Orbital Aperture Research Articles

Gender Determination by Orbital Aperture Morphometry in Nalgonda Population

Background: The orbital aperture morphometry can be considered as a valuable tool in gender determination since orbit possesses resistance to damage and disintegration processes. Aim and Objective: The aim and objective of this study was to evaluate the orbital aperture dimensions in nalgonda population and verify their relationship with gender. Materials and Methods: The present retrospective study was conducted to evaluate the morphometric dimensions of orbital aperture seen on digital orthopantomogram taken using PLANMECA digital machine and ROMEXIS software. The height and width of the orbits were measured using measuring tools in the accompanying software. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Results: Linear measurements such as orbital height and orbital width, were significantly greater in males than females in the Nalgonda population with P < 0.001. The present study found 85.6% accuracy after subjecting the obtained value to discriminant function analysis. Conclusion: The discriminant scores greater than 1.5 value indicate the sample as male and scores lesser than 1.5 value indicate the sample as female. Therefore, orbital aperture measurements can be used for gender determination in human identification.

3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex.

This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.

Morphological and Morphometric Analysis of the Orbital Aperture and Their Correlation With Age and Gender: A Retrospective Digital Radiographic Study.

PurposePrecise knowledge about clinically observed bony orbital aging is needed for surgical planning for acceptable cosmetic results. The effect of age and gender on the facial skeleton and orbital aperture has been appreciated earlier, but its quantification remains ignored. The purpose of this study was to evaluate age- and sex-related changes in the shape of the orbital aperture and construct a reference data set for the aging phenomenon in Indians.MethodsTwo hundred digital radiographs (Water’s/frontal view) of the skull, obtained for various reasons, were evaluated. The radiographs comprised 107 males and 93 females aged between 10 and 60 years (10-59 years). Orbital shape, height/width, and interorbital/biorbital distances were noted, and orbital indices (OIs) were calculated. Orbital parameters thus obtained were compared between right and left sides and males and females. The relation of the parameters with age and gender was analyzed.ResultsFour types of orbits, round (33.5%), elliptical (30.5%), rectangular (27.5%), and square (9.5%), were noted in the study population. The average value of height and width of the right orbit was found to be higher than that of the left (p > 0.05). Male patients had higher (p > 0.05) and wider (p > 0.05) orbits than females. The right OI (81.55 ± 5.30) was higher than the left (80.75 ± 4.80) (p > 0.05). When comparatively evaluated between gender, both orbits were found to be of the microseme type with a mere difference (p > 0.05). The average interorbital/biorbital distance was 1.27 ± 2.11 and 9.78 ± 4.40 cm, respectively, without any gender difference. No significant relation was found between the age change and the parameters defined (p > 0.05), except in one age group (10-19 years).ConclusionsOrbital dimensions showed no association with age and gender except in one age group (10-19 years); a pubertal growth spurt in females might be causing this phenomenon. The morphometric data may be useful in forensic anthropology and better planning for reconstructive surgeries in the orbito-maxillary region.

Orbital Growth is Associated with Eyeball Size: A Study Using CT-based Three-dimensional Techniques

ABSTRACT Aim of the study This study was aimed to investigate the growth patterns and the relationship of the eyeball and the orbit using computed tomography (CT)-based three-dimensional (3D) techniques. Materials and Methods A total of 175 Chinese patients who had undergone craniofacial or orbital CT scans were enrolled. This study only included data from the unaffected eye and orbit. Images were processed using 3D reconstruction to obtain the eyeball and the orbit parameters. Results In early postnatal years, the sizes of eyeball and orbit increased significantly with age (p < 0.001) and reached a turning point at a critical age (8.967 and 12.800 years for the eyeball and orbit volume, respectively). The orbital index and orbital depth index, showing the shape of the orbital aperture and walls, decreased significantly with age (p < 0.001). In all ages, the orbit size was correlated with eyeball size (p < 0.001). The eye-orbit index, equivalent to the ratio of eye volume to orbital volume, declined steadily with age (p < 0.001). Conclusions The eyeball and orbit developed rapidly in early postnatal years, and then matured at a critical age. The eyeball size significantly contributed to the orbital growth; this contribution may be reduced as the eye-orbit index decreased with age. To the best of our knowledge, this is the first report on the growth and interrelation of the eyeball and the orbit using CT-based 3D techniques.

