Lateral Photographs Research Articles

Postoperative effects of anterior nasal spine bone harvesting on overall nasal shape

Bone harvesting from the anterior nasal spine (ANS) is frequently used to correct peri-implant bone defects, particularly during implant placement in the anterior maxilla. However, many clinicians are concerned about the postoperative effect of removing the ANS on the nasal outline, as the ANS is integral to supporting the nose. This study aimed to describe the technique of ANS bone grafting and to investigate postoperative effects of bone harvesting from the ANS on the overall nasal shape. Fifteen patients with single maxillary first incisal rehabilitation using dental implant were enrolled in this prospective clinical study. Simply by extending the subperiosteal dissection in the same surgical field without additional local anesthesia, a bone block of about 0.25-0.5ml could be harvested from the ANS. Nose width (NW), nasolabial angle (NLA), and nasal tip depth (NTD) were measured and analyzed by lateral and frontal photographs taken preoperatively (T0), and at postoperative 1week (T1), 3months (T2), and 6months (T3). Postoperative complications were also recorded. A significant increase in NW and decrease in both NLA and NTD were found at T1 (P<0.05). At T3, NW, NLA and NTD returned to preoperative measurements at T0 without major complications. The ANS could be an effective and easily accessible intraoral source for autologous bone. Despite acute soft tissue swelling, the net postoperative effects of removing the ANS on the overall nasal shape, including on nasal tip collapse or widening of the nose base, were negligible.

Validated Assessment Scale for Neck Volume

Sagging of the neck aesthetic area is an important indicator of age. The development of complex and globally accepted tools for proper assessment of the change in neck volume is an essential contribution to aesthetic research and the routine clinical setting. To develop a grading scale for the objective assessment of the neck volume and to establish the reliability of this scale for clinical research and practice. A 5-point rating scale was developed to assess neck volume objectively. Twelve experts rated frontal and lateral neck photographs of 50 subjects in two separate rating cycles using the neck volume scale. Responses of raters were analyzed to assess inter- and intrarater reliability. Interrater reliability for the neck volume scale was almost perfect, with intraclass correlation coefficients for the first and second rating cycles of 0.85 and 0.84, respectively. Intrarater reliability for the neck volume scale was high (0.90) and Pearson correlation coefficients ranged between 0.88 and 0.95 and were statistically significant. The neck volume scale demonstrates optimal reliability for clinical research and practice.

Book Review

Evaluation of the effect of changes in the horses’ feet after routine trimming and shoeing on gait at the trot is needed improve routine foot care. Evaluate changes in foot conformation and gait after routine farriery. Correlate alterations in a horse's gait before and after routine hoof trimming and shoe application. Fifteen horses received routine hoof trimming and horseshoe application. Dorsal and lateral photographs of the right and left front feet and inertial gait analysis at the trot were completed before and after trimming and shoeing. Measurements were made of hoof photos using a calibrated system. Gait and hoof measurements before and after farrier intervention were compared. Hoof measurement changes in relation to gait changes before and after farrier intervention were analyzed for significant associations. Mean medial to lateral coronary band length (P = .02), lateral (P = .01) and medial (P = .03) coronary band height, dorsal hoof wall length (P = .0004), heel length (P = .0002), heel overhang length (P < .0001), palmar coronary band height (P = .01), and hoof angle (P = .03) in each foot were significantly different pre- and post- farrier intervention. There was no statistical difference in the total head and pelvis movement before and after farrier intervention. The difference in the pooled mean of heel length before and after intervention was correlated with difference in maximum head movement (P = .03.) Pooled mean differences for dorsal hoof wall length (P = .04), heel length and heel overhang length (P = .006) before and after trimming were correlated with differences in maximum pelvis movement. Pooled mean differences for heel length (P = .005) and hoof angle (P = .04) before and after trimming were correlated with difference in minimum pelvis movement. Change in hoof conformation due to routine hoof trimming and shoeing does not change the gait in non–lame horses; however, some hoof characteristics measurements are correlated with immediate change in stride parameters. Use of hoof measurements may assist farriers and veterinarians in applying routine hoof care. Further studies could help determine what hoof conformation changes may be helpful to treat lame horses.

