Soft Tissue Measurements Research Articles

Relationship between gestational weight gain with fetal body composition and organ volumes in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Dimensional Study: a prospective pregnancy cohort.

Inadequate and excessive gestational weight gain (GWG) are associated with increased risk of newborn small- and large-for-gestational-age, respectively, and future offspring adiposity. However, the relationship between GWG and three-dimensional (3D) measures of fetal body composition and organ volumes, which may provide greater insight into fetal growth via measurement of soft tissue, remains unknown. The objective of this study was to examine the relationship between trimester-specific GWG and 3D fetal body composition and organ volume measurements. In a diverse, US prospective pregnancy cohort, trimester-specific GWG was calculated as difference between maternal weight at beginning and end of each trimester, and categorized as inadequate, adequate, or excessive, per 2009 Institute of Medicine (IOM) guidelines. Up to five 3D ultrasound scans were completed across gestation, from which fetal body composition and organ volume measurements were obtained (n = 2675 pregnancies). The associations between trimester-specific GWG categories and 3D fetal body composition and organ volumes were assessed at 15, 29, and 39 weeks. Excessive compared with adequate GWG, in first and second trimesters was associated with larger abdominal circumference (n = 2430; 1st trimester: 1.29 cm, 95% CI: 0.74, 1.84; 2nd trimester: 2.98 cm, 95% CI: 1.62, 4.34) and abdominal area (n = 2401; 1st trimester: 22.04 mm2, 95% CI: 0.48, 43.60; 2nd trimester: 162.34 mm2, 95% CI: 76.25, 248.44), whereas excessive GWG in the first trimester was associated with larger arm subcutaneous tissue thickness (n = 1921; 0.01 cm, 95% CI: 0.00, 0.01). There was a trend toward increased fetal arm, thigh, kidney, and liver volumes and abdominal subcutaneous tissue, although differences did not reach the level of statistical significance for these structures. Excessive GWG was associated with greater fetal size primarily manifested by a pattern of fat accumulation across the fetal arm and abdomen. Future studies should examine whether these fetal changes have functional implications for childhood adiposity and metabolic dysfunction. This trial was registered at https://clinicaltrials.gov as NCT00912132 and NCT03266198.

A reliable and objective method of measuring soft tissue changes in 2D photographs after distraction osteogenesis in individuals with CL/P.

Pre- and postoperative photos to assess results are widely used in plastic and reconstructive surgery, for instance, in patients with cleft lip and palate (CL/P). Evaluations are often performed by assessment panels by viewing the photos. However, these are prone to be subjective. Measurements of soft tissues in photos could be an alternative method but have not been widely used so far. Some patients with CL/P develop a retrognathic maxilla in adolescence, with ensuing Class III malocclusion. In severe cases, distraction osteogenesis (DO) of the maxilla may be indicated. The effect of DO on the facial soft tissues is sparsely reported, perhaps due to the rare procedure. The primary aim of the present study is to provide a reliable and objective method of measuring soft tissue profiles in two-dimensional digital photos. Furthermore, the study aims at assessing changes in soft tissues following DO. Fourteen patients who had undergone DO at our unit were recruited. Preoperative and postoperative photos were identified, and long-term follow-up photos were taken. Three raters performed measurements of four angles and two distances. Inter- and intra-rater reliability and soft tissue changes were analyzed statistically. Inter- and intra-rater reliability was high overall for most variables. Two angles related to facial convexity changed significantly. So did the upper lip height. Soft tissues can be measured with a high degree of accuracy, but further evaluation of the method is necessary. DO causes a favorable increase in facial convexity, and an increased upper lip height.

Evaluation of Perceptual and Anthropometrical Facial Changes According to Increase in Vertical Dimension of Occlusion.

