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Loureiro NB, Marzano-Rodrigues MN, Trindade-Suedam IK, D Aquino A, Trindade SHK. Assessment of Internal Nasal Dimensions of Individuals With Cleft Lip and Palate and Obstructive Sleep Apnea Syndrome by Computed Tomography. Cleft Palate Craniofac J 2024; 61:574-583. [PMID: 36330652 DOI: 10.1177/10556656221133606] [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: 02/17/2024] Open
Abstract
To evaluate nasal cavity (NC) dimensions of individuals with cleft lip and/or palate (CL/P), obstructive sleep apnea (OSA), and primary snoring, by tomographic image analysis, compared to individuals with OSA without CL/P (N-CL/P). Cross-sectional and retrospective. Tertiary referral center. Patients were divided into 2 groups: (G1) CL/P + OSA or primary snoring, n = 11; (G2) N-CL/P + OSA, n = 13. NC tomographic images were reconstructed using ITK-SNAP software, and measurements were obtained from these three-dimensional models using SpaceClaim software. Total NC volumes, right and left NC volumes, and volumes of the nostril to the nasal valve (V1) and from the nasal valve to the superior limit of the nasopharynx (V2), cross-sectional areas, and perimeters. NC volumes (total, right, and left sides), V1, and V2, though smaller in the CL/P + OSA, did not differ significantly from the N-CL/P + OSA. Cross-sectional areas and perimeters of the superior limit of the nasopharynx, in the CL/P + OSA, presented significantly higher values compared to the N-CL/P + OSA (P ≤ .05). The internal nasal dimensions of patients with CL/P do not seem to be part of the etiopathogenesis, nor constitute a risk factor for OSA with greater severity, in this special group of patients.
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Affiliation(s)
- Natalia Bortotti Loureiro
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Maria Noel Marzano-Rodrigues
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Ivy Kiemle Trindade-Suedam
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Alessandro D Aquino
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Sergio Henrique Kiemle Trindade
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
- Otolaryngology Section/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
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Gurgel M, Cevidanes L, Costa F, Pereira R, Cunali P, Bittencourt L, Ruellas A, Gonçalves J, Bianchi J, Chaves C. Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway. BMC Oral Health 2023; 23:436. [PMID: 37391785 PMCID: PMC10314553 DOI: 10.1186/s12903-023-03125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA. METHODS The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation. RESULTS Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region. CONCLUSIONS The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil.
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joao Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Cauby Chaves
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
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Gurgel ML, Junior CC, Cevidanes LHS, de Barros Silva PG, Carvalho FSR, Kurita LM, Cunha TCA, Dal Fabbro C, Costa FWG. Methodological parameters for upper airway assessment by cone-beam computed tomography in adults with obstructive sleep apnea: a systematic review of the literature and meta-analysis. Sleep Breath 2023; 27:1-30. [PMID: 35190957 PMCID: PMC9392812 DOI: 10.1007/s11325-022-02582-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND A reliable method for analyzing the upper airway (UA) remains a challenge. This study aimed to report the methods for UA assessment using cone-beam computed tomography (CBCT) in adults with obstructive sleep apnea (OSA). METHODS We performed a systematic review (PROSPERO #CRD42021237490 and PRISMA checklist) that applied a search strategy to seven databases and grey literature. RESULTS In 29 studies with moderate-to-high risk of bias, investigators mostly reported the body position during CBCT (upright or supine) and hard tissue references, diverging in UA delimitation and terminologies. The meta-analysis showed two subgroups (upright and supine), and no statistical differences were identified (p = 0.18) considering the UA area. The volume in the OSA group was smaller than that in the control group (p < 0.003 and Cohen's d = - 0.81) in the upright position. Patients with OSA showed smaller anteroposterior dimensions than the control group and were not affected by the position during image acquisition (p = 0.02; Cohen's d = - 0.52). The lateral measurements were also lower in the OSA group (supine) (p = 0.002; Cohen's d = - 0.6). CONCLUSIONS Patients with OSA showed smaller UA measurements in the upright (volume) and supine (lateral dimension) positions. The anteroposterior dimension was also reduced in patients with OSA compared to the control group, regardless of the position during CBCT acquisition.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | - Cauby Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil.
