Clinical Photographs Research Articles

Dermoscopic Photographs Impact Confidence and Management of Remotely Triaged Skin Lesions.

IntroductionImproving remote triage is crucial given expansions in tele-dermatology and with limited in-person care during COVID-19. In addition to clinical pictures, dermoscopic images may provide utility for triage.ObjectivesTo determine if dermoscopic images enhance confidence, triage accuracy, and triage prioritization for tele-dermatology.MethodsIn this preliminary parallel convergent mixed-methods study, a cohort of dermatologists and residents assessed skin lesions using clinical and dermoscopic images. For each case, participants viewed a clinical image and determined diagnostic category, management, urgency, and decision-making confidence. They subsequently viewed the associated dermoscopy and answered the same questions. A moderated focus group discussion followed to explore perceptions on the role of dermoscopy in tele-dermatology.ResultsDermoscopy improved recognition of malignancies by 23% and significantly reduced triage urgency measures for non-malignant lesions. Participants endorsed specific utilities of tele-dermoscopy, such as for evaluating pigmented lesions, with limitations including poor image quality.ConclusionsDermoscopic images may be useful when remotely triaging skin lesions. Standardized imaging protocols are needed.

Clinical and radiological comparison of a dynamic implant valve vs a hydraulic maxillary sinus lift augmentation technique with simultaneous implant insertion

The study aimed to compare between dynamic implant valve (DIVA) and the crestal ballooning techniques in elevating the maxillary sinus membrane (MSM) in conjunction with simultaneous implantation. Patients and methods: 20-patient prospective clinical cohort study. Ages ranged from 42 to 53 years, and had atrophic edentulous maxillae in the posterior region. To determine maxillary sinus status, patients were investigated utilizing intraoral clinical photographs and CBCT series. Closed Sinus Lifting done and compared between DIVA and ballooning techniques on patients who were randomly separated into two equal groups. The predicted research variables were intraoperative primary stability and level of sinus membrane lift. The main outcome factors were secondary implant Osseointegration stability (ISQ) and the amount of bone height gain. Results: Before surgery, the DIVA and Balloon groups had mean bone heights of 5.8 ± 0.67mm and 6.8 ± 0.86mm , which increased significantly to 12.8± 0.53 and 10.8± 0.67 after 6 months postoperatively. ISQ for DIVA and Balloon groups were 39.0± 2.16 and 40.0±2.16 preoperatively, respectively, and increased to 71.7±1.60 and 70.4±1.27 nine months postoperatively which was significantly higher at 3 months in DIVA group.

502 The genomic and phenotypic landscape of ichthyosis: An analysis of 1000 kindreds

Objective: Clear genotype-phenotype associations in ichthyosis have been difficult to establish. We aimed to expand the genotypic and phenotypic spectra of ichthyosis and delineate genotype-phenotype associations. Design: We recruited an international group of individuals with ichthyosis, including participants of all ages, races, and ethnicities. Genetic analysis of saliva or blood, a phenotyping questionnaire, and standardized clinical photographs were obtained. Results: Among 1000 unrelated individuals, 266 novel variants in 32 genes were identified.

The effect of natural growth on chin point deviation in patients with unilateral craniofacial microsomia: A retrospective study

This study aimed to investigate the potential progressiveness of mandibular asymmetry and to study factors that influence chin point deviation in patients with unilateral craniofacial microsomia (CFM).Paediatric patients with unilateral CFM with available radiologic imaging and medical photographs were included. Chin point deviation was measured on clinical photographs. A Jonckheere-Terpstra test and linear mixed model for repeated measurements assessed the relation of chin point deviation on natural growth, Pruzansky−Kaban score, and soft tissue score.A total of 110 patients were included. The linear mixed model showed no statistically significant changes of chin point deviation during growth (effect estimate −0.006°, 95% CI –0.04° to −0.03°, p = 0.74). A statistical significant relation between both the Pruzansky-Kaban and soft tissue score on chin point deviation was found (effect estimate −5.10°, 95% CI –6.45° to −3.75°, p ≤ 0.001 and effect estimate −3.42°, CI –5.86° to −0.98°, p ≤ 0.001, respectively).Within the limitations of the study it seems that craniofacial microsomia may be a non-progressive disorder, because chin point deviation did not change over time.

