Important Anatomical Structures Research Articles

Radıologıcal Evaluatıon of the Recesses on the Posterıor Wall of the Nasopharynx wıth Cone-beam Computed Tomography.

The posterior wall of the nasopharynx is composed of loose connective tissue that includes many important anatomical structures. Various structures, such as the opening of the Eustachian tube (ET), the Rosenmüller fossa (RF), and the pharyngeal bursa (PB) are found here. To evaluate the nasopharynx posterior wall anatomic structures, including the Eustachian tube, Rosenmüller fossa, and pharyngeal bursa with cone-beam computed tomography. The depth, width, and length of the Eustachian tube, Rosenmüller fossa, and pharyngeal bursa were measured in 150 patients using axial-sagittal cone-beam computed tomography. The Eustachian tube and Rosenmüller fossa distance to the midsagittal plane, the coronal region passing through the posterior end of the nasal septum, the superior-inferior extremity of the recesses, and the nasal floor plane distance were measured. The relationship between Rosenmüller fossa types and other parameters were evaluated. The incidence of right Rosenmüller fossa types 1, 2, and 3 were 16%, 18%, and 66%, respectively, and that of the left Rosenmüller fossa types 1, 2, and 3 were 16%, 19.3%, and 64.7%, respectively. The mean pharyngeal bursa width, length, and depth were 10.8, 5.7, and 4.0 mm, respectively; those of the Eustachian tube were 5.6, 7.1, and 7.3 m, respectively; those of the right Rosenmüller fossa were 4.0, 12.4, and 10.5 mm, respectively; and those of the left Rosenmüller fossa were 3.8, 12.5, and 10.9 mm, respectively. The posterior wall of the nasopharynx contains several important anatomical structures. Evaluation of these using cone-beam computed tomography has many clinical and radiological advantages. To understand and interpret the coincidental findings in CBCT, dental radiologists should have access to more detailed information concerning the anatomy of the nasopharynx.

Assessment of Anterior Loop of Inferior Alveolar Nerve – A Cone Beam Computed Tomography Study

Introduction: The anterior loop (AL) of the inferior alveolar nerve (IAN) and the mental foramen (MF) are important anatomical structures that should be taken into consideration during preoperative planning in the anterior mandibular region. This study aims to assess the prevalence, length, and type of the AL of the IAN in males and females in a South Indian population. Additionally, the distance from the MF to the lower border of the mandible is assessed. Materials and Methods: A total of 115 cone-beam computed tomography (CBCT) scans of 230 sides of mandibles were taken using a Carestream Select CS9300 CBCT machine (Carestream Dental LLC, Atlanta, USA). The scans were selected from archives and divided into three different age groups (<40, 41–60, >61 years). The scans were analyzed to detect the canal of the AL of the inferior alveolar nerve canal (IANC). The IANC, along with the AL canal and part of the incisive nerve canal, was traced using the CS 9300 software. The length of the mandibular nerve was measured for each patient in cross-sectional and panoramic views. Results: The AL was present in 92.6% of the 115 participants. Overall anterior loop length ranged between 0.9 and 15.2 mm. The mean length of AL in panoramic view on the right side was 3.284 ± 2.314 mm and it was 3.015 ± 2151 mm on the left side. Y-shaped AL was more predominant when compared to T-shaped AL in the sample. Conclusion: The prevalence of AL was relatively higher in subjects ranging from 41 to 60 years with a slight increase in female predominance.

Advantages of Sentinel Lymph Node Mapping by Single Photon Emission Computed Tomography/Computed Tomography in Early-Stage Malignant Head-and-Neck Skin Tumors.

