Bone Contour Research Articles

Relationship of irradiated bone marrow volume and neutropenia in patients undergoing concurrent chemoradiation therapy for cervical cancer.

Concurrent chemoradiation therapy (CCRT) is the standard of care in the management of cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] 2008 Stages IB2-IVA). Apart from the myelotoxic effects of chemotherapy, irradiation of pelvic bone marrow (BM) in the radiation field, can also contribute to hematological toxicity. We examined the relationship of irradiated BM volume and neutropenia in cervical cancer patients undergoing CCRT. This prospective study was conducted in a tertiary cancer center with a longitudinal study design. A total of 43 patients undergoing CCRT for cervical cancer were included. Using auto bone segmentation, the external contour of pelvic bones from L4 vertebral body to ischial tuberosities were delineated as BM. The volume of BM receiving 10, 20, 40, 50 Gy was calculated. Complete blood counts were done weekly to evaluate the neutropenia and were graded according to Common Terminology Criteria for Adverse Events, version 3.0. The risk of developing neutropenia was analyzed using logistic regression. Twenty-seven patients (62.8%) received 5 cycles of chemotherapy, 14 patients (32.6%) received 4 cycles of chemotherapy and 2 patients (4.7%) received 3 cycles of chemotherapy. Overall, 22 patients (51.2%) experienced acute neutropenia. On multivariate analysis increased BM V50Gy had a statistically significantly odds of developing any grade of neutropenia (odds ratio [OR] =1.43; 95% confidence interval [CI], 1.03-1.97; P = 0.028). When comparing patients receiving BM V40Gy ≥40% with BM V40Gy <40% odds of any grade of neutropenia was increased (OR = 2.03; 95% CI, 0.55-7.42; P = 0.28). Moreover, when comparing patients receiving BM V50Gy ≥15% with BM V50Gy <15% odds of any grade of neutropenia was increased (OR = 2.13; 95% CI, 0.57-7.97; P = 0.26). High-dose irradiation to the larger volume of BM prevents compensatory hyperplasia which leads to neutropenia in patients undergoing CCRT for cervical cancer.

Analysis of facial ultrasonography images based on deep learning

Transfer learning using a pre-trained model with the ImageNet database is frequently used when obtaining large datasets in the medical imaging field is challenging. We tried to estimate the value of deep learning for facial US images by assessing the classification performance for facial US images through transfer learning using current representative deep learning models and analyzing the classification criteria. For this clinical study, we recruited 86 individuals from whom we acquired ultrasound images of nine facial regions. To classify these facial regions, 15 deep learning models were trained using augmented or non-augmented datasets and their performance was evaluated. The F-measure scores average of all models was about 93% regardless of augmentation in the dataset, and the best performing model was the classic model VGGs. The models regarded the contours of skin and bones, rather than muscles and blood vessels, as distinct features for distinguishing regions in the facial US images. The results of this study can be used as reference data for future deep learning research on facial US images and content development.

Evaluation of Articular Morphology and Congruency using a Combination of 3 Dimensional CT Based Bone Segmentation and Joint Surface Mapping

