Three-dimensional Photography Research Articles

In vitro biocompatibility and stem cell regenerative assessment of hollow hydroxyapatite spheres deposited wollastonite/Ca2P6O17/TCP/doped-wollastonite scaffolds

This research examines the biological behavior of multilayer ceramic-glass scaffolds for bone tissue engineering. The scaffolds consist of a high-strength core of wollastonite and P6 (Ca2P6O17), with a sequential coating of TCP and wollastonite doped with Na+, K+ and Mg2+ ions to confer bioactivity to the system. Two formulations were investigated: a magnesium-deficient one, which served as a microstructure control, and a magnesium-rich one in which hollow hydroxyapatite (HA) spheres precipitated after one week of immersion in simulated body fluid (SBF). These formulations are denoted as C-Scaffold and HA-Scaffold, respectively. Further exploration and comparison of the physiological effects of both scaffolds is necessary to fully understand their potential as drug release agents and associated therapeutic advantages. The study considered aspects such as protein adhesion, cell morphology, and the inflammatory response. The results showed that the HA-Scaffold had over 34 % more plasma protein adhesion compared to the C-Scaffold. Similarly, cell proliferation assays showed increased cell growth in both HFF-1 fibroblasts and mesenchymal stem cells (MSCs) treated with HA-Scaffold compared to C-Scaffold. This may be attributed to the higher protein adsorption, which acts as a facilitator for cell adhesion. Three-dimensional photography from computerized microtomography confirmed that the scaffolds have a similar morphology and porosity to the intricate structure of trabecular bone in the humeral head. The study shows that the scaffolds made of Wollastonite/Ca2P6O17/TCP/Doped-Wollastonite with HA hollow spheres are highly suitable for use in this bone segment due to their overall porosity of over 86 % and approximate mechanical strength of 1.6 MPa. These findings demonstrate the biocompatibility and enhanced biological properties of the scaffolds, making them an excellent material for bone tissue engineering.

Three-Dimensional Photography for Evaluating the Effectiveness of Botulinum Toxin Injection for Masseter Hypertrophy.

Masseter hypertrophy is a common condition that causes a undesirable square face, and often treated with botulinum toxin type A (BoNTA). Subjective assessments of BoNTA effectiveness vary from physician to patient, necessitating an objective approach for evaluation. This study introduces three-dimensional photography (3DP) for the first time in clinical assessment to evaluate BoNTA treatment for masseter hypertrophy. Ten patients received 36U of BoNTA at three injection points on each side masseter muscle. 3DP scanner using Artec Eva® was taken at the first, third, and sixth postoperative months for objective evaluation. Patient's self-perceived prominence, patients self-rated satisfaction, and physicians provided 5-grade scores were the subjective indicators. A significant decrease in left masseter volume at the sixth month (P = 0.002, P = 0.004 at rest and clenching, respectively) was observed. Patient's self-perceived prominence decreased at the first (P = 0.021) and third (P = 0.039) months. Physicians' scores significantly decreased at all postoperative months. No significant changes were noted in the right masseter volume and patients self-rated satisfaction. Patient self-rated satisfaction did not consistently correlate with objective measures, except for left masseter with clenching at the sixth month. Three-dimensional photography accurately quantifies facial changes post-BoNTA treatment. Despite objective improvements, patient satisfaction may not align consistently. Reliable assessment tools are crucial in cosmetic surgery to manage expectations and prevent disputes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Use of Auricular Composite graft in Rib-Cartilage based Rhinoplasty for Contracted Nose Correction.

This study investigated the effects of combining an auricular composite graft with rib cartilage-based rhinoplasty to correct contracted noses in Asian patients with a history of multiple previous operations. A total of 43 patients were included in the retrospective analysis of secondary rhinoplasty procedures. The surgical approach involved short-nose correction, utilizing rib cartilage for septal extension grafts and chondrocutaneous composite grafts harvested from the conchal part of the ear for internal nasal lining reconstruction. Our assessment encompassed clinical outcomes, the occurrence of complications, and the utilization of three-dimensional (3D) photography for nasal measurements at the preoperative, 3-month, and 1-year postoperative stages. Regarding graft survival, 12 (27.9%) patients showed >80% graft engraftment, followed by 29 (67.4%) patients with 50%-80% graft engraftment, and 2 (4.6%) patients with 20%-50% graft engraftment. Two of these patients required wound irrigation for infection control and additional repair and were finally discharged without significant nasal deformity. At 3 months postoperatively, 3D anthropometry showed significant differences in nasal dorsum length (4.46 ± 1.79 mm), nasal height (1.25 ± 1.25 mm), nasal tip projection (4.06 ± 1.76 mm), and columellar-labial angle (22.75° ± 14.19°). No significant relapse of nasal parameters was noted 1 year postoperatively. Auricular composite graft combined with rib cartilage-based rhinoplasty enables the comprehensive restoration of nasal structures, addressing the inner, intermediate, and outer layers. This approach can serve as an effective and sustainable option for correcting contracted noses in Asian patients who have undergone multiple operations.

