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Kontio R, Wilkman T, Mesimäki K, Chepurnyi Y, Asikainen A, Haapanen A, Poutala A, Mikkonen M, Slobodianiuk A, Kopchak A. Automated 3-D Computer-Aided Measurement of the Bony Orbit: Evaluation of Correlations among Volume, Depth, and Surface Area. J Pers Med 2024; 14:508. [PMID: 38793092 PMCID: PMC11122174 DOI: 10.3390/jpm14050508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
(1)The study aimed to measure the depth, volume, and surface area of the intact human orbit by applying an automated method of CT segmentation and to evaluate correlations among depth, volume, and surface area. Additionally, the relative increases in volume and surface area in proportion to the diagonal of the orbit were assessed. (2) CT data from 174 patients were analyzed. A ball-shaped mesh consisting of tetrahedral elements was inserted inside orbits until it encountered the bony boundaries. Orbital volume, area depth, and their correlations were measured. For the validation, an ICC was used. (3) The differences between genders were significant (p < 10-7) but there were no differences between sides. When comparing orbit from larger to smaller, a paired sample t-test indicated a significant difference in groups (p < 10-10). A simple linear model (Volume~1 + Gender + Depth + Gender:Depth) revealed that only depth had a significant effect on volume (p < 10-19). The ICCs were 1.0. (4) Orbital volume, depth, and surface area measurements based on an automated CT segmentation algorithm demonstrated high repeatability and reliability. Male orbits were always larger on average by 14%. There were no differences between the sides. The volume and surface area ratio did not differ between genders and was approximately 0.75.
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Affiliation(s)
- Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
- Institute of Oral and Maxillofacial Diseases, Helsinki University, 00014 Helsinki, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Yurii Chepurnyi
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
| | - Antti Asikainen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Arto Poutala
- Disior, Maria 01, Building 2, Lapinlahdenkatu 16, 00180 Helsinki, Finland; (A.P.); (M.M.)
| | - Marko Mikkonen
- Disior, Maria 01, Building 2, Lapinlahdenkatu 16, 00180 Helsinki, Finland; (A.P.); (M.M.)
| | - Alina Slobodianiuk
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
| | - Andrii Kopchak
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
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Smadar L, Arazi M, Greenberg G, Haviv L, Benifla O, Zabatani A, Fabian I, Dagan M, Gutovitz JM, Ben Simon GJ, Landau-Prat D. Semiautomated MRI-Based Method for Orbital Volume and Contour Analysis. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00370. [PMID: 38534059 DOI: 10.1097/iop.0000000000002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The architecture of the orbital cavity is intricate, and precise measurement of its growth is essential for managing ocular and orbital pathologies. Most methods for those measurements are by CT imaging, although MRI for soft tissue assessment is indicated in many cases, specifically pediatric patients. This study introduces a novel semiautomated MRI-based approach for depicting orbital shape and dimensions. DESIGN A retrospective cohort study. PARTICIPANTS Patients with at least 1 normal orbit who underwent both CT and MRI imaging at a single center from 2015 to 2023. METHODS Orbital dimensions included volume, horizontal and vertical lengths, and depth. These were determined by manual segmentation followed by 3-dimensional image processing software. MAIN OUTCOME MEASURES Differences in orbital measurements between MRI and CT scans. RESULTS Thirty-one patients (mean age 47.7 ± 23.8 years, 21 [67.7%]) females, were included. The mean differences in delta values between orbital measurements on CT versus MRI were: volume 0.03 ± 2.01 ml, horizontal length 0.53 ± 2.12 mm, vertical length, 0.36 ± 2.53 mm, and depth 0.97 ± 3.90 mm. The CT and. MRI orbital measurements were strongly correlated: volume (r = 0.92, p < 0.001), horizontal length (r = 0.65, p < 0.001), vertical length (r = 0.57, p = 0.001), and depth (r = 0.46, p = 0.009). The mean values of all measurements were similar on the paired-samples t test: p = 0.9 for volume (30.86 ± 5.04 ml on CT and 30.88 ± 4.92 ml on MRI), p = 0.2 for horizontal length, p = 0.4 for vertical length, and p = 0.2 for depth. CONCLUSIONS We present an innovative semiautomated method capable of calculating orbital volume and demonstrating orbital contour by MRI validated against the gold standard CT-based measurements. This method can serve as a valuable tool for evaluating diverse orbital processes.