Category: Hindfoot; Ankle; Other Introduction/Purpose: Recently joint congruence has been given a lot of focus in studies evaluating foot and ankle deformities. XR and WBCT scans are the commonly used techniques, however, neither can accurately reflect articular surfaces particularly in joints where only partial bone surfaces are covered by articular cartilage. This study introduced a novel technique using 3D surface mapping and CT bone segmentation to assess articular morphology and congruence of the calcaneocuboid (CC) joint. Methods: A CT scan of a fresh frozen cadaveric foot without trauma history nor deformity was taken and then the calcaneus and cuboid bones were dissected free with all soft tissue removed. Segmentation and reconstruction of the calcaneus and cuboid from the CT scan was performed using Materialise Mimics. Surface mapping and digital reconstructions of the calcaneus and cuboid bones as well as the calcaneocuboid articular surfaces were then obtained using an Artec Space Spider 3D scanner. Both the CT and surface mapping reconstructions were imported into Geomagic Studio 10 where the reconstructed calcaneus via CT was merged with the reconstructed calcaneus via surface mapping. The same procedures were performed with the reconstructions of the cuboid. Then cartilage surfaces from the calcaneocuboid joint of the surface mapping reconstruction were outlined on and compared to the bone surfaces underneath. Results: The articular surfaces of the calcaneocuboid joint were shaped according to the bone contour noting however that on both sides, the articular surface did not fully match the bone surface. On the calcaneal side, the dimension of the bone surface was 357.72 mm2, while the articular surface was 300.92 mm2 (percentage of bone covered by cartilage: 84.12%). On the Cuboid side, the dimension of the bone surface was 372.41 mm2 while the articular surface was 302.60 mm2 (percentage of bone covered by cartilage: 81.25%). When restoring the articulation of the reconstructed calcaneus and cuboid, there was incongruence of the two bone surfaces with the dorsolateral corner of the calcaneus and the plantarmedial corner of the cuboid uncovered by its contralateral bone. The same applied to the articular surfaces but at a smaller uncovering level (Figure 1). Conclusion: Even with 3D CT segmentation and reconstruction of articulating bones, one has no knowledge of the precise articular surface of a joint. 3D surface scanning is a reliable method to study morphology of the cartilage surface of a joint. 3D CT reconstruction combined with 3D surface mapping is a useful tool for studying both the bony surface and the cartilage surface of a joint. This study has implications for treatment of any joint in the foot which appears subluxated on XR or CT scans and where this may represent the normal bone morphology but not true subluxation. Articular congruence study under weightbearing condition is currently under investigation by our research group.

Reliability of Weight-Bearing Ultrasonography for Diagnosis of Lisfranc Joint Injuries: A Cadaveric Study

Category: Trauma Introduction/Purpose: Ultrasonography is increasingly used to evaluate the stability of various joint in the field of foot and ankle. This study aims to assess and compare the Lisfranc joint stability under stimulated weight bearing condition among progressive stages of Lisfranc ligamentous complex injuries. All the measurements were assessed using ultrasonography, fluoroscopy, and direct open measurement. We hypothesize that there is a correlation between ultrasonographic and fluoroscopic measurements, or between ultrasonographic and direct open measurements when performing stress evaluation of the Lisfranc instability. Methods: Twelve fresh below-knee amputated cadaveric specimens underwent ultrasound, fluoroscopic, and direct gross evaluation of the Lisfranc stability under simulated weight bearing condition. The assessment was first performed with all Lisfranc ligamentous complex intact and thereafter with sequential transection of the dorsal Lisfranc ligament, interosseous Lisfranc ligament, and plantar Lisfranc ligament. The simulated weight bearing condition was performed with 600N of force. The distances evaluated during the experimental set up were C1-M1, C2-M2, C1-M2, C1-C2 and M1-M2. All measurements were recorded in millimeter (mm). The ultrasound machine (GE, LOGIQ E-9 ultrasound machine, Chicago, Illinois, USA) was used to assess the Lisfranc stability by measuring the distances between the hyperechoic bone contours or the pre-defined landmark of the metatarsal and cuneiform bones. Correlations between 1) Ultrasound and fluoroscopic measurements, 2) Ultrasound and direct open measurements, and 3) Fluoroscopic and direct open measurements were evaluated using Pearson correlations coefficient. Results: Strong positive correlations between ultrasonographic and direct open measurements were found when assessed for C1-M1, C1-M2, C1-C2, M1-M2 (Pearson's correlation ranged from 0.73-0.97, p-values &lt;0.001). Strong positive correlations between ultrasonographic and fluoroscopic measurements were found when assessed for C1-M1 from dorsal, medial, and plantar aspect (Pearson's correlation ranged from 0.75-0.90, p-values &lt;0.001). Strong positive correlations between fluoroscopic and direct open measurements were found when assessed for C1-M1, C1-M2, C2-M2, M1-M2 (Pearson's correlation ranged from 0.77-0.93, p-values &lt;0.001). Inter-rater and intra-rater reliability for the ultrasonographic measurements between the MSK radiologist (TK) and the foot and ankle surgeon (JS) were substantial (ICC ranged from 0.81-0.98). Conclusion: Ultrasonography is a reliable and reproducible tool for diagnosing Lisfranc ligamentous complex injuries. Both ultrasonographic and fluoroscopic measurements appear to strongly correlate with values measured by direct open measurement. Based on these data, ultrasonography is likely to become a valuable point of care diagnostic tool due to its ability to readily and dynamically evaluate suspected Lisfranc ligamentous complex injuries, without radiation exposure.

