Identification Of Landmarks Research Articles

Automated Femoral Landmark Detection from Pelvic X-Rays

Surgical planning requires the identification of anatomical landmarks on medical images pre, intra, and post-procedures. Landmark detection on X-rays is thus an important, though time intensive, step to ensure good surgical outcomes. The operative workflow can be made more efficient by using machine learning approaches to automate the detection of landmarks. These models could also assist with the development of robotic surgical procedures, as robotic approaches to surgery require the robotic device to orient itself to the patient's anatomy. Previously described models are effective, but complex, making it difficult for landmark identification to occur in real-time in a robotic system. We propose a streamlined approach to landmark detection on pelvis radiographs that achieves similar accuracy to gold-standard manual annotations. To train and evaluate the network, 902 pelvic radiographs (382 Outlet view, 520 AP view) were annotated with 22 landmarks and split into training (n = 700), validation (n = 99), and testing (n = 103) set. A U-Net architecture with five encoding layers and five decoding layers was used. Landmark labels were converted into 128 × 128 × 22 heatmap array by placing a Gaussian blur filter (5% of image size) over each landmark in order to generate a single 128 × 128 layer of the array, thus generating the 22 layers of the overall heatmap array with one landmark heatmap on each layer. Each layer was an array of 0 except a circular Gaussian around the area of the landmark. A 256 × 256 array representing the image was fed into the U-Net architecture, which outputted a 128 × 128 × 22 heatmap array. Intersection over union loss was used to train the network. Following training for 100 epochs, the algorithm was able to predict the position of 22 clinically relevant landmarks with an average error of 2.36±.5 mm compared to ground-truth annotations made by trained experts and musculoskeletal radiologists with experience in pelvic scan analysis. The network was able to accurately determine the position of relevant landmarks. It was able to do this despite highly variable contrast and brightness in the dataset. Prediction accuracy was invariant to view (AP: 2.27±.51 mm, Outlet: 2.45±.64 mm). A prediction took 1.13±.07 seconds. The network is able to rapidly provide accurate femoral landmarks on a radiograph of the pelvis. This will allow for the automation of numerous clinically relevant measurements. Additionally, an important avenue of further research is exploring whether automated use of these measurements can aid in the prediction of femur fractures in machine learning models.

Peroneus Longus Tendon Harvesting for Anterior Cruciate Ligament Reconstruction.

Identification of anatomical landmarks is performed, including the distal aspect of the fibula and the posterior border of the fibula, 2 cm above the tip of the bone. A longitudinal incision is made along the posterior border of the fibular bone, from 2cm above the tip of the fibula. Care is taken to identify the tendon sheath that covers the longus and brevis approximately 2 cm above the superior extensor retinaculum, and the peroneus longus is stitched to the peroneus brevis. The proximal aspect of the peroneus longus tendon is whipstitched, after which the peroneus longus tendon and surrounding soft tissues are incised. The peroneus longus tendon is then released with use of a closed stripper, and the graft is prepared. Alternative nonoperative treatment options include physical therapy, nonsteroidal anti-inflammatory drugs, rest, and limitation of sporting activities. Alternative surgical treatment options include arthroscopic debridement, ACL repair or reconstruction with bone-patellar tendon-bone or hamstring-tendon autograft, and ACL reconstruction with allograft. Recent studies have shown that ACL reconstruction with use of a peroneus longus tendon autograft is safe and effective, with less donor-site morbidity compared with other tendon autografts4,6,7. The peroneus longus graft has been accepted for ligament reconstruction because of its strength, safety, and less donor-site morbidity7. The peroneus longus graft allows surgeons to harvest the autograft via a relatively small incision, resulting in fewer donor-site complications4. According to Rhatomy et al., the use of a peroneus longus graft provides good functional outcomes that are comparable with those of a hamstring autograft, but it has a larger graft diameter and its harvest results in less thigh hypotrophy8. Additionally, a case series of 10 patients who underwent ACL reconstruction with use of a peroneus longus autograft showed satisfactory Lysholm scores and low disability according to the Foot and Ankle Disability Index9. Examination under anesthesia and arthroscopic confirmation of the ACL tear are recommended prior to harvesting the peroneus longus tendon.Take care to identify the anatomical landmarks of the peroneus longus and brevis.Tenodesis of the peroneus longus to the brevis is performed first, followed by whipstitching of the peroneus longus proximal to the site of the tenodesis.Once the peroneus longus tendon is passed through the closed stripper, gently maintain traction on the sutures while pushing the stripper proximally until the tendon is freed.Care should be taken not to damage the superior peroneal retinaculum, which provides the primary restraint to tendon subluxation.Identification of the peroneus longus and brevis is important. The peroneus longus tendon is free of muscle attachment and more rounded in shape, while the peroneus brevis contains muscle fibers. PL = peroneus longusCI = confidence intervalIKDC = International Knee Documentation Committee.

