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Ingram J, Williams AY, Bright AC, Caleb Butts C. Use of lateral femoral cutaneous nerve blocks by landmark technique is ineffective in decreasing narcotic usage after skin grafts: A retrospective case-control study. Burns 2024; 50:997-1002. [PMID: 38331662 DOI: 10.1016/j.burns.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/24/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Cutaneous burns are commonly treated with autologous skin grafts. Following skin grafting, many patients complain of pain at the donor site. Donor sites are taken most commonly from the lateral thigh, which is innervated by the lateral femoral cutaneous nerve (LFCN). Use of a LFCN blocks should decrease nociception from the donor site. METHODS Our group began utilizing LFCN blocks in 2019. Utilizing anatomic landmarks, LFCN blocks were performed on all patients who received autologous skin grafts to reduce perioperative pain. A retrospective cohort study was performed on all patients with 10% or less total body surface areas burns who received an autologous skin graft. A similar cohort from 2016, prior to use of any local or regional analgesia, was used as a historical control. Post-operative enteral and parenteral narcotic analgesics were collected for each post-operative day up to day 5 or discharge (whichever came first) and converted to morphine milligram equivalents (MME) to quantify analgesia after surgery. RESULTS Chart review identified 55 patients in the 2020 cohort. Fifty-five patients from the 2016 cohort were matched based upon size of skin graft, total body surface area (TBSA) burned, gender, and age. There were no statistically significant differences between the two groups in terms of size of graft, TBSA burned, age, gender, or type of burn. When examining narcotics usage in the immediate perioperative period (days 0-2), we found no difference between the two groups for total MME (113 vs 133, p = 0.28) or IV MME (38 vs 33, p = 0.45). Similar relationships existed in the extended post-operative period (days 1-5) for total MME (149 vs. 188, t = 0.22) or IV MME (37 vs. 50, t = 0.25). Examining daily narcotic usage also yielded no statistically different values. CONCLUSION Our data shows that use of LFCN block by landmark technique did not reduce narcotic usage in patients that undergo skin grafting procedures. Future studies should consider ultrasound-guided LFCN blocks.
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Affiliation(s)
- Jordan Ingram
- University of South Alabama College of Medicine, 5795 USA Drive North, CSAB 170, Mobile, AL 36688, USA.
| | - Ashley Y Williams
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - Andrew C Bright
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - C Caleb Butts
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
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Sirinturk S, Govsa F, Coban I, Bicer A. Measurements of oculo-palpebral landmarks and evaluation of patient's head position. Surg Radiol Anat 2024; 46:585-593. [PMID: 38429405 DOI: 10.1007/s00276-024-03324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
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.
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Affiliation(s)
- Suzan Sirinturk
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Istemihan Coban
- Department of Anatomy, Faculty of Medicine, Izmir Democracy University, Izmir, Turkey
| | - Ahmet Bicer
- Department Plastic and Reconstructive Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Beaudet P, Giunta JC, Agu C, van Rooij F, Saffarini M, Nogier A. Accuracy of Cutaneous Landmarks Compared to Ultrasound to Locate the Calcaneal Footprint of the CFL. J Foot Ankle Surg 2024; 63:353-358. [PMID: 38218343 DOI: 10.1053/j.jfas.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
The purpose was to determine the accuracy of the techniques of Lopes et al. and Michels et al., compared to ultrasound, to locate the center of the calcaneal footprint of the CFL in healthy volunteers. The authors recruited 17 healthy adult volunteers at 1 center with no current ankle pathologies and no previous surgical antecedents on either ankle. The authors recorded the age, sex, height, BMI, and ankle side for each volunteer. Measurements were made on both ankles of the 17 volunteers to increase the sample size and ensure less dispersion of data, independently by 2 surgeons: 1 senior surgeon with 15 years' experience and 1 junior with 3 years' experience. The location of the center of the calcaneal footprint of the CFL was determined by each surgeon using 3 methods: (1) the cutaneous technique of Lopes et al., (2) the cutaneous technique of Michels et al., and (3) ultrasound imaging. The 17 volunteers (34 feet) had a mean age of 26.3 ± 8.7 and a BMI of 21.7 ± 2.9. The Michels point was significantly closer (4.6 ± 3.7 mm) than the Lopes point (11.1 ± 5.4 mm) to the true center of the calcaneal footprint of the CFL determined by ultrasound, notably in the vertical direction. The Michels point was located significantly closer to the true center of the calcaneal footprint of the CFL and demonstrated less dispersion than the Lopes point, indicated by significantly lower absolute mean deviation from the true center of the calcaneal footprint of the CFL, and that ultrasound is therefore preferred to locate the footprint the CFL.
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Sehgal A, Walker B, Tsang FS, Anodiyil S, Hewson DW. Ability of anaesthetists to identify the position of the right internal jugular vein using anatomical landmarks: A double-blind study. Anaesth Intensive Care 2024; 52:200-202. [PMID: 38318652 DOI: 10.1177/0310057x231212504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Apurv Sehgal
- Department of Anaesthesia and Critical Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bethany Walker
- Department of Anaesthesia and Critical Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Sameen Anodiyil
- School of Medicine, University of Nottingham, Nottingham, UK
| | - David W Hewson
- Anaesthesia and Critical Care Research Group, University of Nottingham, Nottingham, UK
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Van Vlasselaer N, Meganck L, Mulder E, Buzzatti L, Cattrysse E. 3D anatomy of the supraorbital and greater occipital nerve trajectories. Surg Radiol Anat 2024; 46:575-584. [PMID: 38485754 DOI: 10.1007/s00276-024-03322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/01/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE This research aims to enhance understanding of the anatomy of the supraorbital nerve (SON) and greater occipital nerve (GON), focusing on their exit points, distal trajectories, and variability, utilizing a novel 3D representation. METHODS Ten cadaveric specimens underwent meticulous dissection, and 3D landmarks were registered. Models were generated from CT scans, and a custom 3D method was employed to visualize nerve trajectories. Measurements, including lengths and distances, were obtained for the SON and GON. RESULTS The SON exhibited varied exit points, with the lateral branches being the longest. The GON showed distinct branching patterns, which are described relative to various anatomical reference points and planes. No systematic left-right differences were observed for either nerve. 3D analysis revealed significant interindividual variability in nerve trajectories. The closest approximation between the SON and GON occurred between lateral branches. CONCLUSION The study introduces a novel 3D methodology for analyzing the SON and GON, highlighting considerable anatomical variation. Understanding this variability is crucial for clinical applications and tools targeting the skull innervation. The findings serve as a valuable reference for future research, emphasizing the necessity for personalized approaches in innervation-related interventions.
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Affiliation(s)
- Nicolas Van Vlasselaer
- Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Brussels, Belgium.
| | - Lore Meganck
- Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Brussels, Belgium
| | - Elles Mulder
- Salvia BioElectronics, High Tech Campus Eindhoven, Eindhoven, The Netherlands
| | - Luca Buzzatti
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Erik Cattrysse
- Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Brussels, Belgium
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Stodulka P, Packard R, Mordaunt D. Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration. J Cataract Refract Surg 2024; 50:498-504. [PMID: 38651697 DOI: 10.1097/j.jcrs.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/08/2023] [Indexed: 04/25/2024]
Abstract
PURPOSE To compare 3 capsulotomy centration methods. SETTING Private clinic, Zlin, Czech Republic. DESIGN Prospective, consecutive case series. METHODS 180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made. RESULTS The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis. CONCLUSIONS The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.
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Affiliation(s)
- Pavel Stodulka
- From the Gemini Eye Clinic, Zlin, Czech Republic (Stodulka); Prince Charles Eye Unit, King Edward VII Hospital, Windsor, United Kingdom (Packard); Department of Engineering, Zurich University of Applied Science, Zurich, Switzerland (Mordaunt)
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Chen C, Zhou L, Li F, Pei H. Nerve Block Guided by Anatomic Landmarks Only Reduces Pain in Botulinum Toxin Type A Treatment for Glabellar and Forehead Wrinkles. Ann Plast Surg 2024; 92:508-513. [PMID: 38685490 DOI: 10.1097/sap.0000000000003914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Botulinum toxin type A is widely used to treat glabellar and forehead wrinkles, but the pain caused by multiple injections often deters patients from receiving long-term treatment. Despite several methods used to alleviate this pain, consistency and effectiveness remain a challenge. Therefore, this study aimed to evaluate the effectiveness and safety of nerve block guided by anatomic landmarks only in reducing pain associated with botulinum toxin type A injections. PATIENTS AND METHODS Between 2018 and 2022, the study enrolled 90 patients divided into 3 groups: the nerve block group (n = 30), the lidocaine cream group (n = 30), and the control group (n = 30). In the nerve block group, a landmarks-based technique was used to perform the nerve block. The study collected general information and comorbidities, and recorded pain at each point and time spent on preparation and treatment for each patient's forehead and glabellar area on each side. Patient-reported outcomes and complications were followed up at 2, 4, and 12 weeks after the injections. RESULTS The nerve block group had significantly lower total pain scores in all regions compared to the lidocaine cream and control groups (P < 0.01). There were no significant differences in patient-reported outcomes between the groups at any follow-up point. Additionally, the complication rates related to injection were low and comparable among the 3 groups. CONCLUSIONS Nerve block guided by anatomic landmarks only is a safe, effective, and consistent approach to reduce pain during botulinum toxin type A treatment for glabellar and forehead lines. This technique may offer advantages over other methods used to alleviate the pain associated with these injections.
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Affiliation(s)
- Chen Chen
- From the The Burns and Plastic Surgery Department of the Hainan Hospital of the People's Liberation Army General Hospital, Honglong Road, Sanya City, Hainan Province, China
| | - Ling Zhou
- The Ultrasonography Department of the First Affiliate Hospital of the Air Forces Medical Military University, Xian City, China
| | - Fei Li
- From the The Burns and Plastic Surgery Department of the Hainan Hospital of the People's Liberation Army General Hospital, Honglong Road, Sanya City, Hainan Province, China
| | - Haina Pei
- From the The Burns and Plastic Surgery Department of the Hainan Hospital of the People's Liberation Army General Hospital, Honglong Road, Sanya City, Hainan Province, China
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Karadag A, Yuncu ME, Middlebrooks EH, Tanriover N. Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation. Surg Radiol Anat 2024; 46:625-634. [PMID: 38530385 DOI: 10.1007/s00276-024-03344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA. METHODS Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data. RESULTS Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube. CONCLUSION The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.
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Affiliation(s)
- Ali Karadag
- Izmir Faculty of Medicine, Department of Neurosurgery, University of Health Sciences, Izmir, Turkey.