Use of 5-Fluorouracil Injections in Traumatic Cicatricial Malposition of Eyelids.

Scarring in the eyelid and periocular regions has both cosmetic and functional implications. Free and unrestricted movement of the eyelids is imperative for opening and closing of the eye and for protection of the ocular surface. Among the nonsurgical modalities of scar treatment, the antineoplastic drug 5-fluorouracil has been used widely.1 We share our experience with its use in posttraumatic cicatrizing eyelid malposition. All the patients had undergone primary treatment for eyelid trauma elsewhere. The patients presented with lagophthalmos (Fig. 1), ptosis, or cicatricial ectropion. [See Figure, Supplemental Digital Content 1, which shows a patient with ptosis caused by cicatricial tethering of eyelid at the lateral orbital rim. Photograph taken 4 weeks after the injury. Lateral view shows the scar (above) and the resolution of ptosis 4 weeks after the last injection. A total of 105 mg of 5-fluorouracil was injected in three sittings. The patient did not desire surgery. Lateral view after 5-fluorouracil injection shows improvement in the scar (below), https://links.lww.com/PRS/F327.] Twelve patients (mean age, 38.3 years; SD, 12.6 years; nine male and three female) received injections before any surgical intervention at our clinic.Fig. 1.: (Above) Clinical photograph showing cicatricial lagophthalmos 4 weeks after trauma. (Below) Clinical photograph of the patient at 12 months follow-up after injection of 5-fluorouracil (total 140 mg in four sittings).Measurements and clinical photographs were taken before and after injection. We continued the injections every 3 to 4 weeks or until improvement plateaued. The earliest injections were at 4 weeks, with a mean delay of 3.08 months. All cases were performed under topical anesthesia with a mixture of lignocaine 2.5% W/W and prilocaine 2.5% W/W (Prilox cream; Neon Laboratories, Bangalore, India). We injected 5-fluorouracil 50 mg/ml (Fluracil; Zydus Cadila, Ahmedabad, India) with a 26-gauge or 30-gauge needle in 0.1-ml aliquots injected at intervals of 5 mm into and around the scar. Traction sutures were applied to facilitate lengthening of the scar. The mean interval from injury to first presentation at our clinic was 3.08 months (range, 1 to 14 months). The mean dose of injections required was 54.3 mg (range, 15 to 105 mg) in one to four sittings. Objective improvement was seen in 11 of 12 patients (91.6 percent) (Fig. 1). [See Figure, Supplemental Digital Content 1, https://links.lww.com/PRS/F327.] Reconstructive surgery could be avoided in six of 12 patients (50 percent). Patients with anterior lamellar skin deficiency required surgery. Pain and burning sensation were reported after the first injections in the first two patients. Oral paracetamol 650 mg immediately after injection kept the patients comfortable. No patient experienced 5-fluorouracil toxicity on the ocular surface. No patient showed wound dehiscence or skin ulceration, known adverse events.2 5-Fluorouracil, an antimetabolite, acts both on the phase of proliferation and the phase of maturation in the healing wound. It inhibits DNA synthesis and repair.2 It also interferes with RNA function, reduces proliferation of dermal fibroblasts, and affects transforming growth factor–β signaling and formation of type 1 collagen.2,3 Reports also show that the inhibitory effects of 5-fluorouracil on fibroblast proliferation and fibroblast action last for more than 6 weeks after a single application.4 There are few original reports of periocular use of 5-fluorouracil.5 Conventional use has been to inject weekly or biweekly, starting soon after surgery.5 For our series, the drug was injected during the phase of wound maturation, with less frequent dosing. The injections were still effective, with few adverse events. We propose that injection of 5-fluorouracil is a safe and effective modality for wound modulation in eyelid scarring and can reduce the need for surgical intervention. PATIENT CONSENT Patients provided written informed consent for the use of their images. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Agreement on classification of clinical photographs of pigmentary lesions: exercise after a training course with young dermatologists.