For restorative demands, increased vertical dimension of occlusion (VDO) is sometimes necessary, as facial changes can be perceptible. This study aimed to evaluate the perception of facial change due to increased VDO and associated soft tissue changes using 3D-scanned facial images. Forty participants with healthy dentition and no loss of VDO were recruited. The VDO was increased by 2, 4, 6 and 8 mm on a semi-adjustable articulator after maxillomandibular impressions. Facebow transfers were taken for each participant to create a personalised device. 3D facial scans were taken with the mandibular occlusal device in place, creating facial capture files from frontal, lateral and anteroposterior views for each scanned data. Sixty evaluators were recruited to consecutively cross-compare maximal intercuspal captures with increased VDO. To evaluate soft tissue changes with increased VDO, facial measurements, total face height, lower face height, lip width, lip height and nasolabial angle were measured thrice in 3D scan images using computer-aided design software. Statistical analysis entailed one-way repeated-measures analysis of variance (α = 0.05). A 4-mm increase in the VDO showed the highest perceptibility for facial change, varying among evaluator groups. Total face height, lower face height and nasolabial angle increased with VDO, while lip width and height decreased. Each soft tissue measurement differed significantly (p < 0.05). For 3D-scanned facial changes, a 4-mm increase in VDO was the most perceptible difference. Increased VDO affects facial changes.

High-Frequency Ultrasound for Detecting Periodontal Inflammation: A Preclinical Diagnostic Accuracy Study.

Ultrasonography (US) has shown accuracy in imaging healthy periodontium. This study aims to evaluate the feasibility and accuracy of US for estimating dimensions of inflamed periodontium induced by ligature and bacteria. Periodontal tissues of maxillary as well as mandibular premolars and molars in six female mini pigs were treated with ligature and three strains of bacteria for 4-10 weeks. Before euthanization, the periodontium was imaged with US. After euthanization, cone-beam computed tomography (CBCT) scans and histology were performed. Soft and hard tissue measurements by calibrated and masked examiners from US, CBCT, and histology were statistically compared. Seventy-one histological samples with corresponding CBCT and US scans were available for analysis. Overall, there was a good to excellent agreement between histology and US (ICC: 0.77-0.96) for parameters such as Soft Tissue Thickness (STT), Gingival Recession, Crestal Bone Thickness (CBT), and the bone-to-cemento-enamel junction (B-CEJ) distance. However, discrepancies were observed for STT at 3 mm below the CEJ and Soft Tissue Height (STH) (ICC: 0.44 and 0.54, respectively). CBCT showed lower agreement with histology, particularly for thin CBT (< 1 mm), with an ICC of 0.20, compared to 0.90 for US vs. histology. CBCT failed to identify crestal bone in 14 cases when the crestal bone was thin. Notably, CBCT results differed more from histological measurements than US in assessing B-CEJ and thin CBT. US demonstrated substantial potential as a transformative tool for periodontal diagnostics, exhibiting high agreement with histology in determining critical parameters. Compared to CBCT, US offered advantages, particularly in cases with thin crestal bone.

Digital Analysis of Dentogingival Factors Influencing the Gingival Margin Position in the Esthetic Zone.

To investigate the correlation between gingival thickness (GT) and buccal bone thickness (BBT), as well as the effects of GT, BBT, bone crest level (BC), and tooth position on the buccal gingival margin location of maxillary teeth in the esthetic zone. Periodontally healthy subjects with prior cone beam computed tomography and intraoral scans for dental implant planning were included. The hard and soft tissue measurements were retrospectively analyzed digitally. Pearson's correlation and ANOVA were used to evaluate the correlations between clinical/anatomical crown height ratios (CCH/ACH), gingival and buccal bone thicknesses, and the distance between the CEJ and BC (CEJ-BC). Forty-two subjects with 252 teeth were analyzed. A positive correlation was found between GT and BBT (p < 0.001). GT and BBT were negatively correlated with CCH/ACH (p = 0.006 and p = 0.004, respectively), while CCH/ACH showed a positive correlation with CEJ-BC (p < 0.001). Within the limitations of our study, we concluded that gingival and buccal bone thicknesses were positively correlated. A thicker gingival phenotype and higher coronal bone crest were linked to a more coronal gingival margin in the esthetic zone.

