Automatic Craniomaxillofacial Landmark Digitization via Segmentation-Guided Partially-Joint Regression Forest Model and Multiscale Statistical Features

The goal of this paper is to automatically digitize craniomaxillofacial (CMF) landmarks efficiently and accurately from cone-beam computed tomography (CBCT) images, by addressing the challenge caused by large morphological variations across patients and image artifacts of CBCT images

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Three-dimensional morphanalysis of the face.

The aim of the work reported in this thesis was to determine the extent to which orthogonal two-dimensional morphanalytic (universally relatable) craniofacial imaging methods can be extended into the realm of computer-based three-dimensional imaging. New methods are presented for capturing universally relatable laser-video surface data, for inter-relating facial surface scans and for constructing probabilistic facial averages. Universally relatable surface scans are captured using the fixed relations principle com- bined with a new laser-video scanner calibration method. Inter- subject comparison of facial surface scans is achieved using inter- active feature labelling and warping methods. These methods have been extended to groups of subjects to allow the construction of three-dimensional probabilistic facial averages. The potential of universally relatable facial surface data for applications such as growth studies and patient assessment is demonstrated. In addition, new methods for scattered data interpolation, for controlling overlap in image warping and a fast, high-resolution method for simulating craniofacial surgery are described. The results demonstrate that it is not only possible to extend universally relatable imaging into three dimensions, but that the extension also enhances the established methods, providing a wide range of new applications

On Craniofacial Microsomia shape and surgery

Craniofacial microsomia (CFM) is the second most common birth defect of the face after cleft lip and palate. However, studies until now have low patient numbers. Patients with CFM typically have an asymmetrical face due to underdevelopment of one side of the face. They have for instance a smaller and/or abnormal shape of the lower jaw or the ears. This thesis includes the largest phenotypic epidemiology study and surgery study. Furthermore this study gives overview of the major shape changes in 3D instead of the classic 2D analysis. It is the first to describe cranial base changes in 3D within this patient group. The most important findings were: 1. All patients with CFM should be screened for birth defects

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

Determining normal and abnormal lip shapes during movement for use as a surgical outcome measure

Craniofacial assessment for diagnosis, treatment planning and outcome has traditionally relied on imaging techniques that provide a static image of the facial structure. Objective measures of facial movement are however becoming increasingly important for clinical interventions where surgical repositioning of facial structures can influence soft tissue mobility. These applications include the management of patients with cleft lip, facial nerve palsy and orthognathic surgery. Although technological advances in medical imaging have now enabled three-dimensional (3D) motion scanners to become commercially available their clinical application to date has been limited. Therefore, the aim of this study is to determine normal and abnormal lip shapes during movement for use as a clinical outcome measure using such a scanner. Lip movements were captured from an average population using a 3D motion scanner. Consideration was given to the type of facial movement captured (i.e. verbal or non-verbal) and also the method of feature extraction (i.e. manual or semi-automatic landmarking). Statistical models of appearance (Active Shape Models) were used to convert the video motion sequences into linear data and identify reproducible facial movements via pattern recognition. Average templates of lip movement were created based on the most reproducible lip movements using Geometric Morphometrics (GMM) incorporating Generalised Procrustes Analysis (GPA) and Principal Component Analysis (PCA). Finally lip movement data from a patient group undergoing orthognathic surgery was incorporated into the model and Discriminant Analysis (DA) employed in an attempt to statistically distinguish abnormal lip movement. The results showed that manual landmarking was the preferred method of feature extraction. Verbal facial gestures (i.e. words) were significantly more reproducible/repeatable over time when compared to non-verbal gestures (i.e. facial expressions). It was possible to create average templates of lip movement from the control group, which acted as an outcome measure, and from which abnormalities in movement could be discriminated pre-surgery. These abnormalities were found to normalise post-surgery. The concepts of this study form the basis of analysing facial movement in the clinical context. The methods are transferrable to other patient groups. Specifically, patients undergoing orthognathic surgery have differences in lip shape/movement when compared to an average population. Correcting the position of the basal bones in this group of patients appears to normalise lip mobility

Biomaterial-based strategies for craniofacial tissue engineering

Damage to or loss of craniofacial tissues, often resulting from neoplasm, trauma, or congenital defects, can have devastating physical and psychosocial effects. The presence of many specialized tissue types integrated within a relatively small volume leads to difficulty in achieving complete functional and aesthetic repair. Tissue engineering offers a promising alternative to conventional therapies by potentially enabling the regeneration of normal native tissues. Initially, a stimulus responsive biomaterial designed for injectable cell delivery applications was investigated with the goal of providing a substrate for osteogenic differentiation of delivered cells. In order to enable faster clinical translation, later efforts focused on novel combinations of regulated materials. Most common approaches using cell delivery for bone tissue engineering involve the harvest and ex vivo expansion of progenitor cell populations over multiple weeks and cell passages. The effect of aging and passage on proliferation and differentiation were analyzed using murine mesenchymal stem cells as a model. These cells lose their ability to proliferate and differentiate with increases in donor age and passages during cell culture. Delivery of uncultured bone marrow mononuclear cells was then investigated, and it was determined that when delivered to porous scaffolds these cells, which can be harvested, isolated, and returned to the body within the setting of a single operation, significantly increased bone regeneration in vivo. Finally, because these techniques of scaffold implantation and cell delivery would likely fail if delivered to an exposed or infected wound, a method of space maintenance was investigated. Space maintainers made of poly(methyl methacrylate) and having tunable porosity and pore interconnectivity were evaluated within a clean/contaminated mandibular defect. Low porosity space maintainers were found to prevent soft tissue collapse or contracture into the bony defect and allowed surrounding soft tissues to penetrate the pores of the implant, enabling healing over 12 weeks. The tissue response and wound healing characteristics of these implant was favorable when compared to solid or high porosity implants. Although optimization and further investigation of these techniques is necessary, in combination these approaches demonstrate one possible and translatable approach towards craniofacial tissue regeneration