Background:The aim of this study was to determine the advantages of preoperative sentinel lymph node mapping (SLNM) by single photon emission computed tomography/computed tomography (SPECT / CT) in patients with early-stage cutaneous head-and-neck malignancies.Materials and Methods:We conduct a 7-year and 6 months retrospective, cross-sectional study. Patients with early-stage malignant head-and-neck skin tumors and cutaneous adnexa who underwent SLNM by SPECT/CT from March 2012 and December 2019, were included in the study.Results:We retrospectively analyzed 28 patients: Melanoma was the most frequent tumor (64.2%), followed by squamous cell carcinoma (25%). The anterior cheek was the most common functional subsite (25%). Twenty-seven patients (96.4%) had a successful SLN detection with SPECT/CT. Neck lymph node dissection was performed in 23 patients (82.1%). According to the pathological specimen, lymph nodes were found in all of them; hence, the efficacy of the SPECT/CT for SLNM was 100%. At 7-year follow-up, systemic recurrence was found in one patient (3.6%), another had locoregional recurrence (3.6%), and the mortality rate was 3.6%.Conclusions:In early-stage malignant head-and-neck skin tumors, there is a high concordance between SLN found by SPECT/CT and the histopathological results. Preoperative SPECT/CT accurately detects the SLN, assesses unexpected lymph nodes and their drainage pathways, and facilitates their location by reliably showing the relationships between sentinel nodes and important anatomic structures. This allows to perform a clear preoperative evaluation, an accurate staging for all patients and to avoid excessive dissections that could result in cosmetic and functional deformities.

SURGICAL TREATMENT OF ECHINOCOCCOSIS OF THE LIVER AND ITS COMPLICATIONS

The aim: To analyze the frequency of complications of echinococcal cysts of the liver, the causes of recurrence and the results of surgical treatment of patients with echinococcal liver disease. Materials and methods: The results of surgical treatment of 79 patients who were hospitalized from January 2011 to JANUARY 2022 with liver echinococcosis and its complications were analyzed. Among them there were 11 men (13,9%) and 68 women (86,1%), with average age 47,5 ± 2,3 years. Complications of echinococcal cysts developed in 17 (21,5%) patients. Results: The choice of surgical intervention method was determined individually, taking into account the location of echinococcal cysts, their size, depth, proximity of important anatomical structures. 53 (67,1%) patients underwent total or subtotal pericystectomy, 8 (10,1%) patients underwent liver segment resection, 5 (6,3%) patients underwent cyst dissection with removal and treatment its cavity, PAIR method was applied in 1 (1,3%) patient. Echinococcectomy was performed laparoscopically in 12 (15,2%) patients. The use of laparoscopic surgery for echinococcosis of the liver reduced intraoperative blood loss, duration of operation, hospital stay. We did not have recurrences of the disease after radical surgery. After palliative surgery, recurrence occurred in 2 (2,63%) patients. Conclusions: Surgical interventions for urgent indications in patients with complicated echinococcal cysts of the liver increase the risk of recurrence of the disease. Pericystectomy was performed in 53 (67,1%) patients, is a radical and efficient operation for complete recovery and does not lead to recurrence of the disease. The efficiency of laparoscopic echinococcectomy has been demonstrated.

Classification and morphological parameters of the coracoid process in Chinese population.

The coracoid process is an important anatomical structure of the scapula, which can be used as a landmark in the diagnosis and treatment of scapula related diseases, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures. The aim of this study was to classify the coracoid process according to morphology and to measure the morphological parameters of the coracoid process. A total of 377 dry and intact scapulae were collected and classified in terms of the connection between the shape of coracoid process and common things in life. The anatomical morphology and the position related to acromion and glenoid socket of the coracoid process were measured in each type by three independent researchers with a digital caliper. The measurements were averaged and recorded. Based on obvious morphological features, five specific types of the coracoid process were described: Type I, Vertical 8-shape; Type II, Long stick shape; Type III, Short stick shape; Type IV, Water drop shape, and Type V, Wedge shape. Type I (30%) and Type III (29%) were more prevalent in China. The tip width of the coracoid process of Type IV was the shortest and significantly different compared to the other types (p <.05), contrary to the longest in Type V. The tip thickness of the coracoid process of Type I was the shortest and significantly different from the other types (p <.05). The coracoid process was classified into five types based on obvious morphological features. Knowing of morphological classification and anatomical parameters of different types of the coracoid process, to some extent, may be helpful to diagnose and treat the shoulder joint disease, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures, and to theoretically reduce postoperative complications.

