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Rashid A, Feinberg L, Fan K. The Application of Cone Beam Computed Tomography (CBCT) on the Diagnosis and Management of Maxillofacial Trauma. Diagnostics (Basel) 2024; 14:373. [PMID: 38396412 PMCID: PMC10888223 DOI: 10.3390/diagnostics14040373] [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: 01/03/2024] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
The assessment and management of facial trauma in an acute setting is one of the core services provided by oral and maxillofacial units in the United Kingdom. Imaging is a pre-requisite for appropriate diagnosis and treatment planning, with a combination of plain radiographs and medical-grade CT being the mainstay. However, the emergence of cone beam CT in recent years has led to its wider applications, including facial trauma assessment. It can offer multi-planar reformats and three-dimensional reconstruction at a much lower radiation dose and financial cost than conventional CT. The purpose of this review is to appraise its potential indications in all anatomical areas of maxillofacial trauma and provide our experience at a level 1 trauma centre.
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Affiliation(s)
- Arif Rashid
- St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK;
| | - Lee Feinberg
- King’s College Hospital NHS Foundation Trust, King’s College London, London SE5 9RS, UK;
| | - Kathleen Fan
- King’s College Hospital NHS Foundation Trust, King’s College London, London SE5 9RS, UK;
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Gellrich NC, Rahlf B, Jehn P, Spalthoff S, Korn P. Outcome and Quality of Life after Individual Computer-AssistedReconstruction of the Midface. Laryngorhinootologie 2022; 101:S90-S102. [PMID: 35605614 DOI: 10.1055/a-1669-6154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Often, midfacial defects are not only relevant regarding functional aspects but also esthetics of such congenital or acquired deformities impair significantly the patients' quality of life. Reconstructions of the midface do not only include replacing lost or non-developed tissue but moreover to achieve predictable results with regard to esthetics as well as function for the individual patient. Digital planning modalities including different surface and volume data in combination with modern additive manufacturing techniques for biomodel and implant production and intraoperative support by using real and virtual 3D volume data for navigation and intraoperative imaging, but also securing the outcome based on postoperative analysis have been implemented in modern midface reconstruction and represent new standards for medical care. The objective of this paper is to describe modern options of patient-specific midfacial reconstruction with integration of computer-assisted planning and production techniques.
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Affiliation(s)
- Nils-Claudius Gellrich
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Björn Rahlf
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philipp Jehn
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Simon Spalthoff
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philippe Korn
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Gascho D, Bolliger SA, Thali MJ. CT and MRI of a transcardiac gunshot wound with an annular distribution of bullet fragments surrounding an exit-re-entrance wound after the bullet burst from a floor tile upon exiting the lying body. J Forensic Leg Med 2020; 77:102087. [PMID: 33249345 DOI: 10.1016/j.jflm.2020.102087] [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: 09/07/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 01/19/2023]
Abstract
This case report describes medicolegal examinations of a decedent with a fatal gunshot wound. The decedent lied on the floor as a bullet was fired into his chest. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed as part of the judicial investigation. The MRI examination was valuable for delineating the wound channel through the left ventricle, which was deemed the main cause for internal bleeding and fatal blood loss. The diagnostic value of CT for the detection of injuries was low in this case. However, CT allowed for the virtual investigation of bullet fragments. According to CT-based dual-energy index calculations, it could be inferred that the fragments were most likely made of lead matching .357 Magnum R-P cartridges that were found at the scene. The bullet fragments were located underneath the skin at the suspected exit wound. The exit wound was actually an exit-re-entrance wound, as it can be assumed that the fragments re-entered the body after the bullet burst from hard ground upon exiting the body of the decedent, who was lying on the floor. CT visualized an uncommon annular distribution pattern for the bullet fragments surrounding the exit-re-entrance wound. The formation of such an annular distribution pattern of bullet fragments and the relevant conclusions that may be drawn from such a distribution pattern are discussed in this article.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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Momeni Roochi M, Razmara F. Maxillofacial gunshot injures and their therapeutic challenges: Case series. Clin Case Rep 2020; 8:1094-1100. [PMID: 32577273 PMCID: PMC7303870 DOI: 10.1002/ccr3.2827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/29/2022] Open
Abstract
Maxillofacial gunshot injuries require proficiency to determine a suitable treatment plan and surgical intervention. In this paper, present 4 gunshot cases. Treatment in these patients is very challenging. Moreover, post-treatment infections are a serious problem in such cases. Thus, step-by-step surgery is essential to obtain a better result in these patients.