- Department of Neurosurgery, Izmir City Hospital, Laka, Bornova / Izmir, 35040, Turkey.
| | - Mustafa Eren Yuncu
- Department of Neurosurgery, Izmir City Hospital, Laka, Bornova / Izmir, 35040, Turkey
| | - Erik H Middlebrooks
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Necmettin Tanriover
- Cerrahpasa Faculty of Medicine, Department of Neurosurgery, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Cerrahpasa Faculty of Medicine, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul University - Cerrahpasa, Istanbul, Turkey
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Khanna H, Shouche S, Singh S. Comparative evaluation between external jugular and internal jugular venous catheterization through landmark technique. J Perioper Pract 2024; 34:132-136. [PMID: 36946178 DOI: 10.1177/17504589231154360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cannulation of a central vein is crucial in patients for hemodynamic management and when insertion of a peripheral line is not possible. The internal jugular vein is the preferred access site; however, in the case of not being accessible, the second cannulation site of choice is still unclear. The study aimed to access the feasibility of external jugular vein cannulation versus internal jugular vein cannulation in terms of success, cannulation time, number of attempts and complications. MATERIALS AND METHODS In this prospective, randomised double-blinded study, 100 patients received 7Fr size triple-lumen central vein catheter either in the internal jugular vein (n = 50) or external jugular vein (n = 50) through the landmark technique as a part of anaesthetic care in the operation theatre. The number of attempts, cannulation time and incidence of complications in both the techniques were observed and recorded. RESULTS The success rate in internal jugular vein cannulation was 88%, while in the external jugular vein, it was 78% (p = 0.17). The external jugular vein cannulation was comparatively quicker in our study (p = 0.01). Similarly, elevated body mass index did not affect the success rate in the number of cannulations attempts in either group (p = 0.08). In terms of complications, the internal jugular vein group had a total of 20% and the external jugular vein group had 28% complications; however, the complications were more severe in the internal jugular vein group. CONCLUSION Anaesthetists should rethink alternate routes for the insertion of central vein cannulation. The external jugular cannulation route is one of them.
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Affiliation(s)
- Hitesh Khanna
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, India
| | - Sachin Shouche
- Department of Cardiothoracic Anesthesia, Military Hospital (CTC), Pune, India
| | - Shalendra Singh
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, India
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Vorakulpipat C, Arayapisit T, Topothai P, Bhunyanaphakul V, Tiptimaphan K, Apilakkitakul N, Chantadul V. Determining the position of the lingula and the mandibular foramen using the antilingula in orthognathic surgery. BMC Oral Health 2024; 24:499. [PMID: 38678231 PMCID: PMC11055278 DOI: 10.1186/s12903-024-04286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible. METHODS This observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides. RESULTS The antilingula could be identified in 92.48% of the mandibles with 86.67 - 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus. CONCLUSIONS The antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.
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Affiliation(s)
- Chakorn Vorakulpipat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Tawepong Arayapisit
- Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Pee Topothai
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | | | | | - Varunya Chantadul
- Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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Tang Z, Liu J, Li J, Ma C. Use of bone landmarks for assessing the safety of acupuncture on the posterior midline of the neck region. BMC Complement Med Ther 2024; 24:168. [PMID: 38649990 PMCID: PMC11034117 DOI: 10.1186/s12906-024-04466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Many acupuncture acupoints are located on the posterior midline of the neck region. The needling depth for acupuncture is important for practitioners, and an unsafe needling depth increases the possibility of damage to the spinal cord and brainstem. Can the safety of acupuncture be assessed by examining bone structures? We focused on this aim to carry out this study. METHODS The shortest distance from the posterior border of the foramen magnum to the line joining both upper ends of the posterior border of the mastoid process was measured on 29 skulls. Distances from the posterior border of the vertebral foramen to the tip of the spinous process and posterior tubercle of the atlas were measured and evaluated from 197 dry cervical vertebrae and 31 lateral cervical radiographs of patient subjects. The anatomic relationships of the vertebral canal with the external occipital protuberance, tip of the spinous process of the axis, tip of the posterior tubercle of the atlas, and upper end of the posterior border of the mastoid process were observed and evaluated via lateral cervical radiography. RESULTS The shortest distance from the foramen magnum to the line between the mastoid processes was 4.65±1.75 mm, and the distance from the superior border of the vertebral foramen of the atlas to the posterior tubercle was less than the distance from the inferior border. The distance from the superior border of the vertebral canal to the tip of the spinous process in C2-C7 was greater than the distance from the inferior border. The mean lengths of the superior border of the C2 spinous process and the inferior border of the C7 spinous process were greater than 21 mm and 31 mm, respectively. The line from the upper end of the posterior border of the mastoid process to the tip of the C2 spinous process or 10 mm deep to the tip of the C2 spinous process was posterior to the vertebral canal. CONCLUSIONS On the posterior midline of the neck region between the tip of spinous process of axis and external occipital protuberance, if the needle reaches the depth of the line between the upper end of posterior border of mastoid process and the tip of the spinous process of the axis, approximately 10 mm along the spinous process of the axis, the needle is in the safe region. The mean length of the C2-C7 spinous process is suitable to accommodate the needling depth of the adjacent acupoint. Bone structures can be used to effectively assess the safety of acupuncture on the posterior midline of the neck region.
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Affiliation(s)
- Zhiliang Tang
- Department of Human Anatomy, School of Basic Medicine Sciences, Weifang Medical University, 7166 Baotongxi Street, Weicheng District, Weifang, 261053, Shandong, China
| | - Jiao Liu
- Department of Human Anatomy, School of Basic Medicine Sciences, Weifang Medical University, 7166 Baotongxi Street, Weicheng District, Weifang, 261053, Shandong, China
| | - Jin Li
- Department of Human Anatomy, School of Basic Medicine Sciences, Weifang Medical University, 7166 Baotongxi Street, Weicheng District, Weifang, 261053, Shandong, China
| | - Chunming Ma
- Department of Human Anatomy, School of Basic Medicine Sciences, Weifang Medical University, 7166 Baotongxi Street, Weicheng District, Weifang, 261053, Shandong, China.
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Jafargholkhanloo AF, Shamsi M, Rahavi-Ezabadi S, Amali A. Angular Photogrammetric Analysis of Facial Soft Tissue by Image Processing Algorithms. Aesthetic Plast Surg 2024; 48:1426-1435. [PMID: 37684414 DOI: 10.1007/s00266-023-03643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The main aim of this study was to present an automatic method based on image processing algorithms for facial anatomical landmark localization and angular photogrammetric analysis applicable for rhinoplasty surgery. We studied and measured color profile photographs of 100 patients before and after rhinoplasty surgery. METHODS In facial anthropometry analysis, anatomical landmarks are often defined by specialists, manually. This process is time-consuming and requires training and skill. The Cascade Regression Method (CRM) was utilized for facial landmark detection to overcome the mentioned problem. In this study, 11 anatomical landmarks were used to measure 9 facial angular metrics. Finally, a t-test (with the significance level set at a p-value of 0.05) was applied to analyze before surgery versus after surgery comparisons. RESULTS Experimental results dedicated that there is a significance difference (p < 0.001) in nasofrontal, nasolabial, mentolabial, nasomental, facial convexity including nose, facial convexity excluding nose, projection of the upper lip to chin, and H angles before and after surgery. Also, results showed that there is not a significance difference in nose tip angle. CONCLUSION We believe that the presented system can aim to reduce the personal errors made by manual measurement and to facilitate facial anthropometry analysis before and after surgery with high accuracy. Also, the normative data for Iranian women can be used as a guide for the diagnosis and planning of oral and maxillofacial, ENT, and plastic surgeries. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Mousa Shamsi
- Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran.
| | - Sara Rahavi-Ezabadi
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Amali
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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13
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Berends B, Bielevelt F, Schreurs R, Vinayahalingam S, Maal T, de Jong G. Fully automated landmarking and facial segmentation on 3D photographs. Sci Rep 2024; 14:6463. [PMID: 38499700 PMCID: PMC10948387 DOI: 10.1038/s41598-024-56956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Three-dimensional facial stereophotogrammetry provides a detailed representation of craniofacial soft tissue without the use of ionizing radiation. While manual annotation of landmarks serves as the current gold standard for cephalometric analysis, it is a time-consuming process and is prone to human error. The aim in this study was to develop and evaluate an automated cephalometric annotation method using a deep learning-based approach. Ten landmarks were manually annotated on 2897 3D facial photographs. The automated landmarking workflow involved two successive DiffusionNet models. The dataset was randomly divided into a training and test dataset. The precision of the workflow was evaluated by calculating the Euclidean distances between the automated and manual landmarks and compared to the intra-observer and inter-observer variability of manual annotation and a semi-automated landmarking method. The workflow was successful in 98.6% of all test cases. The deep learning-based landmarking method achieved precise and consistent landmark annotation. The mean precision of 1.69 ± 1.15 mm was comparable to the inter-observer variability (1.31 ± 0.91 mm) of manual annotation. Automated landmark annotation on 3D photographs was achieved with the DiffusionNet-based approach. The proposed method allows quantitative analysis of large datasets and may be used in diagnosis, follow-up, and virtual surgical planning.
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Affiliation(s)
- Bo Berends
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Freek Bielevelt
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Ruud Schreurs
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (UMC), AMC, Academic Center for Dentistry Amsterdam (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Thomas Maal
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Guido de Jong
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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14
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Hona TWPT, Stephan CN. Global facial soft tissue thicknesses for craniofacial identification (2023): a review of 140 years of data since Welcker's first study. Int J Legal Med 2024; 138:519-535. [PMID: 37804332 PMCID: PMC10861615 DOI: 10.1007/s00414-023-03087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/09/2023] [Indexed: 10/09/2023]
Abstract
This year (2023) marks 140 years since the first publication of a facial soft tissue thickness (FSTT) study. Since 1883, a total of 139 studies have been published, collectively tallying > 220,000 tissue thickness measurements of > 19,500 adults. In just the last 5-years, 33 FSTT studies have been conducted. Herein, we add these data (plus an additional 20 studies) to the 2018 T-Table to provide an update of > 81,000 new datapoints to the global tallied facial soft tissue depths table. In contrast to the original 2008 T-Table, some notable changes are as follows: increased FSTTs by 3 mm at infra second molar (ecm2-iM2'), 2.5 mm at gonion (go-go'), 2 mm at mid-ramus (mr-mr'), and 1.5 mm at zygion (zy-zy'). Rolling grand means indicate that stable values have been attained for all nine median FSTT landmarks, while six out of nine bilateral landmarks continue to show ongoing fluctuations, indicating further data collection at these landmarks holds value. When used as point estimators for individuals with known values across 24 landmarks (i.e., C-Table data), the updated grand means produce slightly less estimation error than the 2018 T-Table means (3.5 mm versus 3.6 mm, respectively). Future efforts to produce less noisy datasets (i.e., reduce measurement and sampling errors as much as possible between studies) would be useful.