The Morphometric Measurements of Median and Anterior Interosseous Nerve in Entrapment Syndromes in South Indian Population – An Anatomical Guide

Aim: To study the parameters that can help release the median nerve and its branch, the anterior interosseous nerve from entrapment neuropathies and various other lesions warranting surgical correction and infective and traumatic disorders of adjacent structures of the region. Materials and methods: Sixty four upper limbs belonging to South-Indian population were carefully dissected using the Cunningham’s Manual of Practical Anatomy, the axillary region was exposed, the cords of brachial plexus were traced and median nerve was identified with its relation to axillary artery. The upper limbs used were all disarticulated. The median nerve was further traced and exposed in the arm and forearm. Acromion process and medial epicondyle were considered as prominent bony landmarks for median and anterior interosseous nerves respectively. Measurements were taken using a non-stretchable thread and scale with the arm consistently placed in supine position. Results: The formation of the median nerve by the union of the lateral and medial roots was 11.83±2.36 cm and 11.58±2.057 cm on the right and left sides respectively located distal to the acromion process. The distance between the origin of the anterior interosseous nerve and the medial epicondyle was 8.946±1.084 cm on the right side and 8.875±1.109 cm on the left side. Conclusion: The knowledge of the level of union of two roots of median nerve and the origin of anterior interosseous nerve can be of use to surgeons and anatomists while marking the median nerve on the surface and also releasing the median and anterior interosseous nerves to relieve from various entrapment syndromes. The present study provides data that can facilitate easy identification of the prominent landmarks of the nerve during surgical procedures.

A new approach to symmetric registration of longitudinal structural MRI of the human brain

BackgroundThis paper presents the Automatic Temporal Registration Algorithm (ATRA) for symmetric rigid-body registration of longitudinal T1-weighted three-dimensional MRI scans of the human brain. This is a fundamental processing step in computational neuroimaging. New methodThe notion of leave-one-out consistent (LOOC) landmarks with respect to a supervised landmark detection algorithm is introduced. An automatic algorithm is presented for identification of LOOC landmarks on MRI scans. Multiple sets of LOOC landmarks are identified on each volume and a Generalized Orthogonal Procrustes Analysis of the landmarks is used to find a rigid-body transformation of each volume into a common space where the volumes are aligned precisely. ResultsQualitative and quantitative evaluations of ATRA registration accuracy were performed using 2012 volumes from 503 subjects (4 longitudinal volumes/subject), and on a further 120 volumes acquired from 3 normal subjects (40 longitudinal volumes/subject). Since the ground truth registrations are unknown, we devised a novel method for showing that ATRA’s registration accuracy is at least better than 0.5 mm translation or 0.5° rotation. Comparison with existing method(s)In comparison with existing methods, ATRA does not require any image preprocessing (e.g., skull-stripping or intensity normalization) and can handle conditions where rigid-body motion assumptions are not true (e.g., movement in eyes, jaw, neck) and brain tissue loss over time in neurodegenerative diseases. In a systematic comparison with the FSL FLIRT algorithm, ATRA provided faster and more accurate registrations. ConclusionsThe algorithm is symmetric, in the sense that any permutation of the input volumes does not change the transformation matrices, and unbiased, in that all volumes undergo exactly one interpolation operation, which precisely aligns them in a common space. There is no interpolation bias and no reference volume. All volumes are treated exactly the same. The algorithm is fast and highly accurate.