Prevalence and Location of Maxillary Sinus Septum and its Relation to Maxillary Sinusitis

Introduction: Maxillary sinus septum is an anatomical variation in the maxillary sinus. Sinus septum is also an important anatomical structure that complicates sinus lift procedure during dental implant placement. Objectives: To assess the prevalence and location of maxillary sinus septa and its relation to maxillary sinusitis using cone beam computed tomography (CBCT scan). Methods: An analytical cross-sectional study was conducted at the Department of Periodontics and Department of Oral Medicine and Radiology, Kantipur Dental College, Kathmandu, Nepal during July 2019 to June 2020 after ethical clearance. In total, 110 subjects and 220 maxillary sinuses were included in the study for evaluation by convenience sampling. The presence of septa, their location and association with maxillary sinusitis were evaluated. Data was analysed using SPSS software with Statistical level set at P&lt;0.05 for significance. Results: The prevalence of maxillary sinus septa in this study was 54 (49.09%). Statistically significant association was found between sinus septa with maxillary sinusitis (p=0.038) and location of septum in the arch (p=0.001). Conclusion: Presence and distribution of maxillary sinus septa is important in planning sinus surgeries and placement of implant in maxillary posterior region.

Infratemporal fossa synovial sarcoma in a 3-month-old infant: an extremely rare tumour in infancy

Soft tissue sarcoma, especially synovial sarcoma, is extremely rare in infancy, with only a few cases reported worldwide. Due to the particularly small size of the head and neck region in infants, with important anatomical structures in close vicinity to one another, surgical resection is very challenging, if the goal is to ensure total disease elimination as well as maintaining function and good cosmetic outcome postoperatively. In the case reported here, following diagnosis, the child was given three cycles of neoadjuvant chemotherapy followed by infratemporal tumour resection via Bramley–Al-Kayat incision incorporated with a modified Blair incision. Postoperatively, the child recovered well, with no recurrence after three months. This case highlights the important role of a multidisciplinary approach in the diagnosis and managing such rare cases. We also discuss the clinical presentation, imaging features, histopathological features, treatment regime, and prognosis of synovial sarcoma of the infratemporal fossa in children, based on cases reported in the literature.

A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

Augmented reality visualization in brain lesions: a prospective randomized controlled evaluation of its potential and current limitations in navigated microneurosurgery

BackgroundAugmented reality (AR) has the potential to support complex neurosurgical interventions by including visual information seamlessly. This study examines intraoperative visualization parameters and clinical impact of AR in brain tumor surgery.MethodsFifty-five intracranial lesions, operated either with AR-navigated microscope (n = 39) or conventional neuronavigation (n = 16) after randomization, have been included prospectively. Surgical resection time, duration/type/mode of AR, displayed objects (n, type), pointer-based navigation checks (n), usability of control, quality indicators, and overall surgical usefulness of AR have been assessed.ResultsAR display has been used in 44.4% of resection time. Predominant AR type was navigation view (75.7%), followed by target volumes (20.1%). Predominant AR mode was picture-in-picture (PiP) (72.5%), followed by 23.3% overlay display. In 43.6% of cases, vision of important anatomical structures has been partially or entirely blocked by AR information. A total of 7.7% of cases used MRI navigation only, 30.8% used one, 23.1% used two, and 38.5% used three or more object segmentations in AR navigation. A total of 66.7% of surgeons found AR visualization helpful in the individual surgical case. AR depth information and accuracy have been rated acceptable (median 3.0 vs. median 5.0 in conventional neuronavigation). The mean utilization of the navigation pointer was 2.6 × /resection hour (AR) vs. 9.7 × /resection hour (neuronavigation); navigation effort was significantly reduced in AR (P < 0.001).ConclusionsThe main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression.German clinical trials registration number.DRKS00016955.