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Affiliation(s)
- Te Wai Pounamu T Hona
- Laboratory for Human Craniofacial and Skeletal Identification (HuCS-ID Lab), School of Biomedical Sciences, The University of Queensland, Brisbane, 4072, Australia.
| | - Carl N Stephan
- Laboratory for Human Craniofacial and Skeletal Identification (HuCS-ID Lab), School of Biomedical Sciences, The University of Queensland, Brisbane, 4072, Australia
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15
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S R, S S, S Murthy P, Deshmukh S. Landmark annotation through feature combinations: a comparative study on cephalometric images with in-depth analysis of model's explainability. Dentomaxillofac Radiol 2024; 53:115-126. [PMID: 38166356 DOI: 10.1093/dmfr/twad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVES The objectives of this study are to explore and evaluate the automation of anatomical landmark localization in cephalometric images using machine learning techniques, with a focus on feature extraction and combinations, contextual analysis, and model interpretability through Shapley Additive exPlanations (SHAP) values. METHODS We conducted extensive experimentation on a private dataset of 300 lateral cephalograms to thoroughly study the annotation results obtained using pixel feature descriptors including raw pixel, gradient magnitude, gradient direction, and histogram-oriented gradient (HOG) values. The study includes evaluation and comparison of these feature descriptions calculated at different contexts namely local, pyramid, and global. The feature descriptor obtained using individual combinations is used to discern between landmark and nonlandmark pixels using classification method. Additionally, this study addresses the opacity of LGBM ensemble tree models across landmarks, introducing SHAP values to enhance interpretability. RESULTS The performance of feature combinations was assessed using metrics like mean radial error, standard deviation, success detection rate (SDR) (2 mm), and test time. Remarkably, among all the combinations explored, both the HOG and gradient direction operations demonstrated significant performance across all context combinations. At the contextual level, the global texture outperformed the others, although it came with the trade-off of increased test time. The HOG in the local context emerged as the top performer with an SDR of 75.84% compared to others. CONCLUSIONS The presented analysis enhances the understanding of the significance of different features and their combinations in the realm of landmark annotation but also paves the way for further exploration of landmark-specific feature combination methods, facilitated by explainability.
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Affiliation(s)
- Rashmi S
- Dept. of Computer Science and Engineering, Sri Jayachamarajendra College of Engineering, JSS Science and Technology University, Mysuru, 570006, India
| | - Srinath S
- Dept. of Computer Science and Engineering, Sri Jayachamarajendra College of Engineering, JSS Science and Technology University, Mysuru, 570006, India
| | - Prashanth S Murthy
- Dept. of Pediatric & Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, 570015, India
| | - Seema Deshmukh
- Dept. of Pediatric & Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, 570015, India
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Ruescas-Nicolau AV, De Rosario H, Bernabé EP, Juan MC. Positioning errors of anatomical landmarks identified by fixed vertices in homologous meshes. Gait Posture 2024; 108:215-221. [PMID: 38118225 DOI: 10.1016/j.gaitpost.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/21/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Human movement analysis is usually achieved by tracking markers attached to anatomical landmarks with photogrammetry. Such marker-based systems have disadvantages that have led to the development of markerless procedures, although their accuracy is not usually comparable to that of manual palpation procedures. New motion acquisition systems, such as 3D temporal scanners, provide homologous meshes that can be exploited for this purpose. RESEARCH QUESTION Can fixed vertices of a homologous mesh be used to identify anatomical landmarks with an accuracy equivalent to that of manual palpation? METHODS We used 3165 human shape scans from the CAESAR dataset, with labelled locations of anatomical landmarks. First, we fitted a template mesh to the scans, and assigned a vertex of that mesh to 53 anatomical landmarks in all subjects. Then we defined a nominal vertex for each landmark, as the more centred vertex out of the set assigned for that landmark. We calculated the errors of the template-fitting and the nominal vertex determination procedures, and analysed their relationship to subject's sex, height and body mass index, as well as their size compared to manual palpation errors. RESULTS The template-fitting errors were below 5 mm, and the nominal vertex determination errors reached maximum values of 24 mm. Except for the trochanter, those errors were the same order of magnitude or smaller than inter-examiner errors of lower limb landmarks. Errors increased with height and body mass index, and were smaller for men than for women of the same height and body mass index. SIGNIFICANCE We defined a set of vertices for 53 anatomical landmarks in a homologous mesh, which yields location errors comparable to those obtained by manual palpation for the majority of landmarks. We also quantified how the subject's sex and anthropometric features can affect the size of those errors.
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Affiliation(s)
- Ana V Ruescas-Nicolau
- Instituto de Biomecánica - IBV. Universitat Politècnica de València, edifici 9C. Camí de Vera, s/n 46022 València, Spain.
| | - Helios De Rosario
- Instituto de Biomecánica - IBV. Universitat Politècnica de València, edifici 9C. Camí de Vera, s/n 46022 València, Spain
| | - Eduardo Parrilla Bernabé
- Instituto de Biomecánica - IBV. Universitat Politècnica de València, edifici 9C. Camí de Vera, s/n 46022 València, Spain
| | - M-Carmen Juan
- Instituto Universitario de Automática e Informática Industrial. Universitat Politècnica de València, edifici 1F. Camí de Vera, s/n 46022 València, Spain
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Švábová P, Matláková M, Beňuš R, Chovancová M, Masnicová S. The relationship between biological parameters and facial soft tissue thickness measured by ultrasound and its forensic implications. Med Sci Law 2024; 64:23-31. [PMID: 37338520 DOI: 10.1177/00258024231182360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Facial soft tissue thickness (FSTT) data are currently widely used in forensic and medical science. In the forensic sciences, they form the basis for craniofacial reconstruction and identification methods. Since there are few FSTT data in the Slovak population, this study aims to enrich the data in well-defined age categories, taking into account differences between sexes and body mass index (BMI). The sample consisted of 127 participants aged 17 to 86 years from Slovakia. In addition to biological sex and age information, stature and body weight were recorded to calculate BMI. Subsequently, 17 facial anthropometric landmarks were used to measure FSTT using a noninvasive General Electric LOGIQe R7 ultrasound device. The mean values of FSTT were greater in the mouth region in males and in the zygomatic and eye regions in females. Differences between males and females, regardless of sex and BMI, were significant only at two landmarks. When BMI and age were taken into account, there were differences in 12 of 17 landmarks. Linear regression results showed the strongest correlation of most landmarks with BMI, followed by age and sex. When the FSTT was estimated in association with sex/age/BMI, landmarks in the zygomatic, mandibular, and frontal regions were the best regressors. The results of the present study demonstrate that B-mode ultrasound measurements of FSTT can be used in facial reconstruction as a function of BMI, age, and sex of the subject. Furthermore, the present regression equations can help practitioners in the forensic/medical field to calculate individual tissue thickness.
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Affiliation(s)
- Petra Švábová
- Department of Anthropology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic
| | - Mária Matláková
- Department of Anthropology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic
| | - Radoslav Beňuš
- Department of Anthropology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic
| | - Mária Chovancová
- Department of Anthropology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic
| | - Soňa Masnicová
- Department of Criminalistics and Forensic Sciences, Academy of Police College, Bratislava, Slovak Republic
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Wang Y, Wang Y, Wang C, Cao Y, Zhang B, Chen Y, Liu C. Mandibular asymmetry in patients with skeletal class I and skeletal class II Malocclusions: A cone-beam computed tomography study. J Stomatol Oral Maxillofac Surg 2023; 124:101441. [PMID: 36933658 DOI: 10.1016/j.jormas.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To study the difference in mandibular asymmetry between patients with skeletal Class I and skeletal Class II malocclusions and analyze the correlation between mandibular asymmetry and different facial skeletal sagittal patterns based on CBCT measurements. METHODS One hundred and twenty patients were selected according to the inclusion and exclusion criteria. Patients were divided into two groups (60 in the skeletal Class I group and 60 in the skeletal Class II group) based on ANB angles and Wits values. Patients' CBCT data were collected. Dolphin Imaging 11.0 was used to determine the mandibular anatomic landmarks and calculate the linear distance in patients in the two groups. RESULTS Intragroup comparison: in skeletal Class I group, measurements of the most posterior point of the condyle (Cdpost), the outer lateral point of the condyle (Cdlat), sigmoid notch point (Sn)), coronoid process point (Cop), gonion point (GO) and antimony notch point (Ag), right>left (P<0.05); in skeletal Class II group, measurements of Cdpost and Cop, right>left (P<0.05). Intergroup comparison: for measurements of GO and Ag, skeletal Class I group>skeletal Class II group (P<0.05). The asymmetry of the Ag and GO points was negatively correlated with the ANB angle (p<0.05). CONCLUSION Mandibular asymmetry was significantly different between patients with skeletal Class I and skeletal Class II malocclusions. The asymmetry of the mandible angle region in the former group was greater than that in the latter group, and the asymmetry of the mandibular angle was negatively correlated with the ANB angle.
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Affiliation(s)
- Yu Wang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong 510120, China
| | - Chunhui Wang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Yuming Cao
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Bing Zhang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Yitian Chen
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Chang Liu
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China.
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Yang S, Song ES, Lee ES, Kang SR, Yi WJ, Lee SP. Ceph-Net: automatic detection of cephalometric landmarks on scanned lateral cephalograms from children and adolescents using an attention-based stacked regression network. BMC Oral Health 2023; 23:803. [PMID: 37884918 PMCID: PMC10604948 DOI: 10.1186/s12903-023-03452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The success of cephalometric analysis depends on the accurate detection of cephalometric landmarks on scanned lateral cephalograms. However, manual cephalometric analysis is time-consuming and can cause inter- and intra-observer variability. The purpose of this study was to automatically detect cephalometric landmarks on scanned lateral cephalograms with low contrast and resolution using an attention-based stacked regression network (Ceph-Net). METHODS The main body of Ceph-Net compromised stacked fully convolutional networks (FCN) which progressively refined the detection of cephalometric landmarks on each FCN. By embedding dual attention and multi-path convolution modules in Ceph-Net, the network learned local and global context and semantic relationships between cephalometric landmarks. Additionally, the intermediate deep supervision in each FCN further boosted the training stability and the detection performance of cephalometric landmarks. RESULTS Ceph-Net showed a superior detection performance in mean radial error and successful detection rate, including accuracy improvements in cephalometric landmark detection located in low-contrast soft tissues compared with other detection networks. Moreover, Ceph-Net presented superior detection performance on the test dataset split by age from 8 to 16 years old. CONCLUSIONS Ceph-Net demonstrated an automatic and superior detection of cephalometric landmarks by successfully learning local and global context and semantic relationships between cephalometric landmarks in scanned lateral cephalograms with low contrast and resolutions.
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Affiliation(s)
- Su Yang
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Eun Sun Song
- Department of Oral Anatomy, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Eun Seung Lee
- Department of Oral Anatomy, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Se-Ryong Kang
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Won-Jin Yi
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
| | - Seung-Pyo Lee
- Department of Oral Anatomy, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
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Boochoon K, Mottaghi A, Aziz A, Pepper JP. Deep Learning for the Assessment of Facial Nerve Palsy: Opportunities and Challenges. Facial Plast Surg 2023; 39:508-511. [PMID: 37290452 DOI: 10.1055/s-0043-1769805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Automated evaluation of facial palsy using machine learning offers a promising solution to the limitations of current assessment methods, which can be time-consuming, labor-intensive, and subject to clinician bias. Deep learning-driven systems have the potential to rapidly triage patients with varying levels of palsy severity and accurately track recovery over time. However, developing a clinically usable tool faces several challenges, such as data quality, inherent biases in machine learning algorithms, and explainability of decision-making processes. The development of the eFACE scale and its associated software has improved clinician scoring of facial palsy. Additionally, Emotrics is a semiautomated tool that provides quantitative data of facial landmarks on patient photographs. The ideal artificial intelligence (AI)-enabled system would analyze patient videos in real time, extracting anatomic landmark data to quantify symmetry and movement, and estimate clinical eFACE scores. This would not replace clinician eFACE scoring but would offer a rapid automated estimate of both anatomic data, similar to Emotrics, and clinical severity, similar to the eFACE. This review explores the current state of facial palsy assessment, recent advancements in AI, and the opportunities and challenges in developing an AI-driven solution.