Smartphone apps may help promoting the early diagnosis of melanoma. The reliability of specialist judgment on lesions should be assessed. Hereby, we evaluated the agreement of 6 young dermatologists, after a specific training. Clinical judgment was evaluated during 2 online sessions, 1 month apart, on a series of 45 pigmentary lesions. Lesions were classified as highly suspicious, suspicious, non-suspicious or not assessable. Cohen's and Fleiss' kappa were used to calculate intra- and inter-rater agreement. The overall intra-rater agreement was 0.42 (95% confidence interval - CI: 0.33-0.50), varying between 0.12-0.59 on single raters. The inter-rater agreement during the first phase was 0.29 (95% CI: 0.24-0.34). When considering the agreement for each category of judgment, kappa varied from 0.19 for not assessable to 0.48 for highly suspicious lesions. Similar results were obtained in the second exercise. The study showed a less than satisfactory agreement among young dermatologists. Our data point to the need for improving the reliability of the clinical diagnoses of melanoma especially when assessing small lesions and when dealing with thin melanomas at a population level.

Clinical Efficacy and Safety of Oral Apremilast: Treatment Analysis for Chronic Plaque Psoriasis

Background: Apremilast is an oral, selective phosphodiesterase-4 (PDE-4) enzyme inhibitor, approved by the US-FDA for management of moderate to severe plaque psoriasis. Apremilast belongs to class of drug that function by modulating pro-inflammatory cytokines and have a low molecular weight (<1 kD), identified as small molecules. Due to its convenience in administration via oral or topical route, adequate efficacy, great safety profile and low cost they are emerging as treatment choices in inflammatory dermatosis and other systemic inflammatory disorders. 
 Material and Methods: A hospital based, prospective, interventional, cohort study was conducted on 78 patients with Chronic plaque psoriasis. Efficacy of Apremilast was studied in 38 patients receiving oral Apremilast with topical steroids in comparison to 36 patients who were given only topical steroids for 16 weeks. Patients were evaluated pre-treatment and then every 4 weeks for a period of 16 weeks and followed up to the 28th week for any adverse effects associated with apremilast therapy. Outcome was assessed on the basis of PASI score and clinical photographs. Side effects in both groups were recorded.
 Results: Primary endpoint (PASI75 and above) was achieved in 68.42% patients in group A. Among this patient's PASI 90 was achieved in 13.16% (n=5) and PASI 100 was obtained in 13.16% (n=5). In Group B, none of the patients achieved PASI 75. Most common side effects observed in group A were GI disturbances. No significant adverse effect was noted in group B.
 Conclusion: Apremilast has good efficacy and safety in patients with chronic plaque psoriasis. and is generally well tolerated which makes it possible to keep other immunosuppressants to be kept in reserve for more severe stages of disease. Our study supports the favorable benefit:risk profile of oral apremilast.

A Study to Compare Efficacy of Non Cultured Autologus Melanocyte Transfer Versus Punch Grafting Technique for Stable Vitiligo Patients

Background: Vitiligo is a common acquired idiopathic hypomelanosis, which is characterized by loss of melanocytes in the epidermis associated with autoimmune and hereditary causes. The various surgical modalities available are tissue grafting techniques such as punch grafts, suction blister grafts, and split-thickness grafts as well as cellular grafts such as autologous noncultured epidermal cell suspensions and cultured melanocyte suspensions. Objective: We aimed to study and compare the efficacy of noncultured melanocyte transfer technique and punch grafting technique in the management of stable vitiligo. Materials and Methods: Fifty patients of both sexes between the ages of 15 and 50 years having stable vitiligo for minimum 1 year were included in the study and divided in two groups. Group 1 was treated with autologous noncultured melanocyte-rich cell suspension and Group 2 was treated by punch grafting technique. Response to treatment was evaluated on the basis of degree of repigmentation (both subjective and objective assessment), which was carried out at monthly intervals for a period of 6 months along with clinical photographs. Results: The results were statistically analyzed using “Chi-square test” and “statistical significance” (p-value) methods. An excellent (>75% repigmentation) result was obtained in 77.27% of patients by NCMT (noncultured melanocyte transfer) technique whereas good (60%–75% repigmentation) result was obtained in 78.57% of patients by punch grafting technique after 6 months. Conclusion: Noncultured melanocyte transfer is a simple and effective technique to produce uniform pigmentation in short duration and is suitable to cover large body surface areas with a cosmetically better outcome and is better than punch grafting.