Change of Lip Curvature Through Extraction and Non-Extraction Orthodontic Treatment

Backgroud: Orthodontic treatment plans face challenges when deciding on tooth extraction, particularly when the retraction of incisors leads to a flattening of the lip curvature. Despite the significance of this issue, quantitative measurements of curvature have not been previously undertaken. This study presents novel soft tissue measurements, namely SAL (A’toSn-Ls) depth, SAL angle, PBL (B’toLi-Pg) depth, and angle, as tools for assessing lip curvature. The aim of this study was to assess whether new parameters demonstrated more pronounced flattening of the upper and lower lips in the extraction group compared to the non-extraction group. Methods: A total of sixty-two patients diagnosed with skeletal Class I malocclusion and treated with extraction or non-extraction orthodontic treatment were included and compared. Cephalometric measurements were analyzed and compared between the initial and final stages of treatment. Results: The difference in SAL (1.99°) and PBL (4.41°) angles and other soft tissue measurements between the groups was not statistically significant. Multiple regression analysis yielded the equation: ΔSAL = 0.66ΔU1 tip – 0.98ΔL1 tip – 1.58. Conclusions: Flattening of the upper lip was not significantly displayed on moderate anchorage. Consequently, orthodontic treatment accompanying the retraction of the upper incisors does not always result in obtuse lip profiles.

Methodology Used in Studies Aimed at Measuring Fetal Soft Tissues by 2D Ultrasound for the Screening of Large for Gestational Age Fetuses: A Systematic Review.

Management of suspected large for gestational age (LGA) fetuses remains unclear because ultrasound-estimated fetal weight (EFW) is not accurate. This was a systematic review of observational studies on fetal soft tissues measurements used alone or in combination to create a new EFW formula, to improve the screening for LGA fetuses. Studies were scored using a predefined set of independently agreed methodological criteria and an overall quality score was assigned for study design, statistical analysis, and reporting methods. There is a need to standardize methodologies for soft fetal tissue measurements. We propose a set of suggestions for this purpose.

Accuracy of web-based automated versus digital manual cephalometric landmark identification.

The purpose of this study was to assess the accuracy of two web-based automated cephalometric landmark identification and analysis programs. Manual landmark identification using Dolphin Imaging software was used as reference. 105 cephalograms were selected and divided into three groups of 35 subjects each, Class I, II and III. Radiographs were traced using Dolphin imaging software. WebCeph™ (South Korea) and Cephio™ (Poland) were used for the automated cephalometric analysis. Bland-Altman limits of agreement and the concordance correlation coefficient (CCC) were calculated. Kruskal Wallis test was used to compare the accuracy of WebCeph™ and Cephio™ measurements between the three groups. Mann-Whitney U test was used to compare the absolute difference between cephalometric measurements obtained using WebCeph™ and Cephio™. The mean difference (MD) between AI and manually-derived measurements was less than 1mm/degree and ranged from 0.01 to 0.8 except for upper lip protrusion (MD 1.35°), nasolabial angle (MD 5.01°), SN-GoGn (MD 1.41°), Ramus height (MD 1.46°), and IMPA (MD 1.94°). The mean CCC was 0.91 (range 0.60 to 0.96). No statistically significant differences were found between the three malocclusion groups for most of the measurements (P > 0.05). For most of the measurements, automated cephalometric measurements were clinically acceptable. Few differences were found between Webceph™ and Cephio™ for most measurements. Measurements including SNA, SN-PP, IMPA as well as soft tissue measurements require extra consideration and manual adjustment of respective landmarks for higher precision and improved efficiency.

Reliability and accuracy of Artificial intelligence-based software for cephalometric diagnosis. A diagnostic study

