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Sternal cleft is a rare congenital malformation resulting from a fusion failure of the sternum and often patients have no clinical signs at birth. The defect is usually divided into partial or complete forms and is often accompanied by other anomalies. We herein report a case of upper sternal cleft that was repaired in the neonatal period by primary closure after partial thymectomy. The patient was discharged 9 days after the operation with good condition and normal respiratory movements. Sternal cleft is a rare case, with little more than 100 cases published worldwide.

This chapter includes (1) BA fenestration and arterial ring, (2) Proximal BA partial duplication, (3) Partial duplication of the distal BA (Caudal fusion of BA), and (4) BA complete duplication. Various forms of fusion failure of the primitive longitudinal arteries result in BA variations. There are 12 figures.

Various congenital anomalies of the female tract such as agenesis, vertical or lateral fusion failure, and canalization failure occur when the normal development of the Müllerian duct disrupts in any stage of developmental milestones. A cavitated non-communicating rudimentary horn is reported in about 20%-25% of women with unicornuate uterus. A 36-year-old patient, gravida 2 para 2, was admitted to the hospital with a complaint of worsening lower abdominal pain occurring on each menses for 8 months. A 6-cm accessory cavitated left uterine mass suggestive of hematometra was shown on ultrasound examination. It was decided to perform hemi-hysterectomy to remove the left uterine horn by the laparoscopic route. Here we aimed to demonstrate the laparoscopic management of a rudimentary horn case and emphasize the crucial steps that surgeons should safely perform during the operation.

Fusion failure of nasal process and oropalatal shelves leads to alveolar cleft which necessitates secondary alveolar bone grafting. There are various donor sites to develop autografts that each has their own advantages and disadvantages. Autogenous bone from intraoral or extraoral donor sites is the gold standard for treatment of large craniomaxillofacial defects. Tissue engineering merges the fields of cell biology, biomaterial engineering, and medicine to fabricate new functional tissues. Changing cell sources, smart scaffolds, dynamic cell culture methods, and bedside modification are the main approaches that scientists are trying to use to enhance success rate in bone regeneration.

International audience; In face-to-face communication, audiovisual (AV) stimuli can be fused, combined or perceived as mismatching. While the left superior temporal sulcus (STS) is presumably the locus of AV integration, the process leading to combination is unknown. Based on previous modelling work, we hypothesize that combination results from a complex dynamic originating in a failure to integrate AV inputs, followed by a reconstruction of the most plausible AV sequence. In two different behavioural tasks and one MEG experiment, we observed that combination is more time demanding than fusion. Using time-/source-resolved human MEG analyses with linear and dynamic causal models, we show that both fusion and combination involve early detection of AV incongruence in the STS, whereas combination is further associated with enhanced activity of AV asynchrony-sensitive regions (auditory and inferior frontal cortices). Based on neural signal decoding, we finally show that only combination can be decoded from the IFG activity and that combination is decoded later than fusion in the STS. These results indicate that the AV speech integration outcome primarily depends on whether the STS converges or not onto an existing multimodal syllable representation, and that combination results from subsequent temporal processing, presumably the off-line reordering of incongruent AV stimuli. Screen-based communication poses specific challenges to our brain for integrating audiovisual (AV) disparities due to either asynchronies between audio and visual signals (e.g. video call software) or to mismatching physical features (dubbed movies). To make sense of discrepant audiovisual speech stimuli, humans mostly focus on the auditory input 1 , which is taken as ground truth, and try to discard the disturbing visual one. In some specific cases, however, AV discrepancy goes unnoticed and the auditory and visual inputs are implicitly fused into a percept that corresponds to none of them 2. More interestingly perhaps, discrepant AV stimuli can also be combined into a composite percept where simultaneous sensory inputs are perceived sequentially 2,3. These two distinct outcomes can experimentally be obtained using the "McGurk effect" 2 , where an auditory /aba/ dubbed onto a facial display articulating /aga/ elicits the perception of a fused syllable /ada/, while an auditory /aga/ dubbed onto a visual /aba/ typically leads to a mix of the combined syllables /abga/ or /agba/. What determines whether AV stimuli are going to be fused 4-6 or combined 7 , and the underlying neural dynamics of such a perceptual divergence is not known yet. Audiovisual speech integration draws on a number of processing steps distributed over several cortical regions, including auditory and visual cortices, the left posterior temporal cortex, and higher-level language regions of the left prefrontal 8-12 and anterior temporal cortices 13,14. In this distributed network, the left superior temporal sulcus (STS) plays a central role in integrating visual and auditory inputs from the visual motion area (mediotemporal cortex, MT) and the auditory cortex (AC) 15-21. The STS is characterized by relatively smooth temporal integration properties making it resilient to the natural asynchrony between auditory and visual speech inputs, i.e. the fact that orofacial speech movements often start before the sounds they produce 6,22,23. Although the STS responds more strongly when auditory and visual speech are perfectly synchronous 24 , its activity remains largely insensitive to temporal discrepancies 25 , reflecting a broad temporal window of integration in the order of