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Affiliation(s)
- Lital Smadar
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
| | - Mattan Arazi
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
| | - Gahl Greenberg
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
- Department of Diagnostic Imaging, Section of Neuroradiology, Sheba Medical Center, Ramat Gan
| | - Limor Haviv
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
- PlanNet - The Sheba 3D Lab, Sheba Medical Center
| | - Or Benifla
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
- PlanNet - The Sheba 3D Lab, Sheba Medical Center
| | - Amit Zabatani
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
- Department of Orthopedics, Sheba Medical Center
- The Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer
| | - Ina Fabian
- Department of Cell and Developmental Biology, School of Medicine, Tel Aviv University, Tel Aviv
| | - Mayan Dagan
- Adelson school of medicine, Ariel University, Ariel, Israel
| | - Joel M Gutovitz
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
| | - Guy J Ben Simon
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
- The Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer
| | - Daphna Landau-Prat
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv
- The Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer
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Sigron GR, Britschgi CL, Gahl B, Thieringer FM. Insights into Orbital Symmetry: A Comprehensive Retrospective Study of 372 Computed Tomography Scans. J Clin Med 2024; 13:1041. [PMID: 38398354 PMCID: PMC10889405 DOI: 10.3390/jcm13041041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The operation planning and production of individualized implants with the help of AI-based software after orbital fractures have become increasingly important in recent years. This retrospective study aimed to investigate the healthy orbitae of 372 patients from CT images in the bone and soft tissue windows using the Disior™ Bonelogic™ CMF Orbital software. (version 2.1.28). Methods: We analyzed the variables orbital volume, length, and area as a function of age and gender and compared bone and soft tissue windows. Results: For all variables, the intraclass correlation showed excellent agreement between the bone and soft tissue windows (p < 0.001). All variables showed higher values when calculated based on bone fenestration with, on average, 1 mL more volume, 0.35 mm more length, and 0.71 cm2 more area (p < 0.001). Across all age groups, men displayed higher values than women with, on average, 8.1 mL larger volume, a 4.78 mm longer orbit, and an 8.5 cm2 larger orbital area (p < 0.001). There was also a non-significant trend in all variables and both sexes toward growth with increasing age. Conclusions: These results mean that, due to the symmetry of the orbits in both the bone and soft tissue windows, the healthy orbit can be mirrored for surgical planning in the event of a fracture.
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Affiliation(s)
- Guido R. Sigron
- Department of Oral and Cranio-Maxillofacial Surgery and 3D Print Lab, University Hospital Basel, CH-4031 Basel, Switzerland; (C.L.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Céline L. Britschgi
- Department of Oral and Cranio-Maxillofacial Surgery and 3D Print Lab, University Hospital Basel, CH-4031 Basel, Switzerland; (C.L.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Brigitta Gahl
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland;
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery and 3D Print Lab, University Hospital Basel, CH-4031 Basel, Switzerland; (C.L.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
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Clinical application of automated virtual orbital reconstruction for orbital fracture management with patient-specific implants: A prospective comparative study. J Craniomaxillofac Surg 2022; 50:686-691. [DOI: 10.1016/j.jcms.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
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Hierl KV, Krause M, Kruber D, Sterker I. 3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex. PLoS One 2022; 17:e0265324. [PMID: 35275980 PMCID: PMC8916626 DOI: 10.1371/journal.pone.0265324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.