Photographic Parameters in Three-Dimensional Facial Image Acquisition. A Scoping Review.

Orthognathic surgery is a viable and reproducible treatment for facial deformities. Despite the precision of the skeletal planning of surgical procedures, there is little information about the relations between hard and soft tissues in three-dimensional (3D) analysis, resulting in unpredictable soft tissue outcomes. Three-dimensional photography is a viable tool for soft tissue analysis because it is easy to use, has wide availability, low cost, and is harmless. This review aims to establish parameters for acquiring consistent and reproducible 3D facial images. A scoping review was conducted across PubMed, SCOPUS, Scientific Electronic Library Online (SciELO), and Web of Science databases, adhering to "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews" guidelines. Articles presenting 3D facial photographs in the diagnostic phase were considered. A total of 79 articles were identified, of which 29 were selected for analysis. The predominant use of automated systems like 3dMD and VECTRA M3 was noted. User positioning has highest agreement among authors. Noteworthy aspects include the importance of proper lighting, facial expression, and dental positioning, with observed discrepancies and inconsistencies among authors. Finally, the authors proposed a 3D image acquisition protocol based on this research findings.

The effect of combined surgery and physiotherapy on the facial asymmetry in patients with congenital muscular torticollis: a retrospective cohort study

The aim of this study was to assess the influence of surgical therapy, intraoperative evaluation, and immediate physiotherapy on the facial asymmetry of patients with congenital muscular torticollis (CMT). Patients who underwent a combination of unipolar sternocleidomastoid muscle release with perioperative physiotherapy between 2014 and 2020 in the Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen were enrolled. Three-dimensional photographs of the face acquired 2 months preoperatively and 1.5–2 years postoperatively were assessed. Based on 43 patients, there was a significant improvement in the asymmetry indices (angles between bilateral exocanthion, bilateral cheilion, and nasion–gnathion lines): mean ± standard deviation reductions in indices (Ex–Ex)–(Ch–Ch), (Ex–Ex)–(Na–Gn), and (Ch–Ch)–(Na–Gn) of 0.88 ± 1.08° (P < 0.001), 1.04 ± 1.26° (P < 0.001), and 0.21 ± 1.06° (P = 0.024), respectively. Analysis of covariance (ANCOVA) showed that intervention at an early age (P = 0.017) and left-sided torticollis (P = 0.030) were associated with a significantly greater improvement in the facial asymmetry. This study found that the use of combined surgery and physiotherapy reduced the facial asymmetry of patients with CMT at 2 years postoperatively. Early intervention and left-sided torticollis were associated with a greater improvement in the facial asymmetry. This indicates that attention should be given to early intervention and right-sided CMT cases postoperatively.

Nasal Morphology in a Young Adult Middle-Eastern Population: A Stereophotogrammetric Analysis.

This study aimed to describe gender-specific three-dimensional morphology of the soft-tissue nose in Lebanese young adults and to explore the associations between nasal morphology with age and body mass index (BMI). Three-dimensional photographs were captured for 176 young healthy Lebanese adults (75 males and 101 females) aged 18.1-37.68 years. Linear and angular nasal measurements were computed and compared between genders, in addition to other established norms. Associations with age and BMI were also assessed. All linear measurements were greater in males than in females, and only the nasolabial angle was significantly larger in females by 2.97 degrees on average. Most of the measurements were found to be larger than the Caucasian norms. A few significant correlations were found between the measurements and age or BMI. This study is the first to present the sex-specific norms for nasal morphology in the Lebanese population and highlights the presence of gender dimorphism in the majority of measurements. Additional studies are needed to validate our data and expand the associations with age and BMI. The data offered in this study could help enhance the accuracy of facial reconstructive surgery and aid in personalized treatment planning for both medical and cosmetic nasal interventions. How to cite this article: Saadeh M, Shamseddine L, Fayyad-Kazan H, et al. Nasal Morphology in a Young Adult Middle-Eastern Population: A Stereophotogrammetric Analysis. J Contemp Dent Pract 2024;25(3):199-206.