Effect of Artificial Intelligence versus guided Landmarks identification on the accuracy of the Lateral Cephalometric Analysis

Effect of Artificial Intelligence versus guided Landmarks identification on the accuracy of the Lateral Cephalometric Analysis

Laparoscopic approach for symptomatic pelvic and para-aortic lymphoceles

Description and demonstration of the feasibility of laparoscopic management of symptomatic pelvic lymphocele after surgical staging in gynecological cancer surgery. Step-by-step description of the surgical procedure using pictures and an educational video. Patient gave informed consent for the use of images and the full video article was approved by the Institutional Review Board of the Hospital of Sant Pau. Lymphocele is one of the most common complications of pelvic or lumbo-aortic lymphadenectomy. Although the incidence is variable at 1-58%, around 5-18% of cases are symptomatic. Only symptomatic lymphocele requires treatment, which can be medical or interventional. Drainage is usuallyperformed by guided radiology although a surgical approach has shown a lower rate of recurrence. A 64-years-old woman diagnosed withendometrial carcinosarcoma was staged laparoscopically by pelvic and para-aortic lymphadenectomy. Para-aortic lymphadenectomy wasperformed using an extraperitoneal approach. Three weeks later she presented with an intense and persistent burning pain, radiating towardsthe left leg. Computed tomography imaging suggested the presence of a 10x7.6 cm lymphocele adjacent to the left external iliac vessels.Laparoscopy was performed with four-port placement configuration, enabling the identification of a large, bilobed lymphocele, adjacent to theleft pelvic wall and left paracolic gutter. Adhesiolysis and identification of main landmarks in the left paracolic gutter and left paravesical fossawas performed as a first step. Peritoneum of each lymphocele was opened in the caudal region and the opening was broadened to facilitatelymph drainage. Owing to the low morbidity and excellent results, we suggest that laparoscopic drainage should be performed as a feasible anduseful treatment for pelvic symptomatic lymphoceles.

Effectiveness of Human-Artificial Intelligence Collaboration in Cephalometric Landmark Detection.

Detection of cephalometric landmarks has contributed to the analysis of malocclusion during orthodontic diagnosis. Many recent studies involving deep learning have focused on head-to-head comparisons of accuracy in landmark identification between artificial intelligence (AI) and humans. However, a human–AI collaboration for the identification of cephalometric landmarks has not been evaluated. We selected 1193 cephalograms and used them to train the deep anatomical context feature learning (DACFL) model. The number of target landmarks was 41. To evaluate the effect of human–AI collaboration on landmark detection, 10 images were extracted randomly from 100 test images. The experiment included 20 dental students as beginners in landmark localization. The outcomes were determined by measuring the mean radial error (MRE), successful detection rate (SDR), and successful classification rate (SCR). On the dataset, the DACFL model exhibited an average MRE of 1.87 ± 2.04 mm and an average SDR of 73.17% within a 2 mm threshold. Compared with the beginner group, beginner–AI collaboration improved the SDR by 5.33% within a 2 mm threshold and also improved the SCR by 8.38%. Thus, the beginner–AI collaboration was effective in the detection of cephalometric landmarks. Further studies should be performed to demonstrate the benefits of an orthodontist–AI collaboration.

Revision Proximal Tibiofibular Joint Reconstruction for the Treatment of Chronic Instability Secondary to Suture Button Construct Failure

Recurrent proximal tibiofibular joint (PTFJ) instability can result from nonanatomic repair using a suture button construct. During initial reconstruction, proper identification of anatomic landmarks is critical for proper placement of suture button construct components and successful patient outcomes. In cases of symptomatic recurrent instability, a PTFJ reconstruction revision is warranted to alleviate symptoms of pain and instability. This Technical Note describes a technique for performing an anatomic PTFJ reconstruction revision and fibular collateral ligament reconstruction in which the semitendinosus is used as a graft for both the FCL and posterior ligamentous complex of the PTFJ. The biceps femoris is also repaired following a tear that resulted from a misplaced suture button.

Proposing Novel Data Analytics Method for Anatomical Landmark Identification from Endoscopic Video Frames.

Background The anatomical landmarks contain the characteristics that are used to guide the gastroenterologists during the endoscopy. The expert can also ensure the completion of examination with the help of the anatomical landmarks. Automatic detection of anatomical landmarks in endoscopic video frames can be helpful for guiding the physicians during screening the gastrointestinal tract (GI). Method This study presents an automatic novel method for anatomical landmark detection of GI tract from endoscopic video frames based on semisupervised deep convolutional neural network (CNN) and compares the results with supervised CNN model. We consider the anatomical landmarks from Kvasir dataset that includes 500 images for each class of Z-line, pylorus, and cecum. The resolution of these images varies from 750 × 576 up to 1920 × 1072 pixels. Result Experimental results show that the supervised CNN has highly desirable performance with accuracy of 100%. Also, our proposed semisupervised CNN can compete with a slight difference similar to the CNN model. Our proposed semisupervised model trained using 1, 5, 10, and 20 percent of training data records as labeled training dataset has the average accuracy of 83%, 98%, 99%, and 99%, respectively. Conclusion The main advantage of our proposed method is achieving the high accuracy with small amount of labeled data without spending time for labeling more data. The strength of our proposed method saves the required labor, cost, and time for data labeling.