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Affiliation(s)
| | - Matthias Krause
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Daniel Kruber
- Department of Informatics and Media, Leipzig University of Applied Sciences, Leipzig, Germany
| | - Ina Sterker
- Department of Ophthalmology, Leipzig University, Leipzig, Germany
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Hamwood J, Schmutz B, Collins MJ, Allenby MC, Alonso-Caneiro D. A deep learning method for automatic segmentation of the bony orbit in MRI and CT images. Sci Rep 2021; 11:13693. [PMID: 34211081 PMCID: PMC8249400 DOI: 10.1038/s41598-021-93227-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/15/2021] [Indexed: 12/23/2022] Open
Abstract
This paper proposes a fully automatic method to segment the inner boundary of the bony orbit in two different image modalities: magnetic resonance imaging (MRI) and computed tomography (CT). The method, based on a deep learning architecture, uses two fully convolutional neural networks in series followed by a graph-search method to generate a boundary for the orbit. When compared to human performance for segmentation of both CT and MRI data, the proposed method achieves high Dice coefficients on both orbit and background, with scores of 0.813 and 0.975 in CT images and 0.930 and 0.995 in MRI images, showing a high degree of agreement with a manual segmentation by a human expert. Given the volumetric characteristics of these imaging modalities and the complexity and time-consuming nature of the segmentation of the orbital region in the human skull, it is often impractical to manually segment these images. Thus, the proposed method provides a valid clinical and research tool that performs similarly to the human observer.
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Affiliation(s)
- Jared Hamwood
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia
| | - Beat Schmutz
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
- Metro North Hospital and Health Service, Jamieson Trauma Institute, Herston, QLD, 4029, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia
| | - Mark C Allenby
- Biofabrication and Tissue Morphology Laboratory, Centre for Biomedical Technologies, School of Mechanical Medical and Process Engineering, Queensland University of Technology (QUT), Herston, Qld, 4000, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia.
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Three-Dimensional Computer-Aided Analysis of 293 Isolated Blowout Fractures - Which Radiological Findings Guide Treatment Decision? J Oral Maxillofac Surg 2021; 79:2306-2318. [PMID: 34339620 DOI: 10.1016/j.joms.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Our study purpose was to clarify the extent of isolated unilateral orbital blowout fracture in relation to surgical treatment and other factors behind the treatment decision. The specific aim was to determine which computer-aided measurements based on radiological images associate with treatment choice. METHODS A retrospective cohort study was implemented on patients with an isolated unilateral orbital blowout fracture. Computer-aided measurement of fracture extent was performed. The study variables included treatment as primary outcome (surgical vs nonsurgical), post-traumatic orbital volume difference (mL) compared to contralateral orbit, fracture area (mm2), fracture depth (mm) as predictor variables, and age, sex, injury mechanism, side and site of orbital fracture and positions of recti muscles as explanatory variables. Postoperative outcomes were reported. Logistic regression analysis was used to determine the risk factors for surgery. The statistical significance level was set at P < .05. RESULTS Of 293 patients, 28.0% received surgical and 72.0% nonsurgical treatment. Volume difference, fracture area and fracture depth predicted surgical outcome (P < .001). In adjusted univariate regression analyses, fractures with moderate and severe displacement of recti muscles were more likely to receive surgical treatment than fractures with mild or no displacement (OR 6.15 and 30.75, respectively, P < .001). Isolated medial wall fractures were significantly less often (OR 0.05, P = .006) and patients with older age (OR 0.97, P = .013) slightly less often treated with surgery. Patients with preoperative symptoms had more often persisting postoperative symptoms than patients without preoperative symptoms. CONCLUSIONS Positions of the recti muscles are an independent radiological factor guiding orbital blowout fracture treatment decision. The bony fracture extent is a combination of volume difference, fracture area and fracture depth which are strongly correlated to each other. A computer-aided method significantly facilitates the systematic evaluation of bone fragments, and the extent of orbital fractures.