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Affiliation(s)
| | - Farnoosh Razmara
- Department of Maxillofacial SurgeryTehran University of Medical SciencesTehranIran
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Application of Computer-Aided Navigation Technology in the Extraction of Foreign Body From the Face. J Craniofac Surg 2020; 31:e166-e169. [PMID: 31895854 DOI: 10.1097/scs.0000000000006126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the oral and maxillofacial foreign body (FB) extraction surgery, computer-aided navigation technical surgery is minimally invasive and safe, and can improve the accuracy, especially for areas with relatively complex and dangerous anatomical structures. A total of 11 patients, including 8 males and 3 females, who underwent the extraction surgery of FB from oral and maxillofacial regions using computer-aided navigation technical surgery were reviewed. According to the positional relationship between the maxillofacial region and the bone tissue, the FBs were divided into 3 categories: FB in the bone; FB aside the bone; and soft-tissue FB. During the operation, the BrainLab Navigation system was used to observe and guide the operation in real-time to evaluate the effectiveness and accuracy of computer-aided navigation technical surgery in the extraction of FBs from the maxillofacial regions. The FBs were successfully located and removed in 11 patients. No adjacent nerves, blood vessels, and other important anatomical structures were injured during the operation. The postoperative function and shape were not significantly affected.
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Javadrashid R, Golamian M, Shahrzad M, Hajalioghli P, Shahmorady Z, Fouladi DF, Sadrarhami S, Akhoundzadeh L. Visibility of Different Intraorbital Foreign Bodies Using Plain Radiography, Computed Tomography, Magnetic Resonance Imaging, and Cone-Beam Computed Tomography: An in Vitro Study. Can Assoc Radiol J 2017; 68:194-201. [DOI: 10.1016/j.carj.2015.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose The study sought to compare the usefulness of 4 imaging modalities in visualizing various intraorbital foreign bodies (IOFBs) in different sizes. Methods Six different materials including metal, wood, plastic, stone, glass. and graphite were cut in cylindrical shapes in 4 sizes (dimensions: 0.5, 1, 2, and 3 mm) and placed intraorbitally in the extraocular space of fresh sheep's head. Four skilled radiologists rated the visibility of the objects individually using plain radiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), and cone-beam computed tomography (CBCT) in accordance with a previously described grading system. Results Excluding wood, all embedded foreign bodies were best visualized in CT and CBCT images with almost equal accuracies. Wood could only be detected using MRI, and then only when fragments were more than 2 mm in size. There were 3 false-positive MRI reports, suggesting air bubbles as wood IOFBs. Conclusions Because of lower cost and using less radiation in comparison with conventional CT, CBCT can be used as the initial imaging technique in cases with suspected IOFBs. Optimal imaging technique for wood IOFBs is yet to be defined.
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Affiliation(s)
- Reza Javadrashid
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Golamian
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Parisa Hajalioghli
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Shahmorady
- Department of Oral Radiology, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Daniel F. Fouladi
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shohreh Sadrarhami
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Akhoundzadeh
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Neubauer J, Benndorf M, Lang H, Lampert F, Kemna L, Konstantinidis L, Neubauer C, Reising K, Zajonc H, Kotter E, Langer M, Goerke SM. Comparison of Multidetector Computed Tomography and Flat-Panel Computed Tomography Regarding Visualization of Cortical Fractures, Cortical Defects, and Orthopedic Screws: A Phantom Study. Medicine (Baltimore) 2015; 94:e1231. [PMID: 26252281 PMCID: PMC4616608 DOI: 10.1097/md.0000000000001231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To compare the visualization of cortical fractures, cortical defects, and orthopedic screws in a dedicated extremity flat-panel computed tomography (FPCT) scanner and a multidetector computed tomography (MDCT) scanner.We used feet of European roe deer as phantoms for cortical fractures, cortical defects, and implanted orthopedic screws. FPCT and MDCT scans were performed with equivalent dose settings. Six observers rated the scans according to number of fragments, size of defects, size of defects opposite orthopedic screws, and the length of different screws. The image quality regarding depiction of the cortical bone was assessed. The gold standard (real number of fragments) was evaluated by autopsy.The correlation of reader assessment of fragments, cortical defects, and screws with the gold standard was similar for FPCT and MDCT. Three readers rated the subjective image quality of the MDCT to be higher, whereas the others showed no preferences.Although the image quality was rated higher in the MDCT than in the FPCT by 3 out of 6 observers, both modalities proved to be comparable regarding the visualization of cortical fractures, cortical defects, and orthopedic screws and of use to musculoskeletal radiology regarding fracture detection and postsurgical evaluation in our experimental setting.