| | | | | | | | - Lúcio Mitsuo Kurita
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | | | - Cibele Dal Fabbro
- Faculty of Dental Medicine, Center for Advance Research in Sleep Medicine & Stomatology, Universite de Montreal & CIUSSS Nord Ile de Montreal, CHUM, Montreal, QC, Canada
| | - Fabio Wildson Gurgel Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
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Lo Giudice A, Ronsivalle V, Gastaldi G, Leonardi R. Assessment of the accuracy of imaging software for 3D rendering of the upper airway, usable in orthodontic and craniofacial clinical settings. Prog Orthod 2022; 23:22. [PMID: 35691961 PMCID: PMC9189077 DOI: 10.1186/s40510-022-00413-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several semi-automatic software are available for the three-dimensional reconstruction of the airway from DICOM files. The aim of this study was to evaluate the accuracy of the segmentation of the upper airway testing four free source and one commercially available semi-automatic software. A total of 20 cone-beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of the upper airway. The software tested were Invesalius, ITK-Snap, Dolphin 3D, 3D Slicer and Seg3D. The same upper airway models were manually segmented (Mimics software) and set as the gold standard (GS) reference of the investigation. A specific 3D imaging technology was used to perform the superimposition between the upper airway model obtained with semi-automatic software and the GS model, and to perform the surface-to-surface matching analysis. The accuracy of semi-automatic segmentation was evaluated calculating the volumetric mean differences (mean bias and limits of agreement) and the percentage of matching of the upper airway models compared to the manual segmentation (GS). Qualitative assessments were performed using color-coded maps. All data were statistically analyzed for software comparisons. RESULTS Statistically significant differences were found in the volumetric dimensions of the upper airway models and in the matching percentage among the tested software (p < 0.001). Invesalius was the most accurate software for 3D rendering of the upper airway (mean bias = 1.54 cm3; matching = 90.05%) followed by ITK-Snap (mean bias = - 2.52 cm3; matching = 84.44%), Seg 3D (mean bias = 3.21 cm3, matching = 87.36%), 3D Slicer (mean bias = - 4.77 cm3; matching = 82.08%) and Dolphin 3D (difference mean = - 6.06 cm3; matching = 78.26%). According to the color-coded map, the dis-matched area was mainly located at the most anterior nasal region of the airway. Volumetric data showed excellent inter-software reliability (GS vs semi-automatic software), with coefficient values ranging from 0.904 to 0.993, confirming proportional equivalence with manual segmentation. CONCLUSION Despite the excellent inter-software reliability, different semi-automatic segmentation algorithms could generate different patterns of inaccuracy error (underestimation/overestimation) of the upper airway models. Thus, is unreasonable to expect volumetric agreement among different software packages for the 3D rendering of the upper airway anatomy.