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Management of Pediatric Orbital Fractures. J Craniofac Surg 2021; 32:224-227. [PMID: 33273204 DOI: 10.1097/scs.0000000000006915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Although uncommon in children, orbital fractures can be devastating to both vision and appearance. Due to the scarce information in the literature, the authors here present our experience and management with all pediatric orbital fracture patients. MATERIAL AND METHODS A 6-years retrospective study was conducted on pediatric patients presented with orbital wall fracture (OFx). All patients (n = 43) were grouped for comparison based on the treatment method. The cohorts were analyzed for demographics data, location of fracture, type of material used for reconstruction, complication rate and follow up length. Data was analyzed utilizing SPSS for χ2 test. RESULTS The majority of patients were male (86%) and the mean age of patients was 12.09 ± 4 years. Mean follow-up time was 237 ± 72 days. Most of Patients 31 (72%) underwent surgical intervention. A higher rate of complications was observed in the surgically treated group (32%) compared to the conservative group (8%) regardless to the defect size. Subgroup analysis of the surgery treated group revealed that large size defect had inferior outcome compared to small size defect. CONCLUSION The consequences of treatment on long-term growth and development must be a cornerstone when choosing the optimal therapeutic method. Conservative management should be considered first in the absence of significant clinical pathologies. In addition, when surgery is indicated the least invasive procedure should be applied. The use of autogenous bone graft is preferable over alloplastic materials, however, when there is insufficient bone quantity the use of alloplastic materials is not contraindicated for reconstruction.
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Bander ED, Tizi K, Wembacher-Schroeder E, Thomson R, Donzelli M, Vasconcellos E, Souweidane MM. Deformational changes after convection-enhanced delivery in the pediatric brainstem. Neurosurg Focus 2021; 48:E3. [PMID: 31896089 DOI: 10.3171/2019.10.focus19679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/07/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the brainstem, there are concerns regarding volumetric alterations following convection-enhanced delivery (CED). The relationship between distribution volume and infusion volume is predictably greater than one. Whether this translates into deformational changes and influences clinical management is unknown. As part of a trial using CED for diffuse intrinsic pontine glioma (DIPG), the authors measured treatment-related volumetric alterations in the brainstem and ventricles. METHODS Enrolled patients underwent a single infusion of radioimmunotherapy. Between 2012 and 2019, 23 patients with volumetric pre- and postoperative day 1 (POD1) and day 30 (POD30) MRI scans were analyzed using iPlan® Flow software for semiautomated volumetric measurements of the ventricles and pontine segment of the brainstem. RESULTS Children in the study had a mean age of 7.7 years (range 2-18 years). The mean infusion volume was 3.9 ± 1.7 ml (range 0.8-8.8 ml). Paired t-tests demonstrated a significant increase in pontine volume immediately following infusion (p < 0.0001), which trended back toward baseline by POD30 (p = 0.046; preoperative 27.6 ± 8.4 ml, POD1 30.2 ± 9.0 ml, POD30 29.5 ± 9.4 ml). Lateral ventricle volume increased (p = 0.02) and remained elevated on POD30 (p = 0.04; preoperative 23.5 ± 15.4 ml, POD1 26.3 ± 16.0, POD30 28.6 ± 21.2). Infusion volume had a weak, positive correlation with pontine and lateral ventricle volume change (r2 = 0.22 and 0.27, respectively). Four of the 23 patients had an increase in preoperative neurological deficits at POD30. No patients required shunt placement within 90 days. CONCLUSIONS CED infusion into the brainstem correlates with immediate but self-limited deformation changes in the pons. The persistence of increased ventricular volume and no need for CSF diversion post-CED are inconsistent with obstructive hydrocephalus. Defining the degree and time course of these deformational changes can assist in the interpretation of neuroimaging along the DIPG disease continuum when CED is incorporated into the treatment algorithm.
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Affiliation(s)
- Evan D Bander
- 1Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York.,2Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karima Tizi
- 3Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland; and
| | | | | | - Maria Donzelli
- 2Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Mark M Souweidane
- 1Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York.,2Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Zeller AN, Neuhaus MT, Gessler N, Skade S, Korn P, Jehn P, Gellrich NC, Zimmerer RM. Self-centering second-generation patient-specific functionalized implants for deep orbital reconstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:372-380. [PMID: 33385579 DOI: 10.1016/j.jormas.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Deep and complete reconstruction of the orbital cavity has been shown to be essential for preventing enophthalmos and hypoglobus in patients with orbital defects or deformities. Additively manufactured patient-specific titanium implants provide unlimited options in design. However, implant malpositioning can still occur, even when intraoperative imaging and navigation are used. In this study, we investigated novel orbital implants containing features facilitating self-centering. Accuracy of implant placement and reconstruction of the orbital dimensions were compared retrospectively between self-centering second-generation patient-specific functionalized orbital implants (study group) and CAD-based individualized implants (control group). Design features of implants in the study group included functionalization with navigation tracks, a preventive design, and flanges - so called stabilizers - towards opposite orbital walls. Implant position was evaluated by fusion of preoperative virtual plans and the post-therapeutic imaging. Aberrances were quantified by 3D heatmap analysis. 31 patients were assigned to the study group and 50 to the control group, respectively. In the study group, most implants were designed with either one (n = 18, 58.06%) or two (n = 10, 32.26%) stabilizers. Twice (6.45%), one stabilizer had to be shortened intraoperatively. Implant fit analysis revealed a significantly more precise (p < 0.001) positioning in the study group (n = 22/31) than in the control group (n = 42/50). Self-centering second-generation patient-specific functionalized orbital implants showed significantly more accurate implant positioning, facilitating the transformation of virtual plans into patient's anatomy. The presented design provides an additional instrument for intraoperative quality control besides intraoperative imaging and navigation.