Performance of Cow Evaluation System Elements in Simulated Environmental Conditions

Animal phenotype assessment plays a crucial role in enhancing the genetic potential of domestic breeds. Currently, research is underway to digitize and automate phenotyping through optical systems, enabling the recognition and evaluation of animals’ linear parameters. A prototype of a non-contact monitoring system for livestock phenotype indicators is currently under development. The movement of animals within the model (a laboratory measuring stand) is restricted by a specially designed transparent barrier made of polyethylene terephthalate, enabling the capture of three-dimensional photographs of the animals’ exterior. To validate the suitability of glass for this purpose, laboratory tests were conducted. (Research purpose) The research aims to determine the degree of relationship between protective glass contamination and the accuracy of the optical animal recognition system. (Materials and methods) The paper outlines the specifications of the laboratory stand, facilities, and equipment used, along with the methods employed and experimental conditions. The probability of determining the degree of protective glass contamination was quantified on a scale of 0 to 1, with a value of 0.78 indicating a high likelihood of accurate determination. (Results and discussion) The findings reveal that the system for determining the linear parameters of animals can operate reliably even when the protective glass is contaminated up to 30 percent. When the contamination reaches 50 percent due to inadequate glass cleaning, the system’s ability to recognize points of interest reduces by a factor of 1.625. Furthermore, at 80 percent contamination, achieving high-quality data collection becomes unfeasible as the camera fails to recognize the object. Proper cleaning of the glass is imperative to maintain the system stability. (Conclusions) The optical system enables the recognition and evaluation of animals’ linear parameters, provided that the protective glass of the laboratory stand is contaminated by no more than 50 percent and undergoes high-quality cleaning. At lower levels of glass contamination, up to 30 percent, these estimates exhibit a 2.6-38 percent increase compared to other contamination levels.

(117) Interrater Agreement and Feasibility of Three-Dimensional Photography for Curvature Assessment in Peyronie's Disease

Abstract Introduction Curvature assessment is an iterative aspect of the evaluation of Peyronie’s Disease (PD); its accuracy is subject to patient erection quality and clinician technique. Prior studies have shown promising results when using 3D modeling software in curvature assessment, yet none have applied the technology to human subjects with complex PD in an authentic clinical scenario. Objective To evaluate the feasibility of using 3D modeling to assess penile deformity in PD patients. Methods MirrorMe3D is a HIPPA-compliant iOS mobile and web-based platform designed for 3D anatomical modeling. 2 trained urology fellows (coders 1 and 2) were trained to create models using the app by acquiring ≥ 12 images of the target obtained in a multiplanar, 360-degree fashion. Participants verbally consented to deidentified penile photography during their clinic visit for penile curvature assessment with Doppler ultrasound (CADUS). Photographs were obtained prior to performing DUS with the patient in the supine position and using a commercially available clip-on ring light and custom 3D-printed holder device placed over the penis base for stabilization. 3D models were generated upon completion of the visit and screened for quality. Curvature assessment on the 3D images included curvature direction, location, degrees, and other defects identified via visual inspection of the digital model. Results 7 unique, quality 3D images were generated using 15-20 photos per participant (Figure 1). The time required to obtain images was 1-2 minutes. Once the 3D image was developed, the curvature assessment took about 5 minutes. Quantitative results are summarized in Table 1. We observed a high rate of agreement in terms of primary direction of curvature and an acceptable variance rate when evaluating degrees of curvature within a margin of 10°; of note, coders were in agreement with each other to within a 10° margin 100% of the time (7/7 patients). We also observed a high agreement rate when evaluating the presence of absence of tapering but low agreement when assessing for the presence of indentation and hourglass deformity. Regarding the penis stabilizer, our experience suggests that it may alter the base of the penis anatomy, but it improves capture of the organ with diminished interference from surrounding anatomy (scrotum, abdomen). Factors influencing the quality of the image were exam room set-up, patient anxiety about losing an erection, lighting, and body hair. Conclusions 3D image-based PD assessment can be implemented with minimal impact to visit efficiency. The 3D technique does not appear to reproduce complex PD measurements obtained by CADUS; however, future studies will evaluate the utility of employing this technology to a larger cohort and also to monitor treatment effect in complex PD patients. Disclosure No.

A Novel Neurovascular Protection Method In Nasolabial Muscle Biomechanical Bionic Surgery For Secondary Unilateral Cleft Lip Repair: A Three-Dimensional Evaluation Of Short And Long-Term Results.