Volar Plate Interposition Arthroplasty of the Proximal Interphalangeal Joint: A Novel, Modified Malerich’s Technique

Summary:The choice of prosthetic or autologous reconstruction for proximal interphalangeal (PIP) joint arthroplasty in degenerative osteoarthritis represents a challenge for hand surgeons, especially in consideration of complications and patient’s quality of life. We report the case of a 49-year-old woman who developed diffuse arthritis of the finger joints, especially at the PIP joint of the third right finger. Radiographs showed destruction of the PIP joint, large osteophytes, marked narrowing of joint space, severe sclerosis, and deformation of bone contour. Through a volar approach, we removed the osteophytes, reshaped the joint, and performed an arthroplasty with volar plate interposition. The patient had an improved range of motion at 3 months postoperatively. This case study gives a detailed description and discussion, together with literature revision, of volar plate interposition arthroplasty to treat PIP osteoarthritis, as an alternative to other methods.

A Novel Bone Contouring Technique Using Multiple Tangential Shaving for Conservative Management of Craniofacial Fibrous Dysplasia.

This study aimed to propose a novel surgical technique, named multiple tangential shaving of bone contour, for the conservative management of craniofacial fibrous dysplasia. We retrospectively reviewed 17 patients who underwent conservative management of craniofacial fibrous dysplasia using multiple tangential shaving technique between July 2005 and December 2020. Demographics, tumor characteristics, and surgery-related factors were investigated. All patients underwent preoperative (T0) and postoperative computed tomography scans taken at least twice within 1 month for immediate assessment (T1) and at least 12 months postoperatively for long-term assessment (T2). Clinical outcomes, including tumor recurrence, perioperative complications, and physician measure of esthetic outcomes (Whitaker score), were investigated. This technique was applied for contouring of the zygomatic-maxillary and calvarial bone for patients aged between 16 and 60 years (mean age: 26y). The mean±SD tumor volume reduction was 15.5±8.95cm 3 , and the postoperative mean±SD tumor growth rate was 5.52±6.26% per year. Satisfactory outcome was obtained in terms of esthetics with a mean±SD Whitaker score of 1.41±0.62. Patients required a mean operation time of 1.67±0.43 hours and a mean number of shaving operations of 1.35±0.61 during the follow-up period. Five of 17 patients required reoperation because of the tumor recurrence (N=4) and to correct new-onset diplopia after surgery (N=1). In conclusion, the multiple tangential shaving technique allows an easy approach for conservative management of craniofacial fibrous dysplasia. An acceptable rate of tumor recurrence and esthetic outcomes can be obtained by selecting the appropriate candidate for a conservative approach.

MANAGEMENT OF A MAXILLO-ZYGOMATIC FIBROUS DYSPLASIA IN A GROWING-UP CHILD: EIGHT YEARS’ FOLLOW-UP CASE REPORT

Fibrous dysplasia (FD) is a benign dysplastic disorder of bone development in which the normal bone matrix is replaced by fibroblastic proliferation. The aim of this case report is to report a case of a 12-year-old White male patient who was referred to an oral and maxillofacial surgery service with the main complaint of facial asymmetry and tumefaction in the right maxillo-zygomatic region. Physical examination, computed tomography, and incisional biopsy were performed, which confirmed the diagnosis of FD. A stereolithographic model was generated to manufacture a surgical guide. Osteoplasty was conducted under general anesthesia and the patient was follows up every 6 months after surgery. After 8 years of follow-up, a positive control of facial asymmetry, contour, and volume of bone affected were achieved. Final computed tomography showed that the maxilla and zygomatic bones increased in size and volume, with no compression of important structures and no functional damage.