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Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, Unit of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, Unit of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giorgio Gastaldi
- Department Orthodontics, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, Unit of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Gurgel M, Cevidanes L, Pereira R, Costa F, Ruellas A, Bianchi J, Cunali P, Bittencourt L, Chaves Junior C. Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes. Clin Oral Investig 2022; 26:875-887. [PMID: 34273012 PMCID: PMC8761785 DOI: 10.1007/s00784-021-04066-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. MATERIALS AND METHODS Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. RESULTS Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. CONCLUSIONS The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. CLINICAL RELEVANCE The craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America.,Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cauby Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
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Miranda F, Garib D, Pugliese F, da Cunha Bastos JC, Janson G, Palomo JM. Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial. Clin Oral Investig 2022; 26:183-195. [PMID: 34041608 DOI: 10.1007/s00784-021-03989-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to compare the upper airway space changes after miniscrew-anchored maxillary protraction with hybrid (HH) and conventional hyrax (CH) expanders. MATERIAL AND METHODS The sample comprised Class III malocclusion growing patients that were randomized into two groups of miniscrew-anchored maxillary protraction. The group HH was treated with a hybrid hyrax appliance in the maxilla and two miniscrews distally to the canines in the mandible. Class III elastics were used from the maxillary first molar to the mandibular miniscrews until anterior crossbite correction. The group CH was treated with a similar protocol except for the conventional hyrax expander in the maxilla. Cone-beam computed tomography was obtained before (T1) and after 12 months of therapy (T2). The shape and size of upper airway were assessed. Intergroup comparisons were performed using Mann-Whitney U test (p < 0.05). RESULTS The group HH was composed of 20 patients (8 female, 12 male) with a mean age of 10.76 years. The group CH was composed of 15 patients (6 female, 9 male) with a mean age of 11.52 years. Anteroposterior and transverse increases of the upper airway were found for both groups. The oropharynx and the most constricted area increased similarly in both groups. CONCLUSIONS No differences in upper airway changes were observed using protraction anchored on hybrid or conventional hyrax expanders. CLINICAL RELEVANCE Maxillary protraction anchored on hybrid or conventional hyrax expanders may benefit patients with breathing disorders due to the increase of the upper airway volume and most constricted area. Registration: ClinicalTrials.gov (NCT03712007).
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Affiliation(s)
- Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, SP, 17012-901, Bauru, Brazil.
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, SP, 17012-901, Bauru, Brazil
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Silvio Marchione 3-20, SP 17012-900, Bauru, Brazil
| | - Fernando Pugliese
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, 9601 Chester Avenue, OH, 44106, Cleveland, USA
| | - José Carlos da Cunha Bastos
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Silvio Marchione 3-20, SP 17012-900, Bauru, Brazil
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, SP, 17012-901, Bauru, Brazil
| | - Juan Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, 9601 Chester Avenue, OH, 44106, Cleveland, USA
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Adults With Unilateral Cleft Lip and Palate Present Reduced Internal Nasal Volumes: Findings of a Three-Dimensional Morphometric Assessment in Cone-Beam Computed Tomography Scans. J Craniofac Surg 2021; 32:e15-e19. [PMID: 33278248 DOI: 10.1097/scs.0000000000006820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The main purpose was to assess and compare nasal cavity (NC) volumes among adults with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) and in noncleft controls (CON), by means of cone-beam computed tomography (CBCT) three-dimensional reconstructions. Forty-five scans of individuals with class III skeletal pattern, matched by age, were gathered in 3 groups: UCLP (n = 15), BCLP (n = 15) and (CON) (n = 15). The NC volume was assessed three-dimensionally, using Dolphin 11.8 software. Descriptive normally distributed data was presented as mean (±SD). Comparisons of NC volume among groups was performed using ANOVA test (P ≤ 0.05). The NC mean volumes corresponded to 14.7(±2.2) cm3 (UCLP), 17.1(±2.2) cm3 (BCLP) and 18.1(±3.8) cm3 (CON), respectively. UCLP individuals presented a significantly reduced NC volume when compared to controls (P = 0.006). No differences were observed between UCLP versus BCLP or BCLP versus CON. The intraclass correlation coefficient suggested a high intra- and inter-examiners agreement (>.075). Individuals with unilateral cleft lip and palate presented reduced NC when compared to individuals without cleft lip and palate. CBCT scans can be considered a highly accurate tool for morphometric assessments of craniofacial structures.
