OBJECTIVE: The purpose of this study is to compare landmark position between cephalometric radiography and midsagittal plane projected images from 3 dimensional (3D) CT. METHODS: Cephalometric radiographs and CT scans were taken from 20 patients for treatment of mandibular prognathism. After selection of landmarks, CT images were projected to the midsagittal plane and magnified to 110% according to the magnifying power of radiographs. These 2 images were superimposed with frontal and occipital bone. Common coordinate system was established on the base of FH plane. The coordinate value of each landmark was compared by paired t test and mean and standard deviation of difference was calculated. RESULTS: The difference was from -0.14 +/- 0.65 to -2.12 +/- 2.89 mm in X axis, from 0.34 +/- 0.78 to -2.36 +/- 2.55 mm (6.79 +/- 3.04 mm) in Y axis. There was no significant difference only 9 in X axis, and 7 in Y axis out of 20 landmarks. This might be caused by error from the difference of head positioning, by masking the subtle end structures, identification error from the superimposition and error from the different definition. CONCLUSIONS: This study revealed innate shortcomings of radiography. For the development of 3D cephalometry, more study was needed.
Axis, Cervical Vertebra ; Cephalometry ; Head ; Humans ; Masks ; Occipital Bone ; Prognathism

PURPOSE: The purpose of this study is to illustrate MR patterns of bone marrow of calvarium and vertebral body in normal subjects according the age distribution and to understand the course of the fatty replacement from red marrow. METHODS AND MATERIAL: We retrospectively evaluated MR examinations of the calvaria(n=71), cervical spine(n=71), thoracic spine(n=65), Imbar spine(n =68) in subjects without bone marrow abnormality whose age ranged 3 weeks to 74 years. Three distinctive patterns were categorized on Tl-weighted images of the skull. In pattern 1, uniformly low signal intensity with or without very small areas of high intensity in frontal and occipital bones is noted. In pattern 2, frontal and occipital bones have uniformly high signal intensity, and patchy area of high intensity appears in parietal bone. In pattern 3, the entire skull has uniformly high signal intensity. In the spine, four patterns were categorized on Tl-weighted MR images. In pattern 1, the vertebral body has uniformly low signal intensity except for linear areas of high intensity superior and inferior to basivertebral vein. In pattern 2, bandlike and triangular areas of high signal intensity are found in the periphery. Pattern 3 and 4 have diffusely distributed areas of high signal intensity; pattern 3 consist of numerous indistinct dots measuring a few millimeter or less, and pattern 4 consist of fairly well marginated areas ranging in size from 5 to 1.5cm. RESULT:In the calvaria, 73% of pattern 1 were younger than 20 years, pattern 2 were evenly distributed, and 86% of pattern 3 were older than 40 years. In the spine, 87% of pattern 1 were younger than 40 years, 72% of pattern 3 were in 40 to 50 years, and 87% of pattern 4 were older than 50 years. Pattern 2 were evenly distributed in the cervical and thoracic spine, but in the thoracic spine 62% were younger than 30 years. CONCLUSION:It is concluded that younger age group shows mainly pattern 1, whereas elderly group has pattern 3 or 4 in the calvarial and vertebral body marrow. This suggests that conversion to fatty marrow begin locally and progress diffusely with age.
Age Distribution* ; Aged ; Bone Marrow* ; Humans ; Occipital Bone ; Parietal Bone ; Retrospective Studies ; Skull* ; Spine ; Veins

This report describes a case of diffuse neurofibroma(DNF) that presented with spontaneous intratumoral hemorrhage. A 31-year-old man with cutaneous manifestations typical of neurofibromatosis type 1(NF1) was referred to hospital with a progressively expanding scalp swelling. Magnetic resonance imaging(MRI) showed an acute hematoma surrounded by a dense mass on the parietooccipital scalp. Plain skull radiographs and a computed tomography(CT) scan revealed bony defects in the occipital bone around the lambdoid suture and the skull base, including the sphenoid and petrous bones. The tumor extended to the upper cervical region and infiltrated through the fascia of the musculature. The tumor and adjacent soft tissue were highly vascular, which made surgical resection difficult. We describe the clinical, radiological and pathological features of this patient and discuss the surgical methods used to avoid a life-threatening hemorrhage during surgery.
Adult ; Fascia ; Hematoma ; Hemorrhage* ; Humans ; Neurofibroma* ; Neurofibromatoses ; Occipital Bone ; Petrous Bone ; Scalp ; Skull ; Skull Base ; Sutures

