Digitalized analysis of philtral anatomy for planning individual treatment

WOS: 000413253400001PubMed ID: 28289871Restoration of the philtral region following traumatic, cleft, and tumor surgeries is often difficult due to influence of this feature to whole facial beauty. The aim of this study is to investigate the types and measurements of the philtrum and its relationship with the upper lip using a software. Standard personal photographs of the philtral region were obtained from 200 young adults participated in this study. Linear analyses (the lengths of philtral column and dimple; the philtral width) and angular analyses (apex and central angles of Cupid's bow) were measured as reference points. As for the shape of the philtral column, it was categorized as four distinct types: parallel, triangular, concave, and unclear type. The philtral width was 11.37 +/- 1.9 mm in males, 10.21 +/- 1.80 mm in females. The length of the philtral dimple was 18.16 +/- 3.6 mm in males, 18.16 +/- 3.6 mm in females. Compared with women, both of the measured average philtral reference lengths displayed a significantly greater value in men. In the meanwhile, compared to women, the angular measurements of Cupid's bow (i.e., the apex and central angle of Cupid's bow) were smaller in men. It was 127.47 +/- 12.74A degrees A mm in males, 134.1 +/- 11.38A degrees A mm in females. The triangular and concave types were associated with a substantial fraction in men, whereas the triangular and parallel types were predominant in women. There were significant gender differences in the esthetic rankings of philtral column shapes. These results suggest digitalized reference values relative to the philtral column which may increase the success of the individual reconstructive treatment of the surgical procedures and reduce possible asymmetrical appearance. With the help of certain software, this research has made possible to investigate the ideal parameters of philtral construction in defining the best surgical solution for the patient

Study of frontal hairline patterns for natural design and restoration

WOS: 000402125200011PubMed ID: 27830323Hair loss is one of the most noticeable esthetic problems of the mankind. Hair transplantation has been a highly effective technique in reducing wide foreheads and recontouring the hairline. Creating a natural hairline is one of the most important elements of a successful hair transplant. This study aims at the requirements which are essential in designing hairline morphometrics and natural frontline. Standard photographs of the forehead region were obtained from two hundred young Turkish adults participated in this study. The hairline contour was classified into five groups as round, M-shaped, rectangular, bell-shaped and triangular. Measurements of the forehead region, such as the height of the forehead, widths of the forehead and supraorbital region were calculated as reference points. In women, the average height of the forehead was 58.3 +/- 6.6 mm, the average width of the forehead and the supraorbital region was 129 +/- 14.4 mm and 125.3 +/- 13.5 mm, respectively. The incidence of the hairline shapes was seen as; round (28%), M-shaped (19%), rectangular (30%), bell-shaped (5%), or triangular (18%). In men, the average height of the forehead was 61.4 +/- 9.7 mm, the average width of the forehead and supraorbital region was 137.1 +/- 18 mm and 133.9 +/- 15.9 mm, respectively. The hairline contour among young male adults was classified as round in 27%, M-shaped in 46%, rectangular in 31%, bell-shaped in 4% and triangular in 2%. The rectangular and M-shaped hairlines resemble a more masculine appearance, whereas round shaped hairline resembles femininity. Ideal reconstruction of scalp defects relies on a comprehensive understanding of scalp anatomy and detailed information of patient factors. The classification of the hairline and measured forehead reference lengths will be beneficial in the correction of wide foreheads. There were significant gender differences in the esthetic rankings of the hairline contour. Compared to women, both of the measured average forehead reference lengths displayed a significantly greater value in men. Our results clearly showed that sex difference affected the predominance of the contour type. The M shape was the most common, and the triangular type was poorly classified in men, whereas the rectangular hairline was the most common type among women

The evaluation of relationship between body mass index and mental foramen area using computer-aided methods

