Anatomical curve identification

Methods for capturing images in three dimensions are now widely available, with stereo-photogrammetry and laser scanning being two common approaches. In anatomical studies, a number of landmarks are usually identified manually from each of these images and these form the basis of subsequent statistical analysis. However, landmarks express only a very small proportion of the information available from the images. Anatomically defined curves have the advantage of providing a much richer expression of shape. This is explored in the context of identifying the boundary of breasts from an image of the female torso and the boundary of the lips from a facial image. The curves of interest are characterised by ridges or valleys. Key issues in estimation are the ability to navigate across the anatomical surface in three-dimensions, the ability to recognise the relevant boundary and the need to assess the evidence for the presence of the surface feature of interest. The first issue is addressed by the use of principal curves, as an extension of principal components, the second by suitable assessment of curvature and the third by change-point detection. P-spline smoothing is used as an integral part of the methods but adaptations are made to the specific anatomical features of interest. After estimation of the boundary curves, the intermediate surfaces of the anatomical feature of interest can be characterised by surface interpolation. This allows shape variation to be explored using standard methods such as principal components. These tools are applied to a collection of images of women where one breast has been reconstructed after mastectomy and where interest lies in shape differences between the reconstructed and unreconstructed breasts. They are also applied to a collection of lip images where possible differences in shape between males and females are of interest

Three-dimensional assessment of facial morphology in infants with cleft lip and palate

Differential growth was demonstrated between facial features and within some facial features. In particular, the columella, nostrils and philtrum did not grow significantly after surgery, although this would be considered normal in the age group studied. Facial growth in children with UCL and UCLP was independent of the head and body growth. The presence of a cleft of the secondary palate accentuated the amount of soft tissue disruption by the cleft in the lip and nose, but not the pattern of disruption. Primary lip / nose repair had no detrimental effect on the early growth and development of the facial features. Likewise, palate repair had no discernible effect on facial soft tissue growth at age 2 years. Primary lip /nose repair had a beneficial effect on facial morphology in terms of reducing asymmetry and was most successful in the improving philtrum and nasal base symmetry, less successful in improving the nasal rim asymmetry. A possible early beneficial effect of cleft repair remote from the surgery site was noted in the reduction of upper face asymmetry in the first year of life. Residual asymmetry in the facial features did not change by age 2 years, despite increases in size with growth. Facial morphology outcomes for UCL and UCLP children in this study was generally similar at 2 years of age, despite marked differences in pre-operative facial form. However, nasal base asymmetry, upper face asymmetry and residual nostril shape deformity were significantly greater in UCLP children at 2 years of age, than in UCL children. These shape differences were not detectable by measurement of facial dimensions alone

Dental anomaly detection using intraoral photos via deep learning

Children with orofacial clefting (OFC) present with a wide range of dental anomalies. Identifying these anomalies is vital to understand their etiology and to discern the complex phenotypic spectrum of OFC. Such anomalies are currently identified using intra-oral exams by dentists, a costly and time-consuming process. We claim that automating the process of anomaly detection using deep neural networks (DNNs) could increase efficiency and provide reliable anomaly detection while potentially increasing the speed of research discovery. This study characterizes the use of` DNNs to identify dental anomalies by training a DNN model using intraoral photographs from the largest international cohort to date of children with nonsyndromic OFC and controls (OFC1). In this project, the intraoral images were submitted to a Convolutional Neural Network model to perform multi-label multi-class classification of 10 dental anomalies. The network predicts whether an individual exhibits any of the 10 anomalies and can do so significantly faster than a human rater can. For all but three anomalies, F1 scores suggest that our model performs competitively at anomaly detection when compared to a dentist with 8 years of clinical experience. In addition, we use saliency maps to provide a post-hoc interpretation for our model’s predictions. This enables dentists to examine and verify our model’s predictions.Fil: Ragodos, Ronilo. University of Iowa; Estados UnidosFil: Wang, Tong. University of Iowa; Estados UnidosFil: Padilla, Carmencita. University of the Philippines; FilipinasFil: Hecht, Jacqueline T.. University of Texas Health Science Center at Houston; Estados UnidosFil: Poletta, Fernando Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Orioli, Ieda Maria. Universidade Federal do Rio de Janeiro; BrasilFil: Buxó, Carmen J.. Universidad de Puerto Rico; Puerto RicoFil: Butali, Azeez. University of Iowa; Estados UnidosFil: Valencia Ramirez, Consuelo. Fundación Clínica Noel; ColombiaFil: Restrepo Muñeton, Claudia. Fundación Clínica Noel; ColombiaFil: Wehby, George. University of Iowa; Estados UnidosFil: Weinberg, Seth M.. University of Pittsburgh; Estados Unidos. University of Pittsburgh at Johnstown; Estados UnidosFil: Marazita, Mary L.. University of Pittsburgh at Johnstown; Estados Unidos. University of Pittsburgh; Estados UnidosFil: Moreno Uribe, Lina M.. University of Iowa; Estados UnidosFil: Howe, Brian J.. University of Iowa; Estados Unido

