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Hyperostosis frontalis interna is an overgrowth on the inner surface of the frontal bone [Hershkovitz et al., 1999]. HFI is accompanied by hormonal and metabolic disorders usually [Hershkovitz et al., 1999]. The rate of HFI in historical groups is low (1–4 %) compared to the modern population, where the incidence of HFI can reach 70 % [Kolyasnikova, Buzhilova, 2023; Barber et al., 1997]. In the modern population, HFI is more common for women, predominantly elderly, which, at first glance, is explained by the general increase in women's life expectancy and the accumulation of various chronic pathologies in old age, including those related to metabolism. To examine the distribution of the HFI trait by sex and age, craniological material from representatives of traditional societies of farmers, hunters, nomadic and seminomadic pastoralists living in different climatic zones was studied. Craniological series were divided into three main groups: inhabitants of the Arctic and subarctic, temperate and continental climatic zones. A total of 1912 skulls were studied from the funds of the Research Institute and the Museum of Anthropology of Moscow State University [Alexeeva et al., 1986]. As a result, using the example of 4 traditional groups from three climatic zones, it was shown that the sign of frontal internal hyperostosis is equally pronounced in both women and men, regardless of ethnic origin, place of residence and type of activity. The age-related increase in the frequency of hyperostosis, taking into account gender, does not give a clear trend in all groups obtained from the analysis of combined samples, which can be explained by the relatively small number of HFI observations in individual subgroups. The pattern of distribution of the trait of frontal internal hyperostosis in the modern population, where the trait is more common in older women, does not correlate with the distribution of HFI in the population adapted to environmental conditions. The results obtained suggest that in traditional societies that have been selected for factors of conditions and lifestyle, regardless of their origin, the distribution of the trait of frontal internal hyperostosis will demonstrate a natural profile that is most adequate to their lifestyle and diet.

Patients with space-occupying lesions adjacent to the superior sagittal sinus (SSS) present several technical considerations. For craniotomies crossing the SSS, a two-part method allows for dissection of the epidural space and dura under direct vision after removing a more lateral parasagittal bone flap. However, when the inner table surface of the medial component of the two-part bone flap is irregular, this can be difficult. We describe a method for channel drilling of the diploic bone, which allows for the piecemeal removal of the inner table using an upbiting rongeur. This article presents the case of meningioma with documented growth and provides a technical note of this technique to facilitate safe dissection of the midline dura. A patient presented with headaches and an anterior one-third parasagittal meningioma with documented growth. She selected surgical removal for treatment. A right frontal two-part parasagittal craniotomy was recommended. The preoperative imaging showed that the frontal bone was thick, with irregularity of the inner table. Intraoperatively, a channel was drilled in the diploic space of the bone, leaving the outer table intact. This provided a thin lip of the inner table that could be dissected over a short distance and then removed with a 2-mm upbiting rongeur. This allowed for further dissection of the dura crossing the midline under direct vision and safe secondary bone piece removal. The dura was opened to the edge of the SSS, allowing full exposure of the parasagittal region and interhemispheric fissure, thus limiting retraction of the medial right frontal lobe. The bone flap was removed in two pieces without a dural tear over the midline in spite of inner table irregularities. A Simpson grade 1 removal was accomplished, including excision of the affected falx, and the postoperative course was uncomplicated. In conclusion, diploic bone channel drilling is a technique that can be used to create a thin lip of the inner table, which can be removed piecemeal for safe dissection of the midline dura crossing the midline.

This case report highlights the importance of recognizing Hyperostosis Frontalis Interna (HFI) in patients with a diverse clinical presentation, particularly in post-menopausal individuals with relevant risk factors. It emphasizes the need for maintaining a high index of suspicion in neurological settings. Timely identification and treatment of HFI can significantly improve patient outcomes and alleviate debilitating symptoms and comorbidities. HFI, often an under-diagnosed condition and an incidental radiological finding, calls for ongoing research and vigilance in clinical practice.

This case report highlights the importance of recognizing Hyperostosis Frontalis Interna (HFI) in patients with a diverse clinical presentation, particularly in post-menopausal individuals with relevant risk factors. It emphasizes the need for maintaining a high index of suspicion in neurological settings. Timely identification and treatment of HFI can significantly improve patient outcomes and alleviate debilitating symptoms and comorbidities. HFI, often an under-diagnosed condition and an incidental radiological finding, calls for ongoing research and vigilance in clinical practice. [ABSTRACT FROM AUTHOR]

Morgagni-Stewart-Morel (MSM) syndrome is characterized by the thickening of the frontal bone of the skull (hyperostosis frontalis interna) obesity, neurological symptoms, and hypertrichosis. We present the case of a 76-year-old patient who complained of confusion, extreme irritability, and headache and was diagnosed with MSM based on examination, imaging, and test results.

Incidental pathology of the skull is frequently detected on cross sectional imaging of the brain. In contrast to the common finding of hyperostosis frontalis interna, biparietal bone thinning is less common. A case of an 87-year-old woman showing coexistence of hyperostosis frontalis interna and biparietal bone thinning is presented. This coexistence has not been reported previously.

