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According to a surgeon, the bullet "entered just back of the right ear injuring the ear and ploughing its way through beneath the skin and through the outer table of the skull making its exit at the external occipital protuberance".
Posteriorly, the mass extends into the adjacent skull with erosion of the outer table.
When arising within the bone, they present as well-delineated osteolytic lesions with sclerotic borders expanding the outer table.
The outer table is partially interrupted by round notches, which leads to necrotic damage in the diploë (Figure 2).
Left: A Right os parietale displaying osteolytic lesions and a worm eaten appearance on the outer table, B right tibia with diffuse lytic changes on the anterior part.
In most patients with FD, CT and CBCT reveal characteristic bony expansion with a "ground-glass" appearance (Figs. 1 and 2) or mixed radiolucency, widened diploic space with outer table displacement or bubbling skull vault lesions (Fig. 2).
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Unequal involvement of the inner and outer tables may give the lesions a characteristic bevelled-edge appearance on CT scans (Fig. 10).
Open image in new window Fig. 10 Axial CT scans of two calvarial lesions show bevelled margins due to unequal destruction of the inner and outer tables of the skull and a "button" sequestrum (i.e. a fragment of residual bone within a lytic lesion) Open image in new window Fig. 11 Axial unenhanced CT scan exhibits an extra-dural hematoma related to the bleeding of a right frontal bone lesion.
Fry et al. [ 24] reported that = 2.5 mm/μs for the diploe (porous internal layer of the bone) and 2.9 mm/μs for both inner and outer tables.
The cancellous bone was cored out from the iliac crest between the inner and outer tables to 1.5 to 2 cm in depth by twisting the inner tube of the T-shaped driver.
We used a specialized hollow cylindrical gouge that accompanied the Solis instrumentation set to core a critical amount of cancellous bone out from the iliac crest between the inner and outer tables.
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