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Abrams MZ, Venkatraman J, Sherman D, Ortiz-Paparoni M, Bercaw JR, MacDonald RE, Kait J, Dimbath ED, Pang DY, Gray A, Luck JF, Bir CA, Bass CR. Biofidelity and Limitations of Instrumented Mouthguard Systems for Assessment of Rigid Body Head Kinematics. Ann Biomed Eng 2024; 52:2872-2883. [PMID: 38910203 DOI: 10.1007/s10439-024-03563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
Instrumented mouthguard systems (iMGs) are commonly used to study rigid body head kinematics across a variety of athletic environments. Previous work has found good fidelity for iMGs rigidly fixed to anthropomorphic test device (ATD) headforms when compared to reference systems, but few validation studies have focused on iMG performance in human cadaver heads. Here, we examine the performance of two boil-and-bite style iMGs in helmeted cadaver heads. Three unembalmed human cadaver heads were fitted with two instrumented boil-and-bite mouthguards [Prevent Biometrics and Diversified Technical Systems (DTS)] per manufacturer instructions. Reference sensors were rigidly fixed to each specimen. Specimens were fitted with a Riddell SpeedFlex American football helmet and impacted with a rigid impactor at three velocities and locations. All impact kinematics were compared at the head center of gravity. The Prevent iMG performed comparably to the reference system up to ~ 60 g in linear acceleration, but overall had poor correlation (CCC = 0.39). Prevent iMG angular velocity and BrIC generally well correlated with the reference, while underestimating HIC and overestimating HIC duration. The DTS iMG consistently overestimated the reference across all measures, with linear acceleration error ranging from 10 to 66%, and angular acceleration errors greater than 300%. Neither iMG demonstrated consistent agreement with the reference system. While iMG validation efforts have utilized ATD testing, this study highlights the need for cadaver testing and validation of devices intended for use in-vivo, particularly when considering realistic (non-idealized) sensor-skull coupling, when accounting for interactions with the mandible and when subject-specific anatomy may affect device performance.
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Affiliation(s)
- Mitchell Z Abrams
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA.
| | - Jay Venkatraman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Donald Sherman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Maria Ortiz-Paparoni
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Jefferson R Bercaw
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Robert E MacDonald
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Jason Kait
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Elizabeth D Dimbath
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Derek Y Pang
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Alexandra Gray
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Jason F Luck
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Cynthia A Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Cameron R Bass
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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Venkatraman J, Abrams MZ, Sherman D, Ortiz-Paparoni M, Bercaw JR, MacDonald RE, Kait J, Dimbath E, Pang D, Gray A, Luck JF, Bass CR, Bir CA. Accuracy of Instrumented Mouthguards During Direct Jaw Impacts Seen in Boxing. Ann Biomed Eng 2024:10.1007/s10439-024-03586-x. [PMID: 39028399 DOI: 10.1007/s10439-024-03586-x] [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: 04/08/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Measuring head kinematics data is important to understand and develop methods and standards to mitigate head injuries in contact sports. Instrumented mouthguards (iMGs) have been developed to address coupling issues with previous sensors. Although validated with anthropomorphic test devices (ATDs), there is limited post-mortem human subjects (PMHS) data which provides more accurate soft tissue responses. This study evaluated two iMGs (Prevent Biometrics (PRE) and Diversified Technical Systems (DTS) in response to direct jaw impacts. METHODS Three unembalmed male cadaver heads were properly fitted with two different boil-and-bite iMGs and impacted with hook (4 m/s) and uppercut (3 m/s) punches. A reference sensor (REF) was rigidly attached to the base of the skull, impact kinematics were transformed to the head center of gravity and linear and angular kinematic data were compared to the iMGs including Peak Linear Acceleration, Peak Angular Acceleration, Peak Angular Velocity, Head Injury Criterion (HIC), HIC duration, and Brain Injury Criterion. RESULTS Compared to the REF sensor, the PRE iMG underpredicted most of the kinematic data with slopes of the validation regression line between 0.72 and 1.04 and the DTS overpredicted all the kinematic data with slopes of the regression line between 1.4 and 8.7. CONCLUSION While the PRE iMG was closer to the REF sensor compared to the DTS iMG, the results did not support the previous findings reported with use of ATDs. Hence, our study highlights the benefits of using PMHS for validating the accuracy of iMGs since they closely mimic the human body compared to any ATD's mandible.