A patients with atlantoaixial instability and osodontoideum underwent atlantoaixial fusion (Harms and Melcher technique) with demineralized bone matrix. But, unfortunately, the both pedicle screws in C2 were fractured within 9 weeks follow-up periods after several suspected episode of neck hyper-flexion. Fractured screws were not contact to occipital bone in several imaging studies, but it could irritate the occipital bone when neck extension because the relatively close distance between the occipital bone and C1 posterior arch. The patient underwent revision operation with translaminar screw fixation with autologus iliac bone graft. Postsurgical course were uneventful except donor site pain, but the bony fusion was not satisfied after 4 months follow-up. The patient re-underwent revision operation in other hospital. Continuous complication after atlantoaixial fusion is rare, but the clinical course could be unlucky to patients. Postoperative immobilization could be important to prevent the unintended clinical course of patients.
Bone Matrix ; Follow-Up Studies ; Humans ; Immobilization ; Neck ; Occipital Bone ; Tissue Donors ; Transplants

A 33-month-old girl was admitted to the department of Neurosurgery, Seoul National University Hospital complaining of progressively growing suboccipital mass of 14 months' duration. A round, rubbery, child-fist sized mass was situated at the suboccipital area slightly on the right side from midline. The mass was not tender, pulsatile, and bruits were not audibl. There were no significant neurological abnormalities. Simple skull x-ray showed the huge, blown-out osteolytic lesion at suboccipital area and right retrograde brachial angiogram demonstrated no vascularity within the mass. The thick grayish white, well encapsulated cystic mass was firmly adhered to the adjacent bone and underlying dura, and contained about 30cc of chocolate-like deep brownish red, greasy fluid, and soft grumous brownish materials representing organizing blood clots, and consisted of spongy or honeycombed, coarsely trabeculated architecture. The mass was totally extirpated. The report of biopsy was a typical aneurismal bone cyst. She had uneventful postoperative course.
Aneurysm* ; Biopsy ; Bone Cysts ; Child, Preschool ; Female ; Humans ; Neurosurgery ; Occipital Bone* ; Seoul ; Skull

A 33-month-old girl was admitted to the department of Neurosurgery, Seoul National University Hospital complaining of progressively growing suboccipital mass of 14 months' duration. A round, rubbery, child-fist sized mass was situated at the suboccipital area slightly on the right side from midline. The mass was not tender, pulsatile, and bruits were not audibl. There were no significant neurological abnormalities. Simple skull x-ray showed the huge, blown-out osteolytic lesion at suboccipital area and right retrograde brachial angiogram demonstrated no vascularity within the mass. The thick grayish white, well encapsulated cystic mass was firmly adhered to the adjacent bone and underlying dura, and contained about 30cc of chocolate-like deep brownish red, greasy fluid, and soft grumous brownish materials representing organizing blood clots, and consisted of spongy or honeycombed, coarsely trabeculated architecture. The mass was totally extirpated. The report of biopsy was a typical aneurismal bone cyst. She had uneventful postoperative course.
Aneurysm* ; Biopsy ; Bone Cysts ; Child, Preschool ; Female ; Humans ; Neurosurgery ; Occipital Bone* ; Seoul ; Skull

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children's anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.
Aged ; Cholesteatoma* ; Cranial Fossa, Posterior* ; Craniotomy ; Ear, Middle ; Epithelium ; Female ; Humans ; Mastoid* ; Occipital Bone ; Temporal Bone*