Objective: Anatomical structure of the mental foramen (MF) is an essential orientation point particularly for implant planning at surgical clinics of dentistry, for genioplasty operations, and plastic surgery. The aim is to determine the influential factors such as the patient age, gender, and body mass index (BMI) on MF anatomy of dental periapical radiograms. Materials and Methods: Our study evaluated the BMI, gender, and age relationship with the calculated areas of the MF based on symmetrically taken 202 periapical dental radiography with a parallel technique of the bottom premolar region of total 101 people ages ranging from 17 to 70 weighing 46–108 kg. Patient age, BMI, and gender were recorded and statistically tested for correlations on the area of the MF. Digital imaging and communications in medicine were measured MF area. Results: Right MF area was measured as 0–20.8 mm2 (mean: 4.98 mm2) and left as 0–17.3 mm2 (4.93 mm2). There was not a difference in the areas of MF between the two sides. Furthermore, it was determined that ANOVA test and BMI, Pearson test with age and gender did not appear to have an effect on MF areas. Only within the obese people, left MF area was significantly different than those with other BMI groups. A negative effect on image quality was found statistically significantly correlated with age and MF. None of the investigated MFs were garbled by any of the investigated influence factors. Conclusion: In incidences in which the anatomical structure of the MF and the areas were crucial; age, gender, height, and weight of the individual were not determinant factors. BMI and MF appeared to have a negative impact

Computer-assisted analysis contour lines of aesthetic unit for the assessment of lip augmentation

WOS: 000380266300004Background Lip augmentation and changing contour lines have become more popular ways of improving the appearance. However, validated measures of lip fullness for quantification of outcomes are needed; ethnic background and personal goals can optimise outcomes while tailoring lip enhancement treatment to each individual's anatomy. The aim of this study is to analyse the morphological features of the lip in detail and to clarify the objective parameters in related with the subjective ones regarding the lip augmentation and lip reconstruction. Methods Standard photographs of the lips of 200 young Anatolian adults were calculated with linear and angular components. The features of the lower third of the face were analysed with the software program. Linear analyses (heights of the upper lip, the upper vermilion, the lower lip height, the lower vermillion and the chin height) and angular analyses (the upper lip, the lower lip, the apex and Cupid's bow angles) were measured as reference points. The lip shape was classified into five groups: thin, very thin, medium, full and very full. Results The lower third of the face was divided into three segments (Sn-Sto, Sm-Me and Sto-Sm), and the largest portion of the lower face was occupied by the chin and the smallest by the lower lip height in both genders. The upper vermilion height was 8.07 +/- 1.8 mm in males and 7.08 +/- 1.5 mm in females. The lower vermilion height was 10.1 +/- 2.4 mm in males and 9.7 +/- 1.9 mm in females. The upper lip angle was calculated as 30.3 +/- 9.6 +/- in males and 24.2 +/- 6.2 degrees mm in females. The lower lip angle was calculated as 38.3 +/- 9.7 degrees in males and 36.5 +/- 6.4 degrees in females. Meanwhile, the angular measurements of Cupid's bow (i.e., the apex and the central angle of Cupid's bow) were smaller in men than in women. When the lip was analyzed, the medium and full types in upper and lower lips accounted for substantial fractions in men, whereas medium and thin types were predominant also in women. Conclusions With the help of certain software, this research has made possible to define the best cosmetical redesign solution of lip construction and augmentation with a natural appearance for the patient

Creating vascular models by postprocessing computed tomography angiography images: a guide for anatomical education

WOS: 000408431700012PubMed ID: 28168520A new application of teaching anatomy includes the use of computed tomography angiography (CTA) images to create clinically relevant three-dimensional (3D) printed models. The purpose of this article is to review recent innovations on the process and the application of 3D printed models as a tool for using under and post-graduate medical education. Images of aortic arch pattern received by CTA were converted into 3D images using the Google SketchUp free software and were saved in stereolithography format. Using a 3D printer (Makerbot), a model mode polylactic acid material was printed. A two-vessel left aortic arch was identified consisting of the brachiocephalic trunk and left subclavian artery. The life-like 3D models were rotated 360A degrees in all axes in hand. The early adopters in education and clinical practices have embraced the medical imaging-guided 3D printed anatomical models for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between the anatomical structures. Printed vascular models are used to assist in preoperative planning, develop intraoperative guidance tools, and to teach patients surgical trainees in surgical practice

Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression

WOS: 000456541700014PubMed ID: 30662241Compression of the femoral nerve (FN) to the iliac fossa has been reported as a consequence of several pathologies as well as due to the aberrant muscles. The purpose of this research was to investigate the patterns of the accessory muscles of iliopsoas muscles and the relationship of the FN in fifty semi pelvis. Accessory muscular slips from iliacus and psoas, piercing or covering the FN, were found in 19 specimens (7.9%). Based on the macroscopic structure, the muscle was categorized into two types. Pattern 1 as the more frequent variation, was sheet muscular type covering the FN (17 specimens, 89.5%). Pattern 2, the less frequent variation was found on a muscular slip covering the FN (2 specimens, 10.5%). Iliac and psoas muscles and their variants on both types were defined. Appraising the relation between the muscle and the nerves, each disposition of the patterns may be a potential risk for nerve entrapment. The knowledge about the possible variations of the iliopsoas muscle complex and the FN may also give surgeons confidence during pelvic surgery. Recognition of these variations in normal anatomy may be useful to the clinicians when treating patients with refractory leg pain

Application of the life-size patient-specific three-dimensional cervical spine anatomical model for odontoid fracture fixation

Objective: Cervical fixation is the most common treatment of vertebral fractures, osteosarcoma, osteomyelitis, arthritis, and congenital disorders. Mortal complications, such as internal carotid artery, vertebral artery (VA), and spinal cord damages, may occur during the application. The aim of this study was to create the application of the actual three-dimensional (3D) personalized model which was exercised for screwing insertion in C2 damage patients. Methods: Two patients with Type II of C2 fractures were treated with personalized spine models. These models were investigated to achieve particular information of non- and bony elements such as the highness, thickness, and the field of pedicles and vascular diameters for an intraoperative reference. The model was to determine the probable variations and to observe the success of screw rate in the treatment of C2 fractures. The operation duration, instrumentation time, blood loss volume, and clinical and radiological assessment were done. The 3D model's perception was evaluated. Results: Cervical models were defined to secure intervention areas of the VA pedicles and screws. Neither vascular nor neurologic damages were happened in all cases. Besides, the cases did not include broken nails, screw pullout, fracture of bone structure, or infection. Cervical models demonstrated (1) examination of the VA pattern, (2) valuation of virtual screw trajectory line before screw fixation, (3) the application of prebent rods during procedure to contribute to the safety of the posterior instrumentation, (4) postsurgical confirmation, and (5) examined movements of the neck postoperatively. The perception of 3D model for treating C2 fracture was thereby diminishing surgical time, bleeding amount and operative complications. Survey perception of model was calculated in statistical significance (P 0.05). Conclusion: Personalized model is active and confident in achieving an accurate and safe screw fixation during surgery, especially in anatomically abnormal cases. Cervical model provides an accurate representation of the fracture location, pedicle size, and VA shapes. It is therefore useful in surgical planning as it maximizes the possibility of ideal screw position, as well as providing individualized information concerning cervical spinal anatomy

A retrospective comparison of the conventional versus three-dimensional printed model-assisted surgery in the treatment of acetabular fractures