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Affiliation(s)
| | - Michael Tobias Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nora Gessler
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Sandra Skade
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Rüdiger M Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
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Schreurs R, Klop C, Maal TJJ. Advanced Diagnostics and Three-dimensional Virtual Surgical Planning in Orbital Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:79-96. [PMID: 33516541 DOI: 10.1016/j.cxom.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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12
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Essig H, Wagner MEH, Blumer M. Secondary Corrections of the Orbit: Solitary Fractures. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:129-137. [PMID: 33516534 DOI: 10.1016/j.cxom.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Harald Essig
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, UniversitätsSpital Zürich, Frauenklinikstrasse 24, Zürich 8091, Switzerland.
| | | | - Michael Blumer
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, UniversitätsSpital Zürich, Frauenklinikstrasse 24, Zürich 8091, Switzerland
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Morphometric and Volumetric Measurements of Orbit With Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2020; 79:652-664. [PMID: 33197416 DOI: 10.1016/j.joms.2020.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to determine cone-beam computed tomography (CBCT) as a tool for measuring morphometric and volumetric measurements of the orbit. Also, to assess gender and age variations and compare traditional methods of measurements in dry-skull, cadaveric, and other imaging modalities. PATIENTS AND METHODS Morphometric and volumetric values of 98 orbits (49 subjects, 21 men/28 women) were measured using CBCT. Their mean and standard deviation were measured and analyzed. The gender and age variability older and younger than 40 years were evaluated. They were compared with other dry-skull and imaging studies done among different populations. RESULTS CBCT could accurately measure the various morphometric and volumetric parameters of the orbit. From the reference point infraorbital foramen (I) to lacrimal fossa (F1), inferior orbital fissure (F2), inferior orbital rim (F3), and the optic canal (F4) were (in mm) (mean ± SD) 22.88 ± 1.08, 32.53 ± 0.88, 7.44 ± 0.71, and 51.45 ± 1.28, respectively. From the reference point, superior orbital notch/foramen (S) to superior orbital fissure (S1), lacrimal fossa (S2), and the optic canal (S3) were 49.29 ± 2.1, 26.39 ± 1.58, and 46.82 ± 0.88, respectively. From the reference point frontozygomatic suture (L) to lacrimal fossa (L1), superior orbital fissure (L2), the optic canal (L3), and inferior orbital fissure (L4) were 18.19 ± 0.88, 39.91 ± 1.44, 47.63 ± 1.11, and 35.19 ± 1.02, respectively. Orbital volume was found to show a significant difference between older and younger than 40 years of age, though not significant compared between men and women. CONCLUSION CBCT is a viable tool for morphometric and volumetric measurements of the orbit and other orocraniofacial structures. It can also assess age and gender variability. The low cost, high accuracy, low radiation, and ease of use can help in reproducibility among the different living populations.