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Affiliation(s)
- Jay Venkatraman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
| | - Mitchell Z Abrams
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Donald Sherman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | | | | | - Robert E MacDonald
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Jason Kait
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Elizabeth Dimbath
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Derek Pang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Alexandra Gray
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jason F Luck
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Cameron R Bass
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Cynthia A Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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Bouhadana G, Gornitsky J, Saleh E, El Jalbout R, Borsuk DE, Cugno S. Determination of Novel, Cranium-Based Relationships for Construct Placement in Microtia Reconstruction for Hemifacial Microsomia Patients. Cleft Palate Craniofac J 2024; 61:631-638. [PMID: 36310432 DOI: 10.1177/10556656221135925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Determine if the ideal location of the construct in microtia reconstruction for hemifacial microsomia (HFM) can be more accurately derived from measurements on the cranium. DESIGN High-resolution computerized tomography (CT) images were analyzed through craniometric linear relationships. SETTING Our tertiary care institution from 2000 to 2021. PATIENTS/PARTICIPANTS Patients diagnosed with HFM and microtia, who had high-resolution craniofacial CT scans, yielding 36 patients accounting for 44 CT scans. MAIN OUTCOME MEASURE(S) First, the integrity of the posterior cranial vault among HFM patients was determined. If proven to be unaffected, it could be used as a reference in the placement of the construct. Second, the position of the ear in relation to the cranium was assessed in healthy age-matched controls. Third, if proven to be useful, the concordance of these cranium-based relationships could be validated among our HFM cohort. RESULTS The posterior cranial vault is unaffected in HFM (P > .001). Further, craniometric relationships between the tragus and the Foramen Magnum, as well as between the tragus and the posterior cranium, have been shown to be highly similar and equally precise in predicting tragus position in healthy controls (P > .001). These relationships held true across all age groups (P > .001), and importantly among HFM patients, where the mean absolute difference in predicted tragus position never surpassed 1.5 mm. CONCLUSIONS Relationships between the tragus and the cranium may be used as an alternative to distorted facial anatomy or surgeon's experience to assist in pre-operative planning of construct placement in microtia reconstruction for HFM patients.
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Affiliation(s)
- Gabriel Bouhadana
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Jordan Gornitsky
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Eli Saleh
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Ramy El Jalbout
- Division of Diagnostic Radiology, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel E Borsuk
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
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Liu L, Wu G. Three-dimensional SPACE MR with CAIPIRINHA fourfold acceleration for assessing long head of biceps tendon. Acta Radiol 2021:2841851211055324. [PMID: 34854744 DOI: 10.1177/02841851211055324] [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: 11/16/2022]
Abstract
BACKGROUND Data regarding controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) T2-weighted sampling perfection with application optimized contrast evolution (SPACE) with fourfold acceleration factor for assessing long head of biceps tendon (LHBT) disorder is lacking. PURPOSE To investigate the feasibility of 3D CAIPIRINHA SPACE with fourfold acceleration in assessing LHBT disorder. MATERIAL AND METHODS A total of 42 consecutive patients underwent shoulder magnetic resonance (MR) examinations including CAIPIRINHA SPACE with fourfold acceleration, and non-CAIPIRINHA SPACE with twofold acceleration, and 2D fast spin echo (FSE). A subjective score of depiction of LHBT was given to 3D sequence according to a 4-point scale (0-3, "poor" to "excellent"). The Wilcoxon signed rank test was used to compare depiction scores between 3D sequences. Three statuses of LHBT were defined in the study: normal, tendonitis, and tear. McNemar's test was used compare diagnostic accuracy. RESULTS LHBT was better depicted with CAIPIRINHA SPACE versus non-CAIPIRINHA SPACE (2.1 ± 0.4 vs. 1.5 ± 0.4; P < 0.001). Inter-modality agreement between CAIPIRINHA SPACE and 2D FSE was almost perfect (kappa = 0.884 ± 0.064). The sensitivity and specificity in detecting LHBT disorder were 95% (20/21) and 95% (20/21), respectively, for CAIPIRINHA SPACE, and 71% (15/21) and 76% (16/21), respectively, for non-CAIPIRINHA SPACE (P = 0.039). CONCLUSION Fourfold acceleration CAIPIRINHA is feasible in reducing the acquisition time of SPACE MR in the shoulder. 3D CAIPIRINHA SPACE with fourfold acceleration is highly accurate in detecting LHBT disorder.