Three-dimensional assessment of dentofacial deformity in children with clefts

Background: Changes in clinical management; advances in non-invasive three-dimensional imaging; developments in methods of shape analysis. Aim: To assess three-dimensional dentofacial deformity with a view to early appraisal of primary surgical outcome. Results: Significant differences in upper lip morphology were found between the cleft children and their unaffected peers; nasal asymmetry that became more obvious in function was noted in cleft children; the maxillary dental arches of the children with repaired cleft palate were shallow, short and narrow; and the dental arch, deformity and the facial soft tissue deformity were unrelated. Contributions to the field: It has been shown that deviation from normal could be detected as young as 3 years of age using computerised stereophotogrammetry; preliminary, objective, three-dimensional analysis of facial function has been completed in young children; the accuracy of three-dimensional CT scanning of dentate study models and the time cost of data collection were quantified; and this study has produced a body of three-dimensional data that can test and support analytical advances

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

An innovative assessment of the dynamics of facial movements in surgically managed Unilateral Cleft Lip using 4D imaging

Introduction Verbal and non-verbal facial expressions form an integral part of everyday social interactions among human beings. Facial expressions may be distorted and asymmetric in conditions like craniofacial anomalies, trauma and facial palsy. Cleft lip and palate is one such craniofacial anomaly, that is managed surgically early in life by means of cleft lip repair surgery, nasal reconstruction and lip revision procedures. The goal of surgical repair is to ensure the renewal of optimum form and function in these patients. Despite these surgical procedures, a certain degree of asymmetry persists in patients, which result in decreased aesthetics and function in areas associated with the poorly approximated muscle bundle or due to scar tissue around the surgically corrected muscle group. This asymmetry that ensues after surgery, affects the performance of facial expressions. It is important to quantify facial movement and facial expressions in an objective fashion, in order to be able to assess the effectiveness of surgery and decide on the need for further revision surgery. A lot of work on quantification of facial movements in cleft lip and palate patients has been carried out previously using 2D and 3D imaging modalities. 2D imaging systems do not analyse the depth of images and therefore these methods lose out on an important dimension of facial morphology that needs to be assessed. 3D systems analyse the depth of images but are unable to assess the moving face (the fourth dimension) and only quantify facial movement on still or static images (3D). The human face is rarely static in day to day life and therefore measurement of facial expressions requires that facial expressions be recorded in a dynamic way in such a way that the speed, magnitude and pattern of facial movement be recorded. Each facial expression has specific muscle groups that undergo contraction and relaxation in different phases of the movement starting from rest to peak expression and final resting position. Some of these muscle groups are surgically corrected or re-approximated during cleft lip repair whereas other muscles are relatively or completely untouched. It is therefore necessary to analyse the entire movement sequence for asymmetry as this will highlight which specific muscle groups are associated with high asymmetry scores during the movement, thereby enabling the surgeon to plan on revision procedures accordingly. Furthermore, it is also essential that the entire facial topography be assessed. A lot of the previous work done on quantifying facial movement and assessing facial asymmetry used individual landmarks on the face and measured the displacement of these landmarks as asymmetry scores. The disadvantage of using individual landmarks is that the remaining facial surface is not taken into consideration and therefore results obtained may not be representative of the entire facial structure. The novelty in this study is that it used a generic face mesh which undergoes elastic deformation in a process called ‘conformation’ in order to resemble the patient’s facial morphology. This conformed face mesh is then used to assess and quantify facial movement and measure facial asymmetry. This study therefore assesses the facial surface in its entirety along with analyzing asymmetry on a moving or dynamically changing facial surface. Colour maps were used to understand the directionality of facial asymmetry and asymmetry was seen in all three spatial planes-the x, y and z directions. Objective To characterise and assess facial asymmetry during four facial expressions- maximum smile, cheek puff, lip purse and grimace, in patients with surgically managed Unilateral Cleft Lip (UCL), using a real time 3D imaging (Di4D) system, and compare these with asymmetry that is seen in an age and sex matched control group. Design Prospective two cohort comparative study. 25 surgically managed UCL cases and 75 controls at 8-10 years of age were recruited. Methods Facial movements during each of the four expressions were recorded using stereo-photogrammetry at a rate of 60 3D facial images per second. Each expression took approximately 3 seconds and generated 180 3D facial images for the analysis. A generic facial mesh which consists of more than 7000 quasi landmarks, was used for the assessment of facial asymmetry. This was wrapped (conformed) on the 3D image, the conformed mesh was mirror imaged, the original and mirror images were superimposed and the distances between the corresponding landmarks of the original and mirrored images of the five selected frames quantified facial asymmetry. Results Statistically significant differences were seen regarding the magnitude of facial asymmetry between the UCL group and the non-cleft controls in all four facial expressions. In maximum smile, asymmetry was prominent in the nasal regions- the nasal tip and alar regions as well as the upper lip vermillion border, the philtrum and columella. Higher average asymmetry in the UCL group in the total face was seen in the 3D frame mid-way between maximum smile and rest (frame 4) followed by the frame at peak expression of maximum smile (frame 3). In cheek puff, asymmetry in the total face was seen most pronounced in frame 2 as the face was moving into the phase of peak facial expression. In the X direction, asymmetry was most noted in the alar regions and philtrum and upper lip regions. Vertical asymmetries were minimal. Anteroposterior asymmetry was most noted in frame 2 in areas around the ala of the nose and upper lip vermillion and philtrum. In lip purse, asymmetry in the UCL group was seen to be higher in the peak frame (frame 3) followed by frame 4 and 2 for the total face. Asymmetry in the total face was most pronounced in the alar regions of the nose, the philtrum and upper lip vermillion border. In grimace, asymmetry in the UCL group was seen to be higher in the mid-way frame (frame 2-mid-way between initial resting frame and peak expression of cheek puff) followed by frame 3 for the total face. Vertical asymmetries were seen to be minimal in all facial expressions except in the case of lip purse. The nasolabial region showed maximum asymmetry during facial movement. Conclusion This study provides a sensitive and innovative tool to assess and quantify the dynamics of facial muscle movement, which correspondingly highlights the anatomical areas of residual asymmetry. This further enables surgeons to understand where the deficiency exists and accordingly plan revision procedures to improve facial symmetry and therefore optimally revive facial form and function. This thesis identifies the limitations and inability of primary lip repair to bring about symmetrical outcomes and helps understand the modifications and refinements required during cleft lip repair which ultimately improves the quality and efficacy of the surgery and the quality of life in patients with cleft lip and palate