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Kuster I, Osterwalder L, Valdec S, Stadlinger B, Wagner MEH, Rücker M, Bichsel D. Autogenous bone augmentation from the zygomatic alveolar crest: a volumetric retrospective analysis in the maxilla. Int J Implant Dent 2020; 6:59. [PMID: 33057980 PMCID: PMC7560644 DOI: 10.1186/s40729-020-00258-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autogenous bone augmentation is the gold standard for the treatment of extended bone defects prior to implantation. Bone augmentation from the zygomatic crest is a valuable option with several advantages, but the current literature for this treatment is scant. The aim of this study was to evaluate the increase in bone volume after locoregional bone augmentation using autogenous bone from the zygomatic alveolar crest as well as the complications and success rate. RESULTS Analysis of the augmented bone volume in seven patients showed a maximum volume gain of 0.97 cm3. An average of 0.54 cm3 of autogenous bone (SD 0.24 cm3; median: 0.54 cm3) was augmented. Implantation following bone augmentation was possible in all cases. Complications occurred in three patients. CONCLUSION The zygomatic alveolar crest is a valuable donor site for autogenous alveolar onlay grafting in a locoregional area such as the maxillary front. Low donor site morbidity, good access, and its suitable convexity make it a beneficial choice for autogenous bone augmentation.
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Affiliation(s)
- Irina Kuster
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Livia Osterwalder
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Maximilian E H Wagner
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.,Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Dominique Bichsel
- Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
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Cornelius CP, Stiebler T, Mayer P, Smolka W, Kunz C, Hammer B, Jaquiéry C C, Buitrago-Téllez C, Leiggener CS, Metzger MC, Wilde F, Audigé L, Probst M, Strong EB, Castelletti N, Prein J, Probst FA. Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions. J Craniomaxillofac Surg 2020; 49:598-612. [PMID: 34020871 DOI: 10.1016/j.jcms.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/09/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification. MATERIAL AND METHODS CT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the "defect body" method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis. RESULTS A total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures - W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm2 to 6.09 cm2 for orbital floor and from 0.29 cm2 to 5.43 cm2 for medial wall fractures. The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm2, W2(i) = 1.64 cm2, W1(i)2(i) = 3.10 cm2, W1(m) = 1.36 cm2, W2(m) = 1.65 cm2, W1(m)2(m) = 2.98 cm2, W1 (im) = 3.35 cm2, W1 (im) 2(i) = 4.63 cm2, W1 (im)2(m) = 4.06 cm2 and W1 (im)2 (im) = 7.16 cm2. CONCLUSION The AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.
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Affiliation(s)
- Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Tobias Stiebler
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Peter Mayer
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Christoph Kunz
- Clinic for Craniomaxillofacial and Oral Surgery, University Hospital, Basel, Switzerland
| | - Beat Hammer
- Craniofacial Center (CFC) Hirslanden Medical Center Aarau, Switzerland
| | - Claude Jaquiéry C
- Clinic for Craniomaxillofacial and Oral Surgery, University Hospital, Basel, Switzerland
| | | | | | - Marc Christian Metzger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Germany
| | - Frank Wilde
- Department of Oral and Plastic Maxillofacial Surgery, Armed Forces Hospital and University Hospital Ulm, Germany
| | - Laurent Audigé
- Statistical Research and Development, Schulthess Clinic, Upper Extremities, Zürich, Switzerland
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Medical School Munich, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Noemi Castelletti
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-University, Munich, Germany
| | - Joachim Prein
- Clinic for Craniomaxillofacial and Oral Surgery, University Hospital, Basel, Switzerland
| | - Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany.
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Chepurnyi Y, Chernohorskyi D, Prykhodko D, Poutala A, Kopchak A. Reliability of orbital volume measurements based on computed tomography segmentation: Validation of different algorithms in orbital trauma patients. J Craniomaxillofac Surg 2020; 48:574-581. [PMID: 32291132 DOI: 10.1016/j.jcms.2020.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/08/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To compare the most common methods of segmentation for evaluation of the bony orbit in orbital trauma patients. MATERIALS AND METHODS Computed tomography scans (before and after treatment) from 15 patients with unilateral blowout fractures and who underwent orbital reconstructions were randomly selected for this study. Orbital volume measurements, volume difference measurements, prolapsed soft tissue volumes, and bony defect areas were made using manual, semi-automated, and automated segmentation methods. RESULTS Volume difference values between intact and damaged orbits after surgery using the manual mode were 0.5 ± 0.3 cm3, 0.5 ± 0.4 cm3 applying semi-automated method, and 0.76 ± 0.5 cm3, determined by automated segmentation (р = 0.216); the mean volumes (MVs) for prolapsed tissues were 3.0 ± 1.9 cm3, 3.0 ± 2.3 cm3, and 2.8 ± 3.9 cm3 (p = 0.152); and orbital wall defect areas were 4.7 ± 2.8 cm2, 4.75 ± 3.1 cm2, and 4.9 ± 3.3 cm2 (p = 0.674), respectively. CONCLUSIONS The analyzed segmentation methods had the same accuracy in evaluation of volume differences between two orbits of the same patient, defect areas, and prolapsed soft tissue volumes but not in absolute values of the orbital volume due to the existing diversity in determination of anterior closing. The automated method is recommended for common clinical cases, as it is less time-consuming with high precision and reproducibility.