MORPHOMETRIC EVALUATION OF PIRIFORM AND ORBITAL APERTURE IN SEX DISCRIMINATION BY USING COMPUTED TOMOGRAPHY IN EGYPTIAN POPULATION

Human skeletal remains identification is crucial in forensic investigations, so the differentiation of the sex of a human bone is a significant initial stage for estimation of age and height of any unknown skeletal bone. AIM: The present study was designed to compare and evaluate the role of piriform and orbital aperture measurements in sex discrimination by using computed tomography in a sample of Egyptian population. SUBJECTS AND METHODS: This study was done by using 89 computed tomography (CT) images of the piriform and orbital bone obtained from the Radiology Department, Menoufia University Hospital for numbers of males' and females' patients (43 of them were for males and 46 were for females) aged from 20 to 70 years. Where morphometric measurements of piriform and orbital aperture were obtained. RESULTS: This study was conducted on 89 CT images; 43 of them were for males representing 48.3% with a mean age of 47.44± 16.54 years, while 46 cases were for females representing 51.7% with a mean age 44.52 ±15.56 years. A highly significant difference (p < 0.01) was obvious between both sex for left orbital width, right, and left orbital area with greater values in males. Measurements of piriform aperture (PA) in this study as length, width, and area showed that males presented with significantly greater mean values than females. Besides that, the Piriform area was the best sex discriminant as it had the highest sensitivity 93%, specificity 85%, and accuracy 88.7% at a cut off equal 64 mm or more suggesting males (p < 0.001). CONCLUSION: Sex determination of human skeletons is important in forensic and anthropological research. The present study revealed that piriform and orbital aperture have sexual dimorphism and can be helpful in sex discrimination especially the piriform area, which had the best accuracy in this study, as it had highest sensitivity 93%, specificity 85% and 88.7% accuracy.

Morphometric analysis of orbital aperture and frontal sinus using cone beam computed tomography as an aid in gender identification in forensic dentistry-a retrospective study

Morphometric analysis of orbital aperture and frontal sinus using cone beam computed tomography as an aid in gender identification in forensic dentistry-a retrospective study

Evaluation of orbital morphometry using 3D computed tomographic images in biological sex determination: A retrospective study

Background: Forensic science, also known as Criminalistics is a field of science that uses science for investigation and its application in civil and criminal proceedings. One of the main challenges is to identify the dead during criminal and mass disaster investigations. Aim: The study aims to evaluate the morphometry of the orbital aperture and to verify its relationship with biological sex discrimination using three-dimensional Computed Tomography (3D CT). Study Design: This retrospective study involves 100 3D CT images of 50 males and 50 females (age 18-60 years). Materials and Methods: The exclusion criteria were congenital anomalies affecting the head and neck region, orbital fracture, systemic diseases affecting bone and head and neck tumor. Eight orbital parameters such as Orbital width, orbital height, orbital roof length, orbital floor-length, lateral orbital wall length, medial orbital wall length, intraorbital distance, and extra orbital distance were measured for all the 3D CT images using RadiAnt DICOM Viewer (64 bit). Statistical Analysis: Descriptive statistics including mean, standard deviation, and percentage distribution were calculated. Mann Whitney U-test assessed the comparison between groups. The linear regression equation and Wilk's lambda were also calculated for every parameter. Results: All the orbital measurements except for intraorbital distance were statistically significant between male and female subjects. Totally, 92.0% of the individuals were correctly classified. Conclusions: Orbital measurements were significantly larger in males than in females. Orbits exhibit the least dimensional change throughout one's life. Hence, it could be used as an adjunct in biological sex determination.

S6A-08 SESSION 6A: CORONAL SYNOSTOSIS NASAL MONOBLOC FOR CORRECTION OF LATE NASAL AND ORBITAL ASYMMETRY OF UNICORONAL SYNOSTOSIS (UCS): A MORPHOMETRIC AND OUTCOMES ANALYSIS.