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Affiliation(s)
- Jakob Neubauer
- From the Department of Radiology (JN, MB, HL, LK, CN, EK, ML); Department of Plastic and Hand Surgery (FL, HZ, SMG); and Department of Orthopedics and Traumatology, University Hospital Freiburg, Freiburg, Germany (LK, KR)
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Using cone-beam CT as a low-dose 3D imaging technique for the extremities: initial experience in 50 subjects. Skeletal Radiol 2015; 44:797-809. [PMID: 25652734 DOI: 10.1007/s00256-015-2105-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/31/2014] [Accepted: 01/12/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively evaluate a dedicated extremity cone-beam CT (CBCT) scanner in cases with and without orthopedic hardware by (1) comparing its imaging duration and image quality to those of radiography and multidetector CT (MDCT) and (2) comparing its radiation dose to that of MDCT. MATERIALS AND METHODS Written informed consent was obtained for all subjects for this IRB-approved, HIPAA-compliant study. Fifty subjects with (1) fracture of small bones, (2) suspected intraarticular fracture, (3) fracture at the site of complex anatomy, or (4) a surgical site difficult to assess with radiography alone were recruited and scanned on an extremity CBCT scanner prior to FDA approval. Same-day radiographs were performed in all subjects. Some subjects also underwent MDCT within 1 month of CBCT. Imaging duration and image quality were compared between CBCT and radiographs. Imaging duration, effective radiation dose, and image quality were compared between CBCT and MDCT. RESULTS Fifty-one CBCT scans were performed in 50 subjects. Average imaging duration was shorter for CBCT than radiographs (4.5 min vs. 6.6 min, P = 0.001, n = 51) and MDCT (7.6 min vs. 10.9 min, P = 0.01, n = 7). Average estimated effective radiation dose was less for CBCT than MDCT (0.04 mSv vs. 0.13 mSv, P = .02, n = 7). CBCT images yielded more diagnostic information than radiographs in 23/51 cases and more diagnostic information than MDCT in 1/7 cases, although radiographs were superior for detecting hardware complications. CONCLUSION CBCT performs high-resolution imaging of the extremities using less imaging time than radiographs and MDCT and lower radiation dose than MDCT.
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Factors affecting patient movement and re-exposure in cone beam computed tomography examination. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:572-8. [DOI: 10.1016/j.oooo.2015.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/06/2015] [Accepted: 01/27/2015] [Indexed: 11/20/2022]
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Metallic artifacts from internal scaphoid fracture fixation screws: comparison between C-arm flat-panel, cone-beam, and multidetector computed tomography. Invest Radiol 2015; 49:532-9. [PMID: 24691141 DOI: 10.1097/rli.0000000000000052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to compare image quality and extent of artifacts from scaphoid fracture fixation screws using different computed tomography (CT) modalities and radiation dose protocols. MATERIALS AND METHODS Imaging of 6 cadaveric wrists with artificial scaphoid fractures and different fixation screws was performed in 2 screw positions (45° and 90° orientation in relation to the x/y-axis) using multidetector CT (MDCT) and 2 flat-panel CT modalities, C-arm flat-panel CT (FPCT) and cone-beam CT (CBCT), the latter 2 with low and standard radiation dose protocols. Mean cartilage attenuation and metal artifact-induced absolute Hounsfield unit changes (= artifact extent) were measured. Two independent radiologists evaluated different image quality criteria using a 5-point Likert-scale. Interreader agreements (Cohen κ) were calculated. Mean absolute Hounsfield unit changes and quality ratings were compared using Friedman and Wilcoxon signed-rank tests. RESULTS Artifact extent was significantly smaller for MDCT and standard-dose FPCT compared with CBCT low- and standard-dose acquisitions (all P < 0.05). No significant differences in artifact extent among different screw types and scanning positions were noted (P > 0.05). Both MDCT and FPCT standard-dose protocols showed equal ratings for screw bone interface, fracture line, and trabecular bone evaluation (P = 0.06, 0.2, and 0.2, respectively) and performed significantly better than FPCT low- and CBCT low- and standard-dose acquisitions (all P < 0.05). Good interreader agreement was found for image quality comparisons (Cohen κ = 0.76-0.78). CONCLUSIONS Both MDCT and FPCT standard-dose acquisition showed comparatively less metal-induced artifacts and better overall image quality compared with FPCT low-dose and both CBCT acquisitions. Flat-panel CT may provide sufficient image quality to serve as a versatile CT alternative for postoperative imaging of internally fixated wrist fractures.