Application of ultrasound guidance in the oral and maxillofacial nerve block.

IntroductionNerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks.MethodsWe searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings.Results and DiscussionA review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.

OV03 TEP IN COLORS: ANATOMICAL VIEW USING ARTICULATED FORCEPS

Abstract Aim Present through an illustrative and educational video, an anatomical and colorful vision of the totally extraperitoneal laparoscopic approach (TEP) of inguinofemoral hernias, with the aim of favoring the learning process of this technique, facilitating the identification of the main anatomical structures, ensuring a safe and effective approach. Material and Methods In this video we show the laparoscopic approach to inguinofemoral hernias via TEP, highlighting the most important anatomical structures with different colors. Additionally, the surgical technique of this approach using articulated forceps is shown, which we consider to be a good resource for dissection in a space as small as the preperitoneal one. Results The anatomical study of the inguinofemoral area constitutes the basis of a correct preperitoneal approach, especially in PET, where the most difficult is probably the space location and the identification of the structures. Conclusions The preperitoneal PET route is a relatively novel approach for inguinofemoral hernia repair. Its benefits are based on the ability to identify all the anatomical structures of the myopectineal orifice from a preperitoneal view without the need to access the peritoneal cavity. The knowledge of preperitoneal anatomy is the cornerstone for learning the TEP approach, and we consider that anatomical videos of real surgeries are good strategies to shorten the learning curve. Mastering the preperitoneal anatomy ensures obtaining the benefits inherent to the TEP approach, such as bilateral exploration of the myopectineal orifice, direct visualization of the pain and doom triangles, tension-free repair with mesh of all possible defects and faster postoperative recovery.

Morphological evaluation of the incisive canal with reference to gender and age: A cone-beam computed tomography study.

The incisive canal (IC) is an important anatomical structure in the premaxilla that should be considered during many dental procedures. The objective of this study is to associate the IC morphology and dimensions with reference to gender and age by means of cone-beam computed tomography (CBCT). A retrospective study was conducted using archived CBCT records of patients who sought treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. OnDemand 3D Imaging software was utilized in image reconstruction and measurement determination. The parameters evaluated were the IC shape and dimensions in a sagittal and coronal view at two levels: palatal opening and nasal opening. The variables were compared according to age and gender using one-way Analysis of Variance (ANOVA) and Kruskal Wallis tests. Confidence level was obtained at P < 0.05. Out of the 370 CBCT images assessed, only 100 images fulfilled the inclusion criteria; 50 males and 50 females. No substantial variance in IC shapes was found in both the sagittal and coronal perspectives with reference to age and gender. Likewise, there was no statistical variation in IC dimensions with reference to age. On the other hand, there was a statistical difference in IC length when correlated with gender as the male subjects had longer IC as compared to females (P < 0.01). There is no association between IC morphology, age and gender. However, substantial variation in IC length was observed between genders.

The application of contrast‐enhanced CT combined with Image navigation in retrieval of displaced tooth: A case report and literature review

AbstractBackgroundThe displacement of a tooth to deep facial spaces is a rare but serious complication. The lateral pharyngeal space contains important structures such as the internal carotid artery, internal jugular vein and cranial nerves. To remove a displaced tooth from the lateral pharyngeal space is a difficult and high‐risk procedure because of the narrow space and the structures inside it.Material and methodsThis is a report of the application of contrast‐enhanced CT combined with image navigation in retrieval of a displaced tooth from the lateral pharyngeal space.ResultsThe displaced tooth was removed successfully. Satisfactory wound healing was achieved, without postoperative complications.ConclusionThis case report illustrates the importance of a method to optimize navigation, reduce damage to important anatomical structures, and provide a more precise and minimally invasive surgical procedure.