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Affiliation(s)
- Liangjin Liu
- Department of Radiology, Hubei No.3 People’s Hospital of Jianghan University, Wuhan, China
| | - Gang Wu
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
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Sater SH, Sass AM, Seiner A, Natividad GC, Shrestha D, Fu AQ, Oshinski JN, Ethier CR, Martin BA. MRI-based quantification of ophthalmic changes in healthy volunteers during acute 15° head-down tilt as an analogue to microgravity. J R Soc Interface 2021; 18:20200920. [PMID: 33906382 DOI: 10.1098/rsif.2020.0920] [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] [Indexed: 01/17/2023] Open
Abstract
Spaceflight is known to cause ophthalmic changes in a condition known as spaceflight-associated neuro-ocular syndrome (SANS). It is hypothesized that SANS is caused by cephalad fluid shifts and potentially mild elevation of intracranial pressure (ICP) in microgravity. Head-down tilt (HDT) studies are a ground-based spaceflight analogue to create cephalad fluid shifts. Here, we developed non-invasive magnetic resonance imaging (MRI)-based techniques to quantify ophthalmic structural changes under acute 15° HDT. We specifically quantified: (i) change in optic nerve sheath (ONS) and optic nerve (ON) cross-sectional area, (ii) change in ON deviation, an indicator of ON tortuosity, (iii) change in vitreous chamber depth, and (iv) an estimated ONS Young's modulus. Under acute HDT, ONS cross-sectional area increased by 4.04 mm2 (95% CI 2.88-5.21 mm2, p < 0. 000), while ON cross-sectional area remained nearly unchanged (95% CI -0.12 to 0.43 mm2, p = 0.271). ON deviation increased under HDT by 0.20 mm (95% CI 0.08-0.33 mm, p = 0.002). Vitreous chamber depth decreased under HDT by -0.11 mm (95% CI -0.21 to -0.03 mm, p = 0.009). ONS Young's modulus was estimated to be 85.0 kPa. We observed a significant effect of sex and BMI on ONS parameters, of interest since they are known risk factors for idiopathic intracranial hypertension. The tools developed herein will be useful for future analyses of ON changes in various conditions.
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Affiliation(s)
- Stuart H Sater
- Alcyone Therapeutics Inc., Lowell, MA 01852, USA.,Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
| | - Austin M Sass
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
| | - Akari Seiner
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
| | - Gabryel Conley Natividad
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
| | - Dev Shrestha
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
| | - Audrey Q Fu
- Department of Mathematics and Statistical Science, Institute of Bioinformatics and Evolutionary Studies, Institute for Modeling Collaboration and Innovation, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - C Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Bryn A Martin
- Alcyone Therapeutics Inc., Lowell, MA 01852, USA.,Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Drive, MC1122, Moscow, ID 83844-1122, USA
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Surface-based 3-dimensional cephalometry: An objective analysis of cranio-mandibular morphology. Am J Orthod Dentofacial Orthop 2020; 158:535-546. [PMID: 32826124 DOI: 10.1016/j.ajodo.2019.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The purpose of this study was to apply a previously reported homologous model for quantifying and visualizing the three-dimensional (3D) cranio-mandibular morphology. METHODS Twenty-eight 3D cone-beam computed tomography (CBCT) images of Japanese patients (7 to 13 years of age) showing skeletal Class 1 malocclusions were used in this study. Wire mesh fitting was conducted for each patient based on the assignment of landmarks to each 3D surface (homologous modeling). Cranial and mandibular images were generated using surface rendering of the CBCT images. The mean and standard deviation of each point on the wire mesh were calculated as the normative mean. Two operators conducted the process twice for seven patients, with a one-week interval between fittings. The intra- and inter-examiner reliability were determined using the 95% confidence interval minimal detectable change (MDC95) for random error and intra-class correlation coefficients (ICCs). RESULTS The intra- and inter-examiner reliability of the mesh fitting method were almost perfect. Normative ranges of the cranial and mandibular surfaces of Japanese were determined. CONCLUSIONS A clinical method that enables practitioners to quantify and visualize the hard tissues of a patient's face in three dimensions with almost perfect reliability is presented. This method allows practitioners to evaluate how patients' skeletal characteristics differ from normative means in three dimensions.