Abstract Hyperostosis frontalis interna is a benign overgrowth of the inner table of the frontal bone. Exact etiology is unknown. The condition is often an incidental finding and requires no treatment unless there are neurological signs and symptoms.

Hyperostosis frontalis interna (HFI) is a benign bone lesion, which is asymptomatic for the most part and is manifested by the accretion of bone on the endocranial surface of the frontal bone. This type of lesion has been discussed in a multitude of publications since the 19th century. Although a consensus has yet to be reached as to its etiology, it would seem generally accepted that hormones play a role, which would explain the high frequency of this disorder among older and postmenopausal women. The objective of this study is to demonstrate the benefit of HFI diagnosis for identifying individuals (estimating their age and determining their sex) in the archeo‐anthropological analysis of ancient cremation burial sites and in medicolegal investigations on burned human remains. Our sample consisted of 82 cremated individuals from the Roman Porta Nocera necropolis in Pompeii (1st century BC–1st century AD). After excluding juveniles under 15 years of age, as HFI primarily affects adult individuals, our sample was reduced to 71 individuals, and the prevalence of HFI was 15.5% (n = 11). A statistically significant difference is observed between women and men, and no individuals previously identified as male displayed HFI. Furthermore, 90.9% of the individuals displayed degenerative conditions in conjunction with HFI, showing a highly significant correlation of this lesion with signs of aging (chi‐square 9.365; p = 0.01). Finally, this disorder boosted diagnostic performance in respect of determining sex, increasing the number of biologically sexed individuals from 46.5% to 53.5%. Therefore, we propose that the HFI diagnosis offers genuine added value in the identification of burned human remains. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) is a pathological condition characterized by bilateral thickening of the inner surface of the frontal bone. HFI is often an incidental finding during routine clinical examinations of patients by computed tomography. The etiology of the condition is currently unknown, but HFI commonly appears with a number of metabolic disorders and hormonal dysfunctions. According to studies, hyperostosis frontalis interna is more common in women than in men. Frequency of HFI is increasing in the modern population. In this study, 195 CT scans of mature individuals of various sex and ages were analyzed using the Amira 2020.1 software: 145 CT scans of skulls from from the collections of the Anuchin Research Institute and Museum of Anthropology, Moscow State University and 50 CT scans of Israeli Bedouins from the Institute's exchange collection (with the University of Tel-Aviv, Israel). Nine cases of hyperostosis frontalis interna (5 in males and 4 in females) were found among the analyzed scans. A three-step algorithm for identifying HFI was generated, as well as criteria for distinguishing hyperostosis frontalis interna from other endocranial bony overgrowths. The integrity of the skull, the condition of the frontal bone and other skull bones should be evaluated to exclude diffuse pathological changes which are morphologically close to HFI. Also a researcher should pay attention to the localization of the growths, their boundaries and prevalence. The condition of the diploe and endocranial plate of the frontal bone should be evaluated and compared it with other layers in other bones of the skull on 2D slices. Evaluation of the relief of the internal surface of the frontal bone should be performed on 2D slices in different sections. The pathology should be distinguished using data of localization, prevalence, involvement of other bone structures of the skull, as well as the condition of the diploe and inner surface of the frontal bone. The method can be useful for a comparative study using morphological and radiological criteria, which will help to exclude doubtful cases during analyzing pathology on paleoanthropological material.

Objective: Unknown etiology Background: Hyperostosis frontalis interna is a boney overgrowth of the inner side of the frontal bone of the skull caused by overgrowth of the endocranial surface. It is most often found in women after menopause. It is also associated with hormonal imbalance, being overweight, history of headaches, and neurocognitive degenerative conditions. Female gender, advanced age, extended estrogen stimulation, and elevated leptin levels may also play a role. The thickening is usually confined to the frontal bone, but it can spread as far as the anterior parietal and temporal bones. Case Report: During a medical school dissection course, an extensive boney overgrowth in the frontal regions covering the inside of the frontal bone of the skull of a 90-year-old female donor, who died of a cerebrovascular infarction, was identified. This boney overgrowth was mainly confined within the frontal region, but there was some boney overgrowth that extended to the temporal bones. The overgrowth in the endocranium of the temporal bone was not as severe as the overgrowth of the frontal bone. The morphology of the overgrowth was rigid, uneven, and bumpy. Based upon the physical characteristics, we concluded that this presentation was consistent with hyperostosis frontalis interna. Conclusions: Our female donor was found to exhibit a phenomenon which could be clinically underdiagnosed due to its internal nature and asymptomatic presentation. Insight into the potential causes of HFI and its identification during clinical evaluation offers a path for future research to better identify and manage cases of HFI. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) is a human skeletal lesion characterized by nodules of hyperplastic bone and thickening of the frontal bone's inner surface. Despite its prevalence in the general population and its long history of observation-it is one of the most frequently observed pathologies in gross anatomy laboratories-HFI's etiology and pathogenesis remain poorly understood. This is largely due to the lack of a thorough survey of its histology across the various stages of its development. Our study has three major aims: (1) assess HFI histology from incipient to advanced lesions; (2) elucidate lamellar and trabecular structure in HFI; and (3) clarify impacts/roles of the dura mater in HFI. Sections of nondecalcified bone provide evidence for two different categories of lesions: (1) stratum lesions, characterized by lamellar-based overall thickening of the internal table, and (2) eruptive lesions, characterized by nodular formations of initially lamellar bone that appear to form the bulk of bone mass in advanced stages. Sections of nondecalcified bone also suggest that for both lesion types, HFI growths begin as deposits of lamellar bone, which are later remodeled into woven bone deposits; our data do not support the hypothesis that lesions begin as a "diploization" of cortical bone as suggested by prior studies. Trichrome-stained sections provide evidence that growing lesions erode through and engulf the dura mater, effectively destroying this tissue layer as they grow laterally and inwardly. Our results indicate possible avenues of research to better understand the root causes of this disorder., (© 2024 American Association for Anatomy.)