Poster 263: Distance to Neurovascular Bundle During Iliotibial Band ACL Graft Passage: A Cadaveric Study

Objectives:For patients with significant growth remaining, the Micheli (iliotibial band) ACL reconstruction technique has proven to be a reliable procedure with minimal risk for growth disturbance. Recent cadaveric studies have demonstrated that graft passage over the top of the femur may bring the graft and surgical instrument close to the critical neurovascular structures. The purpose of this study was to evaluate the Micheli over-the-top, graft passage technique for ACL reconstruction using pediatric cadaveric knees, and measure the distance between surgical instrument tip and the peroneal nerve, tibial nerve, and popliteal artery.Methods:Gross dissection was performed on seventeen skeletally immature cadaveric knees (12 male and 5 female) between the ages of 4 and 12 years old. A 5.5” curved-tip hemostat clamp was used to create a path through the posterior capsule, after the posterior neurovascular structures were identified. The tip of the clamp was passed from an anterior medial portal through the notch postero-superiorly, towards the proximal lateral capsule, with the knee flexed to 90-100 degrees or more. Once passed, the clamp was positioned in the popliteal fossa and clinical photographs were taken from the posterior aspect of the dissected knee, visualizing the tip of the clamp and the neurovascular structures. A metric ruler was included in all photographs. Digital imaging software was used to measure the distance in centimeters from clamp tip to peroneal nerve laterally, and the popliteal artery and tibial nerve medially for all specimens, FIGURE 1. Distances were averaged and stratified to assess differences in age and sex FIGURE 2.Results:The average distances from clamp to neurovascular bundle were 0.875cm (range: 0.468-1.737cm), 0.968cm (range: 0.312-1.819cm), and 1.149cm (range: 0.202-2.409cm) for tibial nerve, popliteal artery and peroneal nerve, respectfully. Means were further calculated for age groups ≤8, 9-10, and 11-12 years old. The average distance from clamp tip to peroneal nerve was 1.400cm larger for 11–12-year-old patients vs. patients ≤8 after adjusting for sex (95% CI=[0.6, 2.2], p=0.005).Conclusions:Iliotibial band graft ACL reconstruction is one of the best options in the skeletally immature, as it has the lowest risk of growth plate complications and growth arrest. The neurovascular structures are very close to the path for over-the-top graft clamp placement with distances <1 cm in many subjects. When passing the graft through the posterior knee there may be greater accessibility on the lateral cortex of the knee among older patients who are closer in age to physeal closure. The current study provides detailed measurements of instrument proximity to the neurovascular bundle in the posterior compartment of the knee. This knowledge is important to help surgeons who perform the Micheli pediatric ACL reconstruction avoid damage to the nerves and vessels in this region. Careful instrument and graft passage, with awareness of proximity to critical structures, are important to reduce the risk of neurovascular injury.Figure 1.Measurements (cm) from clamp tip to neurovascular bundle structures in right Knee model.Figure 2.Average distance from clamp from tip to neurovascular bundle by age Error bars represent 95%CI,**p<0.01

Teledermatology in the Era of COVID-19, Perspective from a Developing Country

Background: With the advent of the COVID-19 pandemic, the medical fraternity across the world, including India, is facing unprecedented challenges, and to cope with this, creative solutions are required. During this COVID-19 crisis, telemedicine has emerged as a weapon to reduce disease transmission while continuing with non-COVID care. Objectives: The purpose of this study is to highlight the changes and challenges in dermatology practice, to explore the usefulness of tele-dermatology during the pandemic, and to understand the dermatologist's perspective. Materials and Methods: An online cross-sectional survey was done among Indian dermatologists to evaluate the changes in their practice, impact of telemedicine, and their experience, during COVID-19. Results: A total of 177 responses from qualified Indian dermatologists were analyzed. Teleconsultation was done by 20.5% of consultants before lockdown which increased up to 82% after lockdown. Most commonly preferred device was mobile phone (83%), and the most common format was chat applications (WhatsApp/Messenger) (55.7%). Discontinued consultation was due to technical issues, patient's misbehavior, and poor-quality clinical photographs. Only 13.5% of practitioners were satisfied with teledermatology. Conclusion: With the onset of the COVID-19, the shift of clinical care to telemedicine practice has hastened. However, continuous investment in systems and technology as well as refinement of regulations for telemedicine is needed to sustain its widespread adoption.