BackgroundArtificial intelligence (AI) is revolutionizing cephalometric diagnosis in orthodontics, streamlining the patient assessments. This study aimed to assess the reliability, accuracy, and time consumption of artificial intelligence (AI)-based software compared to a conventional digital cephalometric analysis method on 2D lateral cephalogram.Methods408 lateral cephalometries were analysed using three methods: manual landmark localization, automatic localization, and semi-automatic localization with AI-based software. On each lateral cephalogram, 15 variables were selected, including skeletal, dental, and soft tissue measurements. The difference between the two AI-based software options (automatic and semi-automatic) was compared with the conventional digital technique. The time required to produce a complete cephalometric tracing was evaluated for each method using Student’s t-test.ResultsStatistically significant differences in the accuracy of landmark positioning were detected among the three different techniques (p < 0,01). However, it is noteworthy that almost all of these differences were not clinically significant. There was a small difference in accuracy between the semi-automatic AI-based option and conventional digital techniques. Regarding the time used for each technique, the automatic version was the fastest, followed by the semi-automatic option and the conventional digital technique. (p < 0,000).ConclusionsThe study showed a statistical difference in accuracy between the conventional digital technique and two AI-based software alternatives, but these differences were not clinically significant except for specific measurements. The semi-automatic option was more accurate than the automatic one and faster than conventional tracing. Further research is needed to confirm AI’s accuracy in cephalometric tracing.

Long-term photogrammetric outcomes of midface advancement in Apert syndrome: are we nearing normal?

The aesthetic goals of midface surgery in Apert syndrome are to correct the multi-planar midface deficiency and normalize facial ratios. This study characterizes the long-term photogrammetric outcomes of midface advancement in Apert syndrome. Patients with Apert syndrome who underwent midface distraction from 2000 to 2023 were retrospectively reviewed. Soft tissue measurements were applied to preoperative (T0), short-term postoperative (T1), and long-term postoperative (T2) photographs. Long-term changes were compared between subcranial and transcranial procedures, segmental and non-segmental osteotomies, and individual techniques. Frontal facial dimensions at time T2 were compared to age- and sex-matched normal controls from the NIMH-ChEFS face database. Twenty patients had postoperative follow-up of T1 = 0.6 ± 0.4 and T2 = 4.7 ± 1.1years and were compared to 40 normal controls. From time T0 to T2, middle facial third height increased (26.1 ± 3.0% to 27.8 ± 2.6%, p = 0.026), canthal tilt improved (- 7.6° ± 3.7° to - 3.9° ± 4.4°, p < 0.001), and facial convexity increased (182.9° ± 6.2° to 167.9° ± 8.6°, p < 0.001). From time T1 to T2, facial convexity flattened (159.4° ± 10.1° to 167.9° ± 8.6°, p < 0.001). Compared to controls, patients at time T2 had shorter middle facial third height (27.8 ± 2.6% vs. 32.0 ± 1.9%, p < 0.001) and reverse canthal tilt (- 3.9° ± 4.4° vs. 5.4° ± 2.6°, p < 0.001). A tailored treatment approach to the Apert midface yields varying degrees of resolution of central midfacial shortening, canthal tilt, and facial concavity at 5years postoperatively. A slight reduction in facial convexity over time, likely reflecting pseudorelapse in the setting of sagittal overcorrection, should be anticipated. Greater utilization of segmental osteotomies may bring facial third ratios and canthal tilt closer to normal morphometric values.

Comparative analysis of 3D tomography based soft tissue rendering and Proface facial scanning systems in orthognathic surgery

PurposeThis study aimed to investigate the linear and angular differences in the nasolabial soft tissue in patients who underwent bimaxillary orthognathic surgery using two different three-dimensional imaging methods. Furthermore, the advantages, disadvantages, and limitations of these methods were determined after comparing the data obtained from the imaging methods used in the study. Materials and MethodsPreoperative (T0) and 6-months postoperative (T1) cone-beam computed tomography (CBCT) and three-dimensional facial scanning (3DFS) data from 22 patients who underwent maxillary advancement surgery were examined. The DICOM (Digital Imaging and Communications in Medicine) data (CBCT group) and “.obj” format images (3DFS group) of the patients were analyzed using Dolphin software (Dolphin Imaging®, Version 12, Chatsworth, CA, USA). The linear and angular soft tissue measurements were calculated after determining the reference anatomical landmarks for both groups. ResultsMeasurements with CBCT and 3DFS imaging methods were compared at T0, T1, and all measurements (T0+T1). No statistically significant difference was observed between the CBCT and 3DFS groups for five measurements performed at T0 and T0+T1, but statistically significant differences were observed between the groups for the other seven measurements. There was no statistically significant difference between the CBCT and 3DFS groups for six measurements at T1, but there were statistically significant differences between the groups for the other six measurements. After reviewing the postoperative differences in the nasolabial soft tissue, a statistically significant increase in four linear and one angular measurement in the 3DFS group was observed, and there was a statistically significant increase in two linear and two angular measurements in the CBCT group. Upon comparison of postoperative differences in soft tissue alterations, no statistically significant difference between the 3DFS group and the CBCT group were observed in any of the soft tissue measurements. ConclusionOrthognathic surgery has significant effects on nose width and upper lip morphology. Although both 3DFS and CBCT methods can be used to evaluate such effects, the results of the present study revealed differences in sensitivity and limitations between the two methods. Thus, surgical outcomes should be evaluated in consideration of the abovementioned parameters.