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Affiliation(s)
- Kieran Boochoon
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ali Mottaghi
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Aya Aziz
- Department of Human Biology, Stanford University, Stanford, California
| | - Jon-Paul Pepper
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Daniel S, Kopp M, Vollbrecht T, Zeilinger M, Fitz T, Muttke A, Feuerlein U, Uder M, May MS. Personalization of thoracoabdominal CT examinations using scanner integrated clinical decision support systems - Impact on the acquisition technique, scan range, and reconstruction type. Eur J Radiol 2023; 167:111078. [PMID: 37688917 DOI: 10.1016/j.ejrad.2023.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES This study evaluates the impact of a scanner-integrated, customized clinical decision support system (CDSS) on the acquisition technique, scan range, and reconstruction in thoracoabdominal CT. MATERIALS AND METHODS We applied CDSS in contrast-enhanced examinations of the trunk with various clinical indications on a recent scanner with the capability of dual-energy CT (DECT), anatomic landmark detection (ALD), and iterative metal-artifact reduction (MAR). Simple and comprehensive questions about the patient's breath hold capability, the anatomical region of interest, and metal implants can be answered after the localizer. The acquisition technique (single energy, SECT, or dual energy), scan range (chest-abdomen-pelvis or chest-abdomen), and reconstruction technique (with or without MAR) were then automatically adapted in the examination protocols in coherence with these selections. Retrospectively, we compared the usage rates for these techniques in 624 examinations on the study scanner with 740 examinations on a comparable scanner without CDSS. Subgroup analysis of effective dose (ED), scan duration, and image quality (IQ) was performed in the study group. RESULTS CDSS leads to an increased usage rate of DECT (64.4% vs. 2.8%) and MAR (75.4% vs. 44.0%). All scan range adaptations by ALD were successful. The resulting subjective IQ between single energy and DECT acquisitions was comparable (all p > 0.05). Scan duration was significantly longer in DECT than in SECT (16.9 s vs. 6.5 s; p < 0.001). However, the objective IQ was significantly higher in DECT (CNRD 2.1 vs. 1.8; p < 0.01), and the ED significantly lower (6.7 mSv vs. 7.6 mSv; p = 0.004). CONCLUSION CDSS for thoracoabdominal CT leads to a substantially increased usage rate of innovative techniques during acquisition and reconstruction. Patients with adapted protocols benefit from improved image quality and increased post-processing options at lower radiation doses.
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Affiliation(s)
- Sascha Daniel
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.
| | - Markus Kopp
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Thomas Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Martin Zeilinger
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Tim Fitz
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | | | | | - Michael Uder
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany; Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Matthias S May
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany; Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
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Yang G, He S, Meng D, Wei M, Cao J, Guo H, Ren H, Wang Z. Body landmarks and genetic algorithm-based approach for non-contact detection of head forward posture among Chinese adolescents: revitalizing machine learning in medicine. BMC Med Inform Decis Mak 2023; 23:179. [PMID: 37697312 PMCID: PMC10496156 DOI: 10.1186/s12911-023-02285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
Addressing the current complexities, costs, and adherence issues in the detection of forward head posture (FHP), our study conducted an exhaustive epidemiologic investigation, incorporating a comprehensive posture screening process for each participant in China. This research introduces an avant-garde, machine learning-based non-contact method for the accurate discernment of FHP. Our approach elevates detection accuracy by leveraging body landmarks identified from human images, followed by the application of a genetic algorithm for precise feature identification and posture estimation. Observational data corroborates the superior efficacy of the Extra Tree Classifier technique in FHP detection, attaining an accuracy of 82.4%, a specificity of 85.5%, and a positive predictive value of 90.2%. Our model affords a rapid, effective solution for FHP identification, spotlighting the transformative potential of the convergence of feature point recognition and genetic algorithms in non-contact posture detection. The expansive potential and paramount importance of these applications in this niche field are therefore underscored.
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Affiliation(s)
- Guang Yang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Shichun He
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Deyu Meng
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Meiqi Wei
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Jianwei Cao
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA
| | - Hongzhi Guo
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA
- Graduate School of Human Sciences, Waseda University, Tokorozawa, 169-8050, Saitama Prefecture, Japan
| | - He Ren
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA
| | - Ziheng Wang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China.
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA.
- Advanced Research Center for Human Sciences, Waseda University, Tokorozawa, 169-8050, Saitama Prefecture, Japan.
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Weingart JV, Schlager S, Metzger MC, Brandenburg LS, Hein A, Schmelzeisen R, Bamberg F, Kim S, Kellner E, Reisert M, Russe MF. Automated detection of cephalometric landmarks using deep neural patchworks. Dentomaxillofac Radiol 2023; 52:20230059. [PMID: 37427585 PMCID: PMC10461263 DOI: 10.1259/dmfr.20230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVES This study evaluated the accuracy of deep neural patchworks (DNPs), a deep learning-based segmentation framework, for automated identification of 60 cephalometric landmarks (bone-, soft tissue- and tooth-landmarks) on CT scans. The aim was to determine whether DNP could be used for routine three-dimensional cephalometric analysis in diagnostics and treatment planning in orthognathic surgery and orthodontics. METHODS Full skull CT scans of 30 adult patients (18 female, 12 male, mean age 35.6 years) were randomly divided into a training and test data set (each n = 15). Clinician A annotated 60 landmarks in all 30 CT scans. Clinician B annotated 60 landmarks in the test data set only. The DNP was trained using spherical segmentations of the adjacent tissue for each landmark. Automated landmark predictions in the separate test data set were created by calculating the center of mass of the predictions. The accuracy of the method was evaluated by comparing these annotations to the manual annotations. RESULTS The DNP was successfully trained to identify all 60 landmarks. The mean error of our method was 1.94 mm (SD 1.45 mm) compared to a mean error of 1.32 mm (SD 1.08 mm) for manual annotations. The minimum error was found for landmarks ANS 1.11 mm, SN 1.2 mm, and CP_R 1.25 mm. CONCLUSION The DNP-algorithm was able to accurately identify cephalometric landmarks with mean errors <2 mm. This method could improve the workflow of cephalometric analysis in orthodontics and orthognathic surgery. Low training requirements while still accomplishing high precision make this method particularly promising for clinical use.
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Affiliation(s)
- Julia Vera Weingart
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schlager
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Hein
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Suam Kim
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Faculty of Medicine, Medical Center – University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Medical Physics, Faculty of Medicine, Medical Center – University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Olivetti EC, Marcolin F, Moos S, Vezzetti E, Borbon C, Zavattero E, Ramieri G. Do facial soft tissue thicknesses change after surgeries correcting dental malocclusions? An intra- and inter-patient statistical analysis on soft-tissue thicknesses in BSSO + LFI surgeries. Clin Oral Investig 2023; 27:5049-5062. [PMID: 37369817 DOI: 10.1007/s00784-023-05124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed. MATERIALS AND METHODS Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated. RESULTS Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p > .05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region. CONCLUSIONS The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects. CLINICAL RELEVANCE This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.
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Affiliation(s)
- Elena Carlotta Olivetti
- Department of Management and Production Engineering, Politecnico di Torino, corso Duca degli Abruzzi 24, 10129, Turin, Italy.
| | - Federica Marcolin
- Department of Management and Production Engineering, Politecnico di Torino, corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Sandro Moos
- Department of Management and Production Engineering, Politecnico di Torino, corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Enrico Vezzetti
- Department of Management and Production Engineering, Politecnico di Torino, corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Claudia Borbon
- Department of Surgical Sciences, Division of Maxillofacial Surgery, University of Turin, Città della Salute e della Scienza Hospital, 10129, Turin, Italy
| | - Emanuele Zavattero
- Department of Surgical Sciences, Division of Maxillofacial Surgery, University of Turin, Città della Salute e della Scienza Hospital, 10129, Turin, Italy
| | - Guglielmo Ramieri
- Department of Surgical Sciences, Division of Maxillofacial Surgery, University of Turin, Città della Salute e della Scienza Hospital, 10129, Turin, Italy
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Xu M, Liu B, Luo Z, Sun M, Wang Y, Yin N, Tang X, Song T. Using a New Deep Learning Method for 3D Cephalometry in Patients With Hemifacial Microsomia. Ann Plast Surg 2023; 91:381-384. [PMID: 37566820 DOI: 10.1097/sap.0000000000003647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
ABSTRACT Deep learning algorithms based on automatic 3D cephalometric marking points about people without craniomaxillofacial deformities have achieved good results. However, there has been no previous report about hemifacial microsomia (HFM). The purpose of this study is to apply a new deep learning method based on a 3D point cloud graph convolutional neural network to predict and locate landmarks in patients with HFM based on the relationships between points. The authors used a PointNet++ model to investigate the automatic 3D cephalometry. And the mean distance error (MDE) of the center coordinate position and the success detection rate (SDR) were used to evaluate the accuracy of systematic labeling. A total of 135 patients were enrolled. The MDE for all 32 landmarks was 1.46 ± 1.308 mm, and 10 landmarks showed SDRs at 2 mm over 90%, and only 4 landmarks showed SDRs at 2 mm under 60%. Compared with the manual reproducibility, the standard distance deviation and coefficient of variation values for the MDE of the artificial intelligence system was 0.67 and 0.43, respectively. In summary, our training sets were derived from HFM computed tomography to achieve accurate results. The 3D cephalometry system based on the graph convolutional network algorithm may be suitable for the 3D cephalometry system in HFM cases. More accurate results may be obtained if the HFM training set is expanded in the future.