Laparoscopic Resection of Deep Infiltrative Endometriosis of the Bowel and Bladder

<h3>Study Objective</h3> To show a systematic approach to perform resection of deep infiltrating endometriosis of the bowel and bladder in the setting of posterior cul-de-sac obliteration and intentional cystotomy creation. <h3>Design</h3> Step-by-step video demonstration of the technique. <h3>Setting</h3> A university tertiary care hospital. <h3>Patients or Participants</h3> A 28-year-old gravida 0 with a history of several years of severe dysmenorrhea, pelvic pain, and dyspareunia. She had been managed with hormonal medical therapy and physical therapy with little improvement in her symptoms. Pelvic ultrasound and MRI was significant for 0.8 × 1 cm rectal nodule located between the posterior wall of the uterus and anterior wall of the rectum, suggestive of deep infiltrating endometriosis. <h3>Interventions</h3> Studies have shown that surgery can improve pain in the context of deep infiltrating endometriosis. Moreover, deep infiltrating endometriosis has been associated with infertility with retrospective and prospective nonrandomized studies showing that resection improves spontaneous conception rates. Laparoscopy with resection of deep infiltrating endometriosis is performed using a conservative fertility sparing endometriosis surgery with bowel discoid resection. Deep infiltrating endometriosis of the bladder is performed with repair of therapeutic cystotomy. <h3>Measurements and Main Results</h3> We describe three phases of deep endometriosis nodule excision. First, opening pelvic avascular spaces, restoring anatomy, and identifying important anatomical structures. Second, resection of deep infiltrative endometriosis lesions with relevant vital structures properly identified and lateralized. Third, ensure integrity of our repair and hemostasis. At postoperative follow up, the patient reported improvement in pain symptoms. She had no bowel or bladder dysfunction postoperatively. <h3>Conclusion</h3> Management of deep infiltrating endometriosis begins in the preoperative period and continues beyond the immediate postoperative period. Appropriate preoperative evaluation, systematic and skilled intra-operative surgical technique, and appropriate postoperative follow up are important steps necessary to perform safe and effective fertility sparing endometriosis surgery.

Early and mid-term outcomes of modified aortic root repair for acute stanford type A aortic dissection

Abstract Background Acute Stanford type A aortic dissection (ATAAD) is the most common catastrophic aortic event. Most ATAAD involves the aortic root which has many important anatomical structures such as aortic valve, so the proper treatment of dissected root can ensure a good prognosis for patients. However, there is still no consensus on root management strategies for ATAAD patients with aortic root involvement. Purpose This clinical study aimed to evaluate the therapeutic effect of modified aortic root repair in ATAAD. Methods From September 2017 to September 2020, Participants with root involvement of ATAAD were recruited who underwent modified aortic root repair as well as some additional procedure such as aortic valve junction suspension plasty based on the aortic sinus tear extent. During this novel procedure, the proximal anastomosis plane was at the level of the sinu-tubular junction and the false lumen below it was retained. We collected and analyzed the perioperative clinical data and follow-up imaging data of patients, and further evaluated the early and mid-term efficacy of this surgical approach. Results A total of 79 patients were enrolled, including 59 males and 20 females, the age was (52.4±11.3) years old (28–73 years), the diameter of aortic sinus was (38.6±4.1) mm, and the diameter of sinu-tubular junction was (41.8±4.8) mm. In this group, 75 patients (94.9%) received ascending aorta replacement, total arch replacement and frozen elephant trunk, 2 patients (2.5%) received ascending aorta replacement and hybrid total arch replacement, 2 patients (2.5%) received ascending aorta replacement and partial arch replacement. Cardiopulmonary bypass time was (197.2±58.6) min (118–455 min), blocking time was (132.6±38.9) min (73–323 min), circulatory arrest time was (10.3±7.0) min (0–27 min). There was no perioperative death, no paraplegia, one secondary thoracotomy, five renal failures needing hemodialysis treatment and two cerebral infarctions. Before patients discharged, aortic CTA showed that the residual false lumen in the sinus disappeared. And the diameter of the aortic sinus was (35.5±3.1) mm, the diameter of the junction of the aortic sinus was (30.0±3.0) mm. The patients were followed up for (18±12) months (3–35 months). There was one patient died during follow-up and no further surgical intervention at the root of the aorta. Follow-up aortic CTA showed no residual or new dissection in the aortic sinus and no significant difference in the diameters of aortic sinu-tubular junction (P=0.122) or aortic sinus (P=0.37) between postoperative period and follow-up period. Echocardiography showed that the structure and function of the aortic valve were normal. Conclusions The modified aortic root repair for ATAAD is relatively simple, easy to learn and safe in perioperative period. Early and mid-term follow-up image examination showed that the structure of aortic sinus returned to normal. The long-term clinical effect requires close attention. Funding Acknowledgement Type of funding sources: None. Modified aortic root repair procedureAortic root diameter change under CTA