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Leonardi R, Lo Giudice A, Farronato M, Ronsivalle V, Allegrini S, Musumeci G, Spampinato C. Fully automatic segmentation of sinonasal cavity and pharyngeal airway based on convolutional neural networks. Am J Orthod Dentofacial Orthop 2021; 159:824-835.e1. [PMID: 34059213 DOI: 10.1016/j.ajodo.2020.05.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This study aimed to test the accuracy of a new automatic deep learning-based approach on the basis of convolutional neural networks (CNN) for fully automatic segmentation of the sinonasal cavity and the pharyngeal airway from cone-beam computed tomography (CBCT) scans. METHODS Forty CBCT scans from healthy patients (20 women and 20 men; mean age, 23.37 ± 3.34 years) were collected, and manual segmentation of the sinonasal cavity and pharyngeal subregions were carried out by using Mimics software (version 20.0; Materialise, Leuven, Belgium). Twenty CBCT scans from the total sample were randomly selected and used for training the artificial intelligence model file. The remaining 20 CBCT segmentation masks were used to test the accuracy of the CNN fully automatic method by comparing the segmentation volumes of the 3-dimensional models obtained with automatic and manual segmentations. The accuracy of the CNN-based method was also assessed by using the Dice score coefficient and by the surface-to-surface matching technique. The intraclass correlation coefficient and Dahlberg's formula were used to test the intraobserver reliability and method error, respectively. Independent Student t test was used for between-groups volumetric comparison. RESULTS Measurements were highly correlated with an intraclass correlation coefficient value of 0.921, whereas the method error was 0.31 mm3. A mean difference of 1.93 ± 0.73 cm3 was found between the methodologies, but it was not statistically significant (P >0.05). The mean matching percentage detected was 85.35 ± 2.59 (tolerance 0.5 mm) and 93.44 ± 2.54 (tolerance 1.0 mm). The differences, measured as the Dice score coefficient in percentage, between the assessments done with both methods were 3.3% and 5.8%, respectively. CONCLUSIONS The new deep learning-based method for automated segmentation of the sinonasal cavity and the pharyngeal airway in CBCT scans is accurate and performs equally well as an experienced image reader.
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Affiliation(s)
- Rosalia Leonardi
- Department of Orthodontics, School of Dentistry, University of Catania, Catania, Italy.
| | - Antonino Lo Giudice
- Department of Orthodontics, School of Dentistry, University of Catania, Catania, Italy
| | - Marco Farronato
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, Milan, Italy
| | - Vincenzo Ronsivalle
- Department of Orthodontics, School of Dentistry, University of Catania, Catania, Italy
| | | | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, Italy
| | - Concetto Spampinato
- Department of Computer and Telecommunications Engineering, University of Catania, Catania, Italy
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Hassegawa CA, Garcia-Usó MA, Yatabe-Ioshida MS, Trindade IEK, Fukushiro AP, Carreira DGG, Trindade-Suedam IK. Internal nasal dimensions of children with unilateral cleft lip and palate and maxillary atresia: comparison between acoustic rhinometry technique and cone-beam computed tomography. Codas 2021; 33:e20200099. [PMID: 34037161 DOI: 10.1590/2317-1782/20202020099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the nasal cavity geometry of children and teenagers with cleft lip and palate and maxillary atresia by two methods: cone-beam computed tomography, considered the gold standard, and acoustic rhinometry. METHODS Data on cone-beam computed tomography and acoustic rhinometry examinations of 17 children and teenagers with cleft lip and palate and maxillary atresia, previously obtained for orthodontic planning purposes, were evaluated prospectively. Using Dolphin Imaging 11.8 software, the nasal cavity was reconstructed by two evaluators, and the internal nasal volumes were obtained. Using rhinometry, the volumes of regions V1 and V2 were measured. The values of each examination were then compared at a significance level of 5%. RESULTS Statistical analysis showed high intra- and inter-rater reproducibility in the cone-beam computed tomography analysis. The mean internal nasal volumes (± standard deviation) obtained using acoustic rhinometry and cone-beam computed tomography corresponded to 6.6 ± 1.9 cm3 and 8.1 ± 1.5 cm3, respectively. The difference between the examinations was 17.7%, which was considered statistically significant (p = 0.006). CONCLUSION The nasal volumes measured via the two methods were different; that is, they presented discrepancies in the measurements. The gold standard technique identified larger volumes than acoustic rhinometry in the nasal cavity. Therefore, determining which test reflects clinical reality is an essential future step.
