in the future.

This study looks at the case of a 20-year-old fisherman, who was speared in the head, the spear entering at his jaw and protruding from the top of his scull, while he was swimming unaccompanied; he was rescued, admitted to the intensive care unit for an operation, remained in a coma for a few days and then had a full recovery. About 10 days before the rescue, he had visited a monk who, intuited and functioning as channel of the divine spirit, had told him that he 'should not be afraid of anything', rubbing the top of his scull and his jaw exactly at the points through which the 40-inch spear passed. After the incident, the monk prescience again the exact day on which he would recover from the coma. It is concluded that the survival of the fisherman can be attributed to a paranormal event. The monk's prescience permit the assumption that a divine spirit was pervasive throughout the universe and present in this life-threatening situation, endeavouring to assist the lifeguard, the neurosurgeons and the young fisherman.

Post mortem examination is often relied upon in order to determine whether a suspicious death was natural, accidental, suicidal or homicidal. However, in many cases the mechanism by which a single injury has been inflicted cannot be determined with certainty based on pathological examination alone. Furthermore the current method of assessing applied force relating to injury is restricted to an arbitrary and subjective scale (mild, moderate, considerable, or severe). This study investigates the pathophysiological nature of head injuries caused by blunt force trauma, specifically in relation to the incidence and formation of a laceration. An experimental model was devised to assess the force required to cause damage to the scalp and underlying skull of porcine specimens following a single frontoparietal impact. This was achieved using a drop tower equipped with adapted instrumentation for data acquisition. The applied force and implement used could be correlated with resultant injuries and as such aid pathological investigation in the differentiation between falls and blows. Experimentation revealed prevalent patterns of injury specific to the reconstructed mechanism involved. It was found that the minimum force for the occurrence of a laceration was 4000 N. Deposited by bulk import 1/11/2013. SB.