Injectable platelet rich fibrin therapy for androgenetic alopecia: a series of 15 cases

&lt;p&gt;Androgen dependent hair loss is the most common cause of progressive hair loss due to androgenetic miniaturization of hair follicles. Grade 1 and 2 of alopecia is managed well with topical and oral modalities, however grade 3 onwards the need adjuvant treatment arises. To evaluate the efficacy, safety profile and feasibility of injectable-platelet rich fibrin (I-PRF) in androgenetic alopecia and assess the patient satisfaction with this new treatment modality, we conducted a pilot study. Here, 15 patients of androgenetic alopecia were treated with injectable PRF and micro-needling at 2 weekly interval for 4 sittings with a background therapy of minoxidil, finasteride and multivitamin supplements. Monitoring was done with clinical photographs and dermoscopic evaluation prior to each session and a standard assessment questionnaire was given at the end of the study. A significant improvement in hair growth was observed clinically with positive score of 7.42 on the patient satisfaction scale and visible changes were noticed on clinical photographs and dermoscopy. Hence, we concluded that I-PRF is safe, easy, time and cost-effective adjuvant modality for managing androgenetic alopecia with some theoretical advantages over PRP.&lt;/p&gt;

Clinical photography processes (ClinPhoto) study for photo diversity

Although clinical photography serves an important role in the education of clinicians, there is still a disparity of darker skin tones in the photographs used for medical education. This disparity results in a skill deficit for clinicians because the differences in skin pigmentation change the appearance of visible diseases so that it is essential for students and trainees to have examples of clinical photographs on varying skin tones. To effectively address the problem, we need to understand the complex sociotechnical processes involved in clinical photography, which is more than simply the act of taking a photograph. Therefore, we conducted semi-structured interviews on clinical photography with 10 clinicians, 1 medical photographer, and 1 clinical administrator at a tertiary academic medical centre. The interviews revealed 5 deductive themes based on the questions and 19 inductive codes within those themes on how clinical photography is conducted. Analysis of the themes through a lens of critical theory showed how simple awareness of the disparity has not led to interventions for the poor representation of varying skin tones in photographs for medical education and also suggests initial next steps.

QS68. Making the Diagnosis in Sagittal Craniosynostosis—It’s Height, Not Length, That Matters

Purpose: This study assesses the diagnostic reliability of a novel photogrammetric measurement to distinguish sagittal craniosynostosis (SS) from control and false positive cases (SNS). Methods: All head CT imaging at our institution between 2014-2020 was reviewed for patients with sagittal synostosis (SS, n = 177), patients with suspected sagittal craniosynostosis based on clinical examination but normal head CT (SNS, n = 30), and controls (n = 100). A novel measurement reflecting the anterior-posterior location of the vertex was measured by an angle drawn between the cranial vertex, nasion, and opisthocranion (VNO) in profile view with the head in a neutral position. NilRead Enterprise Viewer (Hyland Software, Inc. Westlake, OH) and Microsoft PowerPoint (Microsoft Corp. Redmond, Wash.) were used to measure VNO angles on 3D Head CT Reconstructions (n = 307) and clinic photos (n = 172) respectively. Three masked raters measured VNO angle on clinic photos, and one author (DYC) reviewed all photos to binarily determine the presence or absence of frontal bossing (FB) and occipital bulleting (OCB). Patients’ medical charts were reviewed for demographic information, preoperative cephalic index (CI), and operative approach when indicated. To determine the best combination of clinical findings to distinguish sagittal synostosis, Receiver operating characteristic analysis (ROC) was conducted for the various permutations of VNO, FB, OCB, and CI. Results: Mean age at pre-operative head CT was 9.5 months for the SS cohort, 4.2 months for the SNS cohort, and 8.9 months for the control cohort (p =.327). Mean age at the time of pre-operative clinical photo was 9.5 months for the SS cohort and 4.2 months for the SNS cohort (p =.149). Pearson correlations revealed no significant association between age and VNO angle for any group. The average VNO angle measured on clinical photos was 54.7°±3.8° for the SS group, 43.1°± 2.2° for the SNS group, and 41.1°± 3.7° for controls (p<.001). Three-rater analysis yielded a moderate intraclass correlation coefficient of 0.742 (p=.004). ROC analysis yielded a cut-off of 50° to determine SS versus SNS and controls. AUC for the permutations of VNO angle, FB, OCB, and CI ranged from.187 to.956. The largest AUC value of.956 was obtained when for VNO angle alone, with a corresponding sensitivity and specificity of 96.6% and 99.2% respectively. Conclusion: Measurement of the VNO angle is a reliable screening tool to diagnose sagittal craniosynostosis, with an angle of 50° or more suggesting suture synostosis. This method relies on the relationship between the anterior displacement of the cranial vertex and occipital bulleting to approach the diagnostic accuracy of CT imaging.