Introduction: Despite best efforts, surgical correction of UCS in infancy often results in residual naso-orbital asymmetry that persists into adulthood. The aim of this study is to describe the results of a nasal monobloc procedure for secondary correction of the late nasal and orbital asymmetry of unicoronal synostosis by mobilizing a united nasal and medial orbital segment of bone to perform corrective translational and rotational movement. Methods: A retrospective review of all UCS patients treated with nasal monobloc at our institution was performed. Demographic information was recorded, and relevant imaging (3D and 2D photographs) was utilized for morphometric outcome analysis. Outcomes and complications were tabulated. Results: 14 patients with a mean age of 14.5 years (10.4 to 20.2 years) underwent the nasal monobloc procedure. Follow up was 13.5 to 68.1 months (mean = 22.6 months). There were no complications in our series. One patient had a repeat procedure following technique modification. All patients were satisfied with their outcome, and no subsequent revisions were performed. 3D morphometric analysis demonstrated correction of frontal nasal deviation by 67.24% (5.35 degrees), basal nasal deviation by 62.47% (4.52 degrees), and aperture index asymmetry by 79.95%. Frontal nasal deviation decreased from a mean of 7.58 degrees (SD = 1.58) to 3.44 degrees (SD = 3.81), p = 0.006. Axial deviation also was corrected from 5.93 degrees (SD = 2.75) to 2.47 degrees (SD = 1.71), p = 0.004. Aperture symmetry was improved from an index of 1.06 (SD = 0.11) to 0.99 (SD = 0.03), p = 0.002. Conclusion: Late naso-orbital asymmetry is a consistent sequela following the surgical correction of unicoronal synostosis in infancy. Nasal monobloc now provides a reasonable surgical treatment to improve both the nasal and orbital asymmetries associated with unicoronal synostosis, including frontal nasal deviation, basal nasal deviation, and orbital aperture asymmetry.

Morphometric Analysis of the Orbital Aperture in North Indian Population: A Retrospective Digital Forensic Study.

Introduction:The morphometric variations seen in the orbital aperture play a significant role in forensic anthropology, for determining the personal and gender identification, especially in case of mass disasters.Aim:The aim of the present study was to evaluate the orbital aperture dimensions along with interorbital distance as observed on posteroanterior (PA) cephalograms for personal and gender identification.Materials and Methods:The present retrospective study was conducted to evaluate the morphometric dimensions of orbital aperture seen on PA cephalogram taken using PLANMECA digital machine and ROMEXIS software. The height and width of the orbits along with the interorbital distance were measured using measuring tools in the accompanying software. Data were analyzed using SPSS software version 21.0.Results:All the linear measurements such as orbital height, orbital width, and interorbital distance were significantly greater in males than females in the North Indian population with P = 0.001. The present study found 84.8% accuracy after subjecting the obtained value to discriminant function analysis.Conclusion:The morphometric analysis of the orbital aperture using postero-anterior cephalogram can be used as an adjuvant for personal and gender identification in forensic anthropology.

Sex Discrimination from Orbital Aperture by Using Computed Tomography: Sample of Egyptian population

The present study was designed to measure and compare various measurements of orbital apertures between male and female subjects using digital computed tomography. Also to assess the usefulness of orbital aperture measures as an aid in sex determination in sample of Egyptian population. The study included 92 subjects (44 males and 48 females) with age ranged from 18 to 65 years. The results showed that males exhibited greater mean values for all the measurements except for left orbital width that was slightly increased in females. There were significant differences (p<0.05) between males and females regarding right orbital height, right and left area and inter zygomatic distance. The accuracy of correct sex classification was achieved up to 74.7%. Discriminant analysis revealed that inter zygomatic distances showed significant discrimination (p= 0.028) between both sexes. Receiver Operating Characteristic (ROC) curve analysis for sex discrimination demonstrated that inter zygomatic distance at a cutoff of 96.7 had sensitivity 76.7%, specificity 65% and accuracy 71% (p<0.001). In conclusion, inter zygomatic distance was found to be the best reliable parameter and achieved the highest accuracy 71%. So, it was seen that inter zygomatic distance could be used for the sex determination from computed tomography.