Hyperostosis frontalis interna (HFI) is a benign entity manifested by bony overgrowth in the frontal endocranial surface. It is most commonly reported incidentally among postmenopausal elderly women. Tracer uptake appearances of HFI can vary on planar bone scans, enabling it to be easily confounded with bone metastases. We report a case of HFI in a 69-year-old postmenopausal female with treated left breast cancer detected on bone scintigraphy, with subsequent confirmation by computed tomography. Our case highlights the importance of having awareness of HFI and its key pattern findings to avoid mistaking it for pathology, and to recognise the use of computed tomography and hybrid fusion imaging techniques as reliable diagnostic tools for HFI.

Hyperostosis is a slow-growing benign bone tumour often seen in the bones of the cranial vault, more commonly found in elderly females. It is an incidental finding noted during radiological examination. The clinical manifestation of such tumour depends on its location inside the cranial cavity: the proximity to the paranasal sinuses, brain tissue, nerves, or blood vessels, etc. Its clinical findings may range from mild obstruction of the paranasal sinuses or blood vessels to severe compression of the surrounding cranial nerves. Here a rare case of hyperostosis of the frontal and temporal bones found during a routine cadaveric dissection in the Department of Anatomy is presented. Causes of the formation of such unusually enlarged bone masses inside the cranial cavity and their clinical presentation are discussed.

Large bone defects caused by various conditions or diseases still remain one of the most challenging issues to be addressed in both human and veterinary orthopedics. Conventionally, bioglass 45S5 has been applied to reconstruct large bone defects. We fabricated yttria-stabilized tetragonal zirconia-bioglass 45S5 and iron-bioglass 45S5 composite powders to enhance osteoconductive and osteoinductive effects of conventional bioglass 45S5 in rabbit calvarial bone defects. First, these composite powders were analyzed via different in vitro analyses. For in vivo study, four circular calvarial defects of 10 animals were randomly filled with yttria-stabilized tetragonal zirconia-bioglass 45S5, iron-bioglass 45S5, and bioglass 45S5 powders or left without any treatment. Diagnostic imaging techniques and histological evaluations were conducted to assess all bone defects in different experimental groups. The cell viability and cytotoxicity analysis showed that there was no significant cytotoxic effect associated with 5 and 15 mg/mL of yttria-stabilized tetragonal zirconia-bioglass 45S5, iron-bioglass 45S5, and bioglass 45S5. In vitro results showed that the expression level of osteogenic markers increased in yttria-stabilized tetragonal zirconia-bioglass 45S5 (osteocalcin: 2.56-fold and alkaline phosphatase: 2.68-fold) and iron-bioglass 45S5 (osteocalcin: 2.44-fold and alkaline phosphatase: 3.84-fold) composite when compared to bioglass 45S5 (osteocalcin: 1.32-fold and alkaline phosphatase: 2.04-fold) and control group. The in vivo experiments confirmed the in vitro results and showed that iron-bioglass 45S5 (bone ingrowth%: 85.4 and bone volume/total volume%: 60.2) significantly enhanced new bone formation followed by yttria-stabilized tetragonal zirconia-bioglass 45S5 (bone ingrowth %: 73.2 and bone volume/total volume (%): 53.4) when compared to bioglass 45S5 (bone ingrowth %: 35.6 and bone volume/total volume (%): 31.4) and untreated controls (bone ingrowth %: 17.2 and bone volume/total volume (%): 10.6). Based on the present results, yttria-stabilized tetragonal zirconia- and iron successfully increased the bone regenerative capacity of bioglass 45S5 which could be used as new additives in future commercial bone cement. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) is a condition defined as abnormal bone growth on the posterior aspect of the frontal bone. Despite uncertainties regarding its etiology and prognosis, clinicians typically consider HFI a benign pathology. There are no studies organizing all the possible manifestations of the disease. The present study aims to organize all the clinical manifestations of HFI within the current case report/series literature. A blinded PRISMA-guided search of HFI case reports and case series yielded 43 relevant articles and provided 110 patients for analysis. The symptoms presenting alongside HFI were extracted and tabulated. We found high-frequency clinical manifestations of HFI (>20% of patients) to include headaches, obesity, vertigo/dizziness symptoms, cognitive decline, and depression. An additional 15 symptoms were tabulated at frequencies found to be less than 20%. Based on our analysis, we suggest the constellation of high-frequency symptoms can offer a more comprehensive clinical picture of symptomatic HFI which may be valuable to consider for clinicians and future researchers in the field of HFI., (© 2024 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