Correction: Real-time identification of gastric lesions and anatomical landmarks by artificial intelligence during magnetically controlled capsule endoscopy.

Correction: Real-time identification of gastric lesions and anatomical landmarks by artificial intelligence during magnetically controlled capsule endoscopy.

Dataset of human intracranial recordings during famous landmark identification

For most people, recalling information about familiar items in a visual scene is an effortless task, but it is one that depends on coordinated interactions of multiple, distributed neural components. We leveraged the high spatiotemporal resolution of direct intracranial recordings to better delineate the network dynamics underpinning visual scene recognition. We present a dataset of recordings from a large cohort of humans while they identified images of famous landmarks (50 individuals, 52 recording sessions, 6,775 electrodes, 6,541 trials). This dataset contains local field potential recordings derived from subdural and penetrating electrodes covering broad areas of cortex across both hemispheres. We provide this pre-processed data with behavioural metrics (correct/incorrect, response times) and electrode localisation in a population-normalised cortical surface space. This rich dataset will allow further investigation into the spatiotemporal progression of multiple neural processes underlying visual processing, scene recognition and cued memory recall.

Real-time identification of gastric lesions and anatomical landmarks by artificial intelligence during magnetically controlled capsule endoscopy.

Corrected by: Correction: Real-time identification of gastric lesions and anatomical landmarks by artificial intelligence during magnetically controlled capsule endoscopyEndoscopy 2022; 54(11): C17-C17DOI: 10.1055/a-1761-5217

A Multicenter, Prospective Study Comparing Subxiphoid and Parasternal Views During Brief Echocardiography: Effect on Image Quality, Acquisition Time, and Visualized Anatomy

BackgroundRecent literature has suggested echocardiography (echo) may prolong pauses in chest compressions during cardiac arrest. ObjectvesWe sought to determine the impact of the sonographic approach (subxiphoid [SX] vs. parasternal long [PSL]) on time to image completion, image quality, and visualization of cardiac anatomy during echo, as performed during Advanced Cardiac Life Support. MethodsThis was a multicenter, randomized controlled trial conducted at 29 emergency departments (EDs) assessing the time to image acquisition and image quality between SX and PSL views for echo. Patients were enrolled in the ED and imaged in a simulated cardiac arrest scenario. Clinicians experienced in echo performed both SX and PSL views, first view in random order. Image quality and time to image acquisition were recorded. Echos were evaluated for identification of cardiac landmarks. Data are presented as percentages or medians with interquartile ranges (IQRs). ResultsWe obtained 6247 echo images, comprising 3124 SX views and 3123 PSL. Overall time to image acquisition was 9.0 s (IQR 6.7–14.1 s). Image acquisition was shorter using PSL (8.8 s, IQR 6.5–13.5 s) compared with SX (9.3 s, IQR 6.7–15.0 s). The image quality was better with the PSL view (3.86 vs. 3.54; p < 0.0001), twice as many SX images scoring in the worst quality category compared with PSL (8.6% vs. 3.7%). Imaging of the pericardium, cardiac chambers, and other anatomic landmarks was superior with PSL imaging. ConclusionsEcho was performed in < 10 s in > 50% of patients using either imaging technique. Imaging using PSL demonstrated improved image quality and improved identification of cardiac landmarks.

Functional endoscopic sinus surgery outcome in chronic rhinosinusitis patients with hypoplastic maxillary sinus.

To review the clinical characteristics, prevalence and outcomes of chronic rhinosinusitis patients with a hypoplastic maxillary sinus who underwent functional endoscopic sinus surgery. A retrospective review was performed for the 814 consecutive, elective functional endoscopic sinus surgery procedures performed at an academic centre from 2010 to 2020, to identify patients with a hypoplastic maxillary sinus. A total of 56 hypoplastic maxillary sinus cases were detected. Maxillary sinus hypoplasia presented unilaterally in 20 cases and bilaterally in 18 cases. Of the maxillary sinus hypoplasia cases, 38 were type I, 17 were type II and 1 was type III. The average Lund-McKay score was 8.6. No major post-operative complications were reported. Four patients had minor complications and one had persistent post-nasal drip. Functional endoscopic sinus surgery is a safe and effective procedure for improving the clinical condition of patients with a hypoplastic maxillary sinus; however, careful pre-operative radiological evaluation, identification of intra-operative endoscopic landmarks and use of additional techniques may be essential to achieve satisfactory results and avoid possible serious complications.