Curved-line cleft lip repair in unilateral complete cleft lip patients: Comparative analysis of lip dimensions after cheiloplasty

This study aimed to restore upper lip symmetry and minimize tissue sacrifice using a curved line design and wire technique and analyze the postoperative outcomes. In this retrospective study, medical records of patients with complete unilateral cleft lip who underwent unilateral cheiloplasty between August 2017 and February 2019 were reviewed. The postoperative clinical photos were analyzed to determine vertical, diagonal philtral heights and the horizontal lengths of the upper lip. The average of the cleft side to non-cleft side length ratios were compared between the curved line group and conventional group. At 3, 6, and 12 months, the average vertical length ratios were significantly greater in the curved line group than in the conventional group (0.927–0.823, p = 0.007; 0.940 to 0.885, p = 0.037; and 0.947 to 0.883, p = 0.040, respectively), but the average horizontal length ratios were not significantly different between the two groups. Within the limitations of the study it seems that curved line cheiloplasty aids in preventing short lip deformity development at regular term without significantly sacrificing the horizontal length and, therefore, should be adopted whenever appropriate.

Abstract 5935: Malignant risk assessment of clinical and histological subtypes of lichenoid mucositis with dysplasia

Abstract Introduction: Oral lichen planus (OLP), a common, chronic inflammatory condition, is categorized as potentially malignant by the World Health Organization. However, some hypothesize that only lichenoid lesions with dysplasia (LLD) are at risk of progression to cancer. Others have proposed subtypes of LLD, with differing malignant risks. Objectives: To determine if subtypes of LLD exist, based on clinical and histological features, and to determine the proportion of malignant progression in these subtypes. Methods: A nested case control study was conducted using tissue samples and longitudinal data of patients enrolled in the Oral Cancer Prediction Longitudinal study. Inclusion criteria were a biopsy confirmed diagnosis of lichenoid mucositis with dysplasia, no history of head and neck cancer, at least 5 years of follow-up, and accessible clinical photographs and bio-banked tissue. A chart review was conducted, and photographs reviewed to assess for lesion features characteristic of OLP. Histological sections were examined for lichenoid inflammation, and immunohistochemical staining for collagen IV was used to evaluate the integrity of the basement membrane (BM). Two subtypes of LLD were proposed: 1) a primary lichenoid and secondary dysplastic (L1D2) type defined as a lesion with a reticular and bilateral clinical presentation, subepithelial inflammation, and evidence of BM degeneration, and 2) a primary dysplastic and secondary lichenoid type (D1L2), which may present unilaterally or bilaterally, clinically resemble OLP or leukoplakia, and exhibit subepithelial inflammation with or without evidence of BM degeneration. Association with outcome, which was defined as progression to severe dysplasia, carcinoma in situ, or squamous cell carcinoma, was tested using Fisher’s Exact test. Results: All progressing cases had a non-homogenous clinical presentation (P=0.005) and were more apt to change (in size, texture, and/or appearance) over time (P=0.002). A reticular, smooth appearance was more common in non-progressing cases (P=0.007, P=0.016, respectively). 30% of cases in the D1L2 subtype progressed to malignancy, compared to none in the L1D2 group, though this finding did not reach statistical significance (P=0.081). Conclusion: LLD with a non-homogenous, non-reticular clinical presentation are at greater risk of progression, and a high proportion of cases exhibiting primary dysplastic features progressed to malignancy, indicating that LLD should be under close clinical follow-up. Citation Format: Iris Lin, Oh Run Kim, Leigha Rock, Lewei Zhang, Miriam Rosin, Martial Guillaud, Denise Laronde. Malignant risk assessment of clinical and histological subtypes of lichenoid mucositis with dysplasia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5935.