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Todd R. Dental imaging-2D to 3D: a historic, current, and future view of projection radiography. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/etp.12067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol 2014; 6:794-807. [PMID: 25349663 PMCID: PMC4209425 DOI: 10.4329/wjr.v6.i10.794] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 07/04/2014] [Accepted: 08/27/2014] [Indexed: 02/06/2023] Open
Abstract
Dentistry has witnessed tremendous advances in all its branches over the past three decades. With these advances, the need for more precise diagnostic tools, specially imaging methods, have become mandatory. From the simple intra-oral periapical X-rays, advanced imaging techniques like computed tomography, cone beam computed tomography, magnetic resonance imaging and ultrasound have also found place in modern dentistry. Changing from analogue to digital radiography has not only made the process simpler and faster but also made image storage, manipulation (brightness/contrast, image cropping, etc.) and retrieval easier. The three-dimensional imaging has made the complex cranio-facial structures more accessible for examination and early and accurate diagnosis of deep seated lesions. This paper is to review current advances in imaging technology and their uses in different disciplines of dentistry.
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Kaviani F, Javad Rashid R, Shahmoradi Z, Gholamian M. Detection of foreign bodies by spiral computed tomography and cone beam computed tomography in maxillofacial regions. J Dent Res Dent Clin Dent Prospects 2014; 8:166-71. [PMID: 25346836 PMCID: PMC4206759 DOI: 10.5681/joddd.2014.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 12/09/2013] [Indexed: 12/22/2022] Open
Abstract
Background and aims. The imaging techniques commonly used for foreign body detection include plain radiography, xeroradiography, computed tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasonography. The aim of the present study was to compare cone-beam computed tomography (CBCT) with conventional CT scan in determination of the exact location of a foreign body in the maxillofacial area in vitro. Materials and methods. In this descriptive study, seven different materials were selected as foreign bodies with dimensions of approximately 2 mm, 1 mm, and 0.5 mm. These materials consisted of metal, glass, wood, stone, plastic, graphite and tooth. These foreign bodies were placed in a sheep head between the corpus of the mandible and muscle, in the tongue and in an air space. One conventional CT scan and two CBCT scans were made on the models. Results. Tooth, metal, stone and glass foreign bodies were seen clearly on CT and CBCT scans made by NewTom at the smallest size in air. However, CBCT scan by NewTom was a more effective technique for visualization of foreign bodies in air compared to conventional CT. Foreign bodies measuring 0.5 mm made of metal, stone, glass, graphite and teeth were detected by all devices in muscle tissue and adjacent bone. Conclusion. According to the results, CBCT scans of NewTom and Planmeca are appropriate tools for detecting foreign bodies with relative high density in the maxillofacial area.
