Search Results (40)

Background/Objectives: The anatomical variability of the human foot represents a subject of substantial interest, offering valuable insights in anthropological research as well as in clinical practice. The aim of this study is to document anatomical variants of the tarsal bones in a CISC//XXI skeletal sample (21st Century Identified Skeletal Collection), with a particular focus on the prevalence of accessory ossicles. Methods: The studied sample consisted of 163 individuals (83 females and 80 males). The prevalence of six accessory tarsal bones was recorded (os trigonum, calcaneum secundarium, the accessory navicular bone, os sustentaculum, os vesalianum and os intermetatarseum). Results: A total of 35 individuals (21.4%; 35/163) exhibited at least one accessory ossicle, with 13 females (15.7%; 13/83) and 22 males (27.5%; 22/80). The os trigonum and calcaneum secundarium were the most frequently observed accessory bones, respectively, in 9.3% (15/162) and 6.9% (11/159) of the individuals. No sex differences were observed. All accessory bones occurred more frequently unilaterally, and no co-occurrences of accessory bones were observed. Conclusions: These findings are crucial in both the biomedical and anthropological fields, where a detailed knowledge of foot anatomy and its variations is relevant. Full article

Background/Objectives: This study aimed to evaluate factors necessitating alternative techniques during cochlear implant (CI) surgery and to compare outcomes with standard procedures. Methods: Patients of all ages who underwent CI at our center between January 2003 and January 2024 were included. Alternative methods were defined as removal of external auditory canal/posterior canal wall, removal of ossicles to enhance surgical view, use of an endoscope for round window visualization, or similar approaches. Results: A total of 404 patients (mean age 13 ± 19.7 years) were analyzed. Preoperative imaging revealed inner ear anomalies in 44 patients (10.9%). Alternative methods were used in 41 patients (10.1%), including incus removal (n = 16), endoscopic assistance (n = 14), posterior canal wall removal (n = 4), incus buttress removal (n = 3), combined ossicle removal (n = 3), and one canal wall down mastoidectomy with fat graft obliteration and blind pouch closure. Alternative methods were significantly more frequent in patients with inner ear anomalies or additional otologic disease (p = 0.01 and p < 0.01, respectively), but not across age groups (p = 0.65). Partial electrode insertion occurred in 17 cases. Electrode insertion and complication rates were comparable between groups (p = 0.08 and p = 0.99, respectively). Bony cochleostomy was significantly more common in the alternative methods group (p = 0.01). Conclusions: Inner ear anomalies and additional otologic diseases may necessitate alternative CI techniques. These methods achieve electrode insertion and complication rates comparable to standard approaches, supporting their effectiveness in selected cases. Full article

The red swamp crayfish (Procambarus clarkii) is an exceptionally invasive species introduced into the Egyptian freshwater ecosystems in the 1980s for aquaculture purposes. Despite its ecological and economic significance, the age distribution of this species has not been assessed properly using an accurate method. This study is the first to validate the use of growth band counts in the mesocardiac ossicles as a direct technique for age determination in P. clarkii using 166 known-age individuals reared under various temperature regimes. The findings confirm that band counts represent age rather than number of molts. Field comparisons between northern (Giza) and southern (Aswan) Nile populations revealed maximum longevities of six and seven years, respectively, using direct methods, while indirect size–frequency analysis underestimated age at three years. Growth rates were higher at 25 °C compared to 32 °C, both in the lab and in situ. Males matured at larger sizes than females, though age at sexual maturity averaged one year in both regions. This study demonstrates the superiority of direct aging over traditional indirect aging methods, offering critical insights for managing crayfish populations and ensuring sustainable fisheries in the River Nile in Egypt. Full article