Pedicle screws are typically used for fusion, percutaneous fixation, and means of gripping a spinal segment. The screws act as a rigid and stable anchor points to bridge and connect with a rod as part of a construct. The foundation of the fusion is directly related to the placement of these screws. Malposition of pedicle screws causes intraoperative complications such as pedicle fractures and dural lesions and is a contributing factor to fusion failure. Computer assisted spine surgery (CASS) and patient-specific drill templates were developed to reduce this failure rate, but the trajectory of the screws remains a decision driven by anatomical landmarks often not easily defined. Current data shows the need of a robust and reliable technique that prevents screw misplacement. Furthermore, there is a need to enhance screw insertion guides to overcome the distortion of anatomical landmarks, which is viewed as a limiting factor by current techniques. The objective of this study is to develop a method and mathematical lemmas that are fundamental to the development of computer algorithms for pedicle screw placement. Using the proposed methodology, we show how we can generate automated optimal safe screw insertion trajectories based on the identification of a set of intrinsic parameters. The results, obtained from the validation of the proposed method on two full thoracic segments, are similar to previous morphological studies. The simplicity of the method, being pedicle arch based, is applicable to vertebrae where landmarks are either not well defined, altered or distorted.

It is well known that high rates of fusion failure and pseudoarthrosis development (5–35%) are concomitant in spinal fusion surgery, which was ascribed to the shortage of suitable materials for bone regeneration. Citrate was recently recognized to play an indispensable role in enhancing osteoconductivity and osteoinductivity, and promoting bone formation. To address the material challenges in spinal fusion surgery, we have synthesized mechanically robust and fast degrading citrate-based polymers by incorporating N-methyldiethanolamine (MDEA) into clickable poly(1,8-octanediol citrates) (POC-click), referred to as POC-M-click. The obtained POC-M-click were fabricated into POC-M-click–HA matchstick scaffolds by forming composites with hydroxyapatite (HA) for interbody spinal fusion in a rabbit model. Spinal fusion was analyzed by radiography, manual palpation, biomechanical testing, and histological evaluation. At 4 and 8 weeks post surgery, POC-M-click–HA scaffolds showed optimal degradation rates that facilitated faster new bone formation and higher spinal fusion rates (11.2 ± 3.7, 80 ± 4.5 at week 4 and 8, respectively) than the poly(L-lactic acid)–HA (PLLA–HA) control group (9.3 ± 2.4 and 71.1 ± 4.4) (p < 0.05). The POC-M-click–HA scaffold-fused vertebrates possessed a maximum load and stiffness of 880.8 ± 14.5 N and 843.2 ± 22.4 N mm−1, respectively, which were also much higher than those of the PLLA–HA group (maximum: 712.0 ± 37.5 N, stiffness: 622.5 ± 28.4 N mm−1, p < 0.05). Overall, the results suggest that POC-M-click–HA scaffolds could potentially serve as promising bone grafts for spinal fusion applications.