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Affiliation(s)
- Farzaneh Kaviani
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javad Rashid
- Assistant Professor, Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Shahmoradi
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Masoud Gholamian
- Post-graduate Student, Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Tozoğlu U, Cakur B. Evaluation of the morphological changes in the mandible for dentate and totally edentate elderly population using cone-beam computed tomography. Surg Radiol Anat 2013; 36:643-9. [PMID: 24292424 DOI: 10.1007/s00276-013-1241-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/19/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The loss of teeth considerably modifies the mandibular shape. The aim of this study was to compare the morphological changes in the mandible for dentate and totally edentate elderly subjects using cone-beam computed tomography. METHODS In total, 50 cone-beam computed tomography patients (25 dentate, 25 edentate) without any maxilla-mandibular dysmorphosis were analyzed retrospectively. Panoramic representations of the mandible with superimposed axial slices and cross-sectional slices were developed with the cone-beam computed tomography scans. Values of the mandibular cortical index, bone quality index, gonial angle, antegonial angle, antegonial depth and condyle angle in the left and right side were measured. RESULTS There was a significant difference in the mandibular cortical index between the total edentate group and the dentate group in the left side of the mandible (p < 0.001). There was a significant difference in the bone quality index between the total edentate group and the dentate group in the right side and the left side (p < 0.001). There was a significant difference in the bone quality index between the right side and the left side (p < 0.005). When comparing gender, there was only a difference in the right side (p < 0.05). CONCLUSIONS Our study concluded that the mandibular basal bone morphology changes as a consequence of tooth loss. Cone-beam computed tomography is shown to be a good tool in investigating and achieving these results.
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Affiliation(s)
- Ummühan Tozoğlu
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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Essig H, Dressel L, Rana M, Rana M, Kokemueller H, Ruecker M, Gellrich NC. Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. Head Face Med 2013; 9:18. [PMID: 23815979 PMCID: PMC3750456 DOI: 10.1186/1746-160x-9-18] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
Background The aim of orbital wall reconstruction is to reestablish anatomically exact orbital volumes to avoid long-term complications. Navigation could facilitate complex reconstructions. Methods Quality of the orbital reconstruction (n = 94) was measured based on (A) volume changes and (B) on 3D shape deviations compared to the unaffected side. Volume analysis included segmentation of the orbital cavity in the pre- and post-operative 3D data set (VoXim®, IVS Solutions, Germany), and shape analysis was performed by vector-based 3D tools (Comparison®, 3Dshape, Germany). Results Orbital volume of the unaffected side ranged from 26.6 ml ± 2.8 ml in male and 25.2 ml ± 2.6 ml in female (CT). Significant orbital enlargement was found in orbital fractures with involvement of the posterior third of the orbital floor and in comminuted fracture pattern. Reconstructed orbital volume ranged from 26.9 ± 2.7 ml in male and 24.26 ± 2.5 ml in female (CBCT). 3D Analysis of the color mapping showed minor deviations compared to the mirrored unaffected side. Conclusion Measurements demonstrate that even in comminuted orbital fractures true-to-original reconstruction is feasible.
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CONNOR SEJ, CHAUDHARY N. Imaging of maxillofacial and skull base trauma. IMAGING 2013. [DOI: 10.1259/imaging.20100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Spin-Neto R, Mudrak J, Matzen LH, Christensen J, Gotfredsen E, Wenzel A. Cone beam CT image artefacts related to head motion simulated by a robot skull: visual characteristics and impact on image quality. Dentomaxillofac Radiol 2012; 42:32310645. [PMID: 22842641 DOI: 10.1259/dmfr/32310645] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess artefacts and their impact on cone beam CT (CBCT) image quality (IQ) after head motion simulated by a robot skull. METHODS A fully dentate human skull incorporated into a robot simulated pre-determined patient movements. Ten head motion patterns were selected based on the movement of the C-arm of the CBCT units (no motion as reference). Three CBCT units were used [a three-dimensional eXam (K) (KaVo Dental GmbH, Biberach, Germany), a Promax 3D MAX (P) (Planmeca Oy, Helsinki, Finland) and a Scanora(®) 3D (S) (Soredex Oy, Tuusula, Finland)]. Axial images were qualitatively assessed at three levels: mental foramen (MF), infraorbital foramen and supraorbital foramen, and artefacts characterized as stripe-like, double contours, unsharpness or ring-like. A 100 mm visual analogue scale (VAS) was used to quantitatively assess IQ. Cross-sectional images of the lower third molar and MF bilaterally were also evaluated by VAS. Four blinded examiners assessed the images. RESULTS For all units and motion patterns, stripe-like artefacts were the most common. The four observers agreed on the presence of at least one artefact type in 90% of the images. Axial images showed lower overall IQ after motion (VAS = 72.4 ± 24.0 mm) than reference images (VAS = 97.3 ± 2.6 mm). The most severe artefacts were seen at the MF level. For cross-sectional images, IQ was lowest after tremor. The mean IQ range was 74-89 and 57-90 for isolated (tilting, rotation and nodding) and combined (nodding + tilting and rotation + tilting) movements, respectively. IQ for MF was lower than for third molar for any movement except tremor. CONCLUSIONS Head motion of any type resulted in artefacts in CBCT images. The impact on IQ depended on the region and level in the skull.