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Affiliation(s)
- Meng Xu
- From the Cleft Lip and Palate Center
| | - Bingyang Liu
- Maxillo-facial Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Zhaoyang Luo
- HaiChuang Future Medical Technology Co Ltd, Hangzhou, China
| | - Min Sun
- From the Cleft Lip and Palate Center
| | | | | | - Xiaojun Tang
- Maxillo-facial Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Tao Song
- From the Cleft Lip and Palate Center
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Sehrawat JS, Ahlawat B. Systematic review on forensic craniofacial reconstruction. I. facial soft-tissue thickness. Forensic Sci Rev 2023; 35:107-136. [PMID: 37531497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Forensic anthropologists are traditionally interested in facial approximations and reconstruction of physiognomies of individuals from past populations and creation of lifelike features onto unknown skulls retrieved from forensic or bioarchaeological contexts. Present review article examines the significance of facial soft-tissue thickness (FSTT) in craniofacial reconstruction by revisiting the studies published in the recent past decade (2010-21). The searches for published articles mentioning the FSTT and related topics over these years were performed using the following search engines: PubMed, ScienceDirect, Web of Science, and Scopus. A total of 325 research articles were identified using different keywords, out of which 84 studies were found relevant for systematic review presented in this article. The selected studies were further analyzed based on the adopted study design, radiographic modality used for estimating FSTT, and generated databases and their advantages and limitations. Out of 84 relevant articles, 30 articles presented databases for sex, age, and ethnicity-dependent variations in soft tissue thickness measurements. Finally, 17 studies reporting sexual dimorphic variations in FSTT values estimated in supine or upright postured individuals (aged 18-90 years and above) were considered for meta-analysis. This article gives a decisive outlook on research trends in FSTT estimations, its contributions in refining craniofacial reconstruction technology, and identifying where we lack and where we can improve.
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Affiliation(s)
- J S Sehrawat
- Department of Anthropology, Panjab University, Chandigarh, Union Territory, India
| | - B Ahlawat
- Department of Anthropology, Panjab University, Chandigarh, Union Territory, India
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Blum FMS, Möhlhenrich SC, Raith S, Pankert T, Peters F, Wolf M, Hölzle F, Modabber A. Evaluation of an artificial intelligence-based algorithm for automated localization of craniofacial landmarks. Clin Oral Investig 2023; 27:2255-2265. [PMID: 37014502 PMCID: PMC10159965 DOI: 10.1007/s00784-023-04978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Due to advancing digitalisation, it is of interest to develop standardised and reproducible fully automated analysis methods of cranial structures in order to reduce the workload in diagnosis and treatment planning and to generate objectifiable data. The aim of this study was to train and evaluate an algorithm based on deep learning methods for fully automated detection of craniofacial landmarks in cone-beam computed tomography (CBCT) in terms of accuracy, speed, and reproducibility. MATERIALS AND METHODS A total of 931 CBCTs were used to train the algorithm. To test the algorithm, 35 landmarks were located manually by three experts and automatically by the algorithm in 114 CBCTs. The time and distance between the measured values and the ground truth previously determined by an orthodontist were analyzed. Intraindividual variations in manual localization of landmarks were determined using 50 CBCTs analyzed twice. RESULTS The results showed no statistically significant difference between the two measurement methods. Overall, with a mean error of 2.73 mm, the AI was 2.12% better and 95% faster than the experts. In the area of bilateral cranial structures, the AI was able to achieve better results than the experts on average. CONCLUSION The achieved accuracy of automatic landmark detection was in a clinically acceptable range, is comparable in precision to manual landmark determination, and requires less time. CLINICAL RELEVANCE Further enlargement of the database and continued development and optimization of the algorithm may lead to ubiquitous fully automated localization and analysis of CBCT datasets in future routine clinical practice.
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Affiliation(s)
| | | | - Stefan Raith
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Tobias Pankert
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Florian Peters
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Michael Wolf
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
| | - Frank Hölzle
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Ali Modabber
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
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Schobs LA, Swift AJ, Lu H. Uncertainty Estimation for Heatmap-Based Landmark Localization. IEEE Trans Med Imaging 2023; 42:1021-1034. [PMID: 36383596 DOI: 10.1109/tmi.2022.3222730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Automatic anatomical landmark localization has made great strides by leveraging deep learning methods in recent years. The ability to quantify the uncertainty of these predictions is a vital component needed for these methods to be adopted in clinical settings, where it is imperative that erroneous predictions are caught and corrected. We propose Quantile Binning, a data-driven method to categorize predictions by uncertainty with estimated error bounds. Our framework can be applied to any continuous uncertainty measure, allowing straightforward identification of the best subset of predictions with accompanying estimated error bounds. We facilitate easy comparison between uncertainty measures by constructing two evaluation metrics derived from Quantile Binning. We compare and contrast three epistemic uncertainty measures (two baselines, and a proposed method combining aspects of the two), derived from two heatmap-based landmark localization model paradigms (U-Net and patch-based). We show results across three datasets, including a publicly available Cephalometric dataset. We illustrate how filtering out gross mispredictions caught in our Quantile Bins significantly improves the proportion of predictions under an acceptable error threshold. Finally, we demonstrate that Quantile Binning remains effective on landmarks with high aleatoric uncertainty caused by inherent landmark ambiguity, and offer recommendations on which uncertainty measure to use and how to use it. The code and data are available at https://github.com/schobs/qbin.
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Feng B, Yu X, Wang Y, Ouyang W, Wu F, Yu M, Chen Q. Using the anterior cranial base to provide a reliable reference plane for patients with or without facial asymmetry. Am J Orthod Dentofacial Orthop 2022; 162:e230-e245. [PMID: 36055884 DOI: 10.1016/j.ajodo.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This study aimed to investigate the midsagittal reference plane (MSP) reliability derived from the 3-dimensional characteristics of patients with or without facial asymmetry in the anterior cranial base (ACB). METHODS We divided the cone-beam computed tomography (CBCT) images of 60 adult patients into maxillofacial symmetry and asymmetry groups. The ACB models were 3-dimensionally constructed, and then symmetrical characteristics were evaluated with surface asymmetry for each group. The reliability of the MSP derived from the symmetry of the anterior cranial base (MSPACB) was assessed in comparison with the true craniofacial symmetry plane determined using the morphometric method. RESULTS The ACB was symmetrical, as demonstrated by slight surface asymmetry. The MSPACB was reliable for maxillofacial asymmetrical analysis as the intraobserver and interobserver measurements using the MSPACB were of excellent agreement, and there was no significant difference between MSPACB and morphometric method in asymmetrical measurements in both groups. The MSPACB remained stable (maximum deviation <0.32 mm) when cranial landmark identification errors (1 mm and 4 mm) were simulated. CONCLUSIONS MSPACB is reliable for patients with or without facial asymmetry in maxillofacial asymmetry analysis, which is beneficial to patients with severe midfacial asymmetry or trauma when conventional landmarks are displaced or disappear. When using MSPACB for patients with cranial malformations or those whose ACBs differ from normal dimensions, caution should be taken.
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Affiliation(s)
- Bin Feng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Xiaowen Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Yang Wang
- Department of Oral Medical Imaging, West China School of Stomatology, Sichuan University, and State Key Laboratory of Oral Diseases, Chengdu, China
| | - Wangtao Ouyang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Fuli Wu
- School of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China.
| | - Mengfei Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China.
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
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Topcu H, Ozçiftçi S, Şahiner Y. Comparative effectiveness of real-time ultrasound-guided tracheostomy and anatomic landmark percutaneous dilatational tracheostomy: a retrospective cohort study. Eur Rev Med Pharmacol Sci 2022; 26:7883-7891. [PMID: 36394736 DOI: 10.26355/eurrev_202211_30139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The role of ultrasound during various airway procedures has been in the spotlight in recent years. This study reconsiders the potential role and effectiveness of ultrasound use during percutaneous dilatational tracheostomy in intensive care patient population. This study aims to assess the impact of real-time ultrasound (US) use on complication rates and procedural success in percutaneous dilational tracheostomy (PDT) opened with forceps dilatation technique using anatomical landmarks. PATIENTS AND METHODS In this study, 59 patients who had undergone PDT in the intensive care unit (ICU) were reached. Written-electronic files and intensive care follow-up forms of the patients were reviewed retrospectively. The patients were divided into two groups: 44 patients in Group G (anatomical landmark PDT) and 15 patients in Group U (real-time US PDT). Demographic data, duration of intubation and ICU stay, discharge status, procedural characteristics and postoperative complications of the patients were determined. RESULTS A total of 59 patients were analyzed. The mean age of the patients was 74.9±11.7 years, the mean tracheostomy duration was 33.3±20 days, and the mean duration of ICU stay was 60±45 days. Complications occurred in 62.7% of all patients. Minor bleeding was present in five (8.5%), moderate bleeding in 13 (22%), and major bleeding in 11 (18.6%) patients. In addition, pneumothorax was observed in one patient, misplacement of the tracheostomy cannula and emphysema in one patient, and esophageal injury in three patients. A total of 50 (84.7%) patients died, and nine (15.3%) patients continued to be treated in the ICU. Bleeding, hypoxemia, hypercapnia, tracheostomy opening time duration, and the number of attempts for the successful procedure were significantly higher in Group G than Group U (p<0.05). A negative correlation was found between the groups regarding the duration of tracheostomy (p = 0.001) and tracheostomy opening technique (p = 0.001). CONCLUSIONS The use of real-time ultrasound in percutaneous tracheostomies opened under elective conditions in the ICU reduces the complications of hypoxemia, hypercapnia and bleeding by dwindling the duration of the procedure and the number of attempts than the conventional technique.
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Affiliation(s)
- H Topcu
- Department of Anesthesia, Pain and Intensive Care, Faculty of Medicine, Hitit University, Corum, Turkey.
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Lang Y, Lian C, Xiao D, Deng H, Thung KH, Yuan P, Gateno J, Kuang T, Alfi DM, Wang L, Shen D, Xia JJ, Yap PT. Localization of Craniomaxillofacial Landmarks on CBCT Images Using 3D Mask R-CNN and Local Dependency Learning. IEEE Trans Med Imaging 2022; 41:2856-2866. [PMID: 35544487 PMCID: PMC9673501 DOI: 10.1109/tmi.2022.3174513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cephalometric analysis relies on accurate detection of craniomaxillofacial (CMF) landmarks from cone-beam computed tomography (CBCT) images. However, due to the complexity of CMF bony structures, it is difficult to localize landmarks efficiently and accurately. In this paper, we propose a deep learning framework to tackle this challenge by jointly digitalizing 105 CMF landmarks on CBCT images. By explicitly learning the local geometrical relationships between the landmarks, our approach extends Mask R-CNN for end-to-end prediction of landmark locations. Specifically, we first apply a detection network on a down-sampled 3D image to leverage global contextual information to predict the approximate locations of the landmarks. We subsequently leverage local information provided by higher-resolution image patches to refine the landmark locations. On patients with varying non-syndromic jaw deformities, our method achieves an average detection accuracy of 1.38± 0.95mm, outperforming a related state-of-the-art method.