A 3D reconstruction method based on multi-views of contours segmented with CNN-transformer for long bones.

In computer-assisted diagnosis for orthopedic treatment, 3D reconstruction of bones is critical. Traditional 3D imaging technologies like CT and MRI have been proposed, but their high radiation dose and the requirements for lying postures could impact the accuracy of reconstructed bones and diagnosis results. Meanwhile, methods based on bone contours always depend on prior knowledge and lack precise bone segmentation methods. To address these issues, a bone reconstruction method based on multi-views of contours is proposed, as well as a hybrid CNN-Transformer approach for bone contours segmentation. A four-step strategy is introduced including segmenting bone contours from X-ray images, calculating 3D sparse, dense point clouds based on contours, and reconstructing surface. The Trans-DetSeg approach for interest regions detection and bone segmentation is proposed for accurate contours. Besides, the mathematical description of mapping relationships between contours in different views of X-ray images is provided. Then, bone sparse and dense point clouds are generated subsequently. Based on dense point clouds and the power crust method, realistic bone models are reconstructed. Evaluated on 301 bone X-ray images and by considering p-value < 0.05, the proposed Trans-Detseg approach performed better with Dice Similarity Coefficient of 0.949 and Hausdorff Distance of 26.17 than three state-of-the-art models. Furthermore, the accuracy of the bone 3D reconstruction was investigated in three tibia cases and the proposed method was verified based on comparisons of results and CT data. It was proved that increased views of X-ray images could reduce the Average Surface Distance and perfect the structure information of reconstructed bones. A new method for bone 3D reconstruction based on segmented bone contours on multi-views of X-ray images has been developed. Besides, a hybrid CNN-Transformer approach is introduced to segment bone contours. Evaluations proved the efficiency and accuracy of the proposed bone 3D reconstruction method.

Decoronation-induced infected alveolar socket defect rat model for ridge preservation

Current rat alveolar ridge preservation models have not been well standardized. In this study, we proposed decoronation-induced infected alveolar socket model of rat. The bilateral maxillary first molars (M1) of twenty-four rats were decoronized or extracted. After 2, 6, 10, and 14 weeks, bone and soft tissue changes at M1 and periodontal conditions of maxillary second (M2) and third molars (M3) were evaluated by micro-computed tomography and histological analysis. Additional eighteen rats with standardized size defects were grafted with Bio-Oss Collagen to compare with unmanipulated contralateral side. Decoronation preserved greater bone and soft tissue dimensions at M1, provided larger three-dimensional (3D) bone contour volume, but also promoted periodontal breakdown of M2 Histological results showed intense inflammatory cell infiltrations and severe bone resorption within M1 socket and at mesial aspect of M2. The critical dimensions to accommodate largest standardized defect at M1 were 2.2–2.3 mm at vertical bone height and 2.8–3.2 mm at alveolar crestal width. Bio-Oss Collagen could not fully preserve buccal or palatal bone height but could be beneficial in preserving ridge width in large alveolar defects. Collectively, if periodontally-involved alveolar bone defect is preferred, we suggest extracting M1 roots 6 weeks after decoronation to allow periodontitis to occur at M2. If standardized critical dimension defect is preferred, we suggest extracting M1 roots 2 weeks after decoronation, and creating defect in the middle of M1 site with size no larger than 2.7 mm diameter to its full depth.

Autogenous Bone is Still the Gold Standard of Graft Materials in 2022.