Silicone sling frontalis suspension for congenital ptosis: Outcome of 174 consecutive cases.

Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children. A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD1 ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing. One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years. Mean follow up time was 32 ± 20.5months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD1 improved by an average of 1.5 mm. The final MRD1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD1 difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%). Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.

Influence of Cone-beam Computed Tomography in Clinical Decision-making among Different Specialists in External Cervical Resorption Lesions: A Before-After Study

IntroductionInadequate management of external cervical resorption (ECR) lesions may impact the treatment outcome. This study aimed to ascertain the influence of cone-beam computed tomography (CBCT) in clinical decision-making choices in cases of ECR among dentistry specialists (endodontics, prosthodontics, oral surgery, periodontics orthodontics, and general dentistry). A secondary objective was to evaluate the self-reported level of difficulty in choosing a treatment plan before and after viewing the CBCT images. MethodsSixty examiners from different specialties were chosen to evaluate 12 cases of ECR lesions. Each case included clinical photographs, digital periapical radiographs, and a small-volume CBCT scan. In the first assessment, the examiners were given all the relevant information of each case, except the CBCT scan. Each examiner was asked to select 1 of the proposed treatment options and assess the difficulty of decision-making. Four weeks later, the examiners randomly reviewed the same 12 cases with additional information from the CBCT data. ResultsAfter the CBCT evaluation, the clinicians changed their treatment plan in 72.2% of the cases (P < .05). The self-reported level of difficulty in choosing a treatment changed in all groups after evaluating the CBCT scans (P < .05). After viewing the CBCT scan, the extraction option increased significantly in all groups (P < .05). ConclusionsCBCT scan had a significant impact on clinical decision-making in cases of ECR evaluated by different specialists.

Reproducibility of Manual Transfer of the Clinical Natural Head Position: Influence on the Soft Tissue and Hard Tissue Position of 3-Dimensional Virtual Surgical Planning

The purpose of this study was to assess the reproducibility of manually transferring the clinical natural head position (NHP) to the 3-dimensional (3D) virtual surgical planning and its subsequent influence on the soft tissue and maxillary hard tissue position. A retrospective cohort study was set up. The study population consisted of subjects who underwent bimaxillary osteotomies between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery in Radboud University Medical Centre (Nijmegen, the Netherlands). Cone beam computed tomography scans, dentition data, and clinical photographs were acquired 4weeks before surgery. Two attempts (NHP1 and NHP2) were performed by a single examiner to manually transfer the NHP. 3D transformation matrices were used to quantify the transferred NHP in 3 degrees of freedom (pitch, roll, and yaw). Landmarks and surface-based matching were used to quantify the influence on the soft tissue and hard tissue positions in 6 degrees of freedom. The primary outcome variable was the reproducibility of manually aligning the NHP. The secondary and tertiary outcome variables were the effect of the reproducibility of the manually aligned NHP on the soft tissue and hard tissue displacements in the 3D virtual surgical planning. The study population consisted of 109 subjects: 37 males (33.9%) and 72 females (66.1%) with a mean age of 29.1±10.3years (range, 17.0 to 59.0). The manual transfer of pitch alignment (2.24±1.64⁰; 95% confidence interval [CI], 1.93 to 2.55) was significantly less reproducible than the roll (0.56±0.44⁰; 95% CI, 0.48 to 0.64; P<.001) and yaw (0.67±0.92⁰; 95% CI, 0.50 to 0.85; P<.001). Subsequently, this alignment error influenced the position of the maxilla (incisal point) and soft tissue menton by 0.85±0.86mm and 1.01±1.00mm vertically and 0.78±1.10mm and 0.80±1.18mm sagittally. The present study demonstrated that the manual transfer of the NHP from the clinical situation to the virtual environment influenced the soft tissue and hard tissue position and that a more reproducible method of transferring the clinical NHP is recommended.