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Harper KD, Nzeogu MI, Vakil JJ, Abdelfadeel WM, Saxena A, Star AM. A Consistent Anatomic Landmark for Identifying the Lateral Femoral Circumflex Artery in a Direct Anterior Hip Approach. Orthopedics 2022; 45:262-268. [PMID: 35700431 DOI: 10.3928/01477447-20220608-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A direct anterior approach (DAA) is a technique practiced by arthroplasty surgeons that can be technically challenging, most notably for inexperienced surgeons. The lateral femoral circumflex artery (LFCA) is a branch of the femoral artery that crosses the surgical field during DAA and is an important landmark for superficial surgical dissection. If the vessel is not identified, significant bleeding may occur, and visualization may be impaired. This study aimed to develop a reliable method to identify and ligate the LFCA with minimal bleeding. First, a retrospective review was performed on a series of patients who underwent primary DAA total hip arthroplasty. Epidemiologic and intraoperative radiologic information was collected to determine the 2-dimensional location of the LFCA as it coursed through the surgical interval. Second, a series of computed tomography (CT) angiograms were compared to validate the intraoperative anatomic findings. In this study, 108 patients were evaluated fluoroscopically and 100 CT angiograms were obtained, for 208 total patients. The distance of the LFCA from the lesser trochanter with standard fluoroscopy (LT/TD) was 0.600 vs 0.438 on CT angiogram. Mean offset from midline (offset/femur diameter) was 0.166 lateral to midline vs 0.36 medial to midline. Median value of offset was 0 vs 0.411-representing a position on the anatomic axis of the femur. This study confirmed that the LFCA is found approximately one-third to two-thirds of the way between the lesser and greater trochanters along the anatomic axis of the femur for most patients. Surgeons who are new to DAA can use the LFCA as a reliable landmark to confirm the correct interval. [Orthopedics. 2022;45(5):262-268.].
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Chen R, Ma Y, Chen N, Liu L, Cui Z, Lin Y, Wang W. Structure-Aware Long Short-Term Memory Network for 3D Cephalometric Landmark Detection. IEEE Trans Med Imaging 2022; 41:1791-1801. [PMID: 35130151 DOI: 10.1109/tmi.2022.3149281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Detecting 3D landmarks on cone-beam computed tomography (CBCT) is crucial to assessing and quantifying the anatomical abnormalities in 3D cephalometric analysis. However, the current methods are time-consuming and suffer from large biases in landmark localization, leading to unreliable diagnosis results. In this work, we propose a novel Structure-Aware Long Short-Term Memory framework (SA-LSTM) for efficient and accurate 3D landmark detection. To reduce the computational burden, SA-LSTM is designed in two stages. It first locates the coarse landmarks via heatmap regression on a down-sampled CBCT volume and then progressively refines landmarks by attentive offset regression using multi-resolution cropped patches. To boost accuracy, SA-LSTM captures global-local dependence among the cropping patches via self-attention. Specifically, a novel graph attention module implicitly encodes the landmark's global structure to rationalize the predicted position. Moreover, a novel attention-gated module recursively filters irrelevant local features and maintains high-confident local predictions for aggregating the final result. Experiments conducted on an in-house dataset and a public dataset show that our method outperforms state-of-the-art methods, achieving 1.64 mm and 2.37 mm average errors, respectively. Furthermore, our method is very efficient, taking only 0.5 seconds for inferring the whole CBCT volume of resolution 768×768×576 .
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Chuang YJ, Hwang SJ, Buhr KA, Miller CA, Avey GD, Story BH, Vorperian HK. Anatomic development of the upper airway during the first five years of life: A three-dimensional imaging study. PLoS One 2022; 17:e0264981. [PMID: 35275939 PMCID: PMC8916633 DOI: 10.1371/journal.pone.0264981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/21/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Normative data on the growth and development of the upper airway across the sexes is needed for the diagnosis and treatment of congenital and acquired respiratory anomalies and to gain insight on developmental changes in speech acoustics and disorders with craniofacial anomalies. Methods The growth of the upper airway in children ages birth to 5 years, as compared to adults, was quantified using an imaging database with computed tomography studies from typically developing individuals. Methodological criteria for scan inclusion and airway measurements included: head position, histogram-based airway segmentation, anatomic landmark placement, and development of a semi-automatic centerline for data extraction. A comprehensive set of 2D and 3D supra- and sub-glottal measurements from the choanae to tracheal opening were obtained including: naso-oro-laryngo-pharynx subregion volume and length, each subregion’s superior and inferior cross-sectional-area, and antero-posterior and transverse/width distances. Results Growth of the upper airway during the first 5 years of life was more pronounced in the vertical and transverse/lateral dimensions than in the antero-posterior dimension. By age 5 years, females have larger pharyngeal measurement than males. Prepubertal sex-differences were identified in the subglottal region. Conclusions Our findings demonstrate the importance of studying the growth of the upper airway in 3D. As the lumen length increases, its shape changes, becoming increasingly elliptical during the first 5 years of life. This study also emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions.
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Affiliation(s)
- Ying Ji Chuang
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Seong Jae Hwang
- Department of Computer Science, University of Pittsburgh, Pittsburg, Pennsylvania, United States of America
| | - Kevin A. Buhr
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Courtney A. Miller
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gregory D. Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Brad H. Story
- Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Houri K. Vorperian
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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Gupta A, Ghosh S, Roychoudhury A. Radiological and clinical correlations of the anterior ethmoidal artery in functional endoscopic sinus surgery. J Laryngol Otol 2022; 136:154-157. [PMID: 34730079 DOI: 10.1017/s002221512100342x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To correlate computed tomography findings and endoscopic localisation of the anterior ethmoidal artery during surgery, and to analyse the intranasal landmarks and abnormalities of the artery. METHOD The anterior ethmoidal artery was studied with high-resolution computed tomography and endoscopic surgery in 30 patients undergoing functional endoscopic sinus surgery (group A), and with endoscopic dissection on 30 human cadavers (group B). RESULTS The anterior ethmoidal artery was demonstrated on computed tomography in 25 patients and intra-operatively in 12 (group A). It was identified in 26 cadavers (group B). Dehiscence of bony canal and branching was noted in 10.53 per cent of cases. The mean (± standard deviation) intranasal length of the anterior ethmoidal artery was 7.29 (± 1.21) mm, the distance of the artery from the axilla of the middle turbinate was 16.24 (± 2.75) mm, and the mean distance from the ground lamella was 8.97 (± 1.46) mm. CONCLUSION High-resolution computed tomography scanning prior to functional endoscopic sinus surgery is mandatory to identify the anterior ethmoidal artery. Endoscopically, the axilla of the middle turbinate and the ground lamella can serve as dependable reference points to identify the artery. Cadaver dissection improves understanding of anatomy.
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Affiliation(s)
- A Gupta
- Consultant ENT, Lok Clinic and Hospital, New Delhi, India
| | - S Ghosh
- Department of ENT and Head Neck Surgery, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, India
| | - A Roychoudhury
- Department of ENT and Head Neck Surgery, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, India
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Schoenbrunner A, Konschake M, Zwierzina M, Egro FM, Moriggl B, Janis JE. The Great Auricular Nerve Trigger Site: Anatomy, Compression Point Topography, and Treatment Options for Headache Pain. Plast Reconstr Surg 2022; 149:203-211. [PMID: 34807011 DOI: 10.1097/prs.0000000000008673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peripheral nerve decompression surgery can effectively address headache pain caused by compression of peripheral nerves of the head and neck. Despite decompression of known trigger sites, there are a subset of patients with trigger sites centered over the postauricular area coursing. The authors hypothesize that these patients experience primary or residual pain caused by compression of the great auricular nerve. METHODS Anatomical dissections were carried out on 16 formalin-fixed cadaveric heads. Possible points of compression along fascia, muscle, and parotid gland were identified. Ultrasound technology was used to confirm these anatomical findings in a living volunteer. RESULTS The authors' findings demonstrate that the possible points of compression for the great auricular nerve are at Erb's point (point 1), at the anterior border of the sternocleidomastoid muscle in the dense connective tissue before entry into the parotid gland (point 2), and within its intraparotid course (point 3). The mean topographic measurements were as follows: Erb's point to the mastoid process at 7.32 cm/7.35 (right/left), Erb's point to the angle of the mandible at 6.04 cm/5.89 cm (right/left), and the posterior aspect of the sternocleidomastoid muscle to the mastoid process at 3.88 cm/4.43 cm (right/left). All three possible points of compression could be identified using ultrasound. CONCLUSIONS This study identified three possible points of compression of the great auricular nerve that could be decompressed with peripheral nerve decompression surgery: Erb's point (point 1), at the anterior border of the sternocleidomastoid muscle (point 2), and within its intraparotid course (point 3).
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Affiliation(s)
- Anna Schoenbrunner
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Department of Plastic, Reconstructive, and Aesthetic Surgery, Center of Operative Medicine, and Department of Anatomy, Histology, and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck; and Department of Plastic Surgery, University of Pittsburgh
| | - Marko Konschake
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Department of Plastic, Reconstructive, and Aesthetic Surgery, Center of Operative Medicine, and Department of Anatomy, Histology, and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck; and Department of Plastic Surgery, University of Pittsburgh
| | - Marit Zwierzina
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Department of Plastic, Reconstructive, and Aesthetic Surgery, Center of Operative Medicine, and Department of Anatomy, Histology, and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck; and Department of Plastic Surgery, University of Pittsburgh
| | - Francesco M Egro
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Department of Plastic, Reconstructive, and Aesthetic Surgery, Center of Operative Medicine, and Department of Anatomy, Histology, and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck; and Department of Plastic Surgery, University of Pittsburgh
| | - Bernhard Moriggl
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Department of Plastic, Reconstructive, and Aesthetic Surgery, Center of Operative Medicine, and Department of Anatomy, Histology, and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck; and Department of Plastic Surgery, University of Pittsburgh
| | - Jeffrey E Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Department of Plastic, Reconstructive, and Aesthetic Surgery, Center of Operative Medicine, and Department of Anatomy, Histology, and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck; and Department of Plastic Surgery, University of Pittsburgh
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Rijs Z, de Groot PCJ, Zwitser EW, Visser CPJ. Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial. Clin Orthop Relat Res 2021; 479:2483-2489. [PMID: 33950868 PMCID: PMC8509907 DOI: 10.1097/corr.0000000000001803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder injections for conditions such as adhesive capsulitis are commonly performed and can be administered through image-based or landmark-based injection approaches. Ultrasound-guided injections are widely used and accurate because ultrasound allows real-time visualization of the needle and injected contrast. Landmark-based injections would be advantageous, if they were accurate, because they would save the time and expense associated with ultrasound. However, few prospective studies have compared well-described landmark-based shoulder injection techniques without ultrasound. QUESTION/PURPOSE Using anatomic landmarks, and without using ultrasound, is the accuracy of glenohumeral injection for adhesive capsulitis greater via the posterior approach or via a new anterior approach? METHODS Between 2018 and 2020, we treated 108 patients potentially eligible for adhesive capsulitis treatment. These patients had clinical symptoms of aggravating shoulder pain with a duration of less than 4 months and passively impaired, painful glenohumeral ROM. Due to the exclusion of patients with other shoulder conditions (full-thickness rotator cuff ruptures and posttraumatic stiffness), 95 patients received an injection in this sequential, prospective, comparative study. Between 2018 and 2019, 41 patients (17 males and 24 females; mean age 52 ± 5 years; mean BMI 24 ± 3 kg/m2) were injected through the posterior approach, with the acromion as the anatomical landmark, during the first part of the study period. After that, between 2019 and 2020, 54 patients (20 males and 34 females; mean age 54 ± 4 years; mean BMI 23 ± 3 kg/m2) received an injection through a new anterior approach, with the acromioclavicular joint as the anatomic landmark, during the second part of the study period. Injections via both approaches were administered by two experienced shoulder specialists (both with more than 10 years of experience). Both specialists had experience with the posterior approach before this study, and neither had previous training with the new anterior approach. Injections contained a corticosteroid, local anaesthetic, and contrast medium. Radiographs were taken within 20 minutes after the injection, and a radiologist blinded to the technique determined accuracy. Accurate injections were defined as having contrast fluid limited to the glenohumeral joint, while inaccurate injections displayed leakage of contrast fluid into the soft tissue or subacromial space. All of the enrolled patients were analyzed. RESULTS In the group with the posterior approach, the accuracy was 78% (32 of 41) in contrast to 94% (51 of 54, odds ratio 0.21 [95% CI 0.05 to 0.83]; p = 0.03) in patients with the new anterior approach. CONCLUSION The new anterior approach without the use of ultrasound was more accurate than the posterior approach. In fact, it was nearly as accurate as previously published ultrasound-guided approaches. We recommend using the new anterior approach for intraarticular glenohumeral injections instead of ultrasound-guided injections because it will save time and costs associated with ultrasound. Still, the clinical effects (anxiety, pain, functional outcome, and adverse events) of the new anterior approach should be compared with ultrasound-guided injections in a randomized study. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Zeger Rijs
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Lin KT, Kao YS, Chiu CW, Lin CH, Chou CC, Hsieh PY, Lin YR. Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: A systematic review and meta-analysis. PLoS One 2021; 16:e0258972. [PMID: 34710141 PMCID: PMC8553067 DOI: 10.1371/journal.pone.0258972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/09/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Ultrasound-guided tracheostomy (UGT) and bronchoscope-guided tracheostomy (BGT) have been well compared. However, the differences in benefits between UGT and landmark tracheostomy (LT) have not been addressed and, in particular, lack a detailed meta-analysis. We aimed to compare the first-pass success, complication rate, major bleeding rate, and tracheostomy procedure time between UGT and LT. Methods In a systematic review, relevant databases were searched for studies comparing UGT with LT in intubated patients. The primary outcome was the odds ratio (OR) of first-pass success. The secondary outcomes were the OR of complications, OR of major bleeding, and standardized mean difference (SMD) of the total tracheostomy procedure time. Results The meta-analysis included three randomized controlled studies (RCTs) and one nonrandomized controlled study (NRS), comprising 474 patients in total. Compared with LT, UGT increased first-pass success (OR: 4.287; 95% confidence interval [CI]: 2.308 to 7.964) and decreased complications (OR: 0.422; 95% CI: 0.249 to 0.718). However, compared with LT, UGT did not significantly reduce major bleeding (OR: 0.374; 95% CI: 0.112 to 1.251) or the total tracheostomy placement time (SMD: -0.335; 95% CI: -0.842 to 0.172). Conclusions Compared with LT, real-time UGT increases first-pass success and decreases complications. However, UGT was not associated with a significant reduction in the major bleeding rate. The total tracheostomy placement time comparison between UGI and LT was inconclusive.
