Accuracy of Guided Surgery and Real-Time Navigation in Temporomandibular Joint Replacement Surgery

Background: Sophisticated guided surgery has not been implemented into total joint replacement-surgery (TJR) of the temporomandibular joint (TMJ) so far. Design and in-house manufacturing of a new advanced drilling guide with vector and length control for a typical TJR fossa component are described in this in vitro study, and its accuracy/utilization was evaluated and compared with those of intraoperative real-time navigation and already available standard drilling guides. Methods: Skull base segmentations of five CT-datasets from different patients were used to design drilling guides with vector and length control according to virtual surgical planning (VSP) for the TJR of the TMJ. Stereolithographic models of the skull bases were printed three times for each case. Three groups were formed to compare our newly designed advanced drilling guide with a standard drilling guide and drill-tracking by real-time navigation. The deviation of screw head position, screw length and vector in the lateral skull base have been evaluated (n = 72). Results: There was no difference in the screw head position between all three groups. The deviation of vector and length was significantly lower with the use of the advanced drilling guide compared with standard guide and navigation. However, no benefit in terms of accuracy on the lateral skull base by the use of real-time navigation could be observed. Conclusion: Since guided surgery is standard in implant dentistry and other CMF reconstructions, this new approach can be introduced into clinical practice soon, in order to increase accuracy and patient safety

Continuous Multidisciplinary Care for Patients With Orofacial Clefts—Should the Follow-up Interval Depend on the Cleft Entity?

Objective: The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. Design:We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 (n=1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. Results: Patients with CLP made up the largest group (n=537), followed by patients with cleft of the soft palate (n=371) and CL ±A (n=218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. Conclusion: Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in followup appointments

Lippen-Kiefer-Gaumen-Spalten: Individuelle Analyse der Lippenspalte durch 3-D-Lasertopometrie

Zusammenfassung: Hintergrund: Mit Gipsmodellen und Fotografien ist die dreidimensionale Analyse einer Lippen-Kiefer-Gaumen-Spalte meist nur unzureichend möglich. Ziel der vorliegenden Studie war es daher, die 3-D-Lasertopometrie auf ihre Anwendbarkeit zur dreidimensionalen Weichgewebserfassung bei Patienten mit Lippen-Kiefer-Gaumen-Spalten zu testen. Patienten und Methode: Bei 20 Patienten (3-35 Jahre), die eine einseitige, nicht operierte Lippen-, Lippen-Kiefer- oder Lippen-Kiefer-Gaumen-Spalte aufwiesen, wurde mit einem 3-D-Laserscanner die Gesichtsoberfläche prä- und postoperativ dreidimensional erfasst. Die dabei erzeugten digitalen Datensätze wurden in einer virtuellen Umgebung metrisch analysiert und anhand von Quotienten größenunabhängig wiedergegeben. Sie dienten der Auswahl der Operationstechnik und der Beurteilung des Operationsergebnisses. Ergebnisse: Mit dem 3-D-Laserscanner wurden 3-D-Oberflächen guter Qualität erstellt, die sich im Millimeterbereich ausmessen ließen. Die dreidimensionale Spaltmorphologie konnte in den Datensätzen reproduzierbar mit Landmarks versehen und vermessen werden. Auch die postoperative Symmetrie ließ sich so kontrollieren und objektivieren. Als nachteilig erwiesen sich die relativ lange Messzeit und die Notwendigkeit zur Kombination mehrerer Ansichten. Schlussfolgerung: Das vorgestellte 3-D-Laserverfahren ermöglicht eine präzise dreidimensionale Weichteilanalyse der Lippen- und Nasenregion bei Spaltpatienten. Es eignet sich jedoch nur bedingt für lebhafte Säuglinge und unkooperative Patiente

Clinical Follow-Up in Orofacial Clefts—Why Multidisciplinary Care Is the Key

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005–2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers

3D Surface Measurement for Medical Application—Technical Comparison of Two Established Industrial Surface Scanning Systems

In 3D mapping of flexible surfaces (e.g. human faces) measurement errors due to movement or positioning occur. Aggravated by equipment- or researcher-caused mistakes considerable deviations can result. Therefore first the appliances' precision handling and reliability in clinical environment must be established. Aim of this study was to investigate accuracy and precision of two contact-free 3D measurement systems (white light vs. laser). Standard specimens of known diameter for sphere deviation, touch deviation and plane deviation were tested. Both systems are appropriate for medical application acquiring solid data (<mm). The more complex white-light system shows better accuracy at 0.2s measuring time. The laser system is superior concerning robustness, while accuracy is poorer and input time (1.5-2.5s) longer. Due to the clinical demand the white-light system is superior in a laboratory environment, while the laser system is easier to handle under non-laboratory condition