Background/Objectives: The os supranaviculare (OSSN), also known as os talonaviculare dorsale, astragalo-scaphoid ossicle, or Pirie’s bone, is a small extra bone that was first described in 1921 by A.H. Pirie and is located at the top front part of the navicular bone or talonavicular joint. The knowledge regarding the epidemiology of the OSSN is scarcely established, as its prevalence remains unknown and varies significantly among multiple studies. This meta-analysis aims to clarify and systematically summarize all available data on the characteristics and prevalence of the OSSN. Methods: Four major databases (PubMed/Medline, Embase, ScienceDirect, Scopus) were thoroughly searched for studies reporting original data regarding the OSSN up until May 2025. The protocol of this study was pre-registered on PROSPERO (ID: CRD42025638111) and adhered to PRISMA guidelines. To evaluate the between-study heterogeneity, the 95% prediction intervals (95%PI) were calculated; I² statistic and Chi² test were also used. The AQUA-tool was used to assess the quality of included studies. Results: In total, 13 studies (18,745 feet) qualified for inclusion in the quantitative analysis. The pooled prevalence estimate (PPE) of the OSSN in the general population was found to be 0.88% (95%CI: 0.62–1.24%). The PPE of the OSSN was higher in males (0.87%, 95%CI: 0.58–1.32%) than in females (0.48%, 95%CI: 0.14–1.64%). The os supranaviculare was similarly prevalent in both European (1.04%, 95%CI: 0.55–1.96%) and Asian (0.87%, 95%CI: 0.66–1.13%) populations. Conclusions: the os supranaviculare is a very rare anatomical variation that is present in less than one in a hundred feet. Moreover, although usually asymptomatic, it can occasionally be associated with dorsal foot pain or navicular stress fractures. Accurate differentiation from avulsion fractures is essential to avoid unnecessary invasive treatment. Full article

The detailed study of the morphology and morphometrics of the auditory ossicles in swine became a topic for investigation due to their resemblance to the human ear. The methods used in this study cover the typical macroscopical investigation of gross morphology: a detailed metrical and histological assessment through H&E standard protocol on auditory ossicles originating from eight pig fetuses originating from four distinctive sows. The ossicular assembly in the malleus, incus and stapes present in 66-day fetuses shows all the features generally described in swine. The malleus comprises two uneven laminae of mineralized hyaline cartilage and a medullary cavity. The areas of the head and neck show a high degree of vascularization. The incus has two similar cortical fascicles separated by a compartmentalized medullary cavity, with the highest degree of mineralization found at the distal part of the long process. Stapes show an early degree of mineralization at the level of the crura, lacking medullary cavities. The ossicular chain shows typical morphological elements, similar to adults, and from a dimensional perspective, our investigations point to an uneven degree of development of the ossicles, according to gestational age: the malleus and stapes reach almost 80% and the incus about 50–60% of their adult sizes. Full article

Background: Skull base tumors can extend into the temporal bone and occasionally even be visible through the tympanic membrane (TM) if they grow into the middle ear cavity. The differential diagnosis of a skull base mass is extensive and ranges from non-tumorous lesions like cholesteatoma to benign tumors like schwannoma and to malignant lesions like metastatic cancer. Optical coherence tomography (OCT) is a noninvasive imaging technique that can image tissue with high resolution in three dimensions, including through structures such as the TM and bone. OCT angiography is also able to assess tissue vascularity. We hypothesized that OCT could help shrink the differential diagnosis in clinic on the day of initial presentation. Specifically, we thought that OCT angiography could help distinguish between highly vascular skull base tumors such as glomus jugulare and other less vascular tumors and middle ear pathologies such as cholesteatoma and schwannoma. Objectives: We sought to determine whether OCT can image through the TM in clinic to distinguish a normal ear from an ear with a mass behind the tympanic membrane. Furthermore, we sought to assess whether OCT angiography can detect vascularity in these masses to help inform the diagnosis. Methods: We designed and built a custom handheld OCT system that can be used like an otoscope in clinic. It is based off a 200 kHz swept-source laser with a center wavelength of 1310 nm and a bandwidth of 39 nm. It provides a 33.4 μm axial and 38 μm lateral resolution. Cross-sectional images of the middle ear space, including OCT angiography, were captured in an academic neurotology clinic. Patients with normal ear exams, glomus tumors, cholesteatomas, and facial nerve schwannoma were imaged. Results: OCT images revealed key structures within the middle ear space, including the TM, ossicles (malleus and incudostapedial joint), chorda tympani, and cochlear promontory. OCT also identified middle ear pathology (using pixel intensity ratio in the middle ear normalized to the TM) when compared with patients with normal ear exams (mean 0.082, n = 6), in all patients with a glomus tumor (mean 0.620, n = 6, p < 0.001), cholesteatoma (mean 0.153, n = 4, p < 0.01), and facial nerve schwannoma (0.573, n = 1). OCT angiography revealed significant vascularity within glomus tumors (mean 1.881, n = 3), but minimal vascularity was found in normal ears (mean 0.615, n = 3, p < 0.05) and ears with cholesteatoma (mean 0.709, n = 3, p < 0.01), as expected. Conclusions: OCT is able to image through the TM and detect middle ear masses. OCT angiography correctly assesses the vascularity within these masses. Thus, OCT permits the clinician to have additional point-of-care data that can help make the correct diagnosis. Full article

