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Atlanto-axial Dissociation and Cervical Hyperextension
Joseph Junewick, MD FACR
over 7 years ago
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Subdental Synchondrosis Fracture

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR CT
Activities:
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History

15 month old male in motor vehicle accident.


Case Images


Diagnosis

Subdental Synchondrosis Fracture

Findings

CT – Nondisplaced transverse fracture through the dental synchondrosis.

MR – Type 2 odontoid fracture; edema in body of the axis subjacent to the synchondrosis.

Discussion

The right and left dental ossification centers are separated from the body of the axis by the subdental synchondrosis. The subdental synchondrosis usually fuses by adolescence but may variably persist into adulthood. The subdental synchondrosis is a potential weak spot and prone to hyperflexion injury. Since the sagittal fulcrum of the cervical spine is in the upper cervical region in children compared to the lower cervical region in adults, this vulnerability is potentiated. Remnants of the synchondrosis persist in upto 87% of adults and may account for the high incidence of type 2 dens fractures and poor healing (pseudoarthrosis).

Reference

Gebauer M, Lohse C, Barvencik F, et al. Subdental synchondrosis and anatomy of the axis in aging: A histomorphometric study in 30 autopsy cases. Eur Spine J (2006); 15:292-298.



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