Photometric facial analysis of the Igbo Nigerian adult male

Background:A carefully performed facial analysis can serve as a strong foundation for successful facial reconstructive and plastic surgeries, rhinoplasty or orthodontics.Aim:The purpose of this study is to determine the facial features and qualities of the Igbo Nigerian adult male using photometry.Materials and Methods:One hundred and twenty subjects aged between 18 and 28 years were studied at the Anambra State University, Uli, Nigeria. The frontal and right lateral view photographs of their faces were taken and traced out on tracing papers. On these, two vertical distances, nasion to subnasal and subnasale to menton, and four angles, nasofrontal (NF), nasofacial, nasomental (NM) and mentocervical, were measured.Results:The result showed that the Igbo Nigerian adult male had a middle face that was shorter than the lower one (41.76% vs.58.24%), a moderate glabella (NF=133.97°), a projected nose (NM=38.68°) and a less prominent chin (NM=125.87°).Conclusion:This study is very important in medical practice as it can be used to compare the pre- and post-operative results of plastic surgery and other related surgeries of the face.

Quantitative Assessment of Head Posture of Young Adults Based on Lateral View Photographs

Quantitative Assessment of Head Posture of Young Adults Based on Lateral View Photographs

Lipoabdominoplasty: An exponential advantage for a consistently safe and aesthetic outcome

Background:Extensive liposuction along with limited dissection of abdominal flaps is slowly emerging as a well proven advantageous method over standard abdominoplasty.Materials and Methods:A retrospective study analyzed 146 patients managed for the abdominal contour deformities from March 2004 to February 2010. A simple method to project the post operative outcome by rotation of a supine lateral photograph to upright posture in 46 patients prospectively has succeeded in projecting a predictable result. All patients were encouraged to practice chest physiotherapy in ‘tummy tuck’ position during the preoperative counseling. Aggressive liposuction of entire upper abdomen, a limited dissection in the midline, plication of diastasis of rectus whenever indicated, panniculectomy and neoumblicoplasty were done in all patients.Results:The patients had a mean age of 43, youngest being 29 and oldest 72 years. Majority were of normal weight (94%). Twelve were morbidly obese; 57 patients had undergone previous abdominal surgeries; 49 patients had associated hernias. Lipoabdominoplasty yielded a satisfactory result in 110 (94%) patients. The postoperative patient had a definitely less heavy harmonious abdomen with improved waistline. The complications were more with higher BMI, fat thickness of more than 7 cm and prolonged operating time when other procedures were combined.Conclusions:Extensive liposuction combined with limited dissection method applied to all abdominoplasty patients yielded consistently safe, reliable and predictable aesthetic results with less complications and faster recovery. The simple photographic manipulation has helped project the postoperative outcome reliably. The preoperative chest physiotherapy in tummytuck position helped prevent chest complications.

Bidimensional techniques for stronger anterior torque control in extraction cases

To investigate the capacity of bidimensional techniques for torque control of anterior teeth in extraction cases. Two different bidimensional techniques were distinguished by nomenclature as bidimensional-slot (bDS) and bidimensional-wire (bDW), respectively. (1) In the clinical study, patients were randomly assigned to three groups (ie, bDS [n = 27], bDW [n = 24], and control [n = 25] groups). The major inclusion criterion was mild crowding in the upper arch, with the two upper first premolars (teeth 14 and 24) to be extracted. After space closure through standardized treatment, the torque of the upper central incisors (∠TQ _U1) was calculated using the angle formed by the base of the U1 bracket and the working archwire on cephalograms. (2) In the typodont study, a standardized setup of the upper dentition with teeth 14 and 24 extracted was established. The spaces were closed through water bath followed by elastics, using the bDW or the conventional (control) technique, respectively. In six replicate experiments, after space closure, the ∠TQ _U1 was measured on the standardized lateral photographs. (1) In the clinical study, after space closure, the ∠TQ_U1 was 9.4° ± 3.4° (bDS), 8.3° ± 3.3° (bDW), and 5.8° ± 2.9° (control), respectively. The ∠TQ_U1 of bDS and bDW were both significantly (P < .05) larger than that of the control, but no statistical difference was found between them. (2) In the typodont study, after space closure, the ∠TQ_U1 of bDW (8.5° ± 0.9°) was significantly (P < .01) larger than that of the control (4.9° ± 1.0°). The bDS and the bDW techniques may help enhance anterior torque control in extraction cases.

Residents’ journal review

Residents’ journal review

Does the open rhinoplasty incision decrease nasal projection?

To evaluate the effects of open rhinoplasty incisions on tip projection using digitized photographs. Thirty-one patients, who underwent open technique rhinoplasty were prospectively included in the study. The lateral aspect photographs were taken before the operations. Following midcolumellar incision septal elevation was done until septal cartilage was shown. After replacing the skin totally back and suturing midcolumellar incision, the intraoperative photographs were taken. The projection indexes were measured by Goode method from the photographs and the measurements were compared. A statistically significant decline of the nasal projection was established after open technique approach. Open rhinoplasty approach led to the decrease of the nasal tip projection. This result was thought to be the effect of ligamentous disruption.