I read with interest the recent editorial entitled “Is Autogenous Bone Grafting Still the “Gold Standard” in Oral Bone Grafting?”.1 As the authors pointed out, I wrote a similar editorial in 2010 and concluded that indeed autogenous bone was the gold standard of graft materials.2 However, the authors have challenged my conclusion. To support their opinion, they referenced two publications on sinus bone grafting evaluating histomorphometric results and implant survival.3,4 They claimed these studies found that “bone substitutes either performed in a like manner or superior to autogenous bone alone”. However, the histomorphometric analysis showed autogenous bone resulted in the highest amount of new bone formation compared to bone substitutes, but bone substitutes seem to be a good alternative.3 The systematic review on sinus bone grafting concluded implant survival rates using bone substitutes were as effective as autogenous bone when used alone or in combination with autogenous bone.4 Although the implant survival was lower with 100% autogenous bone (87.7%) compared to autograft with bone substitutes (94.9%) or bone substitutes alone (96%), the data clearly shows that the majority of machined implants were placed in sinuses grafted with autogenous bone. The review found rough surface implants had superior survival rates compared to machined implants (96% vs. 85.6%), so this explains the lower implant survival rate in autogenous grafts. Pjetursson et al5 performed a systematic review evaluated the grafting of pneumatized sinuses that had 6.0 mm or less residual bone height. Focusing on outcomes using only rough surface implants they found high implant survival rates for all types of grafts (> 96%). However, rough implants placed in particulate autogenous bone had a significantly higher estimated three-year survival (99.8%). There are limitations in using a secondary outcome measure, such as implant survival, to evaluate graft success. The assumption is that if the implant survived the graft was successful. The influence of the amount of native bone supporting the implant is unknown in some studies unless the residual bone limit was defined, such as in the Pjetursson et al study.Another important distinction is the relationship of the augmentation to the osseous defect. Bone defects inside the bony contour, such as sockets and the maxillary sinus floor, are much easier and predictable to reconstruct than horizontal and vertical augmentation outside the bone contour. Intrabony defects have a greater number of bone walls with a higher regenerative capacity. There is also greater ease in achieving soft tissue coverage, space maintenance, graft stability and protection. As such bone substitutes perform well in treating these types of contained defects. However, horizontal and vertical bone augmentation outside the bone contour is more biologically challenging. The greater the distance from the native bone, the more difficult it may become for vascular ingrowth, cell migration and bone formation at the outer limits of the graft. As such a graft material with greater regenerative capacity may be needed to obtain the required bone gains. Autogenous bone has superior biologic qualities compared to osteoconductive bone substitutes. It is the only bone graft material that fulfills all three aspects of the tissue engineering triad - osteogenesis, osteoinduction and osteoconduction. Autogenous bone contains osteocompetent cells and osteoconductive growth factors that can positively influence bone formation. Although cancellous bone contains a higher amount of osteoblasts and mesenchymal stem cells, cortical bone grafts contain cells that have the ability to proliferate and differentiate into the osteogenic lineage, suggesting that these cells can also contribute to bone regeneration following transplantation.6 Research has found cortical bone chips contain over 40 different growth factors that can modulate the cellular aspects of bone regeneration.7 The healing time of autogenous bone grafts also is shorter than bone substitutes.8Rather than focus on implant survival, it would be more clinically relevant to evaluate horizontal and vertical bone gains produced by different graft materials. When reviewing studies measuring bone gains it becomes evident that autogenous bone is needed for larger bone augmentations and vertical gains.9,10,11,12 While I agree with my colleagues that bone substitutes may be used effectively in many clinical situations, I still maintain that autogenous bone is the gold standard of graft materials. This does not mean it is the first choice option, but it does offer biologic advantages unmatched by bone substitutes. The use of a local donor site and bone scrapers can decrease the morbidity of bone harvest. In addition, some donor sites for block grafting, such as the mandibular ramus, have a lower incidence of postoperative complications.13 Surgeons should weigh the advantages and disadvantages of each material and select an approach that has the highest likelihood of clinical success.14

Osseous surgery: Traditional vs fiber retention resective surgery

Periodontitis is a disease originating from bacteria in a susceptible host, in which a nonprotective, chronic inflammatory process results in the destruction of supporting soft and hard tissues surrounding the teeth, eventually causing the loss of dentition over time. The ultimate goal of periodontal treatment is to control the progression of periodontal disease. This is achieved by removing the causative factors and stopping progression of clinical attachment loss and ultimately preventing loss of teeth. Osseous resective surgery (ORS) is one of the treatment modalities used to gain access to the root surfaces and boney defects, visualize removal of plaque and calculus from the root surfaces, and reestablish proper bone and soft tissue contours in order to facilitate removal of plaque by the patient as well as dental professionals. Osseous resective surgery fiber retention (FibReORS) is another less commonly used variation of this resective approach. Although it has shown promising results, little research exists comparing the two approaches. The aim of this review is to revisit the dogma of traditional ORS and highlight the differences between the two surgical approaches in regard to clinical procedures, clinical outcomes, and patient's reported outcomes.