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Affiliation(s)
- Caroline Akemi Hassegawa
- Programa de Pós-graduação, Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil
| | | | - Marília Sakayo Yatabe-Ioshida
- Departemento de Ortodontia e Odontopediatria, School of Dentistry, University of Michigan - UM - Ann Arbor (MI), USA
| | - Inge Elly Kiemle Trindade
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo - FOB USP - Bauru (SP), Brasil
| | - Ana Paula Fukushiro
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo - FOB USP - Bauru (SP), Brasil
| | - Daniela Gamba Garib Carreira
- Setor de Ortodontia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Ortodontia, Faculdade de Odontologia de Bauru - FOB USP - Bauru (SP), Brasil
| | - Ivy Kiemle Trindade-Suedam
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo - FOB USP - Bauru (SP), Brasil
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Garcia-Usó M, Lima TF, Trindade IEK, Pimenta LAF, Trindade-Suedam IK. Three-dimensional tomographic assessment of the upper airway using 2 different imaging software programs: A comparison study. Am J Orthod Dentofacial Orthop 2021; 159:217-223. [PMID: 33483220 DOI: 10.1016/j.ajodo.2020.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 03/01/2020] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Several imaging software programs with different tools are available for upper airway (UAW) analysis by means of cone beam computed tomography. Because of this wide variability, this study aimed to compare the reproducibility of two of the most used software programs on UAW segmentation, that is, Dolphin Imaging (Dolphin Imaging and Management Solutions, Chatsworth, Calif) and Mimics Research (Materialise, Leuven, Belgium). METHODS The sample consisted of 50 scans of adult subjects with Class III malocclusion; pharyngeal volume and minimal cross-sectional area (mCSA) were assessed twice by 2 experienced evaluators using both software programs. Intra- and intersoftware and/or evaluator agreement were calculated using the intraclass correlation coefficient (ICC). Bland-Altman analysis was used to visualize the intersoftware and interevaluator agreement. RESULTS Using Mimics Research and Dolphin Imaging, the respective mean values of volume (cm3) were 27.1 ± 8.4 and 24.7 ± 8.1 (P < 0.05) and of mCSA (mm2) were 167.8 ± 95.5 and 176.5 ± 102.3 (P < 0.05). Although differences between software packages were observed on both the analyzed variables, the results showed a high intersoftware agreement, with ICC of 0.87 (volume) and 0.97 (mCSA) and mean bias of 24.6 (volume) and -8.8 (mCSA). A high intrasoftware agreement was also observed, with values varying from 0.83 to 0.99. Excellent intra- and interevaluator agreement was also obtained, with ICC values from 0.93 to 0.99. CONCLUSIONS Dolphin Imaging and Mimics Research individually provide highly reproducible results, with clinically acceptable agreement between them for UAW segmentation, providing consistent values for volume and mCSA.
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Affiliation(s)
- Michele Garcia-Usó
- Former Post-Graduation Student, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Thiago F Lima
- Former Post-Graduation Student, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Inge Elly K Trindade
- Department of Biological Sciences, Bauru School of Dentistry, and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Luiz Andre F Pimenta
- Craniofacial Center, and Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ivy Kiemle Trindade-Suedam
- Department of Biological Sciences, Bauru School of Dentistry, and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil.
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11
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Bone volume change following vascularized free bone flap reconstruction of the mandible. J Craniomaxillofac Surg 2020; 48:859-867. [DOI: 10.1016/j.jcms.2020.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/03/2020] [Accepted: 07/19/2020] [Indexed: 01/18/2023] Open
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12
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Koç A, Eroğlu CN, Bilgili E. Assessment of prevalence and volumetric estimation of possible Stafne bone concavities on cone beam computed tomography images. Oral Radiol 2019; 36:254-260. [PMID: 31327093 DOI: 10.1007/s11282-019-00402-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our study aimed to determine the prevalence and volumetric estimates of Stafne bone cavities (SBC) on cone beam computed tomography (CBCT) images. METHODS This retrospective study, which involved the CBCT images of 1141 men and 1260 women with an age range of 10-90 years, aimed to determine the prevalence of SBCs and to calculate their volumes using the semi-automatic segmentation method. RESULTS A total of 15 SBCs were diagnosed in 14 patients. Among the detected SBCs, 7.14% were found in a female patient and 92.86% were found in 13 male patients. Of the total number of SBCs, 6.67% were anteriorly located and 93.33% were posteriorly located. Bilateral SBCs had a prevalence of 0.04%; unilateral posterior SBCs 0.54% and anterior SBCs 0.04%. The mean SBC volume was calculated as 338.05 mm3. CONCLUSIONS The results of our study showed that SBC is a rare anomaly. In contrast to two-dimensional imaging techniques, CBCT allows a precise determination of SBCs' pattern of impact on adjacent bony structures, relationship with the mandibular canal and dimensions.