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The median palatal suture serves as a growth center for the maxilla; inadequate growth at this site causes malocclusion and dental crowding. However, the pattern formation mechanism of palatal sutures is poorly understood compared with that of calvarial sutures such as the sagittal suture. In the present study, therefore, we compared the morphological characteristics of sagittal and palatal sutures in human bone specimens. We found that palatal suture width was narrower than sagittal suture width, and the interdigitation amplitude of the palatal suture was lower than that of the sagittal suture. These tendencies were also observed in the neonatal stage. However, such differences were not observed in other animals such as chimpanzees and mice. We also used a mathematical model to reproduce the differences between palatal and sagittal sutures. After an extensive parameter search, we found two conditions that could generate the difference in interdigitation amplitude and suture width: bone differentiation threshold v c and growth speed c. We discuss possible biological interpretations of the observed pattern difference and its cause. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) is a condition characterized by abnormal bone outgrowth on the inner surface of the frontal bone. Most HFI cases occur in post-menopausal elderly women. The pathology of HFI development is uncertain. The estimated incidence of HFI ranges from 5 to 12% in Western countries, but few cases have been reported in the Japanese population. Here, we report a case of HFI in an 86-year-old Japanese female cadaver. Macroscopically, the internal surface of the frontal bone exhibited bilateral nodular protrusion with sparing of the midline, while the external surface was normal. According to the morphological classification of HFI proposed by Hershkovitz et al. this case belongs to type D, the most severe type. Using computed tomography (CT), we defined five layers, designated as I–V from the inner to the outer layer, in the nodular region of HFI; however, the normal frontal bone is composed of three layers. Histological results demonstrated that layers I, III, and V consisted of the cortical bone, and layers II and IV consisted of the trabecular bone. We also observed increases in the numbers of lamellar bone and blood vessels on the dural side of layer I, indicating increased vascularization and active osteogenesis. These results indicate that layer II represents a new diploe within the inner table, which split into layers I and III, suggesting that diploization within the inner table by activated remodeling may be involved in the development of hyperostosis in this case. [ABSTRACT FROM AUTHOR]

An increased thickening of the frontal bone by irregular laminar additions on the inner surface just deep to the dura mater have been known in the archaeological and medical record as hyperostosis frontalis interna (HFI). The distribution of this is idiosyncratically restricted to the frontal and has no known etiology. The prevalence among post-menopausal females and rarity in males suggests that it is hormonally driven. Here we report histopathological findings of particularly hormonally active organs (pituitaries, gonads and liver) from a geriatric cadaveric sample in which HFI is assessed. HFI was present in 50% of males (7/14) and 95% (21/22) of females. All males with HFI had testicular atrophy or had testes absent. Males with HFI category C or D had moderate to severe testicular atrophy. Decreased numbers of interstitial cells (Leydig cells) were present in 83.3% of males with HFI. All but one female (21/22) from this study exhibited evidence of HFI, and ovarian pathologies were unevenly distributed (fibromas in two) and most exhibited signs of being healthy and post-menopausal. Liver pathologies had opposite patterns between the sexes, with more liver pathologies occurring among males without HFI (particularly passive congestion and bile stasis). The only exceptions were that the one case of liver neoplasia was found in a male with HFI and steotosis was found in two cases with HFI and one case without HFI. In females all cases of liver pathologies (steotosis, hepatitis, passive congestion, fibrosis, and bile stasis) were associated with HFI. It appears that gonadal pathology is most closely associated with HFI in males but not females, suggesting that the role of estradiol in this unusual growth of bone in geriatric humans may be worth investigating further. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) is a rare disorder common among postmenopausal females that involve increased volume and porosity of the frontal bone. Depending on the size, it could be symptomatic or asymptomatic. With a little report on the pathophysiology of HFI, we present a peculiar case of HFI with speculations that could shed more light on the already established literature and pose questions for future research.