Sexual dimorphism in right and left orbital fossa measurements from adult human skulls from an eastern Indian population

In forensic anthropology, the pelvis is the most reliable indicator of sex, followed by the skull, with several studies having used the morphometry of the orbital aperture of dry skulls to estimate sex. However, age, sex, ancestry, and evolutionary periods cause variations in orbital characteristics. In this study, we analyzed measurements of orbital fossa from adult human craniums and employed discriminant function analysis to establish a model to predict sex. A manual Vernier caliper was used to obtain measurements of the left and right orbital fossa. On comparing the measurements (including mean, minimum, and maximum), we found that all the dimensions were greater in males than in females. Wilks' lambda for the sex-discriminating model was 0.533, signifying a moderate discriminating power. The discriminant function equation was: df = −10.274 × right orbit width + 13.44 × left orbit width − 7.982 × right orbit height + 7.694 × left orbit height − 12.234 (constant). The cutoff point was (90.567− [−1.512])/2 = 1.0395. Therefore, above this value of 1.0395, cases were predicted to be male, while below it, they were predicted to be female. Orbital aperture measurements can play an important role in estimating sex from dry craniums. Orbital measurements could be a useful adjunctive test for sex estimation in forensic practice.

Abstract: The Impact of Age, Injury Severity, and Mechanism on Orbital Blow-out Fracture Patterns after Blunt Trauma: An 11-Year Review

BACKGROUND: Craniofacial injuries contribute substantially to morbidity after blunt trauma, with orbital fractures seen in approximately 10–25% of all traumatic facial fractures. Orbital blow-out fractures occur when an orbital wall is fractured with an intact orbital rim, and usually occurs after significant blunt trauma from an object larger than the orbital aperture. The aim of this study is to determine the impact of age, injury severity, and mechanism of injury on orbital blow-out fracture patterns. METHODS: We retrospectively reviewed all patients admitted to a regional Level 2 Trauma Center, who sustained blunt orbital fractures, over an 11-year period, from January 2006 to December 2016. We excluded all patients who had orbital rim fractures and all penetrating trauma. Only patients who had a computed tomography scan of their face on presentation were included. There were 825 patients who met inclusion criteria. Individual charts were reviewed for demographics, length-of-stay(LOS), mechanism of injury(MOI), injury severity score(ISS), and mortality. Individual facial CT scans were reviewed along with the formal radiologist report to determine fracture locations. Statistical significance was set at a p value ≤0.05. This study was approved by our Institutional Review Board. RESULTS: Our cohort consisted of 825 patients, with 42 mortalities (5.1%). The mean age was 40.4 years old (range 1–97) and there was an approximate 4:1 male:female ratio. The mean LOS was 5.4 days (range 0–78) and the mean ISS was 14.7(range 1–50). The most common MOI was motor vehicle collisions(MVC) in 211 patients, followed by assault, ground-level mechanical falls, All-Terrain Vehicle(ATV) accidents, motorcycle collisions(MCC), and other mechanisms in 171, 151, 112, 53, and 127 patients, respectively. Overall, the most common orbital blow-out fracture involved the orbital floor in 567 patients (68.7%), followed by the lateral, medial, superior(roof), and posterior walls in 310(37.6%), 183(22.2%), 160(19.3%), and 16(1.8%) patients, respectively. The most common fracture pattern combination was orbital floor and lateral wall fractures in 202 patients (24.5%). The mean number of orbital blow-out fractures per patient in the entire cohort was 1.50. Orbital floor fractures remained the most common blow-out fracture in all age groups, accounting for 72.4% in pediatrics (1–17 years old), 66.4% in adults (18–64 years), and 77.7% in the elderly (age ≥65 years). Patients with ISS <15 were significantly more likely to have an orbital floor fracture when compared to patients with ISS ≥15, with fractures present in 81.1% and 56.9% of patients, respectively(p<0.05). MCC resulted in the highest mean number of orbital blow-out fractures per patient (1.83), which was significantly higher than other mechanisms(p<0.05). Patients who had ground-level mechanical falls were most likely to have orbital floor blow-out fractures (90.0%) compared with other mechanisms(p<0.05). CONCLUSION: Orbital blow-out fractures are a common injury after significant blunt craniofacial trauma. The orbital floor is most frequently involved, and patients who have mechanical falls seem particularly prone to this injury. Patients with lower ISS in our cohort likely had more concentrated craniofacial injuries, explaining their worse fracture patterns. MCC appears to confer the greatest craniofacial trauma with the most severe orbital blow-out fracture patterns. Age did not independently predict fracture patterns.