Gallbladder duplication complicated by cholecystitis and unsuspected choledocholithiasis: A case report and review of literature.

IntroductionGallbladder duplication is a rare congenital anomaly of the biliary tree. Although a double gallbladder by itself is not clinically significant, complications of gallstone disease increases the complexity of the management. Preoperative recognition decreases the risk of complications during laparoscopic cholecystectomy.Presentation of casePresented herein is the case of a 52 year old who presented with abdominal pain. A transabdominal ultrasound was suggestive of a gallbladder duplication with the larger gallbladder filled with cholelithiasis. Subsequent imaging studies, including an endoluminal ultrasound, confirmed the diagnosis and documented a choledocholithiasis. Endoscopic extraction of the biliary stone with subsequent laparoscopic cholecystectomy of both gallbladders was successfully performed.DiscussionThis case is being presented not only for the rarity of the condition but also of the challenges in management it poses. In gallbladder duplication, pathologic involvement of one gallbladder requires removal of both gallbladders. A high index of suspicion on initial scanning warrants further delineation of the important anatomic structures of the biliary tree to avoid perioperative complications.ConclusionLaparoscopic cholecystectomy may be safely performed in patients with gallbladder duplication. Preoperative recognition with appropriate imaging modalities, including ultrasound and MRCP may avoid surgical complications. In cases where the anomaly is detected intraoperatively during cholecystectomy, meticulous dissection and intraoperative cholangiography will avoid iatrogenic injuries and lead to successful outcomes.

Integration between the cranial boundaries of the nasopharynx and the upper cervical vertebrae in Homo and Pan.

The nasopharynx is an important anatomical structure involved in respiration. Its bony boundaries, including the basicranium and upper cervical vertebrae, may be subject to selective pressures and constraints related to respiratory function. Here, we investigate phenotypic integration, or covariation, between the face, the basicranial boundaries of the nasopharynx, and the atlas and axis to understand constraints affecting these structures. We collected three-dimensional coordinate data from a sample of 80 humans and 44 chimpanzees, and used two-block partial least squares to assess RV (a multivariate generalization of Pearson's r2 ), rPLS , the covariance ratio, and effect size for integration among structures. We find that integration is significant among some of these structures, and that integration between the basicranial nasopharynx and vertebrae and between the face and vertebrae is likely independent. We also find divergences in the pattern of integration between humans and chimpanzees suggesting greater constraints among the human face and nasopharynx, which we suggest are linked to divergent developmental trajectories in the two taxa. Evolutionary changes in human basicranial anatomy, coupled with human-like developmental trajectories, may have required that the face grow to compensate any variation in nasopharyngeal structure. However, we were unable to determine whether the nasopharynx or the face is more strongly integrated with the vertebrae, and therefore whether respiration or biomechanical considerations related to positional behavior may be more strongly tied to vertebral evolution. Future work should focus on greater sample sizes, soft tissue structures, and more diverse taxa to further clarify these findings.