Automatizing Bone Surface Mapping in 3D Reconstructed Tomographies

Introduction: In orthopedic surgery, having the bone in it’s exactly position is the most important factor for success. In comminuted fractures there is no bone edge to fit, surgeon’s ability becomes fundamental and human error is common. The way to diminish the human factor is to provide anatomically contoured implants so they can be guides for the surgeon. To make these implants it is necessary to compare the 3D bone contour in the population and find the most fitable implant. Materials and Methods: Twenty ankle tomographies were selected and 3D reconstructed for this research. We design and tested a software for semiautomatized bone superficial scanning. The software marked points on bone surface and constructed a spreadsheet with the 3D cartographic reference for each point. Results: The software was able to set the points in bone surface and the reconstruction of the original bone from the spreadsheet was successful. We were not able to reconstruct an average ankle from the averages of the points. Conclusion: Despite the transformation of the 3D bone surface in its numeric presentation was successful, we were still not able to compare individuals. We believe that volumetric paring could be a solution.

Guided Perio-Prosthodontic Rehabilitation of Heavy Bruxists

To investigate the opportunities and limits in predefining new gingival and alveolar bone contour in combined surgical-restorative treatments with the aid of superimposition of DICOM, intraoral scan (IOS) and pre-operative digital prosthodontic wax-up; to fuel discussions to define scientific research protocols; to formulate needs for software and hardware innovation to improve existing protocols. Milled bite-planes establish physiological vertical dimension after severe wear; the vertical dimension dictates in smile design the amount of acceptable lengthening on the incisal-occlusal aspect of the teeth; golden proportions define the position of the cervical tooth margin and thus the gingival contour; considering biological width and phenotype new alveolar profile is determined; templates are produced to guide osteoplasty; temporary crowns are rebased and cemented with open flap; flaps are sutured after cleaning cement; during healing, if necessary, temporaries are adjusted for function or papilla fill; final IOS of the temporaries is captured; CAD/CAM final restorations are delivered. Satisfying clinical results are obtained with simultaneous periodontal recontouring surgery and restorative temporization. Mainstream CAD and planning software does not provide segmentation tools that allow for accurate design on both teeth, soft tissue, and bone surface. As a consequence templates will not physically adapt to the bone. Premilled temporaries need to be rebased. Perfect prediction of free-hands tooth preparation is impossible. There is a need for innovation to improve the segmentation of superimposed files that represent different anatomical layers and structures.

Biomechanical Evaluation of Stress Distribution in Equicrestal and Sub-crestally Placed, Platform-Switched Morse Taper Dental Implants in D3 Bone: Finite Element Analysis.

AimThe aim of the study was to assess the effect of implant placement depth on stress distribution in bone around a platform-switched and Morse taper dental implants placed at the equi-crestal and 1 mm and 2 mm sub-crestal levels in a D3 bone using the 3D finite element analysis.MethodologyA mechanical model of a partially edentulous maxilla was generated from a computerized tomography (CT) scan of an edentulous patient, as it can give exact bony contours of cortical bone. Also, from accurate geometric measurements obtained from the manufacturer, 3D models of Morse taper and platform-switched implants were manually drawn. The implant and bone models were then superimposed to simulate implant insertion in bone. Three implant positioning levels such as the equi-crestal, 1 mm sub-crestal, and 2 mm sub-crestal models were created, and meshing was done to create the number of elements for distribution of applying loads. The elastic properties of cortical bone and implant, such as Young's modulus and Poisson's ratio (µ), were determined. A load (axial and oblique) of 200N that simulated masticatory force was applied.ResultsOn comparing stresses within the bone around the equi-crestal and 1 mm and 2 mm sub-crestal implants, it was observed that the maximum stresses were seen within cortical bone around the equi-crestally placed implant (21.694), the least in the 2 mm sub-crestally placed implant (18.85), and intermediate stresses were seen within the 1 mm sub-crestally placed implant (18.876).ConclusionSub-crestal (1-2mm) placement of a Morse taper and a platform-switched implant is recommended for long-term success, as maximum von Mises stresses were found within cortical bone around the equi-crestal implant followed by the 1 mm sub-crestal implant and then the 2 mm sub-crestal implant.