Sex discrimination from orbital aperture dimensions using computed tomography: Sample of Egyptian population

Abstract The present study was designed to measure and compare various measurements of orbital apertures between male and female subjects using digital computed tomography. Also to assess the usefulness of orbital aperture measures as an aid in sex determination in sample of Egyptian population. The study included 92 subjects (44 males and 48 females) with age ranged from 18 to 65 years. The results showed that males exhibited greater mean values for all the measurements except for left orbital width that was slightly increased in females. There were significant differences (p

The relationship of cranial, orbital and nasal cavity size with the morphology of the supraorbital region in modern Homo sapiens.

Morphological variation of the supraorbital region (SR) in human crania has been investigated and its potential sources suggested, along with the importance of the size of the facial skeleton, neurocranium, and orbit for the formation of this region. However, previous studies have not indicated whether facial size exhibits a stronger association with SR robusticity than neurocranial size or sex; moreover, the association between orbital volume and SR robusticity has been analysed only in non-human primate skulls. In this study we investigate whether the size of the facial skeleton, neurocranium, two measures of relative orbital size (orbital volume and estimated orbital aperture area), the relative size of the nasal cavity, and the relative estimated area of the anterior nasal cavity opening are related to SR robusticity; we also examine which of these analysed relationships is strongest, as well as independent of the influence of the other traits, in a geographically diverse modern human cranial sample. The results of Spearman's rank and partial rank correlations (encompassing models including or excluding sex and geographic origin) show a relationship between most of the above-mentioned variables and SR robusticity, with the exception of the estimated relative area of the orbital opening (in the case of the results of Spearman's rank correlations) and the traits of the nasal cavity. Of all the analysed traits, sex appears to be the most important for the formation of SR robusticity and, of two measures of cranial size, neurocranial size was the most significant. The strong relationship between SR robusticity and relative orbital volume was observed in models without the geographic origin factor. The results concerning analysed models suggest the influence of this factor on this relationship; however, to explain this influence, further studies are needed.

What is the Main Potential Factor Influencing Ocular Protrusion?

BackgroundThe aim of the present study was to establish the normal-range orbital parameters and to explore the relationships between ocular protrusion and various orbital morphological factors.Material/MethodsA retrospective, non-comparative case series was conducted from January 2014 to December 2015. We recruited 56 subjects (112 orbits), including 27 males (21 to 87 years of age) and 29 females (22 to 88 years of age) in this study. Nine length measurements, 2 angle measurements, and 2 volume measurements of various aspects of the orbit were obtained using Mimics v18.0 software. The data were collected manually using a 3D measurement technique. Statistical analyses using t tests and Pearson’s correlation analyses were performed to evaluate the differences and relationships between the parameters, respectively.ResultsOcular protrusion in both sexes was closely related to the following values: orbital soft tissue volume (OSTV) (males: r=0.61, p<0.001; females: r=0.39, p=0.003), orbital soft tissue volume/bony orbital volume (OSTV/BOV) (males: r=0.90, p<0.001; females: r=0.87, p<0.001), orbital width (males: r=0.40, p=0.003; females: r=0.53, p<0.001), orbital height (males: r=0.29, p=0.038; females: r=0.45, p<0.001), and globe diameter (males: r=0.52, p<0.001; females: r=0.48, p<0.001). No differences were found between the right and left orbits.ConclusionsThe study provides insight into the potential factors that influence ocular protrusion, which include the OSTV/BOV ratio, the shape of the orbital aperture, and the ocular axial length. The results of orbital surgery can be made more predictable by accounting for these 3 factors. The database and regression formula might provide support for surgical planning in the future.

Orbital aperture morphometry in Indian population: A digital radiographic study.