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Affiliation(s)
- Kun-Te Lin
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yung-Shuo Kao
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Wen Chiu
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Department of Education, National Chiayi University, Chiayi, Taiwan
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Chi-Hsien Lin
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chu-Chung Chou
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Pei-You Hsieh
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yan-Ren Lin
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- * E-mail:
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Abstract
The human pelvic canal (true pelvis) functions to support the abdominopelvic organs and serves as a passageway for reproduction (females). Previous research suggests that these two functions work against each other with the expectation that the supportive role results in a narrower pelvic midplane, while fetal passage necessitates a larger opening. In this research, we examine how gut size relates to the size and shape of the true pelvis, which may have implications on how gut size can influence pelvic floor integrity. Pelves and in vivo gut volumes were measured from CT scans of 92 adults (48 female, 44 male). The true pelvis was measured at three obstetrical planes (inlet, midplane, outlet) using 11 3D landmarks. CT volumetry was used to obtain an individual’s gut size. Gut volume was compared to the pelvic planes using multiple regression to evaluate the relationship between gut size and the true pelvis. We find that, in males, larger gut sizes are associated with increased mediolateral canal dimensions at the inlet and midplane. In females, we find that larger gut sizes are associated with more medially-projecting ischial spines and an anteroposteriorly longer outlet. We hypothesize that the association of larger guts with increased canal width in males and increased outlet length in females are adaptations to create adequate space for the gut, while more medially projecting ischial spines reduce the risk of pelvic floor disorders in females, despite its possible spatial consequences for fetal passage.
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Affiliation(s)
- Jeanelle Uy
- Anthropology, California State University Long Beach, Long Beach, California, United States of America
- * E-mail:
| | - Natalie M. Laudicina
- Biomedical Sciences, Grand Valley State University, Allendale, Michigan, United States of America
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Hong E, Kwak DS, Kim IB. Morphological symmetry of the radius and ulna-Can contralateral forearm bones utilize as a reliable template for the opposite side? PLoS One 2021; 16:e0258232. [PMID: 34613996 PMCID: PMC8494372 DOI: 10.1371/journal.pone.0258232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
The most important precondition for correction of the affected forearm using data from the contralateral side is that the left and right bone features must be similar, in order to develop patient-specific instruments (PSIs) and/or utilize computer-assisted orthopedic surgery (CAOS). The forearm has complex anatomical structure, and most people use their dominant hand more than their less dominant hand, sometimes resulting in asymmetry of the upper limbs. The aim of this study is to investigate differences of the bilateral forearm bones through a quantitative comparison of whole bone parameters including length, volume, bowing, and twisting parameters, and regional shape differences of the forearm bones. In total, 132 bilateral 3D radii and ulnae 3D models were obtained from CT images, whole bone parameters and regional shape were analyzed. Statistically significant differences in whole bone parameters were not shown. Regionally, the radius shows asymmetry in the upper section of the central part to the upper section of the distal part. The ulna shows asymmetry in the lower section of the proximal part to the lower section of the central part. Utilizing contralateral side forearm bones to correct the affected side may be feasible despite regional differences in the forearm bones of around 0.5 mm.
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Affiliation(s)
- Eunah Hong
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy / Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail: (IBK); (DSK)
| | - In-Beom Kim
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Anatomy / Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail: (IBK); (DSK)
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Abstract
Image-guided diagnostic block and radiofrequency ablation of the knee joint to manage pain require detailed understanding of joint innervation in relation to soft tissue and bony landmarks. In this article, the origin, course, and relationship to anatomic landmarks of articular nerves supplying the knee joint are discussed. The innervation pattern of the anterior and posterior aspects of the knee joint capsule is relatively consistent, with some variation in supply by the saphenous, anterior division of obturator, and common fibular nerves. To improve nerve capture rates for diagnostic block and radiofrequency ablation, multiple target sites could be beneficial.
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Affiliation(s)
- John Tran
- Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Room 1158, Toronto, Ontario M5S 1A8, Canada.
| | - Philip W H Peng
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, Ontario M5T 2S8, Canada
| | - Vincent W S Chan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, Ontario M5T 2S8, Canada
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Room 1158, Toronto, Ontario M5S 1A8, Canada
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Bahk MS, Greiwe RM. What Are Practical Surgical Anatomic Landmarks and Distances from Relevant Neurologic Landmarks in Cadavers for the Posterior Approach in Shoulder Arthroplasty? Clin Orthop Relat Res 2021; 479:2323-2331. [PMID: 33938480 PMCID: PMC8445576 DOI: 10.1097/corr.0000000000001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traditional total shoulder arthroplasty is performed through the deltopectoral approach and includes subscapularis release and repair. Subscapularis nonhealing or dysfunction may leave patients with persistent pain, impairment, and instability. Alternative approaches that spare the subscapularis include rotator interval and posterior shoulder approaches; however, to our knowledge, a cadaveric study describing pertinent surgical anatomy for a posterior shoulder approach regarding shoulder arthroplasty has not been performed. QUESTIONS/PURPOSES (1) What are the distances from important neurologic structures of the shoulder for arthroplasty through a posterior approach? (2) What surgical landmarks can help identify the internervous interval between the infraspinatus and teres minor? METHODS Twelve hemitorso cadaver specimens with intact rotator cuffs were dissected to study posterior shoulder anatomy regarding posterior shoulder arthroplasty. The median (range) age of the specimens was 79 years (55 to 92). Six of the 12 specimens were right-hand dominant, and 10 specimens were male. Cadaver height was a median 171 cm (155 to 191) and weight was a median of 68 kg (59 to 125). A posterior deltoid split and internervous approach between the infraspinatus and teres minor were used. A posterior T capsulotomy was performed. The distances to important neurologic structures were measured with an electronic caliper and provided in median (range) distances in millimeters. Although not as meaningful as distance ratios accounting for a specimen's body size, neurologic distances in millimeters are surgically practical and provide intraoperative usefulness. Surgical landmarks that can help identify the infraspinatus and teres minor plane were noted. Practical visual and tactile cues between the infraspinatus and teres minor were identified. Posterior rotator cuff tendon morphologies and widths were recorded. RESULTS The closest important neurologic structure was the axillary nerve, measuring a median (range) 17 mm (9 to 19) from the inferior glenoid rim while the infraspinatus branch of the suprascapular nerve measured 21 mm (15 to 36) from the posterior glenoid rim. The axillary nerve measured 84 mm (70 to 97) from the posterior tip of the acromion in the deltoid split. Three surgical landmarks were helpful for identifying the plane between the infraspinatus and teres minor in all 12 specimens: (1) identifying the triangular teres minor tendon insertion, (2) medial palpation identifying the low point between the prominent muscle bellies of the infraspinatus and teres minor, and (3) identifying the distinct and prominent teres minor tubercle, which is well localized and palpable. CONCLUSION A major benefit of the posterior approach for shoulder arthroplasty is subscapularis preservation. Multiple practical surgical cues are consistently present and can help identify the infraspinatus and teres minor interval. We did not find the presence of fat stripes to be helpful. The suprascapular nerve is in proximity to posterior surgical dissection and differs from the deltopectoral approach. This is an important distinction from an anterior approach and requires care with dissection. Future studies are necessary to assess iatrogenic risk to the posterior rotator cuff and external rotation strength. This may entail intraoperative nerve conduction studies of the posterior rotator cuff and clinical studies assessing external rotation strength. CLINICAL RELEVANCE Studying posterior shoulder anatomy is an initial first step to assessing the feasibility of the posterior approach for anatomic shoulder arthroplasty. Additional studies assessing the degree of glenohumeral exposure and possible iatrogenic posterior rotator cuff injury are necessary. Because of the proximity of neurologic structures, it is recommended that surgeons not perform this technique until sufficient evidence indicates that it is equivalent or superior to standard anterior approach total shoulder arthroplasty. After such evidence is available, proper training will be necessary to ensure safe use of the posterior shoulder approach.