Background Fusion rates following rigid internal instrumentation for occipitocervical and atlantoaxial instability approach 100% in many reports. Based on this success and the morbidity that can be associated with obtaining autograft for fusion, surgeons increasingly select alternative graft materials. Objective To examine fusion failure using various graft materials in a retrospective observational study. Methods Insurance claims databases (Truven Health MarketScan® [Truven Health Analytics, Ann Arbor, Michigan] and IMS Health Lifelink/PHARMetrics [IMS Health, Danbury, Connecticut]) were used to identify patients with CPT codes 22590 and 22595. Patients were divided by age (≥18 yr = adult) and arthrodesis code, establishing 4 populations. Each population was further separated by graft code: group 1 = 20938 (structural autograft); group 2 = 20931 (structural allograft); group 3 = other graft code (nonstructural); group 4 = no graft code. Fusion failure was assigned when ≥1 predetermined codes presented in the record ≥90 d following the last surgical procedure. Results Of 522 patients identified, 419 were adult and 103 were pediatric. Fusion failure occurred in 10.9% (57/522) of the population. There was no statistically significant difference in fusion failure based on graft material. Fusion failure occurred in 18.9% of pediatric occipitocervical fusions, but in 9.2% to 11.1% in the other groups. Conclusion Administrative data regarding patients who underwent instrumented occipitocervical or atlantoaxial arthrodesis do not demonstrate differences in fusion rates based on the graft material selected. When compared to many contemporary primary datasets, fusion failure was more frequent; however, several recent studies have shown higher failure rates than previously reported. This may be influenced by broad patient selection and fusion failure criteria that were selected in order to maximize the generalizability of the findings.

Background Data: Anterior cervical corpectomy was the best solution in some cases of subaxial fracture but this defect was a problem to fill after corpectomy, so this study was to show the efficacy and safety of carbon cage and plating in the treatment of this problem. Study Design: A clinical case series review Purpose: To review the safety, efficacy and outcome of anterior cervical corpectomy with cage and plating in the management of subaxial cervical fractures. Patients and Methods: From January 2009 to January 2014, twenty patients underwent anterior cervical corpectomy with cage and plating for the treatment of subaxial spinal injuries. The functional status was assessed using the modified Japanese Orthopedic Association Score preoperatively and at 1, 3 and 6 months postoperatively. Radiological assessment was done preoperatively with MRI, CT scan and plain radiograph, and at 1, 3 and 6 months postoperativelyby plain radiograph and CT scan. Results: Patients’ ages ranged from 17 to 60 years (mean 38.5 years); 14 patients were males. Fourteen patients underwent one-level corpectomy and six patients underwent two-level corpectomy. Of our 20 patients; 16 patients (80%) had satisfactory significant recovery (one point or more on (mJOA) score), while four patients (20%) had no clinical improvement (same preoperative points on (mJOA) score). There was no case of cervical instability, instrument break down, or fusion failure during follow up period. Conclusion: The anterior cervical corpectomy with cage and plating is a safe and effective technique in subaxial spinal injuries in selected patients. (2013ESJ057)

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the incidence of fusion failure after anterior screw fixation of type II and rostral shallow type III fractures and to identify related risk factors. SUMMARY OF BACKGROUND DATA: Although several studies have reported fusion rates after anterior odontoid screw fixation of type II and rostral shallow type III fractures, few reports have analyzed in detail the risk factors associated with fusion failure. METHODS: Forty-one patients with a type II and rostral shallow type III odontoid fracture were treated using anterior screw fixation. The patients were 33 men and 8 women mean age = 46.6 years; age range = 15-79 years. Range of follow-up was 7 to 48 months. RESULTS: Anterior odontoid screw fixation resulted in solid bony union in 33 patients (80.5%), fibrous union in 3 (7.3%), and nonunion in 5 (12.2%). When surgery was delayed for more than 1 week, the incidence of fusion failure significantly increased (P = 0.0051). Furthermore, a fracture gap of 2 mm or more was found to be significantly associated with fusion failure (P = 0.0172). However, patient age and fracture displacement were not found to be significantly associated with fusion failure (P = 0.8236 and P = 0.5762, respectively). CONCLUSION: Our study of anterior odontoid screw fixation reveals that the risk of fusion failure is 37.5 times greater in patients with a delay of more than 1 week before operation, and 21 times greater in patients with a fracture gap of greater than 2 mm.