Painful Os Peroneum Syndrome (POPS) is a rare cause of lateral midfoot pain due to pathologies involving the os peroneum, an accessory ossicle within the peroneus longus tendon. POPS may result from fractures, tendon tears, tenosynovitis, or degenerative changes. This review evaluates outcomes of conservative and surgical management of POPS based on the current literature. A comprehensive review of published case reports, series, and relevant studies on POPS management was conducted. Clinical outcomes, radiographic findings, and complications following conservative and surgical interventions were analysed. Conservative management, including immobilisation, physiotherapy, cryotherapy, and corticosteroid injections, showed variable success, particularly in nondisplaced fractures or inflammatory causes. Surgical management demonstrated better outcomes in severe cases, including displaced fractures or tendon ruptures. Techniques such as os peroneum excision, tendon repair, tenodesis to the peroneus brevis, and tendon grafting yielded high patient satisfaction, reduced pain scores, and improved functional outcomes. Reported complications included delayed wound healing, sural neuritis, and chronic pain. Despite promising surgical results, a lack of standardised treatment protocols remains a challenge. Both conservative and surgical management of POPS can be effective, depending on injury severity and pathology. Surgical intervention appears superior for advanced cases, especially with tendon rupture or os peroneum fracture. Further research with standardised scoring systems and larger cohorts is needed to establish optimal treatment algorithms and improve clinical outcomes. Full article

Background: Os trigonum (OT) is an accessory ossicle that develops from the failure of the secondary ossification center of the posterior talar process fusion. It is clinically significant due to its association with posterior ankle pain and impingement syndromes. Despite its tremendous clinical relevance, limited data exist on the frequency of OT in Middle Eastern populations. Objectives: This study aimed to determine the frequency, morphological variations, and dimensions of OT in Omani subjects using computed tomography (CT) imaging and to evaluate the sex and laterality differences in its occurrence. Methods: A retrospective cross-sectional study of 352 foot and ankle CT scans were conducted to assess the OT at Sultan Qaboos University Hospital. OT presence, dimensions, and classification along with patient demographics, including age and sex, were recorded. Descriptive statistical analysis and the chi-square test were employed to present the data. Results: The overall prevalence of OT was 10.2%, with a frequency of 11.2% on the left side and 8.9% on the right side. Type IIA was the most prevalent subtype in both feet (41.2% right, 44.4% left). The average minor-axis and macro-axis dimensions were 7.88 ± 2.998 mm and 10.76 ± 4.280 mm on the right side, while they were 8.06 ± 2.600 mm and 11.50 ± 4.997 mm on the left side. No statistically significant sex or laterality differences were observed with regard to the OT frequency (p > 0.05). Conclusions: This study provides the first detailed evaluation of OT in the Omani population, highlighting its frequency and morphological variability. These findings emphasize the importance of CT imaging in identifying OT and guiding clinical management. Future studies should explore OT’s clinical correlations to enhance its diagnostic and therapeutic implications. Full article