Neurovascular protection within the upper lip muscles is essential in muscle tension reconstruction and functional recovery during surgery. This study aimed to investigate a novel neurovascular protection method based on the intramuscular neurovascular partitions of the upper lip applied to nasolabial muscle biomechanical bionic surgery for secondary unilateral cleft lip repair and to evaluate postoperative outcomes. From November 30, 2019 to October 31, 2020, 50 consecutive patients with secondary unilateral cleft lips who underwent the modified biomechanical bionic surgery were reviewed retrospectively. Three-dimensional (3D) photographs of patients were collected preoperatively, 7-day postoperatively, and during long-term follow-up (at least 6 months). The Global Aesthetic Improvement Scale was used to evaluate surgical subjective outcomes, and statistical analysis of nasolabial measurements on 3D photographs was used to evaluate objective outcomes before and after surgery. The Global Aesthetic Improvement Scale showed that 94% of patients had improved upper lip morphology and 92% had improved nasal morphology 7-day postoperatively. In all, 84% maintained favorable nasolabial morphology during long-term follow-up. Statistical results showed that the postoperative alar width, philtral depth, columellar angle, and nasal base inclination angle were significantly improved compared with preoperatively ( P <0.01). The differences between the above 4 indexes were not statistically significant ( P >0.05) between 7-day postoperatively and long-term follow-up, indicating that the postoperative lasting outcomes were satisfactory. The novel method of neurovascular protection in nasolabial muscle biomechanical bionic surgery can achieve a long-term improvement of labial-nasal morphology and function in patients with secondary unilateral cleft lip.

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Bifrontal Transbasal Approach, Surgical Principles, and Illustrative Cases.

Introduction The transbasal approach traditionally uses a bicoronal scalp incision with bifrontal craniotomy to establish an extradural midline skull base working corridor. Depending on additional craniofacial osteotomies, this approach can expand its reach to the nasal cavity and paranasal sinuses and may be employed for the resection of particularly complex sinonasal and midline skull base tumors. Given its discrepancy in nomenclature and differences in interoperator technique, we propose a practical, operatively oriented guide for trainees performing this approach. Methods Three formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic-assisted visualization. Stepwise dissections of the transcranial-transbasal approach with common modifications were performed, documented with three-dimensional photography, and supplemented with representative case applications. Results The traditional transbasal approach via bifrontal craniotomy affords wide extradural access to the anterior cranial fossa and central skull base. The addition of craniofacial osteotomies further expands access into the sinonasal cavities, clivus, and craniocervical junction. Key steps described include patient positioning, bicoronal skin incision, pericranial graft harvest, bifrontal craniotomy, orbital rim osteotomy, sphenoidotomy, bilateral ethmoidectomies, and microsurgical dissection of the sellar region. Basal superior sagittal sinus ligation and durotomy allow for intradural exposure. Reconstruction techniques are also discussed. Conclusion While the transbasal approach is rich with historical descriptions, illustrations, and modifications, its stepwise performance may be relatively unknown and unclear to younger generations of trainees. We present a comprehensive guide to optimize familiarity with the transbasal approach and its indications in the surgical anatomy laboratory, mastery of the relevant microsurgical anatomy, and simultaneous preparation for learning and participation in the operating room.

Primary Cleft Rhinoplasty with Custom Suture Needle for Alar Cartilage Repositioning in Unilateral Cleft Lip Patients: 3D Nasal Analysis.

Primary nasal correction has been demonstrated to be a beneficial practice for patients with unilateral cleft lip and palate. However, there is currently no consensus among cleft surgeons regarding the ideal approach to addressing the malpositioned cartilages. This study aims to introduce a new surgical technique for repositioning deformed lower lateral cartilage during primary cleft rhinoplasty, which involves using a customized suture needle. Retrospective cohort study. Tertiary university-affiliated hospital. This retrospective study included 51 patients with unilateral cleft lip and palate who underwent primary rhinoplasty during the labial repair. A morphological analysis of the nose was conducted using three-dimensional (3D) photographs. The cleft-to-noncleft side ratios of various nasal parameters, including nasal tip volume, nostril width, height, and area, were calculated at three time points: preoperative (T0), 3 months postoperative (T1), and 1 year postoperative (T2). Significant improvement (p < 0.05) was observed in the cleft-to-noncleft side ratios of nasal volume and nostril parameters. The nasal volume ratio and nostril height ratio remained stable, with no significant differences between the T1 and T2 periods. The nostril width ratio increased from 0.96 ± 0.13 at T1 to 1.05 ± 0.16 at T2, indicating an appropriate degree of surgical overcorrection of nasal width during primary lip repair. Primary cleft rhinoplasty using a Chang's needle allows direct suture placement in the intercartilaginous region with minimally invasive approach, thereby preserving growth potential of the nose and restoring the nasal symmetry.