Effects of barefoot trimming on hoof morphology

To monitor changes in hoof morphology in response to barefoot trimming. Seven horses were trimmed every 6 weeks according to barefoot trimming principles, which involved levelling the hoof to live sole, lowering the heels, bevelling the toe and rounding the peripheral wall, while leaving the sole, frog and bars intact. A 4-month period was allowed to lower the heels sufficiently to achieve a hoof shape representative of the barefoot trim. This was regarded as the starting point for morphological adaptations in response to maintenance of the trim. Hoof morphology was measured from lateral, dorsal and solar view photographs and lateromedial radiographs taken at 0, 4 and 16 months. Changes from 0 to 4 months represented differences between a natural hoof shape and the trim, while changes from 4 to 16 months represented adaptive effects during hoof growth. Establishment of the barefoot trim involved significant shortening of the toe, heel and medial and lateral walls, with increases in angulation at the toe, medial and lateral walls, but not at the heel. Maintenance of the trim resulted in a palmar/plantar migration of the heels, with increases in support length, heel angle and solar angle of the distal phalanx (P3). Bevelling the toe and engaging the frog and bars in the weight-bearing function of the foot resulted in elevation of the heel angle and solar angle of P3. These changes may be beneficial in treating under-run heels and negative solar plane angulation of P3.

Visual perception of skeletal class and biotype in Spain

The aim of this study was to determine and compare the visual accuracy of students and experienced orthodontists in distinguishing the different skeletal classes and facial biotypes using only lateral photographs. A group of 19 orthodontic students (4 males and 15 females, aged between 23 and 30 years) and 9 experienced orthodontists (three males and six females, aged between 30 and 56 years) were shown a slide presentation of 100 (50 males and 50 females) patients aged between 8 and 42 years and were asked to indicate the skeletal class and the facial biotype of each subject. Data were analysed using a one-way repeated measures analysis of variance, with Bonferroni post hoc adjustment for multiple testing. P-values less than 0.05 were considered statistically significant. Only 32.75 per cent of the participants identified the facial biotype of the patients with respect to Rickett's vertical (Vert) pattern and 47.96 per cent the skeletal class. The students performed better than the experienced orthodontists (P < 0.05) but only for skeletal class. The results indicate that lateral photographs are not sufficient for determining the skeletal class or facial biotype of patients.

Reliability of photogrammetry in the evaluation of the postural aspects of individuals with structural scoliosis

The purpose of this study was to investigate the reliability of photogrammetry in the measurement of the postural deviations in individuals with idiopathic scoliosis. Twenty participants with scoliosis (17 women and three men), with a mean age of 23.1 ± 9 yrs, were photographed from the posterior and lateral views. The postural aspects were measured with CorelDRAW software. High inter-rater and test-retest reliability indices were found. It was observed that with more severity of scoliosis, greater were the variations between the thoracic kyphosis and lumbar lordosis measures obtained by the same examiner from the left lateral view photographs. A greater body mass index (BMI) was associated with greater variability of the trunk rotation measures obtained by two independent examiners from the right, lateral view (r = 0.656; p = 0.002). The severity of scoliosis was also associated with greater inter-rater variability measures of trunk rotation obtained from the left, lateral view (r = 0.483; p = 0.036). Photogrammetry demonstrated to be a reliable method for the measurement of postural deviations from the posterior and lateral views of individuals with idiopathic scoliosis and could be complementarily employed for the assessment procedures, which could reduce the number of X-rays used for the follow-up assessments of these individuals.

The Average Indian Female Nose

This study aimed to delineate the anthropometric measurements of the noses of young women of an Indian population and to compare them with the published ideals and average measurements for white women. This anthropometric survey included a volunteer sample of 100 young Indian women ages 18 to 35 years with Indian parents and no history of previous surgery or trauma to the nose. Standardized frontal, lateral, oblique, and basal photographs of the subjects' noses were taken, and 12 standard anthropometric measurements of the nose were determined. The results were compared with published standards for North American white women. In addition, nine nasal indices were calculated and compared with the standards for North American white women. The nose of Indian women differs significantly from the white nose. All the nasal measurements for the Indian women were found to be significantly different from those for North American white women. Seven of the nine nasal indices also differed significantly. Anthropometric analysis suggests differences between the Indian female nose and the North American white nose. Thus, a single aesthetic ideal is inadequate. Noses of Indian women are smaller and wider, with a less projected and rounded tip than the noses of white women. This study established the nasal anthropometric norms for nasal parameters, which will serve as a guide for cosmetic and reconstructive surgery in Indian women.