Optimized fitting of amidface implant to anchor amagnetic nasal prosthesis using 3D printing

HintergrundPlattenbasierte Ankersysteme zur fazialen Epithesenversorgung bieten gegenüber extraoralen Einzeltitanimplantaten Vorteile hinsichtlich einer flexibleren Wahl knöcherner Verankerungspunkte und höherer Stabilität. Nachteile werden in einer aufwendigen individuellen intraoperativen Anpassung der Plattensysteme am meist schlecht zugänglichen Knochen deutlich. Wir stellen eine Methode vor, diese Nachteile zu überwinden und die Vorteile plattenbasierter Systeme stärker auszuspielen.MethodikDas knöcherne Mittegesicht eines Patienten mit erfolgter Rhinektomie bei Karzinom des Naseneingangs wurde anhand der präoperativen Computertomographie als virtuelles 3‑D-Modell rekonstruiert. Die verwendete Open-Source-Software (3-D-Sclicer) ermöglichte die einfache und schnelle Rekonstruktion sowie Anpassung zum Druck des 3‑D-Modells mittels transparenten Kunststoffs (MED610; stratasys Ltd., MN, USA).ErgebnisseDie als Epithesenanker verwendete Titan-Brückenplatte (MEDICON) konnte am 3‑D-Druck des Mittelgesichts äußerst präzise vorangepasst werden. Wichtige anatomische Strukturen wurden geschont und die Verschraubungspunkte entsprechend der gegebenen Knochendicke gewählt. Die Implantation der vorangepassten Titanplatte erfolgte komplikationslos ohne weitere intraoperative Anpassungen.SchlussfolgerungDie Voranpassung plattenbasierter Ankersysteme für faziale Epithesen am 3‑D-Druck des Mittelgesichts überwindet deren Nachteile einer aufwendigen ggf. unpräzisen intraoperativen individuellen Anpassung. Diese Methode spielt die Vorteile der besseren Kraftverteilung durch mehr mögliche Verschraubungen, auch in dünnerem Knochen, weiter aus und kann somit Implantatlockerungen vorbeugen. Zudem ermöglicht die Voranpassung am 3‑D-Modell die bessere Identifikation und Schonung wichtiger anatomischer Strukturen und spart Op.-Zeit ein.

How important is the Sphenoseptal cell in identifying the skull base? Recent incidence and demonstration of endoscopic surgical steps

Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell.Materials and methods In this study, 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery.Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). ConclusionAlthough an SSC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.

Ankle foot motion recognition based on wireless wearable sEMG and acceleration sensors for smart AFO

Ankle joint is one of the important anatomical structures of the human body, smart ankle-foot orthosis(AFO) can assist human walking and improve the ankle motion for patients. This study focused on ankle foot movements recognition based on data fusion via sEMG and acceleration sensors. A wireless signal acquisition system (WAS) was designed specifically, forming a platform to demonstrate and record individual sEMG and acceleration data simultaneously. In the experimental tests, three channel sEMG signals from Tibialis Anterior (TA), Gastrocnemius (GM) and Soleus (SO), as well as three-axis acceleration data of the ankle joints, were collected when subjects performed four kinds of typical motions including dorsiflexion, plantar flexion, eversion and inversion. A total of 21,600 frames of sEMG /acceleration action data were constructed and then different kinds of classification algorithms were studied to classify the motions by the principal component analysis (PCA) based data fusion signal features. Results showed that the classification accuracy of bi-directional long short-term memory (BiLSTM) algorithm performed the best compared with traditional networks such as support vector machine(SVM), artificial neural network (ANN) and reached 99.8 %. These results demonstrated the potential application for accurate ankle foot intent identification by sEMG and acceleration sensors, which provided the basis for further implementation of subsequent smart AFO manipulation.