Severe chronic osteomyelitis of the os ileum in an alpaca - Diagnostic and pathological findings

A 5.5-year-old alpaca mare was referred to the University Clinic for Ruminants due to a lameness in the right hind limb. Six months prior to presentation, the mare had been treated with systemic antibiotics resulting in resolution of the initial lameness. At the time there had been no indication of an inciting trauma. Clinical examination revealed an approx. 2 × 2 cm large, fluctuating, neither excessively warm nor painful mass caudal to the right tuber coxae fixed to the underlying tissue. In addition, a moderate, mixed lameness with a predominant proportion of the swinging leg component was present in the right hind limb. Subsequently, sonographic examination of the right gluteal region was performed, revealing severe alterations of bone contour in the area of the right hip joint. Radiographic assessment of the pelvis was carried out for further clarification. Based on the clinical finding of a fistula in the right gluteal region as well as the results of the radiologic examination, a long-standing infected fracture of the right iliac bone accompanied by high-degree, irregularly calcified callus formation and low to moderate osteomyelitis in the fracture area was diagnosed. The patient was euthanized in consequence of the grave prognosis. Computed tomographic examination of the pelvis and the lumbar spine in the L3-L6 area was undertaken in order to further document the extent of the pathological changes. For final clarification, patho-histological examination as well as a microbiologic analysis of the abscess exudate were performed.The presented case shows the importance of clinical as well as orthopedic examinations, as the individual animal frequently only exhibits minimal clinical signs despite the presence of severe changes.

Craniofacial Reconstruction with Personalized Lightweight Scaffold Fabricated Using Electron-Beam Additive Manufacturing

Implants are the most popular option for restoring the facial anatomy in the event of a mishap. The commercially available craniofacial implants are of standard shapes, which need to be tailored and shaped to accurately fit the patient’s anatomy. The manual shaping of the implant to match the bone contours is conducted during surgical operation, and is a cumbersome and inaccurate process. Recent breakthroughs in computer-aided design, analysis, and additive manufacturing (AM) have allowed the precise and rapid manufacture of bespoke scaffolds for difficult anatomical restoration. The goal of this research is to investigate the use of scaffolds for craniofacial reconstruction and their fabrication using electron-beam additive manufacturing (EBAM). Personalized cheekbone scaffolds are additively fabricated using Ti6Al4V and subjected to compression testing. Finally, the scaffold design with the highest compressive strength is subjected to biomechanical analysis. The biomechanical analysis results indicate that the maximum Von Mises stress (40 MPa) and equivalent strain (0.4 µm) are significantly low in magnitude, thus providing a desirable implant that is both flexible and stable. The custom-designed cheekbone scaffold manufactured with AM technology not only aids in bone-implant ingrowth but also helps in reducing implant weight and ensuring implant stability and long-term effectiveness.

Donor Site Morbidity in Patients Undergoing Maxillofacial Reconstruction Using Free Fibula Flap Versus Deep Circumflex Artery Flap-A Systematic Review.

A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction. The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps. A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap. The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).

Measuring Knee Joint Laxity in Three Degrees-of-Freedom In Vivo Using a Robotics- and Image-Based Technology.