Preoperative planning using computed tomography in tibial plateau levelling osteotomy: A comparison with conventional radiography.

BackgroundTibial plateau levelling osteotomy (TPLO) is currently one of the most common surgical procedures for the correction of the stifle joint with a ruptured cranial cruciate ligament. TPLO is based on the preoperative tibial plateau angle (TPA); therefore, it is essential to optimise the consistency and repeatability of TPA measurements.ObjectivesThis study aims to compare computed tomography (CT) with conventional radiography in the preoperative planning of TPLO.MethodsThis prospective study included six dogs (12 hindlimbs) and 13 canine cadaveric hindlimbs. In the six beagle dogs, TPAs were measured by three radiologists using digital radiographic and CT images to evaluate the intra‐ and inter‐observer agreement. To evaluate the intra‐observer agreement of the TPA before and after surgery, and the intended angle of the postoperative TPA according to the preoperative planning method, 13 cadaveric hindlimbs were evaluated thrice at random by a single radiologist.ResultsThe intra‐ and inter‐observer intraclass correlation coefficients (ICCs) of the CT method were higher than those of the radiographic method in normal beagle dogs. The intra‐observer ICC of the CT method before and after TPLO was generally higher than that of the radiographic method in the cadaver. However, no significant difference was noted in the evaluation of the intended postoperative TPA according to the preoperative planning method.ConclusionsThe intra‐ and inter‐observer ICCs allowed for easy identification of landmarks required to consistently determine the TPA in the preoperative planning of TPLO based on CT images.

Fibular ligament lesions-reliable ultrasound diagnostics : Tricks and tips

In 2020 a total of 126patients attended the practice with distortion trauma of the ankle. Based on athorough clinical and ultrasound examination 25ligamentous injuries of the anterior talofibular ligament (ATFL, 9.8%), 8osseous ligament avulsions (6.3%), 7injuries of the lateral calcaneocuboid ligament (CC ligament, 5.6%), 5lesions of the calcaneofibular ligament (CFL) each combined with ATFL injuries (3.9%) and 1syndesmosis injury (0.6%) were recorded. This didactic article presents acomprehensible ultrasound examination course in an instructive manner from the clinical practice. Identification of osseous and ligamentous landmarks is often difficult clinically and even in an anatomical preparation but it can easily be done using ultrasound. Hemarthrosis of the ankle has a high predictive value with respect to an associated ligament tear and is easily detectable by ultrasound. Injuries of the ATFL, the anterior syndesmosis and damage to the lateral malleolar epiphysis can easily be clearly distinguished sonographically. Apositive decompression test confirms the distal avulsion of the ATFL. Sonographic stability testing of the AFTL can be carried out immediately after the clinical examination in the same position and visualized on the monitor. The talofibular advance can be measured on the monitor. Instability of the anterior syndesmosis can be visually demonstrated on the monitor using the sonographic Frick test. Afinal ultrasound control on the monitor confirms the structural healing and the re-establishment of ligamentous stability.