Hearing impairment in patients with rheumatoid arthritis has been underestimated for decades. Rheumatoid arthritis can affect both the middle ear (specifically, the incudomalleolar and incudostapedial joints) and inner ear (including the cochlea and acoustic nerve) simultaneously. Despite ongoing research, consensus on effective treatments for hearing impairment in these patients remains elusive. This systematic review aims to consolidate clinically relevant information for healthcare providers by summarizing current evidence on hearing impairment in rheumatoid arthritis patients. We conducted the current systematic review by searching platforms of PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect to retrieve eligible articles regarding hearing impairment related to rheumatoid arthritis. We extract any data on characteristics, pathophysiology, examination, and treatment related to rheumatoid arthritis. Based on the currently available evidence, we advocate for the use of specific audiometric tests to facilitate early detection of hearing impairment in these patients. Regular audiological assessments are recommended to monitor hearing ability and potentially prevent further deterioration. Finally, we propose a modified treatment protocol that integrates steroids, hydroxychloroquine, and non-invasive brain stimulation as a novel therapeutic approach for managing these symptoms. This protocol aims to offer clinicians new strategies to address hearing impairment in patients with rheumatoid arthritis effectively. Full article

Laser Doppler vibrometry (LDV) is an essential tool in assessing by evaluating ossicle vibrations. It is used in fundamental research to understand hearing physiology better and develop new surgical techniques and implants. It is also helpful for the intraoperative hearing assessment and evaluation of postoperative treatment results. Traditional volumetric LDVs require access in a straight line to the test object, which is challenging due to the structure of the middle ear and the way the auditory ossicles are accessible. Here, we demonstrate the usage of a fiber-based laser Doppler vibrometer (FLDV) for middle ear diagnostics. Compared to classical vibrometers, the main advantages of this device are the ability to analyze several arbitrarily selected points simultaneously and the flexibility achieved by employing fiber optics to perform analysis in hard-to-reach locations, which are particularly important during endoscopic ear surgery. The device also allows for a simple change in measuring probes depending on the application. In this work, we demonstrate the properties of the designed probe and show that using it together with the FLDV enables recording vibrations of the auditory ossicles of the human ear. The obtained signals enable hearing analysis. Full article

Soft continuum robots, characterized by their dexterous and compliant nature, often face limitations due to buckling under small loads. This study explores the enhancement of axial performance in soft robots intrinsically actuated with extensile fluidic artificial muscles (EFAMs) through the incorporation of bio-inspired radial supports, or ossicles. By conducting quasi-static force response experiments under varying pressure conditions (103.4–517.1 kPa), and a modified Euler column buckling model, we demonstrate that ossicles significantly increase the robots’ resistance to buckling, thereby extending their application scope in payload-carrying tasks. These findings not only underscore the effectiveness of ossicle reinforcement in improving structural robustness but also pave the way for future research to optimize soft robot design for enhanced performance. Full article