AN APPLICATION OF THE RELATIVE WARPS ANALYSIS TO PROBLEMS IN HUMAN PALEONTOLOGY - WITH NOTES ON RAW DATA QUALITY

This study investigates the use of geometric morphometrics as well as methodological aspects specifically related to its application in paleoanthropology. Based on lateral photographs taken from a fossil sample of 58 specimens, a relative warps analysis was computed in order to assess the variation of cranial shape among various hominin groups. The fossil sample represents Middle and Late Pleistocene populations commonly assigned to H. erectus, H. neanderthalensis, archaic H. sapiens as well as anatomically modern H. sapiens. The preliminary results indicate that several fossil skulls considered as belonging to archaic H. sapiens have a distinct shape compared to modern humans. The results suggest that these hominins are not as closely related to modern humans as previously thought. Instead, their morphometric affinities suggest that they are as distinct from modern humans as are the Neandertals. Methodological aspects, such as raw data accuracy and the use of type 2 and 3 landmarks that are directly related to this type of quantitative analysis and that potentially affect their results, are discussed.

Common Standards in Facial Esthetics: Craniofacial Analysis of Most Attractive Black and White Subjects According to People Magazine During Previous 10 Years

The aim of the present case-control study was to determine--using the 10 most recent annual listings of the most beautiful black and white people--whether any common, measurable esthetic parameter could be extracted from both groups. A total of 80 women (40 white and 40 black), who had been included in the list of People magazine's 100 most beautiful people during the previous 10 years, were selected. Lateral photographs of all 80 subjects were obtained from Internet databases, oriented, and sized. A modified photogrammetric analysis was performed on the lateral view of each subject to obtain the angle and proportion measurements. Differences between the 2 groups were compared with 95% significance using the Student t test for independent samples. Facial similarities in the 2 ethnic groups were observed for the angle of the inferior facial third, labiomental angle, angle of facial convexity, and cervicomental angle. These results point to a similar conformation of the lower part of the face in relation to the neck that was shared by both groups of beautiful women. Additionally, both groups showed similar results for the lower lip projection. Likewise, similar proportional measurements were found for the upper lip proportion, notwithstanding differences in protrusion. Modern society is changing the classic concept of facial beauty because of globalization and the prevalence of multiethnic communities in the developed world. Independently of ethnic origin, beautiful women tend to have similar facial features that are a mixture of both black and white features.

Can facial proportions taken from images be of use for ageing in cases of suspected child pornography? A pilot study

The age of the victim plays a crucial role for the legal implications concerning pornography. Judges therefore often call on forensic experts to verify the age of individuals depicted on photographs or videos. However, there is no scientifically established protocol available for forensic practice in such cases. The conventional methods such as the evaluation of secondary sexual characteristics provide unsatisfactory results particularly when the legally relevant ages for child pornography (i.e. 14 and 18 years) are concerned. To overcome these limits, a European research group has explored the applicability of facial proportions as an age indicator on images. In this pilot study, standardized facial images of 353 females and 20 males from four age groups (6, 10, 14 and 18 years) were randomly selected for the metric analysis from a large data set including German, Italian and Lithuanian subjects. In this sample, several indices extracted from the frontal and lateral photographs were closely correlated to their respective indices taken from the living individuals. Furthermore, age-related changes were identified for indices taken from the photographs. The discriminant analysis showed that for the pooled sample, 60.3% of the cases were correctly classified into the respective age group. The percentage of correctly classified cases increased in the respective country samples as follows: 69.9% for Germany, 69.4% for Lithuania and 80.5% for Italy. The present study suggests that the metric assessment of the face may be used for age estimation on images. Nonetheless, more work needs to be done in order to verify the reliability of these findings on a large sample.

下顎枝垂直骨切り術後の遠位骨片と下顎頭の安定性に関する検討

The purpose of this study was to assess the postoperative stability of the distal segment and the condylar head of the mandible in eleven follow-up patients after intraoral vertical ramus osteotomy (IVRO). Retrospective radiographic assessments of horizontal and vertical changes of point B on distal segment and preoperative amount of overbite were performed based on lateral cephalograms. In addition, the position of the condylar head and the inclination angle of the condylar process were also analyzed by lateral panoramic temporomandibular joint projection photographs and computer tomography.The results were as follows:1. The distal segment of the mandible tended to move in the postero-inferior direction in five cases, four of which were open-bite.2. The five cases tended to show a delay in adaptation of the condylar head in the grenoid fossa postoperatively. In particular, two cases in whom the distal segment showed large clockwise rotation, possessed a shallow inclination angle of the condylar process.The results of this study suggest that the stability of the distal segment after IVRO depends on the preoperative amount of overbite before operation. The relation between the inclination angle of the condylar process and postoperative stability, however, was not elucidated.