ЗБЕРЕЖЕННЯ ІСТОРИЧНОГО МІСЬКОГО СЕРЕДОВИЩА У ПОЛОНІ СТАРИХ ПОМИЛОК

The article is devoted to the analysis of the current situation with the preservation and regeneration of the historic urban environment. The means and procedures used for this are analyzed. It is concluded that this area has significantly degraded over the past 20 years. This manifested itself in the fact that now the historical and architectural reference plan remains in fact the only document that protects the traditional nature of the historic city environment. As a fixation document, not a regulatory one, the historical-architectural reference plan does not actually perform this function. There is a return to the archaic - to an inefficient and long-rejected discrete approach to the protection of each individual monument, which is a fundamental mistake. The most important practical measures are the development of historical and architectural reference plans and projects of protected areas. They have practical meaning only in a complex and in a single sequence, when the results of the historical and architectural reference plan are embodied in the design of protected areas and research and design documentation to determine the boundaries and modes of use of historic sites. Only a full set of these works, carried out consistently and in a short time (1-2 years), a single interdisciplinary group of experts, can ensure the effectiveness of urban protection of cultural heritage and traditional environment. In urban planning documentation - master plans and detailed plans of historical cities - historical and architectural reference plans, boundaries of historical areas and protection zones are a basis for project decisions to ensure the protection of immovable cultural heritage, planning and construction. The practice of urban planning in historic cities poses new challenges, to solve which it is necessary to update the regulatory framework. In this sense, the most difficult group of problems is the identification and preservation of landmarks, ie areas recognized as landscape monuments (so-called cultural landscape), as well as urban monuments. It is also necessary to develop separate regulations (or supplement existing ones) to ensure the preservation of architectural and urban heritage in rural areas and outside settlements, as this issue has its own specifics and today is effectively addressed only in the case of a state historical and cultural reserve. It is proposed to develop a comprehensive territorial approach to the preservation of the entire immovable cultural heritage of the city and the traditional nature of its environment as a single spatial system.

Sectional Anatomy Quiz - VII.

This series involves a quiz pertaining to the identification of key anatomical landmarks and normal structures present at a given level on the computed tomography (CT) image. The current quiz demonstrates examples of normal and abnormal axial CT images at the level of origin of the coeliac artery. The representative image is subsequently followed by further images demonstrating various commonly encountered pathologies found at this level in clinical practice. In each image, readers are expected to identify highlighted anatomical structures and appreciate how given pathologies can alter the appearance of normal structures. This series aims to advance understanding of sectional anatomy and aid nuclear physicians in the interpretation of the CT component of single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies.

Deep Learning-Based Auricular Point Localization for Auriculotherapy

Auriculotherapy is one of the main forms of treatment in Traditional Chinese Medicine, whose potential as an alternative medicine for both health evaluation and disease treatment has been reported in many cases. However, its efficacy highly relies on the accurate localization of auricular points, which are not easy to be remembered due to their complexity. To explore an efficient way of locating auricular points, this study proposed a deep learning-based method of automatically locating auricular points from auricular images. A self-collected dataset named EID was created for TCM auriculotherapy research, with 91 auriculotherapy-related landmark points manually annotated according to the Chinese national standardization. A deep neural network structure was trained for landmark detection, and a direction normalization module was proposed to compensate for the detection error caused by the difference between the left and right ears. The trained model was validated on dataset EID. An average NME of 0.0514±0.0023 was achieved, which outperformed similar works. In addition, a certain auricular area corresponding to the digestive system was segmented based on the localized landmarks, and the results were tested in real-time video streaming. The proposed work for both auricular landmark and area identification can be widely used in auriculotherapy education and applications.

Effects of facemask therapy in the treatment of skeletal class III malocclusion in Vietnamese children

Sparse data are available on the effects of facemask therapy in treatment of skeletal class III malocclusion in Vietnamese children. The purpose of this study was to investigate the skeletal, dental, and soft-tissue profile changes following facemask treatment in children with skeletal class III malocclusion. Twenty-four children (7-12 years-old) with skeletal class III malocclusion treated with facemask appliance were included in this study. All lateral cephalograms taken before and after treatment had been manually traced, followed by cephalometric landmark identification and parameter measurements. Significant skeletal, dental and soft tissue profile changes after treatment were recorded and statistically evaluated by paired t test at a 0.05 significance level. After treatment, the maxilla moved forward (SNA increased 1.53 degrees and A–Y increased 1.93 mm; p&lt;0.001). The mandible rotated backwards and downwards (SNB decreased 1.35 degrees; B–Y decreased 1.12mm; p&lt;0.001). These movements in the maxilla and mandible caused a significant improvement in intermaxillary sagittal relationship (ANB increased 2.89degrees; the convexity angle increased 4.7 degrees; Wits appraisal increased 3.77mm; p&lt;0.001). The maxillary incisors moved forward (4.57 degrees). The improvement in overjet was 5.83 mm. The change in Prn-Y and Ls–E measurement was 2.46mm and 2.72mm, respectively. Our results showed that facemask was highly effective for treating skeletal class III malocclusion and improving facial esthetics. Facemask treatment is a highly effective for skeletal class III malocclusion because it leads to positive changes in the jaws, teeth and soft tissue after 1-year of treatment.