OBJECTIVE: To study the clinical manifestation, radiograph features, pathology, diagnosis and treatment of fibrous dysplasia in cranial bone. METHOD: A case of fibrous dysplasia involving sphenoid and occipital is reported and literature were reviewed. RESULT: The most common complaint were headache, proptosis, diplopia, or visual changes. Distinguishing features of fibrous dysplasia on CT include "ground-glass" appearance, bone fiber anisotrophy, aneurysmal bone cyst formation and thickness of the cranial cortices. Fibrous dysplasia could be exactly diagnosed by pathology. Computed tomography was also a choice for diagnosis. CONCLUSION Fibrous dysplasia involving the cranial bone can present in myriad ways. Modern imaging modalities and histopathologic analysis is required to make accurate diagnosis. Surgery, particularly in a challenging region such as sphenoid and occipital bone, should preserve the existing function for the patients with functional impairment or a cosmetic deformity.
Adult ; Fibrous Dysplasia, Polyostotic ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Male ; Occipital Bone ; Radiography ; Sphenoid Bone

A pneumatocele is an air-filled cavity in the body. In the head and neck areas, the extensive hyperpneumatization of the temporal and occipital bones is typically associated with pneumatocele formation, which results in the spontaneous collection of gas, usually air, beneath the pericranium or within the skull. We herein report a case of stenosis of the external auditory canal caused by a left mastoid pneumatocele in a 12-year-old boy who was successfully treated with left simple mastoidectomy and canaloplasty.
Child ; Constriction, Pathologic ; Ear Canal* ; Head ; Humans ; Male ; Mastoid ; Neck ; Occipital Bone ; Skull ; Temporal Bone

The mastoid foramina and the superficial mastoid canals at the mastoid area are well known to have much clinical and anthropological significances. However, few sutdies on these structures were reported. Authors performed this study to analyze those structures of the Korean men, and compared with other populations. The existence, number, location of matoid foramen, distance from the posterior border of the opening of external acoustic meatus were measured. In addition, the existence, shape and the direction of the superficial mastoid canals were investigated. The results were as follows; 1. Among the 67 skulls of Korean men, there was no mastoid foramen on both sides in 1 case. In 10 cases, there was mastoid foramen on right side only, and in 4 cases left side only. In 52 cases (77.6%), there was mastoid foramen on both sides. 2. In the incidence of mastoid foramen, 1 in 27 cases, 2 in 23 cases and 3 in 11 cases on the right side, and 1 in 25 cases, 2 in 22 cases and 3 in 17 cases on the left side were found. 3. 64.0% of mastoid foramina located on the temporal bone, 28.5% were on the occipitomastoid suture, 5.2% were on the occipital bone, 1.9% were on parietomastoid suture, and 1 case on the parietal bone. 4. In the sidedness of mastoid foramen, 1-1 foramen on each side was 15 cases, 2-2 foramina on each side was 10 cases, 1-2 foramina on right-left side was 8 cases, and 0-0 on each side, 2-4 on right-left side, and 4-3 on right-left side were 1 case respectively. 5. The average diameter of mastoid foramen was 2.0+/-0.69 mm, and the distance from the posterior margin of the external acoustic meatus was 33.6+/-3.69 mm. There was no significant differences between right and left sides. 6. The superficial mastoid canals appeared in 23 cases (34.3%), among which 12 cases were on right side and 11 cases were on left side. 14 canals were straight in shape, 2 were grooved, and others were arched, sigmoid or bridged. 21 canals directed toward parietal bone and others directed occipital bone. According to the above results, the existence, number, size and the distance from external acoustic meatus of mastoid foramina, and the incidence, shapes and directions of superficial mastoid canals were much variable. Of course, these variations would have great clinical significances during the neurosurgical and otolaryngeal surgery. These data would contribute to study epigenetic study of minor variations of skull and anthropological study.
Colon, Sigmoid ; Ear Canal ; Epigenomics ; Humans ; Incidence ; Male ; Mastoid* ; Occipital Bone ; Parietal Bone ; Skull ; Sutures ; Temporal Bone