In vitro characterisation of human cleft fibroblasts isolated from patients with differing cleft manifestations

Following surgical correction of cleft lip and palate a number of patients develop post-operative complications including oronasal-fistulae (ONF) and hypertrophic scarring (HTS). As these conditions can form due to pathological wound healing, this study aimed to characterise fibroblast behaviour, derived from patients with differing cleft phenotypes, to identify potential contributing factors. Fibroblasts were isolated from oral mucosal tissues derived from 29 cleft patients and were subsequently characterised and compared in terms proliferation, migration, ECM deposition and gene expression. Cleft fibroblasts were clustered into two statistically distinct migratory groups: fast and slow, with fast migrating fibroblasts secreting greater amounts of collagen. Although these groups did not correlate with cleft phenotype, CL fibroblasts all presented increased motility coupled with increased collagen deposition and upregulation of COL1A1. As both elevated motility and collagen secretion are hallmarks of HTS, it is possible that patients with faster migrating fibroblasts, including those derived from CL, may be at greater risk of pathological wound healing. Further, as fast migrating fibroblasts contained greater quantities of F-actin and upregulated ARP2, a major component of the ARP2/3 complex which acts as an actin filament nucleator, the observed increase in motility may be a result of altered cytoskeletal dynamics

Clinic, diagnosis, treatment, prevention, prosthetics various dentofacial anomalies and deformities

Orthodontics- section of dentistry, has been studying the etiology and pathogenesis of dentoalveolar anomalies, improvement of methods of diagnosis, the development of methods of prevention and elimination of anomalies of the teeth, the form of the dental arches, malocclusion, managing the growth of the jaws, the normalization function of dental system, the elimination of aesthetic disorders, the study of the influence of dentition abnormalities in the development of related organs and body as a whole. The problem of providing orthodontic care for children, adolescents and adults remains relevant because of dentoalveolar anomalies have considerable spread. Currently, there has been five major areas of development: 1) Preventive Orthodontics; 2) Specialized treatment of children in orthodontic offices or classrooms; 3)Orthodontic treatment of adults; 4) Orthodontic treatment and tooth-jaw denture patients with congenital clefts in the maxillofacial region in the system of complex treatment; 5) Orthodontic treatment as the preliminary and final stages after surgical removal of tooth-jawfacial anomalies. Toolkit is designed for students of 3-5 courses of the international faculty