Introduction. The field of paleopathology, which studies the diseases of ancient people, makes important contribution to the reconstruction of the lifestyle and history of the Sarmatian nomads. When examining human bone remains, such a pathological condition as the hyperostosis frontalis interna (HFI) is sometimes revealed on the frontal bone from the endocranium. Today, most physisians and paleopathologists believe that this condition is the result of the Morgagni-Stewart-Morel syndrome, which stimulates the development of endocrine disorders in the human body. Methods and materials. The research material is represented with the skulls of Sarmatian nomads from the burial grounds of the Lower Volga and the Lower Don. A total of 465 craniums have been examined. The degree of frontal hyperostosis development has been assessed by the method of I. Hershkovitz, et al. Analysis. As a result of the analysis of bone material, 35 cases of the HFI have been recorded on the Sarmatian skulls. Genetic predisposition, specific lifestyle (nomadism), unhealthy and unsystematic diet (high content of proteins and fats, periods of hunger alternated with overeating periods), psycho-emotional disorders typical of the nomads of the early Iron Age were, most likely, the determining factors stimulating the development of endocrine disorders markers. Results. We’ve come to the conclusion that, as opposed to the modern character of the disease spreading, which is more typical for women aged 45-60, this deviation in Sarmatians is more common in men. The analysis of written, ethnographical and archaeological sources, the study of medical and paleopathological literature allows assuming that the HFI in the Sarmatians of the Lower Volga and the Lower Don could develop as a result of the abovementioned factors. E. V. Pererva has carried out the the paleopathological study of materials and the comparison of the obtained results with domestic and foreign works in the field of medicine and anthropology. V. I. Moiseev has interpreted the obtained results in the context of written and archaeological sources.

We hypothesized that subjects with hyperostosis frontalis interna (HFI), which represents local, endocranial thickening of the frontal bone, would express extra-calvarial manifestations of this condition. Therefore, we compared femoral bone mineral density, geometry, and microarchitecture of males and females with HFI to those without this condition as well as between males and females with HFI. The sample was taken from human donor cadavers, 38 males (19 with and 19 without HFI) and 34 females (17 with and 17 without HFI) that were age-matched within the same sex. The specimens of femoral bones were scanned using microcomputed tomography and dual-energy X-ray absorptiometry (DXA). Parameters of hip structure analysis (HSA) were calculated from data derived from DXA scans. Females with HFI had increased cortical bone volume fraction and their cortical bone was less porous compared to females without HFI. Males with HFI showed microarchitectural differences only with the trabecular bone. They had increased bone volume fraction and decreased trabecular separation compared to males without HFI, although with borderline significance. These microarchitectural changes did not have significant impact on femoral geometry and bone mineral density. The same, still unknown etiological factor behind HFI might be inducing changes at the level of bone microarchitecture at a remote skeletal site (femoral bone), in both sexes. These alterations still do not have the magnitude to induce obvious, straightforward overall increase of bone mineral density measured by DXA. HFI could be a systemic phenomenon that affects both males and females in a similar manner. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) represents irregular thickening of the endocranial surface of the frontal bone, mostly seen in postmenopausal females. The microarchitecture of this condition is poorly studied. The aim of this cross-sectional autopsy study was to investigate and compare microarchitectural structure of the frontal bone affected with HFI in both sexes and to test whether HFI severity could be distinguished at the microarchitectural level. The sample was taken from human donor cadavers, 19 males (61 ± 15 years old) and 17 females (75 ± 15 years old). After classification of HFI severity (type A, B, C or D), samples of the frontal bone were taken and scanned using micro-computed tomography. Bone volume fraction was higher and total porosity lower only in the outer table of males with HFI, compared to females with HFI. Mean total sample thickness differed only between males with HFI type A and D. Bone microarchitecture between males and females with corresponding HFI types (e.g., male with type A versus female with type A) differed only in HFI type C regarding the fractal dimension of diploe. The degree of anisotropy differed between HFI subtypes in males, but the post hoc analysis revealed no significant differences between individual groups. Other microarchitectural parameters did not differ among males with different HFI subtypes, as well in females, in any part of the frontal bone. There is no difference in microarchitectural structure of the frontal bone between males and females with HFI, in general aspect and within corresponding HFI subtypes. HFI severity could not be distinguished at the microarchitectural level, neither in males nor in females. [ABSTRACT FROM AUTHOR]

The article offers a discussion on diagnosis and pathology of mucosal ulceration with lingual sequestration. Topics include susceptible sites for occurrence of sequestra in bones with thin overlying mucosa such as the mylohyoid ridge and exostoses; features of lingual mandible in promoting mucosal injury and oral mucosal trauma causing bony sequestration.

Hyperostosis frontalis interna (HFI) represents an abnormality of the frontal cranial bone that is characterized by bilateral, nodular thickening of its inner lamina and may sometimes be associated with neuropsychiatric symptoms such as headaches and depression. The aim was to assess prevalence, sex and age differences of HFI and frontal bone thickness by means of MRI. This retrospective study included 908 subjects who were divided into male and female groups and further subdivided into three groups, youngest (≤45 years), middle-aged (46-65 years) and the oldest group (>65 years). The thickness of the frontal bone was measured on the T2-weighted axial images at the top level of the lateral ventricles as a mean from both sides. We considered 10mm or thicker frontal bone as HFI. The total prevalence of HFI was 8.1%, with a more frequent occurrence in women (p<0.05). In males, there was no difference in the frontal bone thickness between different age groups (p>0.05), while in females we found differences between the youngest and the oldest group, and also between the middle-aged and the oldest group (p<0.05). The female respondents had a thicker frontal bone, which was statistically significant only in the oldest group (p<0.001). Frontal bone thickness was age-dependent only in women (Spearman's Rho 0.11; p≤0.01). In women, unlike in men, there is an age-related progression of HFI with increasing prevalence, with 16.4% occurrence in the oldest group. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) has been reported in older women, but reports in men are rare. We present a novel case of migraine headache in a gentleman with Klinefelter's syndrome and HFI, along with a discussion of possible pathophysiologic mechanisms underlying both the headache and the HFI.