Fractional lasers in dermatology - Current status and recommendations

Fractional laser technology is a new emerging technology to improve scars, fine lines, dyspigmentation, striae and wrinkles. The technique is easy, safe to use and has been used effectively for several clinical and cosmetic indications in Indian skin. Different fractional laser machines, with different wavelengths, both ablative and non-ablative, are now available in India. A detailed understanding of the device being used is recommended. Common indications include resurfacing for acne, chickenpox and surgical scars, periorbital and perioral wrinkles, photoageing changes, facial dyschromias. The use of fractional lasers in stretch marks, melasma and other pigmentary conditions, dermatological conditions such as granuloma annulare has been reported. But further data are needed before adopting them for routine use in such conditions. Any qualified dermatologist may administer fractional laser treatment. He/ she should possess a Master's degree or diploma in dermatology and should have had specific hands-on training in lasers, either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist or plastic surgeon with experience and training in using lasers. Since parameters may vary with different systems, specific training tailored towards the concerned device at either the manufacturer's facility or at another center using the machine is recommended. Fractional lasers can be used in the dermatologist's minor procedure room for the above indications. Detailed counseling with respect to the treatment, desired effects and possible postoperative complications should be provided to the patient. The patient should be provided brochures to study and also adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. Consent form should include information on the machine, possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. A close-up front and 45-degree lateral photographs of both sides must be taken. There are different machines based on different technologies available. Choice parameters depend on the type of machine, location and type of lesion, and skin color. Physician needs to be familiar with these requirements before using the machine. Fractional laser treatment can be carried out under topical anesthesia with eutectic mixture of lidocaine and prilocaine. Some machines can be used without any anesthesia or only with topical cooling or cryospray. But for maximal patient comfort, a topical anesthetic prior to the procedure is recommended. Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. A sunscreen is mandatory, and emollients may be prescribed for the dryness and peeling that could occur.

The diagnostic value of the facial features of Marfan syndrome

We examined the prevalence of known facial features of Marfan syndrome (MFS)-dolicocephaly, malar hypoplasia, enophthalmos, retrognathia, and down-slanting palpebral fissures-and the diagnostic utility (sensitivity, specificity, accuracy, predictive values, and likelihood ratios) of using them for screening and diagnosis. Frontal and lateral photographs of 76 subjects with MFS (average age 18.3years) and of 76 age- and gender-matched controls were obtained, randomized, and compiled into an online survey. Three physicians experienced with MFS rated each photograph for the presence of each feature and indicated whether each photograph triggered a suspicion for MFS. Eight non-expert orthopaedic surgeons reviewed a subset of those photographs and indicated if each triggered a suspicion for MFS. Half of the non-experts then received a brief diagnosis instructional sheet, and all non-experts were retested. The results were compared using Chi-square tests and t-tests with a significance level of P<0.05. Using facial features alone, the accuracy of experienced physicians in identifying individuals with MFS was 73%. Facial features had a 54% sensitivity, a 91% specificity, an 86% positive predictive value (PPV), a 67% negative predictive value (NPV), a 6.9% positive likelihood ratio (PLR), and a 50% negative likelihood ratio (NLR) for MFS. There was no significant difference in the diagnostic accuracy between non-experts receiving and not receiving instructions. Facial features are more specific than sensitive for MFS. Therefore, the recognition of facial features of MFS can be used as an initial screening tool, but facial features do not have a high sensitivity for MFS.

Matching profiles of masked perpetrators: a pilot study

Seventeen male volunteers were photographed laterally with and without a tight-fitting balaclava. We then matched these photographs in blind trials. The matches were performed in two separate trials: as side-by-side comparisons, and by using superimposition. In both trials we graded the matches as good, possible and no fit. We found a very high true identification rate of 94% using superimposition, i.e. whether a match judged as good was in fact the correct match. The correct exclusion rate was also high, 94%, when using superimposition, i.e. when no match was found this was in fact correct. However, even though we were often correct in judging the best fit, we often had several possible matches for each case, which means that comparing profiles is not very selective. As such, using superimposition to compare the profile of a masked perpetrator with lateral photos of one or more suspects may indicate the possible matches, and perhaps even the best match, which may be helpful in police investigations, but it would not carry enough weight to be used as evidence per se. This study only focused on the profile. Future studies will use surface laser scans to analyse congruence between masked and unmasked subjects using the whole head.