Objective: the aim of this study was to compare the clinical and radiological outcomes of the conventional versus individualized three-dimensional (3D) printing model-assisted pre-contoured plate fixation in the treatment of patients with acetabular fractures. Methods: the data from 18 consecutive patients who underwent surgery for the acetabular fractures were retrospectively analyzed. the patients were divided into two groups (9 in each): conventional and 3D printed model-assisted. the groups were then compared in terms of the duration of surgery, time of instrumentation, time of intraoperative fluoroscopy, and volume of blood loss. the quality of the fracture reduction was also evaluated postoperatively by radiography and computed tomography in both the groups. the quality of the fracture reduction was defined as good (2 mm) based on the amount of displacement in the acetabulum. Results: the conventional group included 9 patients (9 males; mean age=41.7 years; age range=16-70) with a mean follow-up of 11.9 months (range=8-15); the 3D printed model-assisted group consisted of 9 patients (9 males; mean age=46.2 years; age range=30-66) with a mean follow-up of 10.33 months (range=7-17). the average duration of surgery, mean time of instrumentation, time of intraoperative fluoroscopy, and mean volume of blood loss were 180.5±9 minutes, 36.2±3.6 minutes, 6±1 times, and 403.3±52.7 mL in the 3D printed model-assisted group, and 220±15.6 minutes, 57.4±10.65 minutes, 10.4±2.2 times, and 606.6±52.7 mL in the conventional group, respectively. Procedurally, the average duration of surgery, mean time of instrumentation, and mean time of fluoroscopy were significantly shorter, and the mean volume of blood loss was significantly lower in the 3D printed model-assisted group (p<0.05). the quality of the fracture reduction was good in 7 patients (78%) in the conventional group and 8 patients (89%) in the 3D printed model-assisted group. Conclusion: As compared with the conventional surgery, the 3D printing model-assisted pre-contoured plate fixation technique can improve the clinical and radiological outcomes of the acetabular fractures, with shorter surgery, instrumentation, intraoperative fluoroscopy times, and blood loss

Multidisciplinary Assessment of Planning and Resection of Complex Bone Tumor Using Patient-Specific 3D Model

WOS: 000461306700021PubMed ID: 30948885Oncological interventions in thoracic cavity have some important problems such as choice of correct operative approaches depending on the tumor, size, extension, and location. In sarcoma surgery, wide resection should be aimed for the curative surgery. Purpose of this study was to evaluate pre-operative planning of patient-specific thoracic cavity model made by multidisciplinary surgeon team for complex tumor mass for oncological procedures. Patient's scans showed a large mass encroaching on the mediastinum and heart, with erosion of the adjacent ribs and vertebral column. Individual model of this case with thoracic tumor was reconstructed from the DICOM file of the CT data. Surgical team including six interdisciplinary surgeons explained their surgical experience of the use of 3D life-size individual model for guiding surgical treatment. Before patients consented to surgery, each surgeon explained the surgical procedure and perioperative risks to her. A questionnaire was applied to 10 surgical residents to evaluate the 3D model's perception. 3D model scans were useful in determining the site of the lesion, the exact size, extension, attachment to the surrounding structures such as lung, aorta, vertebral column, or vascular involvement, the number of involved ribs, whether the diaphragm was involved also in which order surgeons in the team enter the surgery. 3D model's perception was detected statistical significance as <0.05. Viewing thoracic cavity with tumor model was more efficient than CT imaging. This case was surgically difficult as it included vital structures such as the mediastinal vessels, aorta, ribs, sternum, and vertebral bodies. A difficult pathology for which 3D model has already been explored to assist anatomic visualization was mediastinal osteosarcoma of the chest wall, diaphragm, and the vertebral column. The study helped to establish safe surgical line wherever the healthy tissue was retained and enabled osteotomy of the affected spinal corpus vertically with posterior-anterior direction by preserving the spinal cord and the spinal nerves above and distal the tumor. 3D tumor model helps to transfer complex anatomical information to surgeons, provide guidance in the pre-operative planning stage, for intra-operative navigation and for surgical collaboration purposes. Total radical excision of the bone tumor and reconstructions of remaining structures using life-size model was the key for successful treatment and better outcomes. The recent explosion in popularity of 3D printing is a testament to the promise of this technology and its profound utility in orthopedic oncological surgery