Introduction: Morgagni hernia is a birth defect that occurs in more than 30% of patients with Down syndrome. Case presentation: This is a thirteen-month-old female patient, who was admitted with respiratory symptoms, initially suspecting community-acquired pneumonia; however, a later chest X-ray confirmed that it was a Morgagni hernia. Laparoscopic surgery was performed with good postoperative evolution. Conclusion: In children with Down syndrome with persistent respiratory symptoms, Morgagni hernia should be suspected, since it is a common congenital malformation in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Hyperostosis frontalis interna (HFI) is a common and often incidental finding seen on imaging. There is a significant paucity of radiology literature, particularly regarding the MRI imaging appearance of HFI., Case Presentation: We reported two cases of HFI on MRI, which showed focal enhancement. These were stable on long-term follow-up studies and thought to be most consistent with benign enhancement., Conclusion: Further studies are needed to elucidate the underlying pathogenesis; however, it is important to be aware that regions of HFI may demonstrate variable enhancement and are sometimes mistaken for osseous metastatic disease.

Hyperostosis frontalis interna is a benign overgrowth of the inner table of the frontal bone. Exact etiology is unknown. The condition is often an incidental finding and requires no treatment unless there are neurological signs and symptoms. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna is a common phenomenon, which may have been overrated in its significance in the past, and may, currently be underrated in its significance. We present three cases of hyperostosis frontalis interna found during medicolegal autopsies and discuss their forensic considerations. The patients were all middle‐aged women with metabolic and endocrine manifestations and psychiatric ailments; thickening of the inner table of the frontal bone of the skull was found during each autopsy. We describe the relationship between hyperostosis frontalis interna, metabolic manifestations, and neuropsychiatric symptoms as part of Morgagni‐Stewart‐Morel syndrome. There is still considerable disagreement in the scientific community as to whether this syndrome is a clinical entity. Nonetheless, awareness of Morgagni‐Stewart‐Morel syndrome can be of help in understanding the circumstances surrounding death. In some other cases, hyperostosis frontalis interna could be used by forensic pathologists as criteria for sexing and aging a skeleton. [ABSTRACT FROM AUTHOR]

Abstract Objective The prevalence of hyperostosis frontalis interna (HFI) was examined in different periods of the Carpathian Basin from 4900 BCE to 17th century AD. The study seeks to evaluate temporal changes in HFI and the possible impact of lifestyle on it. Materials The studied material consisted of 4668 crania from Hungary and Serbia. Methods The crania were analyzed employing macroscopic and endoscopic examination. Results In historic periods, sex and age played a pivotal role in HFI development. Among predominantly pastoralist populations of the 5th–8th and 10th centuries, prevalence of HFI was considerably higher than in the medieval populations of the 9th–17th centuries. Conclusions In addition to age and sex, other factors could be implicated in HFI development. The physiological effects of the pastoralist lifestyle and diet on insulin regulation could explain the increased risk of developing HFI in the 5th–8th and 10th-century populations. Significance The study provides the first comprehensive dataset of HFI from different archaeological periods from the Carpathian Basin. It has implications for lifestyle and risk of HFI development in past populations. Limitations The archaeological periods are not equally represented. Suggestions for further research In order to better understand the etiology of HFI, lifestyle factors can be used to elucidate the risk of developing HFI in ancient populations. [ABSTRACT FROM AUTHOR]

Abstract Hyperostosis frontalis interna (HFI) is a condition manifested by thickening of the inner surface of the frontal bone and it could be useful when dealing with the identification of human remains in various anthropological and forensic investigations. We compared the macroscopic appearance and morphologic (metric) features of the skulls in cases with and without HFI, in both sexes, and wanted to establish whether age determined occurrence of HFI. To achieve this aim, we performed prospective autopsy study, covering ten-year period (2007–2016). Study group consisted of southeast Europe Caucasian subjects, with determined age and sex. The severity of HFI was classified by two forensic pathologists independently, according to the four types (A–D) proposed by Hershkovitz et al. Thicknesses of the frontal and temporal bones, as well as the longitudinal and frontal diameters of the skulls were measured. The sample consisted of 35 males and 112 females with HFI, and 55 males and 202 females without HFI (404 individuals in total). Type B was the most common type of HFI among males (45%) and type C among females (41%). HFI type D was almost four times more common in females than in males (OR = 3.73). Frontal and temporal bones were thicker in all subjects who have HFI. Thickness of the skull was not age-dependent, in the entire sample, or in subjects with HFI, or in the control group (in all the cases Spearman's Rho was <0.3). Age seemed to be a predicting factor for HFI occurrence only in females. Females younger than 55 years have similar risk for HFI occurrence as males. An unidentified skull with the general markers of old age and severe form HFI is most probably from a female decedent. [ABSTRACT FROM AUTHOR]