Stepwise surgical management of binder syndrome with skeletal class III malocclusion in adults

Our study aimed to evaluate a stepwise treatment of class III malocclusion accompanied with flat nasal deformity, using orthodontics, orthognathic surgery, and rhinoplasty, as well as stability during long-term follow-up.In total, 27 patients with nasomaxillary hypoplasia and skeletal class III malocclusion were enrolled in this study. All patients had accepted orthodontic and orthognathic surgery, followed by rhinoplasty with costal cartilage as the second surgical procedure. Clinical results were evaluated by radiography, medical photography, questionnaire, and cephalometric analysis.All patients were satisfied with the surgical results and no serious complications occurred. During the follow-up, the patients showed well-corrected midface contour and nasal projection, and stable occlusion. The costal cartilage grafts were well fixed, without obvious absorption deformation. Lateral cephalometric analysis and overlay results showed that the postoperative point A had advanced approximately 5.20 ± 1.43 mm and the SNA angle had increased by approximately 5.59 ± 2.86°. Soft-tissue measurements showed a 14.22 ± 6.56° decrease in the facial lobe, while the nasolabial angle had increased by 16.83 ± 6.65° postoperatively.The results suggested that stepwise orthodontic-orthognathic surgery and rhinoplasty produce a predictable and stable result in long-term follow-up.

New Solution in the Treatment of Children with Class II Malocclusion: Biblock Appliance.

A new design, the Biblock appliance, was developed for the functional treatment of Class II malocclusions. To compare the effects of Biblock appliance (BA) and Activator appliance (AA) on the skeleton, dentoalveolar, and soft tissue in Class II malocclusions. Thirty-five patients with mandibular retrognathia caused by skeletal Class II malocclusion and normodivergent growth pattern were included in this study. After selecting the BA group (n = 17, 8 boys and 9 girls, mean age = 12.08 ± 0.37 years), we selected the active control group treated with AA (n = 18, 9 boys and 9 girls, mean age = 12.3 ± 0.27 years), which matched the BA group's development and gender. All patients were between PP2 = DP3u periods according to hand-wrist maturation. Cephalometric variables related to the skeletal, dentoalveolar, and soft tissue were measured. Treatment duration was 18.17 ± 1.45 months with BA and 16.92 ± 1.09 months with AA. Skeletal Class II malocclusion improved significantly in both groups. In the compared groups, the increase in ANS-Me was significantly higher in the AA group (P < 0.05). The Cd⊥SN and S-Cd increase in the compared groups was significantly higher in the BA group (P < 0.05). There was no significant difference in measurements between the groups in skeletal, dentoalveolar, and soft tissue measurements (P > 0.05). The effects of AA, an appliance accepted by the orthodontic community, and BA, a new design, on the skeletal, dentoalveolar, and soft tissue were similar.