Talipes Equinovarus in Loeys-Dietz Syndrome.

Loeys-Dietz syndrome (LDS) commonly presents with foot deformities, such as talipes equinovarus (TEV), also known as "clubfoot." Although much is known about the treatment of idiopathic TEV, very little is known about the treatment of TEV in LDS. Here, we summarize the clinical characteristics of patients with LDS and TEV and compare clinical and patient-reported outcomes of operative versus nonoperative treatment. We identified 47 patients with TEV from a cohort of 252 patients with LDS who presented to our academic tertiary care hospital from 2010 to 2016. A questionnaire, electronic health records, clinical photos and radiographs, and telephone calls were used to collect baseline, treatment, and outcome data. The validated disease-specific instrument was used to determine patient-reported foot/ankle functional limitations after treatment. Patients were categorized into nonoperative and operative groups, with the operative group subcategorized according to whether the posteromedial release was performed. Within our TEV cohort, bilateral TEV was present in 40 patients (85%). Thirty-seven patients underwent surgery (14 involving posteromedial release), and 10 were treated nonoperatively. The operative group had a higher incidence of posttreatment foot/ankle functional limitation (71%) than the nonoperative group (25%) ( P =0.04). The pain was the most common functional limitation (54%). The posteromedial release was associated with a higher incidence of developing hindfoot valgus compared with surgery not involving posteromedial release (43% vs. 8.7%, P =0.04) and compared with nonoperative treatment (43% vs. 0.0%, P =0.02). We found that patients with LDS have a high incidence of bilateral TEV. Operative treatment was associated with posttreatment foot/ankle functional limitations, and posteromedial release was associated with hindfoot valgus overcorrection deformity. These findings could have implications for the planning of surgery for TEV in LDS patients. Level III-retrospective comparative study.

Artificial intelligence-based diagnostics of molar-incisor-hypomineralization (MIH) on intraoral photographs

ObjectiveThe aim of this study was to develop and validate a deep learning–based convolutional neural network (CNN) for the automated detection and categorization of teeth affected by molar-incisor-hypomineralization (MIH) on intraoral photographs.Materials and methodsThe data set consisted of 3241 intraoral images (767 teeth with no MIH/no intervention, 76 with no MIH/atypical restoration, 742 with no MIH/sealant, 815 with demarcated opacity/no intervention, 158 with demarcated opacity/atypical restoration, 181 with demarcated opacity/sealant, 290 with enamel breakdown/no intervention, 169 with enamel breakdown/atypical restoration, and 43 with enamel breakdown/sealant). These images were divided into a training (N = 2596) and a test sample (N = 649). All images were evaluated by an expert group, and each diagnosis served as a reference standard for cyclic training and evaluation of the CNN (ResNeXt-101–32 × 8d). Statistical analysis included the calculation of contingency tables, areas under the receiver operating characteristic curve (AUCs) and saliency maps.ResultsThe developed CNN was able to categorize teeth with MIH correctly with an overall diagnostic accuracy of 95.2%. The overall SE and SP amounted to 78.6% and 97.3%, respectively, which indicate that the CNN performed better in healthy teeth compared to those with MIH. The AUC values ranging from 0.873 (enamel breakdown/sealant) to 0.994 (atypical restoration/no MIH).ConclusionIt was possible to categorize the majority of clinical photographs automatically by using a trained deep learning–based CNN with an acceptably high diagnostic accuracy.Clinical relevanceArtificial intelligence-based dental diagnostics may support dental diagnostics in the future regardless of the need to improve accuracy.