Abstract The osteogenetic potential of photo-immobilized azdiophenyl (Az)-natural polymers as a carrier of bone morphogenetic protein-2 (BMP-2) was assessed in 56 rats randomized to four groups. The control group comprised implanted collagen sheet with BMP-2. In the three experimental groups, the implant comprised collagen sheet with photo-immobilized BMP-2 on Az-gelatin (Az-Gel), Az- O -carboxymethyl chitosan (Az-OMC), or Az‑ O ‑carboxymethyl low molecular chitosan (Az-LMC). Micro-computed tomography analysis revealed more regenerated bone in Az-Gel at 8 weeks. Immunohistochemical analysis at 4 weeks revealed that the positively expressed cellular ratio in RUNX2-stained cells was significantly higher in Az-Gel and Az-OMC groups. At 8 weeks, only the Az-Gel group showed higher positively expressed cellular ratio compared with the control group. These results demonstrate the superior osteogenetic potential of photo-immobilized BMP-2 using Az-Gel carrier in a rat calvarial defect model compared with control group. Photo-immobilization of BMP-2 using Az-gelatin could be a more effective carrier system of BMP-2 than a chitosan-based carrier system. [ABSTRACT FROM AUTHOR]

Hyperostosis frontalis interna (HFI) is a rare disorder common among postmenopausal females that involve increased volume and porosity of the frontal bone. Depending on the size, it could be symptomatic or asymptomatic. With a little report on the pathophysiology of HFI, we present a peculiar case of HFI with speculations that could shed more light on the already established literature and pose questions for future research. [ABSTRACT FROM AUTHOR]

The present study aimed to examine the influence of neomangiferin on murine calvarial inflammatory osteolysis induced by ultra-high-molecular-weight polyethylene (UHMWPE) particles. Eight-week-old male C57BL/J6 mice served as an inflammatory osteolysis model, in which UHMWPE particles were implanted into the calvarial subperiosteal space. The mice were randomly distributed into four groups and treated with different interventions; namely, a sham group [phosphate-buffered saline (PBS) injection and no UHMWPE particles], model group (PBS injection and implantation of UHMWPE particles), low-dose neomangiferin group (UHMWPE particles +2.5 mg/kg neomangiferin), and high-dose neomangiferin group (UHMWPE particles +5 mg/kg neomangiferin). Following 3 weeks of feeding according to the above regimens, celiac artery blood samples were collected for an enzyme-linked immunosorbent assay (ELISA) to determine the expression of receptor activator of nuclear factor-κB ligand (RANKL), osteoclast-related receptor (OSCAR), cross-linked C-telopeptide of type I collagen (CTX-1); osteoprotegerin (OPG), tumor necrosis factor (TNF)-α, and interleukin (IL)-1β. Subsequently, the mice were sacrificed by cervical dislocation following ether-inhalation anesthesia, and the skull was separated for osteolysis analysis by micro-computed tomography (micro-CT). Following hematoxylin and eosin staining, tartrate-resistant acid phosphatase (TRAP) staining was performed to observe the dissolution and destruction of the skull. The micro-CT results suggested that neomangiferin significantly inhibited the murine calvarial osteolysis and bone resorption induced by UHMWPE particles. In addition, the ELISA results showed that neomangiferin decreased the expression levels of osteoclast markers RANKL, OSCAR, CTX-1, TNF-α and IL-1β. By contrast, the levels of OPG increased with the neomangiferin dose. Histopathological examination revealed that the TRAP-positive cell count was significantly reduced in the neomangiferin-treated animals compared with that in the positive control group, and the degree of bone resorption was also markedly reduced. Neomangiferin was found to have significant anti-inflammatory effects and to inhibit osteoclastogenesis. Therefore, it has the potential to prevent the aseptic loosening of a prosthesis following artificial joint replacement. [ABSTRACT FROM AUTHOR]

Abstract: Calvarial lesions are often asymptomatic and are usually discovered incidentally during computed tomography or magnetic resonance imaging of the brain. Calvarial lesions can be benign or malignant. Although the majority of skull lesions are benign, it is important to be familiar with their imaging characteristics and to recognise those with malignant features where more aggressive management is needed. Clinical information such as the age of the patient, as well as the patient’s history is fundamental in making the correct diagnosis. In this article, we will review the imaging features of both common and uncommon calvarial lesions, as well as mimics of these lesions found in clinical practice.Teaching Points: • Skull lesions are usually discovered incidentally; they can be benign or malignant.• Metastases are the most frequent cause of skull lesions.• Metastatic lesions are most commonly due to breast cancer in adults and neuroblastoma in children.• Multiple myeloma presents as the classic “punched out” lytic lesions on radiographs.• Eosinophilic granuloma is an osteolytic lesion with bevelled edges. [ABSTRACT FROM AUTHOR]

