Measurements of oculo-palpebral landmarks and evaluation of patient's head position

PURPOSE

Keeping the head in a neutral position is requisite for glasses/lenses/head-up designs, the suitability of oculo-plastic surgery and for the grading the eye shift. Anatomically incompatible glasses are one of the common problems affecting accommodation, reducing comfort and disturbing by causing symptoms such as dizziness and nausea. The oculo-palpebral measurements act as a key determinant in symmetrical facial attractiveness. This study aims to investigate the most effective oculo-palpebral landmarks, head-neutral as the ideal position, taking into account of individual anatomical differences of these patients.

METHODS

100 females and 100 males aged between 18 and 20 years were photographed. Digital photogrammetric measurements were made with the ImageJ program. Interpupillary and interhelical distances, besides bilateral palpebral fissure length and height, and iris diameter were calculated on front-facing photographs.

RESULTS

Mean interpupillary distance was measured wider in males than in females. The mean length of palpebral fissure was 31 mm; palpebral fissure height was 10 mm. These figures were valid in both eyes and gender. The interhelical distance was calculated as the mean and was measured longer in men. Since the measurement values were the same in both sexes and on both sides, they were determined as important landmarks for controlling the head-neutral position, evaluating whether there was a deviation in the eye, and measuring the numerical value when detected.

CONCLUSION

It is essential to check the side-symmetry of the patient's palpebral fissure height, palpebral fissure length, diameter of iris and corneal depth during oculo-plastic invention and artificial design.

Supervised classification approach of biometric measures for automatic fetal defect screening in head ultrasound images

This paper presents an advanced approach for foetal brain abnormalities diagnostic by integrating significant biometric features in the identification process. In foetal anomaly diagnosis, manual evaluation of foetal behaviour in ultrasound images is a subjective, slow and error-prone task, especially in the preliminary treatment phases. The effectiveness of this appearance is strictly subject to the attention and the experience of gynaecologists. In this case, automatic methods of image analysis offer the possibility of obtaining a homogeneous, objective and above all fast diagnosis of the foetal head in order to identify pregnancy behaviour. Indeed, we propose a computerised diagnostic method based on morphological characteristics and a supervised classification method to categorise subjects into two groups: normal and affected cases. The presented method is validated on a real integrated microcephaly and dolichocephaly cases. The studied database contains the same gestational age of both normal and abnormal foetuses. The results show that the use of a support vector machine (SVM) classifier is an effective way to enhance recognition and detection for rapid and accurate foetal head diagnostic.

Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s)?

A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS) is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA) in obese patients following failure of conventional treatment(s). A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances). TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm^-2) exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s).

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There is a paucity of evidence on the subject with complete absence of RCTs.

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The literature supports TORS as a safe multilevel treatment for OSA.

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The effectiveness of TORS for OSA drops with increasing BMI.

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TORS represents an important treatment for OSA in non-morbidly obese patients after failure of conventional treatment(s).

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There is no role for TORS as an OSA treatment in morbidly obese patients.