Ultrasound-based airway assessment in obese patients as a valuable tool for predicting difficult airway: an observational study

BackgroundDifficult airway, characterized by difficult mask ventilation and intubation, is common in obese patients undergoing surgery. The purpose of this study was to evaluate and compare the prognostic efficiency of ultrasound-measured anterior cervical soft tissue parameters as an indicator of difficult airway during anesthesia induction in obese patients. MethodsThis prospective, double-blind, observational study was conducted at Balikesir University Faculty of Medicine Hospital between March 2020 and March 2022. A total of 157 patients age ≥ 18 (BMI ≥ 30 kg.m-2), without previous head and neck surgery were included in the study. Anterior cervical soft tissue measurements were performed at three levels; minimum distance between the hyoid bone and skin at the level of the hyoid bone; (DSHB), distance between the midpoint of the epiglottis and skin at the level of the thyrohyoid membrane; (DSE), distance between the anterior commissure of vocal cords and skin at the vocal cord level; (DSV). The Han scale was used to assess difficult mask ventilation and the Cormack-Lehane scale was used to assess difficult laryngoscopy. ResultsIn the difficult laryngoscopy group, the mean values of DSHB, DSE and DSV were 18.5 ± 3.5, 18.3 ± 3.8, and 18.6 ± 3.4, respectively. The AUC values for DSHB, DSE, and DSV were 0.845, 0.827, and 0.850, respectively. Anterior cervical measurements showed a better predictive value for difficult laryngoscopy compared to difficult mask ventilation. ConclusionUltrasonographic measurements were predictive for difficult laryngoscopy and ventilation with better correlation in laryngoscopy.

Development of a Novel Soft Tissue Measurement Device for Individualized Finite Element Modeling in Custom-Fit CPAP Mask Evaluation

PurposeIndividual facial soft tissue properties are necessary for creating individualized finite element (FE) models to evaluate medical devices such as continuous positive airway pressure (CPAP) masks. There are no standard tools available to measure facial soft tissue elastic moduli, and techniques in literature require advanced equipment or custom parts to replicate.MethodsWe propose a simple and inexpensive soft tissue measurement (STM) indenter device to estimate facial soft tissue elasticity at five sites: chin, cheek near lip, below cheekbone, cheekbone, and cheek. The STM device consists of a probe with a linear actuator and force sensor, an adjustment system for probe orientation, a head support frame, and a controller. The device was validated on six ballistics gel samples and then tested on 28 subjects. Soft tissue thickness was also collected for each subject using ultrasound.ResultsThickness and elastic modulus measurements were successfully collected for all subjects. The mean elastic modulus for each site is Ec = 53.04 ± 20.97 kPa for the chin, El = 16.33 ± 8.37 kPa for the cheek near lip, Ebc = 27.09 ± 11.38 kPa for below cheekbone, Ecb = 64.79 ± 17.12 kPa for the cheekbone, and Ech = 16.20 ± 5.09 kPa for the cheek. The thickness and elastic modulus values are in the range of previously reported values. One subject’s measured soft tissue elastic moduli and thickness were used to evaluate custom-fit CPAP mask fit in comparison to a model of that subject with arbitrary elastic moduli and thickness. The model with measured values more closely resembles in vivo leakage results.ConclusionOverall, the STM provides a first estimate of facial soft tissue elasticity and is affordable and easy to build with mostly off-the-shelf parts. These values can be used to create personalized FE models to evaluate custom-fit CPAP masks.

Automatic soft-tissue analysis on orthodontic frontal and lateral facial photographs based on deep learning.

To establish the automatic soft-tissue analysis model based on deep learning that performs landmark detection and measurement calculations on orthodontic facial photographs to achieve a more comprehensive quantitative evaluation of soft tissues. A total of 578 frontal photographs and 450 lateral photographs of orthodontic patients were collected to construct datasets. All images were manually annotated by two orthodontists with 43 frontal-image landmarks and 17 lateral-image landmarks. Automatic landmark detection models were established, which consisted of a high-resolution network, a feature fusion module based on depthwise separable convolution, and a prediction model based on pixel shuffle. Ten measurements for frontal images and eight measurements for lateral images were defined. Test sets were used to evaluate the model performance, respectively. The mean radial error of landmarks and measurement error were calculated and statistically analysed to evaluate their reliability. The mean radial error was 14.44 ± 17.20 pixels for the landmarks in the frontal images and 13.48 ± 17.12 pixels for the landmarks in the lateral images. There was no statistically significant difference between the model prediction and manual annotation measurements except for the mid facial-lower facial height index. A total of 14 measurements had a high consistency. Based on deep learning, we established automatic soft-tissue analysis models for orthodontic facial photographs that can automatically detect 43 frontal-image landmarks and 17 lateral-image landmarks while performing comprehensive soft-tissue measurements. The models can assist orthodontists in efficient and accurate quantitative soft-tissue evaluation for clinical application.