Background:Morphological variations of the orbital aperture measurements may be used in forensic medicine as a parameter for determining sexual and ethnic identity of an individual.Aim and Objective:The aim and objective of this study was to evaluate the orbital aperture dimensions in Indian individuals and verify their relationship with gender.Materials and Methods:A retrospective study was conducted using digital posteroanterior view radiographs of 50 males and 51 females, which were taken using NEWTOM GIANO-CEFLA SC machine (81 kVp, 10 mA, and 6.6 s). The orbital aperture measurements were carried out using NEWTOM software NNT version 5.5. The maximum width and height of the orbits and the inter-orbital distance were measured. The obtained data were subjected to t-test and discriminant function analysis.Results:In the t-test, significant differences in orbital width and inter-orbital distance were obtained between the genders. On subjecting the data to discriminant function analysis, result was obtained with 86.1% accuracy rate in gender determination.Conclusion:If the discriminant score is >1.0365, the skull is likely to be of a male, and if it is <1.0365, it is likely to be of a female. Therefore, orbital aperture measurements can be used for gender determination in human identification.

Evaluation of Eyeball and Orbit in Relation to Gender and Age.

The orbital aperture is the entrance to the orbit in which most important visual structures such as the eyeball and the optic nerve are found. It is vital not only for the visual system but also for the evaluation and recognition of the face. Eyeball volume is essential for diagnosing microphthalmos or buphthalmos in several eye disorders. Knowing the length of the optic nerve is necessary in selecting the right instruments for enucleation. Therefore, the aim of this study was to evaluate eyeball volume, orbital aperture, and optic nerve dimensions for a morphological description in a Turkish population sample according to gender and body side.Paranasal sinus computed tomography (CT) scans of 198 individuals (83 females, 115 males) aged between 5 and 74 years were evaluated retrospectively. The dimensions of orbital aperture, axial length and volume of eyeball, and diameter and length of the intraorbital part of the optic nerve were measured. Computed tomography examinations were performed on an Activion 16 CT Scanner (Toshiba Medical Systems, 2008 Japan). The CT measurements were calculated by using OsiriX software on a personal computer. All parameters were evaluated according to gender and right/left sides. A statistically significant difference between genders was found with respect to axial length of eyeball, optic nerve diameter, dimensions of orbital aperture on both sides, and right optic nerve length. Furthermore, certain statistically significant side differences were also found. There were statistically significant correlations between age and the axial length of the eyeball, optic nerve diameter, and the transverse length of the orbital aperture on both sides for the whole study group.In this study we determined certain morphometric parameters of the orbit. These outcomes may be helpful in developing a database to determine normal orbit values for the Turkish population so that quantitative assessment of orbital disease and orbital deformities will be evaluated both for preoperative planning and for assessing postoperative outcomes.

Abstract: Nasal Monobloc for Late Nasal and Orbital Asymmetry of Unicoronal Synostosis

PURPOSE: Patients with unicoronal synostosis may develop asymmetries of the orbits and nasal complex long after fronto-orbital advancement. To address these asymmetries, the nasal monobloc procedure was designed at our institution. A nasal monobloc mobilizes a united nasal and medial orbital segment of bone to perform corrective translational and rotational movement. The purpose of this study was to examine the surgical outcomes of nasal monobloc for orbital and nasal asymmetry related to unicoronal synostosis. METHODS: A retrospective review of all patients treated with nasal monobloc at our institution was performed. Demographic information was recorded, and relevant imaging (3D and 2D photographs) was utilized for outcome analysis. From imaging, nasal deviation on frontal view, nasal deviation on basal view, and orbital aperture width were assessed. Aperture index (Left aperture width/right aperture width) was calculated from aperture width measurements to compare orbital symmetry. Patients without imaging were excluded. RESULTS: Inquiry yielded ten patients treated with nasal monobloc, and of these, six patients (3 males, 3 females) had adequate imaging for analysis. Three patients had 3D images, and in the remaining three patients 2D photographs were utilized. 3D images (n=3) exhibited correction of frontal nasal deviation by 67.24% (5.35 degrees), basal nasal deviation by 62.47% (4.52 degrees), and aperture index asymmetry by 79.95%. 2D images (n=3) revealed improvement of frontal nasal deviation by 53.14% (2.95 degrees), basal nasal deviation by 49.75% (2.40 degrees), and aperture index asymmetry by 59.22%. Follow was 3.5 to 68.1 months (mean=22.6 months). All patients were satisfied with their outcome, and no revisions were undertaken. CONCLUSIONS: Nasal monobloc is a reasonable surgical treatment to improve the long-term sequelae of unicoronal synostosis, including frontal nasal deviation, basal nasal deviation, and orbital aperture asymmetry.