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Affiliation(s)
- R Spin-Neto
- Oral Radiology, Department of Dentistry, Aarhus University, Denmark.
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Ahmad M, Jenny J, Downie M. Application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J 2012; 57 Suppl 1:82-94. [PMID: 22376100 DOI: 10.1111/j.1834-7819.2011.01661.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the past decade, the utility of cone beam computed tomography (CBCT) images in oral and maxillofacial surgery has seen continuous increase. However, CBCT images are not always able to replace other imaging modalities. Based on the current published knowledge, this paper discusses advantages and limitations of CBCT images in the diagnosis and surgical planning of dentoalveolar procedures, odontogenic cysts, benign and malignant tumours, inflammatory changes, orthognathic surgery, maxillofacial trauma, sinus disorders, and systemic and osseous conditions that manifest in the maxillofacial area. This paper also suggests alternative imaging modalities when CBCT images are not adequate for surgical planning.
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Affiliation(s)
- Mansur Ahmad
- Division of Oral and Maxillofacial Radiology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.
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Tozoglu U, Caglayan F, Harorli A. Foramen tympanicum or foramen of Huschke: anatomical cone beam CT study. Dentomaxillofac Radiol 2012; 41:294-7. [PMID: 22517996 DOI: 10.1259/dmfr/62359484] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The foramen of Huschke (foramen tympanicum) represents a developmental defect in the antero-inferior aspect of the bony external auditory meatus. The foramen is located at the antero-inferior aspect of the external auditory canal, posteromedial to the temporomandibular joint. The aim of this study is to define the prevalence and location of the foramen of Huschke. METHODS We retrospectively examined 207 cone beam CT (CBCT) studies (414 ears). We used flat panel detector (FPD)-based CBCT (New Tom FP; Quantitative Radiology, Verona, Italy) for imaging in our department. We noted the location of the foramen tympanicum and calculated its prevalence as a percentage. RESULTS We found a foramen tympanicum in 37 (17.9%) of 207 patients. This was unilateral in 24 patients (11.6%) and bilateral in 13 patients (6.3%). Mean axial diameter was 5 mm and mean sagittal diameter was 2 mm. CONCLUSION The foramen tympanicum is an uncommon disorder and is well demonstrated on CBCT. This is the first study to detect the foramen tympanicum using FPD-based CBCT.
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Affiliation(s)
- U Tozoglu
- Department of Oral Diagnosis and Radiology, Ataturk University, Erzurum, Turkey.
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Referencing of markerless CT data sets with cone beam subvolume including registration markers to ease computer-assisted surgery - A clinical and technical research. Int J Med Robot 2012; 9:e39-45. [DOI: 10.1002/rcs.1444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2012] [Indexed: 11/07/2022]
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22
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Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy. Radiat Oncol 2011; 6:159. [PMID: 22087558 PMCID: PMC3247073 DOI: 10.1186/1748-717x-6-159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/16/2011] [Indexed: 12/04/2022] Open
Abstract
The quality of the interdisciplinary interface in oncological treatment between surgery, pathology and radiotherapy is mainly dependent on reliable anatomical three-dimensional (3D) allocation of specimen and their context sensitive interpretation which defines further treatment protocols. Computer-assisted preoperative planning (CAPP) allows for outlining macroscopical tumor size and margins. A new technique facilitates the 3D virtual marking and mapping of frozen sections and resection margins or important surgical intraoperative information. These data could be stored in DICOM format (Digital Imaging and Communication in Medicine) in terms of augmented reality and transferred to communicate patient's specific tumor information (invasion to vessels and nerves, non-resectable tumor) to oncologists, radiotherapists and pathologists.