Os odontoideum has been defined as an independent ossicle, with smooth margins, separated with the base of the odontoid or the axis vertebrae [7, 15–17]. Since Giacomini first described os odontoideum in 1886 [10], its etiology has remained controversial. Supporters of a congenital etiology have considered os odontoideum as a segmental anomaly resulting from fusion failure between the odontoid and the axis vertebrae [2, 3, 8]. Moreover, several case reports of familial os odontoideum have been reported in support of their theory [1, 14, 18, 24]. Recently, we reported a threegeneration family with three members who presented os odontoideum [30]. In contrast, proponents of an acquired etiology state that the ossicle results from an unrecognized fracture or a cartilaginous injury of the odontoid followed by alar ligament contraction and interruption of the blood supply [7, 11, 29]. In support of the acquired theory, Verska et al reported one identical twin with an os odontoideum after documented trauma and the other twin with a normal odontoid and no traumatic history [27]. In the literature, proponents of the acquired etiology also reported 11 patients who had radiographic documentation of a normal odontoid and subsequently developed an os odontoideum after trauma [6, 7, 9, 12, 20, 22, 26]. The previously reported cases are summarized in Table 1. Most of these os odontoideum cases with a pretraumatic normal radiograph were present before CT scans were available. Obviously, solely based on plainfilm evaluation, the possibility of congenital deficits cannot be totally excluded. To our knowledge, the present case is the 12th case reported of posttraumatic os odontoideum who had radiographic documentation of a previous normal odontoid process in the English literature. This case report demonstrates a posttraumatic os odontoideum using reconstructive CT imaging, which has yet to be reported. The family was informed that data concerning the case would be submitted for publication, and consent was obtained.

Congenital fistulas of the lip are commonly found in the lower lip and accompany cleft lip. They are seen as a symptom of Van der Woude syndrome, which is predominantly hereditary. In contrast, congenital fistulas of the upper lip are rare. A number of hypotheses have been proposed to explain the pathogenesis of fistulas of the upper lip, including fusion failure of facial prominences and absence of mesoblasts, suggesting a relationship between this condition and the development of cleft lip. The pathogenesis of this disorder has been attracting attention. We report the case of a 5-year-old girl with congenital fistula of the upper lip.

Instability of the atlantoaxial complex may result from inflammatory, traumatic, congenital, neoplastic, or degenerative disorders and often requires surgical stabilization. Initial dorsal wiring techniques allow safe fixation but require rigid external immobilization and have been associated with high fusion failure rates. Rigid screw fixation techniques including transarticular screw fixation and C1-C2 rod-cantilever fixation offer higher fusion rates and less need for rigid immobilization but are more technically demanding. C1-C2 fixation using crossing C2 laminar screws offers rigid fixation but without the technical demands of C2 pars placement. The history and techniques of dorsal fixation of the atlantoaxial complex are reviewed, and the success rates and complications of each are discussed.

The use of anterior odontoid screw fixation has grown in popularity for the management of acute, unstable Anderson and d'Alonzo Type II and rostral Type III odontoid fractures. This study critically reviews our clinical experience of 48 patients with single odontoid screw fixation for the treatment of Type II and Type III odontoid fractures between 1997 and 2001. This series had a complication rate of 10% (malposition rate 6% and non-union rate 4%), with a satisfactory overall fusion rate of 96%. Odontoid screw fixation is technically demanding and requires strict patient selection, thorough preoperative planning and careful surgical technique. In our experience, advanced age should not be considered a contraindication to anterior odontoid screw fixation, as satisfactory results can be obtained in some of these patients. This study also emphasises that sagittally oblique type II fractures are associated with a high rate of fusion failure when treated by anterior odontoid screw fixation, and should be treated with other instrumentation methods, such as posterior atlantoaxial arthrodesis.