Accurate and reliable information about three-dimensional (3D) knee joint laxity can prevent misdiagnosis and avoid incorrect treatments. Nevertheless, knee laxity assessments presented in the literature suffer from significant drawbacks such as soft tissue artifacts, restricting the knee within the measurement, and the absence of quantitative knee ligament property information. In this study, we demonstrated the applicability of a novel methodology for measuring 3D knee laxity, combining robotics- and image-based technology. As such technology has never been applied to healthy living subjects, the aims of this study were to develop novel technology to measure 3D knee laxity in vivo and to provide proof-of-concept 3D knee laxity measurements. To measure tibiofemoral movements, four healthy subjects were placed on a custom-built arthrometer located inside a low dose biplanar X-ray system with an approximately 60 deg knee flexion angle. Anteroposterior and mediolateral translation as well as internal and external rotation loads were subsequently applied to the unconstrained leg, which was placed inside a pneumatic cast boot. Bone contours were segmented in the obtained X-rays, to which subject-specific bone geometries from magnetic resonance imaging (MRI) scans were registered. Afterward, tibiofemoral poses were computed. Measurements of primary and secondary laxity revealed considerable interpersonal differences. The method differs from those available by the ability to accurately track secondary laxity of the unrestricted knee and to apply coupled forces in multiple planes. Our methodology can provide reliable information for academic knee ligament research as well as for clinical diagnostics in the future.

Clinical application of concentrate growth factors combined with bone substitute in Alveolar ridge preservation of anterior teeth

ObjectiveTo investigate the clinical effect of concentrated growth factors (CGF) combined with deproteinized bovine bone mineral (DBBM) on Alveolar ridge preservation during implantology.MethodsA total of 38 patients were selected and randomly divided into 2 groups, with 19 cases in each group. The extraction sockets were filled with DBBM with or without CGF. Visual analogue scale (VAS) pain score was recorded within1 week and Landry wound healing index (LWHI) was recorded at 1, 2 and 3 weeks after operation. CBCT was taken preoperatively and 3 and 6 months postoperatively to measure and compare the changes of vertical height, width and gray value of alveolar bone at extraction site. The changes of alveolar bone contour were observed clinically and compared between the two groups.ResultsThe VAS score of CGF group was lower than control group on the 1st and 3rd day after operation (P < 0.05). The LWHI of CGF group was higher than control group 1 week after operation (P < 0.05). The absorption of the labial and palatal plates height and the width in the CGF group was significantly less than the control group at 3 months (P < 0.05). The gray value of alveolar bone in CGF group was significantly higher than control group at 3 months (P < 0.05). There was no significant difference in new bone contour between the two groups (P > 0.05). 94.7% cases in CGF group did not undergo bone grafting, which was significantly higher than control group (78.9%).ConclusionsThe use of CGF combined with DBBM can help to reduce postoperative pain at the early stage of healing, form sufficient keratinized gingival tissue, effectively maintain the height and width of alveolar bone in the three-dimensional direction and provide good conditions for implant repair in the future.

Facial Gender Confirmation Surgery: The Lower Jaw. Description of Surgical Techniques and Presentation of Results.

Of the primary procedures associated with facial gender confirmation surgery, those involving the mentomandibular complex have received the least attention in the literature. The authors present their experience with 837 trans feminine patients operated on for facial gender confirmation surgery who underwent mandibular bone contouring procedures, including bone contouring, chin and mandibular body and angle ostectomies, and osteotomies to reposition the chin. The authors describe the surgical techniques and materials used, and present a customized lower border-supported cutting guide designed by their team and used with 205 patients. A femininity perception score was calculated preoperatively and 12 months postoperatively, and satisfaction with the results was measured 12 months postoperatively. The postoperative follow-up ranged from 12 to 110 months. The mean femininity perception score increased from 47.86 preoperatively to 76.41 at 12 months postoperatively (p < 0.001). No emergency surgical operations were required. In no case was there any permanent damage to the mental or inferior dental nerve. The reoperation percentage because of problems detected during the postoperative period was 2.63 percent (22 patients). With facial gender confirmation surgery of the jawline and chin, it is possible to modify the transverse and vertical components of the jaw; soften the gonial angles; change the format, bone volume, and position of the chin; and harmonize the entire mandibular line. The facial feminization achieved high satisfaction scores regarding the results and feminine gender appearance 12 months after surgery. The future of mandibular bone contouring techniques includes planning with virtual software and surgical support with patient-specific cutting guides.