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Affiliation(s)
- Yurii Chepurnyi
- Department of Stomatology, Bogomolets National Medical University, T. Shevchenko Blvd., 13, 01601, Kyiv, Ukraine.
| | - Denys Chernohorskyi
- Department of Stomatology, Bogomolets National Medical University, T. Shevchenko Blvd., 13, 01601, Kyiv, Ukraine
| | - Danylo Prykhodko
- "Imatek Medical (Co "), Prosp, Peremogy, 123, 03179, Kyiv, Ukraine
| | - Arto Poutala
- "Disior Ltd", FI27875878, Terkko Health Hub, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Andriy Kopchak
- Department of Stomatology, Bogomolets National Medical University, T. Shevchenko Blvd., 13, 01601, Kyiv, Ukraine
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Gomes de Oliveira P, Perry da Câmara C, Valejo Coelho P. Intra- and interreader variability of orbital volume quantification using 3D computed tomography for reconstructed orbital fractures. J Craniomaxillofac Surg 2019; 47:1060-1064. [DOI: 10.1016/j.jcms.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/26/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022] Open
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Kim H, Son TG, Lee J, Kim HA, Cho H, Jeong WS, Choi JW, Kim Y. Three-dimensional orbital wall modeling using paranasal sinus segmentation. J Craniomaxillofac Surg 2019; 47:959-967. [PMID: 31027858 DOI: 10.1016/j.jcms.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/11/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Three-dimensional orbital wall modeling is a time-consuming process because of the presence of pseudoforamina. We developed an automated three-dimensional modeling software to characterize the orbital wall, and evaluated it using data from fracture patients. METHODS We first characterized the air and face regions using multiphase segmentation; the sinuses were segmented by applying morphological operations to air regions. Pseudoforamina of the orbital wall were offset with the segmented sinuses. Finally, the three-dimensional facial bone model, with orbital wall, was reconstructed from the segmented images. RESULTS Ten computed tomography data sets were used to evaluate the proposed method. Results were compared with those obtained using the active contour model and manual segmentation. The process took 31.7 ± 8.0 s, which was 30-60 times faster than other methods. The average distances between surfaces obtained with the proposed method and those obtained with manual segmentation (normal side: 0.20 ± 0.06 mm; fractured side: 0.28 ± 0.10 mm) were approximately half those obtained using the active contour model. CONCLUSIONS Three-dimensional orbital wall models, which were very similar to the manually segmented models, were archived within 1 min using the developed software, regardless of fracture presence. The proposed method might improve the safety and accuracy of surgical procedures.
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Affiliation(s)
- Hannah Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Seoul, Republic of Korea.
| | - Tae-Geun Son
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Jeonghwan Lee
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Hyeun A Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Hyunchul Cho
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Biomedical Engineering Research Center, Asan Medical Center, Seoul, Republic of Korea.
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Seoul, Republic of Korea.