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Zubovic E, Skolnick GB, Naidoo SD, Bellanger M, Smyth MD, Patel KB. Endoscopic treatment of combined metopic-sagittal craniosynostosis. J Neurosurg Pediatr 2020; 26:113-121. [PMID: 32302979 DOI: 10.3171/2020.2.peds2029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Combined metopic-sagittal craniosynostosis is traditionally treated with open cranial vault remodeling and fronto-orbital advancement, sometimes in multiple operations. Endoscopic treatment of this multisuture synostosis presents a complex challenge for the surgeon and orthotist. METHODS The authors retrospectively analyzed the preoperative and 1-year postoperative CT scans of 3 patients with combined metopic-sagittal synostosis, all of whom were treated with simultaneous endoscope-assisted craniectomy of the metopic and sagittal sutures followed by helmet therapy. Established anthropometric measurements were applied to assess pre- and postoperative morphology, including cranial index and interfrontal divergence angle (IFDA). Patients' measurements were compared to those obtained in 18 normal controls. RESULTS Two boys and one girl underwent endoscope-assisted craniectomy at a mean age of 81 days. The mean preoperative cranial index was 0.70 (vs control mean of 0.82, p = 0.009), corrected postoperatively to a mean of 0.82 (vs control mean of 0.80, p = 0.606). The mean preoperative IFDA was 110.4° (vs control mean of 152.6°, p = 0.017), corrected postoperatively to a mean of 139.1° (vs control mean of 140.3°, p = 0.348). The mean blood loss was 100 mL and the mean length of stay was 1.7 days. No patient underwent reoperation. The mean clinical follow-up was 3.4 years. CONCLUSIONS Endoscope-assisted craniectomy with helmet therapy is a viable single-stage treatment option for combined metopic-sagittal synostosis, providing correction of the stigmata of trigonoscaphocephaly, with normalization of the cranial index and IFDA.
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Affiliation(s)
- Ema Zubovic
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
| | - Gary B Skolnick
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
| | - Sybill D Naidoo
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
| | | | - Matthew D Smyth
- 2Department of Neurosurgery, Washington University School of Medicine in St. Louis; and
| | - Kamlesh B Patel
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
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Lee C, Rohr J, Sass A, Sater S, Zahid A, Macias B, Stenger MB, Samuels BC, Martin BA, Oshinski JN, Ethier CR. In vivo estimation of optic nerve sheath stiffness using noninvasive MRI measurements and finite element modeling. J Mech Behav Biomed Mater 2020; 110:103924. [PMID: 32957219 DOI: 10.1016/j.jmbbm.2020.103924] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/21/2022]
Abstract
The optic nerve sheath (ONS) is biomechanically important. It is acted on by tension due to ocular movements, and by fluid shifts and/or alterations in intracranial pressure (ICP) in human disease, specifically in pathologies leading to intracranial hypertension. It has also been hypothesized that the ONS is acted on by altered ICP in astronauts exposed chronically to microgravity. However, a non-invasive method to quantify ONS biomechanical properties is not presently available; knowledge of such properties is desirable to allow characterization of the biomechanical forces exerted on the optic nerve head and other ocular structures due to the ONS. Thus, the primary objective of this study was to characterize the biomechanical properties (stiffness) of the human ONS in vivo as a necessary step towards investigating the role of ICP in various conditions, including Spaceflight Associated Neuro-ocular Syndrome (SANS). We acquired non-invasive magnetic resonance imaging (MRI) scans of ostensibly healthy subjects (n = 18, age = 30.4 ± 11.6 [mean ± SD] years) during supine and 15-degree head-down-tilt (HDT) postures, and extracted ONS contours from these scans. We then used finite element modeling to quantify ONS expansion due to postural changes and an inverse approach to estimate ONS stiffness. Using this non-invasive procedure, we estimated an in vivo ONS stiffness of 39.2 ± 21.9 kPa (mean ± SD), although a small subset of individuals had very stiff ONS that precluded accurate estimates of their stiffness values. ONS stiffness was not correlated with age and was higher in males than females.