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Affiliation(s)
- Alaettin Koç
- Department of Oral and Maxillofacial Radiology, Van Yüzüncü Yıl University, Faculty of Dentistry, 65080, Van, Turkey.
| | - Cennet Neslihan Eroğlu
- Department of Oral and Maxillofacial Surgery, Akdeniz University, Faculty of Dentistry, Antalya, Turkey
| | - Ersen Bilgili
- Department of Oral and Maxillofacial Radiology, Trakya University, Faculty of Dentistry, Edirne, Turkey
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Gomes AF, Brasil DM, Silva AIV, Freitas DQ, Haiter-Neto F, Groppo FC. Accuracy of ITK-SNAP software for 3D analysis of a non-regular topography structure. Oral Radiol 2019; 36:183-189. [PMID: 31267257 DOI: 10.1007/s11282-019-00397-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the accuracy of ITK-SNAP software for measuring volumes of a non-regular shape structure, using cone beam computed tomography (CBCT) scans, besides for developing a mathematical model to correct the software measurement error in case it existed. METHODS A phantom made by moulding a rubber duck's head was filled with total (38,000 mm3) and partial volumes of water (7000 mm3, 14,000 mm3, 21,000 mm3, 28,000 mm3 and 35,000 mm3), which constituted the gold standards. The sound phantom and the phantom filled with different volumes of water were scanned in a Picasso Trio CBCT unit set at 80 kVp, 3.7 mA, 0.2 mm3 voxel and 12 × 8.5 cm field of view. Semi-automatic segmentation was performed with ITK-SNAP 3.0 software by two trained oral radiologists. Linear regression analyzed the relation between ITK-SNAP calculated volumes and the gold standard. Intraclass correlation coefficient was applied to analyze the reproducibility of the method. Significance level was set at 5%. RESULTS Linear regression analysis showed a significant relationship between ITK-SNAP volumes and the gold standard (F = 22,537.3, p < 0.0001), with an R2 of 0.9993. The average error found was 4.7 (± 4.3) %. To minimize this error, a mathematical model was developed and provided a reduction of it. ICC revealed excellent intra-examiner agreements for both examiners 1 (ICC = 0.9991, p < 0.0001) and 2 (ICC = 0.9989, p < 0.0001). Likewise, inter-examiner agreement was excellent (ICC = 0.9991, p < 0.0001). CONCLUSION The software showed to be accurate for evaluating non-regular shape structures. The mathematical model developed reduced an already small error on the software's measurements.
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Affiliation(s)
- Amanda Farias Gomes
- Department of Oral Diagnosis-Oral Radiology, Piracicaba Dental School, State University of Campinas, Av. Limeira, 901, Piracicaba, 13414-903, SP, Brazil
| | - Danieli Moura Brasil
- Department of Oral Diagnosis-Oral Radiology, Piracicaba Dental School, State University of Campinas, Av. Limeira, 901, Piracicaba, 13414-903, SP, Brazil.
| | - Amaro Ilídio Vespasiano Silva
- Department of Oral Radiology, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis-Oral Radiology, Piracicaba Dental School, State University of Campinas, Av. Limeira, 901, Piracicaba, 13414-903, SP, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis-Oral Radiology, Piracicaba Dental School, State University of Campinas, Av. Limeira, 901, Piracicaba, 13414-903, SP, Brazil
| | - Francisco Carlos Groppo
- Department of Physiological Sciences-Pharmacology, Anesthesiology and Therapeutics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
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