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[Reconstructive orbital surgery]. HNO 2018; 66:827-833. [PMID: 30327822 DOI: 10.1007/s00106-018-0568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND In complex orbital reconstructions ideal positioning of the bony buttress and surrounding soft tissue is a prerequisite for an aesthetic and functional result. The use of computer-assisted surgery can support the surgeon before and during the reconstruction procedure and facilitate quality control processes. This is illustrated using three clinical examples. MATERIAL AND METHODS The areas of interest (bony defect areas, surrounding tissues) are segmented in a 3D image series. In most cases, the contralateral non-affected side can serve as the reference in virtual reconstruction. The virtual model obtained can now be used for the manufacturing of patient specific models and implants, as well as for intraoperative navigation or direct quality control with the use of intraoperative cone beam computed tomography (CBCT). RESULTS For the reconstruction of primary and secondary traumatic defects as well as for congenital malformations or neoplastic diseases, the presented workflow can be used. Preoperative virtual visualization, patient specific reconstruction and direct quality control using intraoperative CBCT ensure that the preoperatively planned result can be achieved. Together with the interplay of hard and soft tissue the best possible results can be achieved. CONCLUSION Computer-assisted surgery has been continuously further developed over the last two decades and is currently used in the clinical routine. Patient specific implants in combination with the use of direct intraoperative quality control facilitate the reconstruction of complex orbital injuries and defects and enable the ideal reconstruction from both aesthetic and functional aspects.
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Gribova MN, Pluijmers BI, Resnick CM, Caron CJJM, Borghi A, Koudstaal MJ, Padwa BL. Is There a Difference in Orbital Volume Between Affected and Unaffected Sides in Patients With Unilateral Craniofacial Microsomia? J Oral Maxillofac Surg 2018; 76:2625-2629. [PMID: 29859949 DOI: 10.1016/j.joms.2018.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Craniofacial microsomia (CFM) is characterized by malformations of structures derived from the first and second pharyngeal arches. The orbit is variably affected. The purpose of this study was to determine whether there is a difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. The specific aims were to 1) measure orbital volume, 2) compare affected and unaffected sides, 3) evaluate the correlation between clinical evaluation of orbital size and volumetric measurement, and 4) determine whether there is a correlation between orbital volume and severity of mandibular deformity. MATERIALS AND METHODS This study is a retrospective case series of patients with unilateral CFM from Boston Children's Hospital (Boston, MA) who had a computed tomographic (CT) scan. Manual segmentation of the orbit using Mimics software (Materialise, Leuven, Belgium) was performed on CT images of the 2 orbits. The predictor variable was laterality (affected vs unaffected side) and the primary outcome variable was orbital volume. Wilcoxon signed rank test was used to compare these measurements and determine whether the affected side differed from the unaffected side. The correlation between orbital volume and Pruzansky-Kaban type of mandibular deformity, as documented in the medical record, was determined using the Spearman rank correlation coefficient. RESULTS Thirty-nine patients were included. Orbital volume was 10% smaller on the affected side (P = .001) in 80% of patients. There was no correlation between orbital size and severity of mandibular involvement. CONCLUSION The results of this study showed a marked difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. These differences were small and might not be clinically relevant. Orbital volume did not correlate with severity of mandibular deformity.
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Affiliation(s)
- Maria N Gribova
- Medical Student, Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Rotterdam, The Netherlands; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
| | - Britt I Pluijmers
- Attending Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Cory M Resnick
- Resident, Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Rotterdam, The Netherlands
| | - Cornelia J J M Caron
- Resident, Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Rotterdam, The Netherlands
| | - Alessandro Borghi
- Senior Research Associate, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maarten J Koudstaal
- Attending Surgeon and Associate Professor, Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Rotterdam, The Netherlands; Associate Professor, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Associate Professor, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Bonnie L Padwa
- Oral Surgeon-in-Chief and Associate Professor, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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Nilsson J, Nysjö J, Carlsson AP, Thor A. Comparison analysis of orbital shape and volume in unilateral fractured orbits. J Craniomaxillofac Surg 2018; 46:381-387. [DOI: 10.1016/j.jcms.2017.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 11/07/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022] Open
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Virtual reconstruction of midface defects using statistical shape models. J Craniomaxillofac Surg 2017; 45:461-466. [DOI: 10.1016/j.jcms.2016.12.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 11/22/2016] [Accepted: 12/20/2016] [Indexed: 11/21/2022] Open
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Cone-beam computed tomography of the orbit and optic canal volumes. J Craniomaxillofac Surg 2016; 44:1342-9. [DOI: 10.1016/j.jcms.2016.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/25/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022] Open
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