Morphological Integration of the Orbital Region in a Human Ontogenetic Sample.

Most studies on craniofacial morphology have focused on adult individuals, but patterns of variation are the outcome of genetic and epigenetic variables that interact throughout ontogeny. Among cranial regions, the orbits exhibit morphological variation and occupy an intermediate position between neurocranial and facial structures. The main objective of this work was to analyze postnatal ontogenetic variation and covariation in the morphology of the orbital region in a cross-sectional series of humans from 0 to 31 years old. Landmarks and semilandmarks were digitized on the orbital rim, as well as in neighboring neural and facial structures. Data were analyzed using geometric morphometrics. Results indicated that orbital size increases during the first years of postnatal life, while the shape of the orbital aperture does not change significantly with age. In general, the pattern and magnitude of shape covariation do not vary markedly during postnatal life although some subtle shifts were documented. Additionally, the shape of the orbital aperture is more related to the anterior neurocranium than to zygomatic structures, even when the allometry is adjusted. Although we expected some influence from postnatal craniofacial growth and from some functional factors, such as mastication, on the development of the orbits, this assumption was not completely supported by our results. As a whole, our findings are in line with the prediction of an early influence of the eyes and extraocular tissues on orbital morphology, and could be interpreted in relation to processes promoting early neural development that coordinately affects orbital traits and the neurocranial skeleton.

Redesign and treatment planning orbital floor reconstruction using computer analysis anatomical landmarks.

Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to their weak anatomical structure. Restoration of the orbital floor following a traumatic injury or a tumor surgery is often difficult due to inadequate visibility and lack of knowledge on its anatomical details. The aim of this study is to investigate the locations of the inferior orbital fissure (IOF), infraorbital groove (G), and infraorbital foramen (Fo) and their relationship with the orbital floor using a software. Measurements from the inferior orbital rim (IOR) using the Fo, the IOF, G, and the optic canal (OC) were calculated in 268 orbits as reference points. The surgical landmarks from the G and the OC, the G and the IOF, the G and the intersection point were measured as 31.6±6, 12.9±4, and 12±5mm, respectively. The mean distances between the G and the IOR, the Fo and the IOF, and the Fo and the OC were found as 8.3±2.1, 28.7±3.5, and 53.6±5.9mm, respectively. The mean angles were calculated as OC-IOF-G 68.1°±16.4°; intersection-G-IOF as 61.4°±15.8°; IOF-OC-G as 19°±5.5°; OC-G-intersection as 31.5°±11.9°, G-intersection-OC as 129.5°, IOF-intersection-G as 50.5°. Furthermore, variable bony changes on the orbital floor which may lead to the differences at intersection point of the G and Fo were determined. In 28 specimens (20.9%), unilateral accessory Fo (AcFo) was present. In 27 specimens, AcFo was situated supermaedially (96.4%) on the main aperture. In one specimen, two intraorbital canals and Fo emerged from different points and coursed into different apertures. The measured mean distances of the AcFo-IOR and the AcFo-Fo were as 7±2 and 7.3±3.2mm, respectively. The primary principle in the oculoplastic treatment of orbital floor reconstructions must be repositioning the herniated orbital aperture by maintaining the infraorbital artery and the nerve in the orbital floor. The IOF and the G were recommended as the more reliable oculoplastic surgical landmarks for identifying the orbital floor. To avoid pinching of the orbital floor structures, the triangle (IS-G-IOF) should be equilateral with an exigence of a 70° angle within it. Among each distance of the intersection-IOF, IOF-G, G-intersection should be equal. With the help of certain software, this study made possible to investigate the variability of the orbital floor structures, observe the variety in measurements and calculate the parameters which are crucial in implementing personalized reconstruction and implanting support.