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Affiliation(s)
- Chanyoung Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Jesse Rohr
- Department of Biological Engineering, University of Idaho, Moscow, ID, USA
| | - Austin Sass
- Department of Biological Engineering, University of Idaho, Moscow, ID, USA
| | - Stuart Sater
- Department of Biological Engineering, University of Idaho, Moscow, ID, USA
| | - Arslan Zahid
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Brandon Macias
- Cardiovascular and Vision Laboratory, KBR, Houston, TX, USA
| | | | - Brian C Samuels
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, Moscow, ID, USA
| | - John N Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - C Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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Kindler S, Ittermann T, Bülow R, Holtfreter B, Klausenitz C, Metelmann P, Mksoud M, Pink C, Seebauer C, Kocher T, Koppe T, Krey KF, Metelmann HR, Völzke H, Daboul A. Does craniofacial morphology affect third molars impaction? Results from a population-based study in northeastern Germany. PLoS One 2019; 14:e0225444. [PMID: 31756203 PMCID: PMC6874347 DOI: 10.1371/journal.pone.0225444] [Citation(s) in RCA: 5] [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: 02/23/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives It is still not clear why impaction of third molars occurs. Craniofacial morphology and facial parameters have been discussed to be strong predictors for third molar impaction. Thus, this study aimed to investigate the effect of craniofacial morphology on erupted or impacted third molars in a German population sample. Materials and methods Erupted and impacted third molars in 2,484 participants from the Study of Health in Pomerania were assessed by whole-body magnetic resonance imaging. Markers of facial morphology were determined in 619 individuals of those participants in whose 421 participants (16.7%) had at least one impacted third molar. Craniofacial morphology was estimated as linear measurements and was associated in a cross-sectional study design with impacted and erupted third molars by multinomial logistic regression models. Erupted third molars were used as reference outcome category and regression models were adjusted for age and sex. Results Maximum Cranial Width (Eurion-Eurion distance) was significantly associated with impacted third molars (RR: 1.079; 95% confidence interval 1.028–1.132). This association was even more pronounced in the mandible. Individuals with a lower total anterior facial height (Nasion-Menton distance) and a lower facial index also have an increased risk for impacted third molars in the mandible (RR 0.953; 95% confidence interval 0.913–0.996 and RR: 0.943; 95% confidence interval 0.894–0.995). No significant associations of third molar status with facial width (Zygion-Zygion distance), and sagittal cranial dimension (Nasion-Sella distance; Sella-Basion distance) were observed. Conclusion Individuals with an increased maximal cranial width have a higher risk for impaction of third molars in the mandible and in the maxilla. Individuals with a lower anterior total anterior facial height and lower facial index also have an increased risk for third molars impaction in the mandible. These findings could help orthodontic dentists, oral surgeons and oral and maxillofacial surgeons in decision-making for third molars removal in their treatment. These findings highlight the necessity of an additional analysis of the maximal cranial width by the Eurion- Eurion distance.
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Affiliation(s)
- Stefan Kindler
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Catharina Klausenitz
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Philine Metelmann
- Department of Orthodontics, University Medicine Greifswald, Greifswald, Germany
| | - Maria Mksoud
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Christian Seebauer
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Koppe
- Department of Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany
| | - Karl-Friedrich Krey
- Department of Orthodontics, University Medicine Greifswald, Greifswald, Germany
| | - Hans-Robert Metelmann
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Amro Daboul
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
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Toneva D, Nikolova S, Georgiev I, Lazarov N. Impact of Resolution and Texture of Laser Scanning Generated Three‐Dimensional Models on Landmark Identification. Anat Rec (Hoboken) 2019; 303:1950-1965. [DOI: 10.1002/ar.24272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Diana Toneva
- Department of Anthropology and Anatomy, Institute of Experimental Morphology, Pathology and Anthropology with MuseumBulgarian Academy of Sciences Sofia Bulgaria
| | - Silviya Nikolova
- Department of Anthropology and Anatomy, Institute of Experimental Morphology, Pathology and Anthropology with MuseumBulgarian Academy of Sciences Sofia Bulgaria
| | - Ivan Georgiev
- Department of Scientific Computations, Institute of Information and Communication TechnologiesBulgarian Academy of Sciences Sofia Bulgaria
- Department of Mathematical Modeling and Numerical Analysis, Institute of Mathematics and InformaticsBulgarian Academy of Sciences Sofia Bulgaria
| | - Nikolai Lazarov
- Department of Anatomy and HistologyMedical University of Sofia Sofia Bulgaria
- Department of Synaptic Signaling and Communications, Institute of NeurobiologyBulgarian Academy of Sciences Sofia Bulgaria
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11
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Ngan P, Nguyen UK, Nguyen T, Tremont T, Martin C. Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study. APOS TRENDS IN ORTHODONTICS 2018. [DOI: 10.4103/apos.apos_27_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction
Microimplant-assisted rapid palatal expansion (MARPE) has recently been offered to adult patients for correcting maxillary transverse deficiency. However, there is limited information in the literature on the success of this appliance and its skeletal and dental effects on skeletally matured patients. The purpose of this study was to investigate the immediate skeletal, dentoalveolar, and periodontal response to MARPE appliance using cone-beam computed tomography in a skeletally matured patient as assessed by the cervical vertebral maturation method.