A retrospective study of anterior cervical fusion in post-laminectomy swan-neck deformity was carried out, the objective being to observe the effect of anterior interbody fusion on the post-laminectomy swan-neck deformity. Independent segmental interbody fusion procedure was more effective than that of the multi-joint single graft fusion in correcting the deformed cervical spine. However, there was more loss of correction as well as a slightly higher fusion failure in the former procedure than the latter.

Developmental anomalies of the pancreas result from fusion failure between the dorsal and ventral pancreatic ducts (pancreas divisum) or from rotational failure of the ventral bud (pancreas anulare). These variations and anomalies of the ductal anatomy can be asymptomatic throughout life or can cause varying symptoms in different age periods. Pancreas divisum and pancreas anulare can be confirmed exclusively by means of pancreatography. Congenital disorders of the pancreas derive from genetic defects involving different organ systems, which usually dominanate the clinical symptoms. Developmental anomalies and congenital disorders of the pancreas lead to varying morphological alterations of the organ which can be assessed by means of modern imaging.

This article describes a rare congenital abnormality of anterior and posterior C1 fusion failure presenting after an acute athletic injury to the fibrous nonunion. C1 congenital malformations are rare, occurring in approximately 2% of patients; even rarer are combined anterior and posterior arch malformations in the same patient. Posterior ring abnormalities are more common than anterior ring injuries (4.5:1, respectively). To the authors’ knowledge, combined anterior and posterior ring congenital malformations with subsequent injury have not been previously described. In the current patient, a congenital failure of fusion of the anterior and posterior arches of C1 was identified. The anterior fibrous nonunion was injured while the patient played football, leading to transient neurologic injury and dysphagia from soft tissue swelling. The patient was initially diagnosed with an acute fracture at another facility; however, given advanced imaging, flexion and extension views, and a normal neurologic examination, the authors diagnosed a traumatized congenital defect. The injury healed with a short period of cervical collar immobilization and supportive measures. Such malformations are usually found incidentally, but they can be symptomatic after trauma. Images to distinguish these deficits can be difficult because the differences between chronic nonunions and congenital malformations are subtle. Surgery is rarely indicated for congenital malformations because they are often stable even after injury; however, they may predispose patients to neurologic injury in the future with high-risk activities. Because the current patient had an increased chance of future injury secondary to the lack of bone formation in the C1 vertebrae, he was restricted from participating in contact sports.

We studied the IZUMO gene 9 coding exons sequence in four groups of patients including those with fertilization failure by conventional IVF. We observed in our populations two combinations of four polymorphisms that appeared to be preferentially linked (CGG-CG and TAA-TT) without any significant difference between different genotype repartitions.

The sternal cleft is a rare congenital anomaly resulting from a fusion failure of the sternum, generally observed at birth and asymptomatic. Surgery is indicated to protect the heart and major vessels from trauma, to improve respiratory dynamics, and for aesthetic reasons. We observed 2 neonates for a superior and medial thoracic mass. The defect involved the upper two thirds of the sternum. The surgical operation for both patients consisted in the primary closure of the defect.

This article was retracted on November 22, 2004 ![Graphic][1] Normal muscle fiber development (top) goes wrong without paramyosin (bottom).Liu et al. ( [page 899][2]) genetically disrupted the gene for paramyosin, a major component of invertebrate muscle thick filaments, in

The more common consequences of mesodermal migrational delay or failure in the fourth to seventh weeks of gestational life and of plate fusion failure in the seventh to twelfth weeks of gestational life are cleft lip and cleft palate, respectively. The team approach with a balanced emphasis allowing optimal development of deglutition, speech, hearing, facial growth, and dental development combined with acceptable esthetic results provides comprehensive treatment and an improved outlook for this long term problem.

A woman with a septate vagina and two cervices was observed. One of the cervices ended blindly. The other cervix communicated with a normal corpus and two normally positioned patent fallopian tubes. Two explanations for the origin of this accessory cervix are offered: (1) that it originated from a fusion failure of the lower portions of the müllerian ducts, and (2) that it arose from the urogenital sinus.