Anatomical study of the retroarticular process in dry human skulls

Introduction: The retroarticular process is a bony prominence formed by the thickening of the lateral border of the mandibular fossa, forming the posterior wall of the temporomandibular joint. Since little is known and discussed about the retroarticular process, our aim was to study its presence, shape and size, relating these findings to the shape of the skulls according to the horizontal cephalic index. Materials and Methods: We used 400 dry human skulls of the Institute of Science and Technology - UNESP Anatomy Laboratory. Each skull was classified in brachycranics, mesocranics or dolichocranics, and then positioned on a craneostat to measure the height of the retroarticular process from its lower extremity to the auriculo-orbital plane. The width was obtained by measuring the base of the process on its longer lateral axis. Results: The retroarticular process was found bilaterally in 397 skulls (99.25%). All the processes were classified into the following shapes: pyramidal (35.55%), tubercular (31.78%), mammilar (20.73%), crest-like (9.05%) and molar shape (2.89%); 254 skulls (63.50%) showed the same type of process at the right and left sides (Kappa=0.496, moderate agreement). The average height and width were 5.28 mm and 12.81 mm, respectively. Conclusion: The retroarticular process was found in almost all the skulls examined. There are no significant evidences about the relationship among the presence, shape and size of the retroarticular process and the shape of the skulls according to the horizontal cephalic index. However, our findings led us to infer that there would be a functional relationship between the process and the temporomandibular joint.

Endaural access to remove the projectile from a firearm

Background: Surgical approaches to temporomandibular region have been the subject of numerous controversies in the literature. Pre-auricular approaches have been used with the observance of high success rate, and during surgery history, various modifications of this approach were conducted in order to reduce irreversible sequelae. Thus, given the relevance of the study, this article proposes to alert the professionals that carry out these surgical approaches in relation to the anatomical structures involved and to describe and emphasise the benefits of endaural approach. Case report: A Caucasian male patient, victim of a firearm injury, sustained a wound on the right pre-auricular region, and at the time of assessment, he complained of pain, mouth opening difficulty and dysphagia. On physical examination, there was oedema and ecchymosis in the right periorbital region. In the radiological examination, a foreign body compatible with a firearm projectile was observed in the right pre-auricular region, being in accordance with the information collected. The endaural incision and divulsion by plans was then made until the projectile. Discussion: For proper exposure of the region, several studies were designed to evaluate the patterns of branching and anastomosis of the facial nerve. As for the best cosmetic result with the different pre-auricular approaches, the endaural approach was described as an approach that offers great cosmetic results because the incision design guides the surgeon in the wound closure and causes a decrease in the tension of flap, unlike that observed by some authors. © 2012 Springer-Verlag Berlin Heidelberg.

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