Materials and Methods
Eight consecutively treated patients (2 females, 6 males; mean age of 21.9 ± 1.5 years) treated with a maxillary skeletal expander were included in the study. Measurements were taken before and after expansion to determine the amount of midpalatal suture opening, upper facial bony expansion, alveolar bone bending, dental tipping, and buccal bone thickness (BBT). Data were analyzed using a one-way ANOVA and matched-pair t-test (α = 0.05).
Results
Midpalatal suture separation was found in 100% of the patients with no dislodged microimplants. Total maxillary expansion was attributed to 41% skeletal, 12% alveolar bone bending, and 48% dental tipping. Pattern of midpalatal suture opening was found to be parallel in both the coronal and axial planes. On average, the absolute dental tipping ranged from 4.17° to 4.96° and the BBT was reduced by an average of 39% measured at the premolars and molars.
Conclusions
The MARPE appliance can be a clinically acceptable, nonsurgical treatment option for correcting mild to moderate maxillary transverse discrepancies for skeletally matured adult patients with a healthy periodontium.
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Affiliation(s)
- Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, USA
| | | | - Tung Nguyen
- Department of Orthodontics, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Timothy Tremont
- Department of Orthodontics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Martin
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, USA
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12
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Procrustes-based geometric morphometrics on MRI images: An example of inter-operator bias in 3D landmarks and its impact on big datasets. PLoS One 2018; 13:e0197675. [PMID: 29787586 PMCID: PMC5963746 DOI: 10.1371/journal.pone.0197675] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/07/2018] [Indexed: 01/25/2023] Open
Abstract
Using 3D anatomical landmarks from adult human head MRIs, we assessed the magnitude of inter-operator differences in Procrustes-based geometric morphometric analyses. An in depth analysis of both absolute and relative error was performed in a subsample of individuals with replicated digitization by three different operators. The effect of inter-operator differences was also explored in a large sample of more than 900 individuals. Although absolute error was not unusual for MRI measurements, including bone landmarks, shape was particularly affected by differences among operators, with up to more than 30% of sample variation accounted for by this type of error. The magnitude of the bias was such that it dominated the main pattern of bone and total (all landmarks included) shape variation, largely surpassing the effect of sex differences between hundreds of men and women. In contrast, however, we found higher reproducibility in soft-tissue nasal landmarks, despite relatively larger errors in estimates of nasal size. Our study exemplifies the assessment of measurement error using geometric morphometrics on landmarks from MRIs and stresses the importance of relating it to total sample variance within the specific methodological framework being used. In summary, precise landmarks may not necessarily imply negligible errors, especially in shape data; indeed, size and shape may be differentially impacted by measurement error and different types of landmarks may have relatively larger or smaller errors. Importantly, and consistently with other recent studies using geometric morphometrics on digital images (which, however, were not specific to MRI data), this study showed that inter-operator biases can be a major source of error in the analysis of large samples, as those that are becoming increasingly common in the 'era of big data'.