Assessment of hard and soft tissue thickness at mandibular symphysis in skeletal Class III patients with different vertical patterns.

This study aimed to assess the bony and soft tissue parameters at mandibular symphysis among skeletal Class III patients with different vertical growth patterns, using cone-beam computed tomography (CBCT). CBCT images of 60 skeletal Class III non-growing patients were evaluated (mean age 24.9 ± 8.4 years). Study samples were classified into three facial types based on the mandibular plane angle (SN-MP angle): low, normal, and high angle. The bony and soft tissue parameters at the mandibular symphysis were evaluated. Among hard tissue variables, symphysis and pogonion width were significantly narrower in the high-angle group (P < .05). The thickness of the buccal cortex at pogonion was also significantly thinner in subjects with high angles (P < .01). Symphysis height showed an increasing tendency from the low-angle to the high-angle group. However, no significant differences were found in chin width and height according to vertical patterns. Across all soft tissue measurements, the low-angle group exhibited the highest thickness, which gradually decreased in the high-angle group. Statistically significant differences in soft tissue thickness were observed at Menton (Me) and Gnathion (Gn) (P < .05). A significant negative correlation was observed between the SN-MP angle and the thickness of both hard and soft tissues. In skeletal Class III subjects, significant differences existed in both hard and soft tissues at the mandibular symphysis, depending on the vertical patterns. These results provide a comprehensive evaluation of symphyseal area, which can aid clinicians in identifying appropriate treatment approaches, especially for combined orthognathic and orthodontic treatment.

Multiethnic growth standards for fetal body composition and organ volumes derived from 3D ultrasonography

BackgroundA major goal of contemporary obstetrical practice is to optimize fetal growth and development throughout pregnancy. To date, fetal growth during prenatal care is assessed by performing ultrasonographic measurement of two-dimensional fetal biometry to calculate an estimated fetal weight. Our group previously established two-dimensional fetal growth standards using sonographic data from a large cohort with multiple sonograms. A separate objective of that investigation involved the collection of fetal volumes from the same cohort. ObjectiveThe Fetal 3D Study was designed to establish standards for fetal soft tissue and organ volume measurements by three-dimensional ultrasonography and compare growth trajectories with conventional two-dimensional measures where applicable. Study DesignThe NICHD Fetal 3D Study included research-quality images of singletons collected in a prospective, racially and ethnically diverse, low-risk cohort of pregnant individuals at 12 U.S. sites, with up to five scans per fetus (N=1,730 fetuses). Abdominal subcutaneous tissue thickness was measured from two-dimensional images and fetal limb soft tissue parameters extracted from three-dimensional multiplanar views. Cerebellar, lung, liver and kidney volumes were measured using virtual organ computer aided analysis (VOCAL). Fractional arm and thigh total volumes, and fractional lean limb volumes were measured, with fractional limb fat volume calculated by subtracting lean from total. For each measure, weighted curves (5th, 50th, 95th percentiles) were derived from 15-41 weeks’ using linear mixed models for repeated measures with cubic splines. ResultsSubcutaneous thickness of the abdomen, arm, and thigh increased linearly, with slight acceleration around 27-29 weeks. Fractional volumes of the arm, thigh, and lean limb volumes increased along a quadratic curvature, with acceleration around 29-30 weeks. In contrast, growth patterns for two-dimensional humerus and femur lengths demonstrated a logarithmic shape, with fastest growth in the 2nd trimester. The mid-arm area curve was similar in shape to fractional arm volume, with an acceleration around 30 weeks, whereas the curve for the lean arm area was more gradual. The abdominal area curve was similar to the mid-arm area curve with an acceleration around 29 weeks. The mid-thigh and lean area curves differed from the arm areas by exhibiting a deceleration at 39 weeks. The growth curves for the mid arm and thigh circumferences were more linear with some decelerations. Cerebellar two-dimensional diameter increased linearly, whereas cerebellar three-dimensional volume growth gradually accelerated until 32 weeks and then decelerated. Lung, kidney, and liver volumes all demonstrated gradual early growth followed by a linear acceleration beginning at 25 weeks for lungs, 26-27 weeks for kidneys, and 29 weeks for liver. ConclusionGrowth patterns and timing of maximal growth for three-dimensional lean and fat measures, limb and organ volumes differed from patterns revealed by traditional two-dimensional growth measures, suggesting these parameters reflect unique facets of fetal growth. Growth in these three-dimensional measures may be altered by genetic, nutritional, metabolic or environmental influences and pregnancy complications, in ways not identifiable using corresponding two-dimensional measures. Further investigation into the relationships of these three-dimensional standards to abnormal fetal growth, adverse perinatal outcomes, and health status in postnatal life is warranted.