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Schulze R, Heil U, Gross D, Bruellmann DD, Dranischnikow E, Schwanecke U, Schoemer E. Artefacts in CBCT: a review. Dentomaxillofac Radiol 2011; 40:265-73. [PMID: 21697151 DOI: 10.1259/dmfr/30642039] [Citation(s) in RCA: 582] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Artefacts are common in today's cone beam CT (CBCT). They are induced by discrepancies between the mathematical modelling and the actual physical imaging process. Since artefacts may interfere with the diagnostic process performed on CBCT data sets, every user should be aware of their presence. This article aims to discuss the most prominent artefacts identified in the scientific literature and review the existing knowledge on these artefacts. We also briefly review the basic three-dimensional (3D) reconstruction concept applied by today's CBCT scanners, as all artefacts are more or less directly related to it.
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Affiliation(s)
- R Schulze
- Department of Oral Surgery (and Oral Radiology), University Medical Center of the Johannes Gutenberg-University, Augustusplatz 2, 55131 Mainz, Germany.
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The influence of secondary reconstruction slice thickness on NewTom 3G cone beam computed tomography-based radiological interpretation of sheep mandibular condyle fractures. ACTA ACUST UNITED AC 2011; 110:638-47. [PMID: 20889356 DOI: 10.1016/j.tripleo.2010.05.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 05/13/2010] [Accepted: 05/20/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to examine the diagnostic accuracy of the different secondary reconstruction slice thicknesses of cone beam computed tomography (CBCT) on artificially created mandibular condyle fractures. METHODS A total of 63 sheep heads with or without condylar fractures were scanned with a NewTom 3G CBCT scanner. Multiplanar reformatted (MPR) views in 0.2-mm, 1-mm, 2-mm, and 3-mm secondary reconstruction slice thicknesses were evaluated by 7 observers. Inter- and intraobserver agreements were calculated with weighted kappa statistics. The receiver operating characteristic (ROC) curve analysis was used to statistically compare the area under the curve (AUC) of each slice thickness. RESULTS The kappa coefficients varied from fair and to excellent. The AUCs of 0.2-mm and 1-mm slice thicknesses were found to be significantly higher than those of 2 mm and 3 mm for some type of fractures. CONCLUSION CBCT was found to be accurate in detecting all variants of fractures at 0.2 mm and 1 mm. However, 2-mm and 3-mm slices were not suitable to detect fissure, complete, and comminuted types of mandibular condyle fractures.
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Wang H, Ni L, Yu C, Shi L, Qin R. Utilizing spiral computerized tomography during the removal of a fractured endodontic instrument lying beyond the apical foramen. Int Endod J 2010; 43:1143-51. [PMID: 21039622 DOI: 10.1111/j.1365-2591.2010.01780.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To present a case that used spiral computerized tomography (CT) to locate and successfully remove a fractured endodontic instrument lying beyond the apical foramen using a surgical approach. SUMMARY The fracture of an endodontic instrument beyond the apical foramen is rare. In this case report, after an attempt to remove a fractured instrument failed, a multi-slice spiral computerized tomography (MSCT) was used for diagnosis and treatment planning. The fractured segment was precisely located and found in the soft tissue and successfully removed by surgery. For the successful removal of a fractured endodontic instrument beyond the apical foramen, the following are necessary: (i) knowledge of the cause of fracture and how to plan treatment; (ii) determining the precise location of the fractured segment using CT; and 3) skilful operation. KEY LEARNING POINTS • Fractured endodontic instruments might lie within the soft tissue. • Computerized tomography is an effective diagnostic aid for localizing the precise position of fractured instruments.