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Affiliation(s)
- Michael S. Bahk
- Southern California Orthopedic Institute, UCLA affiliate, Van Nuys, CA, USA
| | - R. Michael Greiwe
- Southern California Orthopedic Institute, UCLA affiliate, Van Nuys, CA, USA
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Carson EW. CORR Insights®: What Are Practical Surgical Anatomic Landmarks and Distances from Relevant Neurologic Landmarks in Cadavers for the Posterior Approach in Shoulder Arthroplasty? Clin Orthop Relat Res 2021; 479:2332-2333. [PMID: 34415881 PMCID: PMC8445571 DOI: 10.1097/corr.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/21/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Eric W Carson
- Professor, Department of Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
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Woodsend B, Koufoudaki E, Mossey PA, Lin P. Automatic recognition of landmarks on digital dental models. Comput Biol Med 2021; 137:104819. [PMID: 34507153 DOI: 10.1016/j.compbiomed.2021.104819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
Abstract
Fundamental principle in improving Dental and Orthodontic treatments is the ability to quantitatively assess and cross-compare their outcomes. Such assessments require calculating distances and angles from 3D coordinates of dental landmarks. The costly and repetitive task of hand-labelling dental models hinder studies requiring large sample size to penetrate statistical noise. We have developed techniques and a software implementing these techniques to map out automatically, 3D dental scans. This process is divided into consecutive steps - determining a model's orientation, separating and identifying the individual tooth and finding landmarks on each tooth - described in this paper. The examples to demonstrate the techniques, software and discussions on remaining issues are provided as well. The software is originally designed to automate Modified Huddard Bodemham (MHB) landmarking for assessing cleft lip/palate patients. Currently only MHB landmarks are supported, however it is extendable to any predetermined landmarks. The software, coupled with intra-oral scanning innovation, should supersede the arduous and error prone plaster model and calipers approach to Dental research, and provide a stepping-stone towards automation of routine clinical assessments such as "index of orthodontic treatment need" (IOTN).
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Affiliation(s)
- Brénainn Woodsend
- School of Science and Engineering, University of Dundee, Nethergate, Dundee, DD1 4HN, United Kingdom.
| | - Eirini Koufoudaki
- School of Dentistry, University of Dundee, Nethergate, Dundee, DD1 4HN, United Kingdom.
| | - Peter A Mossey
- School of Dentistry, University of Dundee, Nethergate, Dundee, DD1 4HN, United Kingdom.
| | - Ping Lin
- School of Science and Engineering, University of Dundee, Nethergate, Dundee, DD1 4HN, United Kingdom.
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梁 九, 王 小. [Individualized imaging analysis of anatomic landmarks of parapharyngeal internal carotid artery via maxillary sinus approach]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:769-773. [PMID: 34628826 PMCID: PMC10127834 DOI: 10.13201/j.issn.2096-7993.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the morphology of bone markers around the parapharyngeal internal carotid artery and its adjacent relationship. Methods:The imaging date of 30 cases which had normal structure of the skull by CTA were randomly selected. Through maxillary sinus approach, the morphology of peripheral bony landmarks (sphenoid spine, vaginal process of the tympanic bone, tympanic crest) from the parapharyngeal internal carotid artery to the entrance of the internal carotid artery and the adjacent relationship with the parapharyngeal internal carotid artery were observed for imaging anatomy. Results:With the external opening of the internal carotid artery as the reference point, the parapharyngeal internal carotid artery was divided into 10 sides (16.7%) in the direction of atlas and 6 sides(10%) in the direction of temporomandibular joint, 44 sides (73.3%) were close to midline. On 53 sides (88.3%), the morphology of sphenoid spine became triangular shape with upper width and lower width, 6 sides (10%) became irregular type with terminal bifurcation, and 1 side (1.7%) had sphenoid spine missing. The shape of the vaginal process of the tympanic bone (VPTB) was a flat, irregular polygon with a smooth surface and no loss on 60 sides (100%). The tympanic crest (TC) was a continuation of the VPTB to the sphenoid spine. It was located between the sphenoid spine and the VPTB. 51 sides (85%) of the TC and 9 sides (15%) of the TC were missing. The three constituted a special anatomical structure located in front of the internal carotid artery of the parapharyngeal segment, which can be divided into 43 inverted J-types (71.7%) and 17 irregular types (28.3%). Conclusion:The special anatomical area composed of sphenoid spine, vaginal process of the tympanic bone, tympanic crest is closely related to the parapharyngeal internal carotid artery observed by maxillary sinus approach, which is the anatomical basis for endoscopic surgery to find the parapharyngeal internal carotid artery. CTA can provide individualized surgical basis.
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Affiliation(s)
- 九思 梁
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 小路 王
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
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Abstract
Implicit in the k-means algorithm is a way to assign a value, or utility, to a cluster of points. It works by taking the centroid of the points and the value of the cluster is the sum of distances from the centroid to each point in the cluster. The aim in this paper is to introduce an alternative way to assign a value to a cluster. Motivation is provided. Moreover, whereas the k-means algorithm does not have a natural way to determine k if it is unknown, we can use our method of evaluating a cluster to find good clusters in a sequential manner. The idea uses optimizations over permutations and clusters are set by the cyclic groups; generated by the Hungarian algorithm.
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Affiliation(s)
- Alfred Kume
- Department of Mathematics, Statistics & Actuarial Science, University of Kent, Canterbury, Kent, United Kingdom
| | - Stephen G. Walker
- Department of Mathematics and Department of Statistics & Data Science, University of Texas at Austin, Austin, Texas, United States of America
- * E-mail:
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Omer SO, Alhabshan FM, Jijeh AMZ, Caimbon NC, Enriquez CC, Männer J, Yelbuz TM. Is Transposition of the Great Arteries Associated With Shortening of the Intrapericardial Portions of the Great Arterial Trunks? An Echocardiographic Analysis on Newborn Infants With Simple Transposition of the Great Arteries to Explore an Animal Model-Based Hypothesis on Human Beings. J Am Heart Assoc 2021; 10:e019334. [PMID: 34278802 PMCID: PMC8475693 DOI: 10.1161/jaha.120.019334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; P<0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; P<0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.
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Affiliation(s)
- Seham O. Omer
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Fahad M. Alhabshan
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Abdulraouf M. Z. Jijeh
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Natalia C. Caimbon
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Carmelita C. Enriquez
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Jörg Männer
- Institute for Anatomy and EmbryologyUMGGeorg‐August‐University of GöttingenGöttingenGermany
| | - Talat Mesud Yelbuz
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
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Fitoussi A, Tacher V, Pigneur F, Heranney J, Sawan D, Dao TH, Hersant B, Meningaud JP, Bosc R. Augmented reality-assisted deep inferior epigastric artery perforator flap harvesting. J Plast Reconstr Aesthet Surg 2021; 74:1931-1971. [PMID: 33985928 DOI: 10.1016/j.bjps.2021.03.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Alexandre Fitoussi
- Medical Imaging department, Henri Mondor Hospital, 51, Avenue du Marechal Lattre de Tassigny, 94000 Creteil, France.
| | - Vania Tacher
- Medical Imaging department, Henri Mondor Hospital, 51, Avenue du Marechal Lattre de Tassigny, 94000 Creteil, France
| | - Frederic Pigneur
- Medical Imaging department, Henri Mondor Hospital, 51, Avenue du Marechal Lattre de Tassigny, 94000 Creteil, France
| | - Julie Heranney
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Dana Sawan
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Thu Ha Dao
- Medical Imaging department, Henri Mondor Hospital, 51, Avenue du Marechal Lattre de Tassigny, 94000 Creteil, France; Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Barbara Hersant
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France; Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Jean-Paul Meningaud
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Romain Bosc
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France; Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France; INSERM Team U955-E10, Biology of the NeuroMuscular System, Paris East University, 94000 Créteil, France
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Dion V, Sabhaney V, Ahn JS, Erdelyi S, Kim DJ. The physical examination is unreliable in determining the location of the distal fibular physis. Am J Emerg Med 2021; 50:97-101. [PMID: 34325216 DOI: 10.1016/j.ajem.2021.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Salter-Harris type 1 (SH1) fractures of the distal fibula are acute orthopedic injuries with tenderness over the physis without radiographic evidence of fracture. Our primary objective was to establish the accuracy of the physical examination performed by pediatric emergency medicine (PEM) physicians in determining the location of the distal fibular physis compared to a criterion standard of ultrasound. METHODS This was a prospective, observational study at an urban academic pediatric emergency department of a convenience sample of children aged 4 to 10 years old between March 2019 and March 2020. A PEM physician or fellow examined the patient's distal fibula and marked the location of the physis with a marker. A study investigator scanned the distal fibula to establish the location of the physis on ultrasound and measured the distance between the clinician's estimated position and the actual sonographic position. We a priori defined a clinically accurate position as a distance of ≤5 mm. We compared the accuracy rate of physical examination to ultrasound landmarking using proportions with 95% confidence intervals (CI). RESULTS We enrolled 71 patients, of whom 52 (73%) were male. The mean age was 6.7 years and the mean weight was 25.5 kg. Participating PEM physicians included 18 attending physicians and 2 fellows. The distal fibular physis was correctly identified in 24 patients, yielding an accuracy rate of 34% (95% CI 23%-46%). The mean distance between the physician's estimated position and the sonographic position was 7.4 mm (95% CI 6.4-8.4 mm). CONCLUSIONS PEM physicians were unable to accurately identify the distal fibular physis on physical examination.
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Affiliation(s)
- Véronique Dion
- Department of Emergency Medicine, Laval University, Quebec City, Quebec, Canada
| | - Vikram Sabhaney
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin S Ahn
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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Houlton TM, Jooste N, Steyn M. Testing regression and mean model approaches to facial soft-tissue thickness estimation. Med Sci Law 2021; 61:170-179. [PMID: 33251942 DOI: 10.1177/0025802420977018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Average facial soft-tissue thickness (FSTT) databanks are continuously developed and applied within craniofacial identification. This study considered and tested a subject-specific regression model alternative for estimating the FSTT values for oral midline landmarks using skeletal projection measurements. Measurements were taken from cone-beam computed tomography scans of 100 South African individuals (60 male, 40 female; Mage = 35 years). Regression equations incorporating sex categories were generated. This significantly improved the goodness-of-fit (r2-value). Validation tests compared the constructed regression models with mean FSTT data collected from this study, existing South African FSTT data, a universal total weighted mean approach with pooled demographic data and collection techniques and a regression model approach that uses bizygomatic width and maximum cranial breadth dimensions. The generated regression equations demonstrated individualised results, presenting a total mean inaccuracy (TMI) of 1.53 mm using dental projection measurements and 1.55 mm using cemento-enamel junction projection measurements. These slightly outperformed most tested mean models (TMI ranged from 1.42 to 4.43 mm), and substantially outperformed the pre-existing regression model approach (TMI = 5.12 mm). The newly devised regressions offer a subject-specific solution to FSTT estimation within a South African population. A continued development in sample size and validation testing may help substantiate its application within craniofacial identification.
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Affiliation(s)
- Tobias Mr Houlton
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Nicolene Jooste
- Department of Human Anatomy and Physiology, University of Johannesburg, Doornfontein, South Africa
| | - Maryna Steyn
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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