Adjusting for the effect of IV contrast on automated CT body composition measures during the portal venous phase.

Fully-automated CT-based algorithms for quantifying numerous biomarkers have been validated for unenhanced abdominal scans. There is great interest in optimizing the documentation and reporting of biophysical measures present on all CT scans for the purposes of opportunistic screening and risk profiling. The purpose of this study was to determine and adjust the effect of intravenous (IV) contrast on these automated body composition measures at routine portal venous phase post-contrast imaging. Final study cohort consisted of 1,612 older adults (mean age, 68.0 years; 594 women) all imaged utilizing a uniform CT urothelial protocol consisting of pre-contrast, portal venous, and delayed excretory phases. Fully-automated CT-based algorithms for quantifying numerous biomarkers, including muscle and fat area and density, bone mineral density, and solid organ volume were applied to pre-contrast and portal venous phases. The effect of IV contrast upon these body composition measures was analyzed. Regression analyses, including square of the Pearson correlation coefficient (r2), were performed for each comparison. We found that simple, linear relationships can be derived to determine non-contrast equivalent values from the post-contrast CT biomeasures. Excellent positive linear correlation (r2 = 0.91-0.99) between pre- and post-contrast values was observed for all automated soft tissue measures, whereas moderate positive linear correlation was observed for bone attenuation (r2 = 0.58-0.76). In general, the area- and volume-based measurement require less adjustment than attenuation-based measures, as expected. Fully-automated quantitative CT-biomarker measures at portal venous phase abdominal CT can be adjusted to a non-contrast equivalent using simple, linear relationships.

Lower incisor position in skeletal Class III malocclusion patients: a comparative study of orthodontic camouflage and orthognathic surgery.

To determine the difference between orthodontic camouflage and orthodontic-orthognathic surgery using the traditional cephalometric measurement IMPA and the newly proposed IA/PAMD, the angle between the long axis of the lower incisor (IA) and the principal axis of the mandibular alveolus (PAMD). This study included 40 cases each in the orthodontic camouflage group (OG) and orthodontic-orthognathic surgery group (SG). The differences between the IMPA and IA/PAMD before and after treatment were compared between the two groups. T0 lateral cephalometric images of the 10 cases with the highest and lowest increase in the IA/PAMD were analyzed to identify characteristics associated with a higher risk of overdecompensation of the lower incisors during presurgical orthodontic treatment. Both the OG and SG showed a significant improvement in hard- and soft-tissue measurements. However, in the OG, there was significant lingual inclination of the lower incisor but only a small change in the IA/PAMD. In the surgical group, the IMPA was close to 90° after treatment, but the IA/PAMD significantly increased. In orthodontic camouflage, the lower anterior teeth were significantly moved lingually with a better root-bone relationship. However, this relationship deteriorated in some surgical patients. Therefore, it is important to conduct cephalometric or cone-beam computed tomography examinations during preoperative orthodontics to identify and prevent possible periodontal risks.