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13
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Guo J, Qian J, Yuan Y. Computed Tomography Measurements as a Standard of Exophthalmos? Two-Dimensional Versus Three-Dimensional Techniques. Curr Eye Res 2018; 43:647-653. [PMID: 29377729 DOI: 10.1080/02713683.2018.1431285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jie Guo
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Myopia Key Laboratory of Health Ministry, Shanghai, China
| | - Jiang Qian
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Myopia Key Laboratory of Health Ministry, Shanghai, China
| | - Yifei Yuan
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Myopia Key Laboratory of Health Ministry, Shanghai, China
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14
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Pittayapat P, Jacobs R, Bornstein MM, Odri GA, Lambrichts I, Willems G, Politis C, Olszewski R. Three-dimensional Frankfort horizontal plane for 3D cephalometry: a comparative assessment of conventional versus novel landmarks and horizontal planes. Eur J Orthod 2017; 40:239-248. [DOI: 10.1093/ejo/cjx066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Pisha Pittayapat
- OIC, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Reinhilde Jacobs
- OIC, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Michael M Bornstein
- OIC, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, China
| | - Guillaume A Odri
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional d’Orléans, Orléans cedex 2, France
| | - Ivo Lambrichts
- Biomedical Research Institute, Laboratory of Morphology, Hasselt University, Campus Diepenbeek, Diepenbeek, Belgium
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, University of Leuven, Belgium
| | - Constantinus Politis
- OIC, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Raphael Olszewski
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
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15
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Rhee SC. A Simple Method for International Standardization of Photographic Documentation for Aesthetic Plastic Surgery. Aesthetic Plast Surg 2017; 41:461-465. [PMID: 28160054 DOI: 10.1007/s00266-017-0788-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Abstract
Due to the lack of internationally standardized, objective, and scientific photographic standardization methods, differences in photographic documents have gravely affected the truth of surgical outcomes by visual misperception or illusion, thus hindering the development of plastic surgery clinically and scholastically. Here I suggest a simple method for standardization of facial photographs. The method consists of an imaginary transverse line (tentatively the "PSA line") rather than the Frankfort horizontal plane and uses a white background with black grids and standard RGB with CMYK circles. This simplified method of photographic standardization would help our professional society to make international standards on facial photographic documentation to maintain scholastic ethics, conscience, and morals. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .
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Affiliation(s)
- Seung Chul Rhee
- Department of Plastic and Reconstructive Surgery, Ilsan Hospital, Dongguk University College of School of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang City, Kyounggi-Do, 10326, Republic of Korea.
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16
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Dias PEM, Miranda GE, Beaini TL, Melani RFH. Practical Application of Anatomy of the Oral Cavity in Forensic Facial Reconstruction. PLoS One 2016; 11:e0162732. [PMID: 27612284 PMCID: PMC5017614 DOI: 10.1371/journal.pone.0162732] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/26/2016] [Indexed: 11/18/2022] Open
Abstract
The oral cavity's importance in defining the facial region makes it a primary feature for forensic facial reconstruction (FFR). The aim of this study is to construct a pattern of reference for dimensions and proportions of the lips and establish parameters that may help estimate the vermilion borders' height dimensions and the mouth's width. By means of cone beam computed tomography, divided into two samples: sample 1 (n = 322; 137 male, 185 female) verified the linear distances delimited by anatomical landmarks in soft tissue. The sample 2 (n = 108; 40 male, 68 female), verified the proportions among the height of the vermilion borders, width of the mouth, and linear distances between craniometric landmarks in hard tissues, both from a Brazilian database. The measurements were completed using OsiriX, and the results were analyzed by means of descriptive statistics at a level of significance of 5%. The height of the vermilion borders corresponded to approximately 26% of the width of the mouth. The width of the mouth increased over the course of time in men and remained stable in women. In men, a mean intercanine distance of 75% of the total mouth's width was found; for women, it was 80%. The parameters of the relations between soft and hard tissues in the oral cavity region presented that the distance between landmarks ID-SM (Infradentale-Supramentale) corresponded to 55% of the height of the vermilion borders of the mouth for both sexes, while the distance between landmarks PM-SD (Philtrum medium-Supradentale) corresponded to 85% in men and 88% in women. Mean values of 97% of the width of the mouth in women and 93% in men were attributed to the distance between the mentonian foramina. It was not possible to estimate the height of the labial vermilion borders by the bone measurements, FIs-Fli (Foramen incisivus superius-inferius) and NS-GN (Nasospinale-Gnathion). Profound knowledge of the anatomy and morphology of the oral cavity may contribute to increasing the precision of FFRs and help with human identification.