Introduction: Morgagni hernias rarely present in adult life and, thus, little data exist on the optimal method of surgical repair. The laparoscopic approach has grown in popularity since the first reported case in 1992. This article showcases a method for laparoscopic repair of Morgagni hernias using both primary closure and mesh reinforcement.Operative Approach: There were three obese women who presented in adulthood with cardiopulmonary symptoms; in all cases, the symptoms were attributable to local compressive effects of large Morgagni hernias. All three hernias were repaired laparoscopically, first by approximating the diaphragm to the fascia of the anterior abdominal wall, followed by insertion of a composite mesh, tacked to the diaphragm, to buttress the closure. All patients had excellent outcomes with symptom resolution.Discussion: This case series describes a method of laparoscopic Morgagni hernia repair using primary closure reinforced with a mesh, with excellent postoperative outcomes. Others have described thoracic or open approaches. The authors feel that the method described herein is likely to reduce recurrence in a patient population who are often overweight or obese and, thus, have a high risk of this complication. Furthermore, we discuss all reported laparoscopic repair cases in the literature and highlight the paucity of evidence on the optimal approach. [ABSTRACT FROM AUTHOR]

Introduction: Morgagni Larray hernia (MLH) is a very rare disease, which accounts for less than 5% of all congenital diaphragmatic hernias. Laparoscopic repair has been widely used and accepted as a treatment option for patients with this disease. The purpose of our study is to analyze the outcomes of patients with MLH who underwent laparoscopic repair, and to evaluate their postoperative course for outcome, morbidity, and mortality.Materials and Methods: A retrospective chart review was performed of patients who were diagnosed with MLH and treated laparoscopically by 10 board-certified pediatric surgeons.Results: Fourteen patients were included in the study. One patient died 1 month postoperatively due to respiratory complications unrelated to the surgery. Thirteen patients were followed for a median of 1.75 years (interquartile 0.3-6.95). There was a single recurrence, which resulted in a partial resection of the hernia sac and repaired without a mesh. We had a success rate of 92.86%.Conclusion: MLH is a rare congenital diaphragmatic hernia that is usually diagnosed incidentally. Laparoscopic repair has high success rates and is a viable option for patients with this pathology. [ABSTRACT FROM AUTHOR]

Introduction: The laparoscopic repair of Morgagni's hernia (MH) has been reported to be safe and feasible. However, it is still unclear whether laparoscopy is superior to open surgery in repairing MH.Materials and Methods: Using a defined search strategy, three investigators independently identified all comparative studies reporting data on open and laparoscopic MH repair in patients <18 years of age. Case reports and opinion articles were excluded. Meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. Data are expressed as mean ± SD.Results: Systematic review - Of 774 titles/abstracts screened, 51 full-text articles were analyzed. Three studies were included (92 patients), with 53 (58%) open approaches and 39 (42%) laparoscopy. Meta-analysis - The length of surgery was shorter in laparoscopy (50.5 ± 17.0 min) than in open procedure (90.0 ± 15.0 min; P < .00001). Laparoscopy shortened the length of hospital stay (2.1 ± 1.4 days) versus open surgery (4.5 ± 2.1 days; P < .00001). There was no difference with regards to complications (laparoscopy: 8.8% ± 5.5%, open: 9.4% ± 1.6%; P = .087) and recurrences (laparoscopy: 2.9% ± 5.0%, open: 5.7% ± 1.8%; P = .84).Discussion: Comparative studies indicate that laparoscopic MH repair can be performed in infants and children. Laparoscopy is associated with shortened length of surgery and hospital stay in comparison to open procedure. Prospective randomized studies would be needed to confirm present data. [ABSTRACT FROM AUTHOR]

Objectives: The healing of bone defects in the craniofacial region is an important clinical issue. We aimed to compare the effects of octacalcium phosphate (OCP) and the combination of OCP/gelatin (OCP/Gel) on calvarial bone regeneration in rats. Materials and Methods: In this study, 72 male Sprague Dawley rats were randomly assigned to the OCP (n=24), OCP/Gel (n=24), and control groups (n=24). Lesions with a diameter of 9 mm were created in the parietal bone and were filled with 9-mg OCP and OCP/Gel disks. In the control group, no substance was implanted in the defect. Sampling was performed on days 10, 14, 21, and 28 after the implantation. After tissue processing, 5-µm sections were prepared and stained by hematoxylin and eosin (H&E) stain. The sections were studied, and the volume fraction of the newly formed bone was assessed by Kruskal-Wallis test at a significance level of 0.05. Results: In the experimental groups, new bone formation was detected at the margins of the defects 10 days after the implantation. With the progression of the healing process, the newly formed bone covered greater areas of the defects and developed a more mature structure. In the control group, the defects were primarily filled with a dense connective tissue with small islands of new bone. The results of histomorphometric assessments showed that the volume of the newly formed bone in the experimental groups had a significant statistical difference with that in the control group (P<0.001). Conclusions: The OCP/Gel composite can be useful in the healing process of calvarial bone defects. [ABSTRACT FROM AUTHOR]