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Affiliation(s)
- H Wang
- Department of Operative Dentistry and Endodontics Department of Oral Radiology Department of Oral and Maxillofacial Surgery School of Stomatology, Fourth Military Medical University, Xi'an, China
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26
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Use of cone beam computed tomography in the management of glass injuries to the face. Br J Oral Maxillofac Surg 2010; 48:308-9. [DOI: 10.1016/j.bjoms.2009.06.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/10/2009] [Indexed: 11/21/2022]
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Gröbe A, Klatt J, Heiland M, Schmelzle R, Pohlenz P. Diagnostic and therapeutic aspects in the treatment of gunshot wounds of the viscerocranium. Eur J Trauma Emerg Surg 2010; 37:41-7. [PMID: 26814749 DOI: 10.1007/s00068-010-0023-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/26/2010] [Indexed: 01/12/2023]
Abstract
Gunshot wounds of the viscerocranium are a rare occurrence during times of peace in Europe. The removal of projectiles is recommended; in some cases, however, this is controversial. The material properties of projectiles and destruction of anatomical landmarks make it difficult to determine their precise location. Therefore, navigation systems and cone-beam computed tomography (CT) provide the surgeon with continuous intraoperative orientation in real-time. The aim of this study was to report our experiences for image-guided removal of projectiles, the use of cone-beam computed tomography and the resulting intra- and postoperative complications. We investigated 50 patients with gunshot wounds of the facial skeleton retrospectively, 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region, 18 had surgical removal of projectiles without navigation assistance and in 28 cases we used cone-beam CT in the case of dislocated projectiles and fractured bones. There was a significant correlation (p = 0.0136) between the navigated versus not navigated surgery and complication rate (8 vs. 32%, p = 0.0132) including major bleeding, soft tissue infections and nerve damage. Furthermore, we could reduce operating time while using a navigation system and cone-beam CT (p = 0.038). A high tendency between operating time and navigated surgery (p = 0.1103) was found. In conclusion, there is a significant correlation between reduced intra- and postoperative complications including wound infections, nerve damage and major bleeding and the appropriate use of a navigation system. In all these cases we were able to present reduced operating time. Cone-beam CT plays a key role as a useful diagnostic tool in detecting projectiles or metallic foreign bodies intraoperatively.
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Affiliation(s)
- A Gröbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - J Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - M Heiland
- Department of Oral and Maxillofacial Surgery, General Hospital of Bremerhaven-Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Germany.
| | - R Schmelzle
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - P Pohlenz
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Gröbe A, Weber C, Schmelzle R, Heiland M, Klatt J, Pohlenz P. The use of navigation (BrainLAB Vector vision(2)) and intraoperative 3D imaging system (Siemens Arcadis Orbic 3D) in the treatment of gunshot wounds of the maxillofacial region. Oral Maxillofac Surg 2009; 13:153-158. [PMID: 19669177 DOI: 10.1007/s10006-009-0166-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Gunshot wounds are a rare occurrence during times of peace. The removal of projectiles is recommended; in some cases, however, this is a controversy. The reproduction of a projectile image can be difficult if it is not adjacent to an anatomical landmark. Therefore, navigation systems give the surgeon continuous real-time orientation intraoperatively. The aim of this study was to report our experiences for image-guided removal of projectiles and the resulting intra- and postoperative complications. PATIENTS AND METHODS We investigated 50 patients retrospectively; 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region. Eighteen had surgical removal of projectiles without navigation assistance. RESULTS There was a significant correlation (p = 0.0136) between the navigated surgery vs. not-navigated surgery and complication rate, including major bleeding (n = 4 vs. n = 1, 8% vs. 2%), soft tissue infections (n = 7 vs. n = 2, 14% vs. 4%), and nerval damage (n = 2 vs. n = 0, 4% vs. 0%; p = 0.038) and between the operating time and postoperative complications. A high tendency between operating time and navigated surgery (p = 0.1103) was shown. When using navigation system, we could reduce operating time. CONCLUSION In conclusion, there is a significant correlation between reduced intra- and postoperative complications, including wound infections, nerval damage, and major bleeding, and the appropriate use of a navigation system. In all these cases, we could present reduced operating time. Cone-beam computed tomography plays an important role in detecting projectiles or metallic foreign bodies intraoperatively.
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Affiliation(s)
- Alexander Gröbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Shintaku WH, Venturin JS, Azevedo B, Noujeim M. Applications of cone-beam computed tomography in fractures of the maxillofacial complex. Dent Traumatol 2009; 25:358-66. [PMID: 19515071 DOI: 10.1111/j.1600-9657.2009.00795.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Imaging plays an essential role in the evaluation of maxillofacial fractures both pre- and postoperatively. Several studies support the use of conventional two-dimensional imaging for traumas involving mainly the mandible, but for more complex situations advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging have higher indication. Nowadays, besides CT, cone-beam computed tomography (CBCT) has appeared as a reasonable and reliable alternative considering radiation dosage, image quality and comfort for the patient. The purpose of this study was to review the fracture patterns involving the maxillofacial complex, provide a technical and practical comparison between CT and CBCT, and finally present the potential applications of CBCT illustrated with clinical examples.
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Affiliation(s)
- Werner H Shintaku
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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