In recent years, the significance of maintaining the alveolar ridge following tooth extractions has markedly increased. Alveolar ridge preservation (ARP) is a commonly utilized technique and a variety of bone substitute materials and biologics are applied in different combinations. For this purpose, a histological evaluation and the clinical necessity of subsequent guided bone regeneration (GBR) in delayed implantations were investigated in a prospective case series after ARP with a novel deproteinized bovine bone material (95%) in combination with a species-specific collagen (5%) (C-DBBM). Notably, block-form bone substitutes without porcine collagen are limited, and moreover, the availability of histological data on this material remains limited. Ten patients, each scheduled for tooth extraction and desiring future implantation, were included in this study. Following tooth extraction, ARP was performed using a block form of C-DBBM in conjunction with a double-folded bovine cross-linked collagen membrane (xCM). This membrane was openly exposed to the oral cavity and secured using a crisscross suture. After a healing period ranging from 130 to 319 days, guided trephine drilling was performed for implant insertion utilizing static computer-aided implant surgery (s-CAIS). Cores harvested from the area previously treated with ARP were histologically processed and examined. Guided bone regeneration (GBR) was not necessary for any of the implantations. Histological examination revealed the development of a lattice of cancellous bone trabeculae through appositional membranous osteogenesis at various stages surrounding C-DBBM granules as well as larger spongy or compact ossicles with minimal remnants. The clinical follow-up period ranged from 2.5 to 4.5 years, during which no biological or technical complications occurred. Within the limitations of this prospective case series, it can be concluded that ARP using this novel C-DBBM in combination with a bovine xCM could be a treatment option to avoid the need for subsequent GBR in delayed implantations with the opportunity of a bovine species-specific biomaterial chain. Full article

This study aimed to investigate the dimensions and types of the os trigonum and evaluate their relationship with various pathologic conditions on the posterior ankle using ankle MRI images. A total of 124 non-contrast-enhanced ankle and foot MR images of 123 consecutive patients were included in this retrospective study. The images were presented randomly, and they contained no patient information. The MR images were retrospectively and independently reviewed by two reviewers with a fellowship-trained musculoskeletal radiologist. The images were classified as type I and II based on the ossicle’s medial border overlying the talus’s posterior process and the groove for the flexor hallucis longus tendon (FHL). The study revealed that patients with type II os trigonum had a longer transverse diameter of the ossicle than type I, and there were statistically significant differences. Detachment status tended to be less in type I than in type II os trigonum, and the differences between the groups were statistically significant. There were no significant differences between type I and II os trigonum regarding posterior talofibular ligament (PTFL) abnormality, bone marrow edema, FHL tenosynovitis, and posterior synovitis. The study concluded that the os trigonum is a common cause of posterior ankle impingement, and type II os trigonum has a longer transverse diameter of the ossicle than type I. Full article

This article delves into the life and accomplishments of Juan Valverde de Amusco (c. 1525–c. 1587), a Spanish anatomist. Specifically, it focuses on his book titled HISTORIA de la composición del cuerpo humano. The book was the first anatomy opus published after Andreas Vesalius’ De humani corporis fabrica libri septem, written in a Romance language, the Castilian Spanish language, making it the most renowned post-Vesalian anatomy book in Europe and beyond during the 16th and 17th centuries. Compiling complete editions and reproductions of figures, it had 19 editions and several translations. One of its principal contributions was the initial graphical representation of the stapes ossicle. It provided the first accurate description of the pulmonary circulation, vomer bone, and four extraocular rectus muscles. Throughout the book, Valverde corrected numerous of Vesalius’ anatomical observations. HISTORIA de la composición del cuerpo humano was the first anatomy book to use chalcographic illustrations, which are of superior anatomical quality than those printed from engraved wood in Andreas Vesalius’ book. Next, many anatomy textbooks of that time incorporated Valverde’s book illustrations. Valverde’s book was practical, timely, and well referenced, making it a valuable resource for scholars and non-scholars. The conclusion is that Juan Valverde de Amusco merits a place as a pioneer in scientific knowledge transfer. Full article

Background: Hearing loss caused by middle ear malformations is treated by tympanoplasty to reconstruct the acoustic conduction system. The mobility of the ossicles plays a crucial role in postoperative success. However, identifying the location of ossicular malformation based solely on preoperative audiograms is challenging due to the complex relationship between fixation location, deformity levels, and ossicular mobility. Methods: Middle ear finite element models for simulating ossicular malformations were created, and the results were compared with the actual preoperative audiograms. Results: This approach objectively diagnosed ossicular fixation and disarticulation, bypassing traditional criteria reliant on physician examination or imaging. Conclusion: This study suggests that future research should focus on developing a diagnostic framework utilizing large-scale data. Full article