RecycleNet: Latent Feature Recycling Leads to Iterative Decision Refinement

Despite the remarkable success of deep learning systems over the last decade, a key difference still remains between neural network and human decision-making: As humans, we cannot only form a decision on the spot, but also ponder, revisiting an initial guess from different angles, distilling relevant information, arriving at a better decision. Here, we propose RecycleNet, a latent feature recycling method, instilling the pondering capability for neural networks to refine initial decisions over a number of recycling steps, where outputs are fed back into earlier network layers in an iterative fashion. This approach makes minimal assumptions about the neural network architecture and thus can be implemented in a wide variety of contexts. Using medical image segmentation as the evaluation environment, we show that latent feature recycling enables the network to iteratively refine initial predictions even beyond the iterations seen during training, converging towards an improved decision. We evaluate this across a variety of segmentation benchmarks and show consistent improvements even compared with top-performing segmentation methods. This allows trading increased computation time for improved performance, which can be beneficial, especially for safety-critical applications.Comment: Accepted at 2024 Winter Conference on Applications of Computer Vision (WACV

Earth system modeling with endogenous and dynamic human societies: the copan:CORE open World-Earth modeling framework

Analysis of Earth system dynamics in the Anthropocene requires explicitly taking into account the increasing magnitude of processes operating in human societies, their cultures, economies and technosphere and their growing feedback entanglement with those in the physical, chemical and biological systems of the planet. However, current state-of-the-art Earth system models do not represent dynamic human societies and their feedback interactions with the biogeophysical Earth system and macroeconomic integrated assessment models typically do so only with limited scope. This paper (i) proposes design principles for constructing world-Earth models (WEMs) for Earth system analysis of the Anthropocene, i.e., models of social (world)-ecological (Earth) coevolution on up to planetary scales, and (ii) presents the copan:CORE open simulation modeling framework for developing, composing and analyzing such WEMs based on the proposed principles. The framework provides a modular structure to flexibly construct and study WEMs. These can contain biophysical (e.g., carbon cycle dynamics), socio-metabolic or economic (e.g., economic growth or energy system changes), and sociocultural processes (e.g., voting on climate policies or changing social norms) and their feedback interactions, and they are based on elementary entity types, e.g., grid cells and social systems. Thereby, copan:CORE enables the epistemic flexibility needed for contributions towards Earth system analysis of the Anthropocene given the large diversity of competing theories and methodologies used for describing socio-metabolic or economic and sociocultural processes in the Earth system by various fields and schools of thought. To illustrate the capabilities of the framework, we present an exemplary and highly stylized WEM implemented in copan:CORE that illustrates how endogenizing sociocultural processes and feedbacks such as voting on climate policies based on socially learned environmental awareness could fundamentally change macroscopic model outcomes

Cruise Report Poseidon 229a/b Kolbeinsey Ridge, Akureyri - Reykjavik, 22.05.1997 - 11.06.1997

General Subject of research: Detailed study of the shallow water hydrothermal system around Kolbeinsey and Grimsey island

First observations of high-temperature submarine hydrothermal vents and massive anhydrite deposits off the north coast of Iceland

High-temperature (250°C) hydrothermal vents and massive anhydrite deposits have been found in a shallow water, sediment-filled graben near 66°36′N in the Tjornes Fracture Zone north of Iceland. The site is located about 30 km offshore, near the small island of Grimsey. The main vent field occurs at a depth of 400 m and consists of about 20 large-diameter (up to 10 m) mounds and 1–3 m chimneys and spires of anhydrite and talc. A north–south alignment of the mounds over a 1-km strike length of the valley floor suggests that their distribution is controlled by a buried fault. Widespread shimmering water and extensive white patches of anhydrite in the sediment between the mounds indicates that the entire 1-km2 area occupied by the vents is thermally active. A 2-man research submersible JAGO was used to map the area and to sample vent waters, gases, and chimneys. Actively boiling hydrothermal vents occur on most of the mounds, and extensive two-phase venting indicates that the field is underlain by a large boiling zone (200×300 m). The presence of boiling fluids in shallow aquifers beneath the deposits was confirmed by sediment coring. The highest-temperature pore fluids were encountered in talc- and anhydrite-rich sedimentary layers that occur up to 7 m below the mounds. Baked muds underlie the talc and anhydrite layers, and pyrite is common in stockwork-like fractures and veins in the hydrothermally altered sediments. However, massive sulfides (pyrite–marcasite crusts) were found in only one relict mound. Subseafloor boiling has likely affected the metal-carrying capacity of the hydrothermal fluids, and deposition of sulfides may be occurring at greater depth. Although the mounds and chimneys at Grimsey resemble other deposits at sedimented ridges (e.g. Middle Valley, Escanaba Trough, Guaymas Basin), the shallow water setting and extensive boiling of the hydrothermal fluids represent a distinctive new type of seafloor hydrothermal system