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Affiliation(s)
- Paulo Eduardo Miamoto Dias
- Laboratory of Forensic Anthropology and Odontology (OFLAB), Department of Social Dentistry, Dental School, University of São Paulo, São Paulo, Brazil
| | - Geraldo Elias Miranda
- Laboratory of Forensic Anthropology and Odontology (OFLAB), Department of Social Dentistry, Dental School, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Thiago Leite Beaini
- Laboratory of Forensic Anthropology and Odontology (OFLAB), Department of Social Dentistry, Dental School, University of São Paulo, São Paulo, Brazil
| | - Rodolfo Francisco Haltenhoff Melani
- Laboratory of Forensic Anthropology and Odontology (OFLAB), Department of Social Dentistry, Dental School, University of São Paulo, São Paulo, Brazil
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17
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Cranial Base and Posterior Cranial Vault Asymmetry After Open and Endoscopic Repair of Isolated Lambdoid Craniosynostosis. J Craniofac Surg 2016; 26:1568-73. [PMID: 26114505 DOI: 10.1097/scs.0000000000001891] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have shown that open cranial vault remodeling does not fully address the endocranial deformity. This study aims to compare endoscopic-assisted suturectomy with postoperative molding helmet therapy to traditional open reconstruction by quantifying changes in cranial base morphology and posterior cranial vault asymmetry. METHODS Anthropometric measurements were made on pre- and 1-year postoperative three-dimensionally reconstructed computed tomography scans of 12 patients with unilateral lambdoid synostosis (8 open and 4 endoscopic-assisted). Cranial base asymmetry was analyzed using: posterior fossa deflection angle (PFA), petrous ridge angle (PRA), mastoid cant angle (MCA), and vertical and anterior-posterior (A-P) displacement of external acoustic meatus (EAM). Posterior cranial vault asymmetry was quantified by volumetric analysis. RESULTS Preoperatively, patients in the open and endoscopic groups were statistically equivalent in PFA, PRA, MCA, and A-P EAM displacement. At 1 year postoperatively, open and endoscopic patients were statistically equivalent in all measures. Mean postoperative PFA for the open and endoscopic groups was 6.6 and 6.4 degrees, PRA asymmetry was 6.4 and 7.6%, MCA was 4.0 and 3.2 degrees, vertical EAM displacement was -2.3 and -2.3 millimeters, and A-P EAM displacement was 6.8 and 7.8 millimeters, respectively. Mean volume asymmetry was significantly improved in both open and endoscopic groups, with no difference in postoperative asymmetry between the 2 groups (P = 0.934). CONCLUSIONS Patients treated with both open and endoscopic repair of lambdoid synostosis show persistent cranial base and posterior cranial vault asymmetry. The results of endoscopic-assisted suturectomy with postoperative molding helmet therapy are similar to those of open calvarial vault reconstruction.
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18
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Hellak AF, Kirsten B, Schauseil M, Davids R, Kater WM, Korbmacher-Steiner HM. Influence of maxillary advancement surgery on skeletal and soft-tissue changes in the nose - a retrospective cone-beam computed tomography study. Head Face Med 2015; 11:23. [PMID: 26152559 PMCID: PMC4495703 DOI: 10.1186/s13005-015-0080-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
Objectives Surgical correction of skeletal maxillary retroposition is often associated with changes in the morphology of the nose. Unwanted alar flaring of the nose is observed in many cases. The aim of the present study was therefore to investigate the influence of surgical advancement of the maxilla on changes in the soft-tissue morphology of the nose. Having a coefficient that allows prediction of change in the nasal width in Caucasian patients after surgery would be helpful for treatment planning. Materials and methods All 33 patients included in this retrospective study were of Caucasian descent and had skeletal Class III with maxillary retrognathia. They were all treated with maxillary advancement using a combination of orthodontic and maxillofacial surgery methods. Two cone-beam computed tomography (CBCT) datasets were available for all of the study's participants (16 female, 17 male; age 24.3 ± 10.4 years): the first CBCT imaging was obtained before the planned procedure (T0) and the second 14.1 ± 6.4 months postoperatively (T1). Morphological changes were recorded three-dimensionally using computer-aided methods (Mimics (Materialise NV, Leuven/Belgium), Geomagic (Geomagics, Morrisville/USA)). Statistical analysis was carried out using SPSS 21 for Mac. Results The mean sagittal advancement of the maxilla was 5.58 mm. The width of the nose at the alar base (Alb) changed by a mean of + 2.59 mm (±1.26 mm) and at the ala (Al) by a mean of + 3.17 mm (±1.32 mm). Both of these changes were statistically highly significant (P = 0.000). The increase in the width of the nose corresponded to approximately half of the maxillary advancement distance in over 80 % of the patients. The nasolabial angle declined by an average of −6.65° (±7.71°). Conclusions Maxillary advancement correlates with a distinct morphological change in nasal width. This should be taken into account in the treatment approach and in the information provided to patients.
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Affiliation(s)
- Andreas F Hellak
- Department of Orthodontics, University Hospital, Georg-Voigt-Strasse 3, Marburg, 35039, Germany.
| | | | - Michael Schauseil
- Department of Orthodontics, University Hospital, Georg-Voigt-Strasse 3, Marburg, 35039, Germany.
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