Creation of the Scaphocephalic Index: Measurement of Global and Regional Severity in Scaphocephaly.

The recently described frontal bossing index (FBI) and occipital bullet index (OBI) allow for quantification of scaphocephaly. A similar index examining biparietal narrowing has not been described. Addition of such an index measuring width would allow for direct evaluation of the primary growth restriction in sagittal craniosynostosis and the formation of an optimized global width/length measure. Computed tomography scans and three-dimensional photographs were used to recreate scalp surface anatomy. Equidistant axial, sagittal, and coronal planes were overlaid, creating a Cartesian grid. Points of intersection were analyzed for population trends in biparietal width. Using the most descriptive point coupled with the sellion protrusion to control for head size, the vertex narrowing index is formed. By combining this index with the FBI and OBI, the scaphocephalic index (SCI) is created as a tailored width/length measure. Using 221 controls and 360 individuals with sagittal craniosynostosis, the greatest difference occurred superiorly and posteriorly at a point 70% of the head's height and 60% of the head's length. This point had an area under the curve of 0.97 and sensitivity and specificity of 91.2% and 92.2%, respectively. The SCI has an area under the curve of 0.9997, sensitivity and specificity greater than 99%, and interrater reliability of 0.995. The correlation coefficient between computed tomography imaging and three-dimensional photography was 0.96. The vertex narrowing index, FBI, and OBI evaluate regional severity, while the SCI is able to describe global morphology in patients with sagittal craniosynostosis. These measures allow for superior diagnosis, surgical planning, and outcome assessment, independent of radiation.

Evaluation of Orthodontic Treatment Success in Terms of Symmetry in Patients with Class III Malocclusion after Maxillary Expansion and Protraction

Background: Facial asymmetries are common in patients with skeletal class III malocclusion and posterior crossbite. Maxillary expansion and protraction (ME&P) and then fixed orthodontic treatment may affect positively on these asymmetries. Objectives: We aimed to investigate the effects of applying ME&P by the rapid maxillary expansion (RME) and face mask and then fixed orthodontic treatment on soft tissue asymmetries in adolescent patients with skeletal class III malocclusion and posterior crossbite. For this purpose, the 3D facial imaging system of stereophotogrammetric (3dMD) recordings was analyzed quantitatively in the pre-treatment (T0), ME&P (T1), and post-fixed orthodontic treatment periods (T2). Materials and methods: The study included 28 (11 females, 17 males) individuals with skeletal class III malocclusion and posterior cross-bite (5 patients with bilateral and 23 patients with unilateral cross-bite) and soft tissue facial convexity angle of 175.11º±1.06º with a mean age of 9.37 ± 0.54 years. Three-dimensional photographs were taken from the individuals before the ME&P (T0), 6 months after the ME&P procedure and before starting fixed orthodontic treatment (T1), and after removing all orthodontic appliances from the mouth at the end of the fixed orthodontic treatment (T2). 3dMD Vultus® software was used to evaluate the data of 34 linear and 16 volumetric as a total of 50 measurements in soft tissue analysis. Results: The right-left volume differences, the Root Mean Square (RMS) values, and linear width measurements in the upper, mid, and lower face regions when evaluated at the T1-T0, T2-T1, and T2-T0 period intervals, were found to a decrease in these values and improvement of asymmetry. Conclusion: The asymmetry in the soft tissue in all face regions was corrected with ME&P and fixed orthodontic treatment. The most obvious asymmetry improvement occurs in the lower face area. It should be taken into consideration that asymmetry will improve with RME and face mask application and fixed orthodontic treatment in adolescents with Class III malocclusion and posterior cross-bite and treatment planning should be done according to that.

Longitudinal Three-Dimensional Follow-Up and Secondary Treatment Aspects after Endoscopic and Open Scaphocephaly Surgery.

This retrospective cohort study evaluated the longitudinal three-dimensional cranial shape developments and the secondary treatment aspects after endoscopically assisted craniosynostosis surgery (EACS) with helmet therapy and open cranial vault reconstruction (OCVR) for scaphocephaly. Longitudinally collected three-dimensional photographs from scaphocephaly patients and healthy infants were evaluated. Three-dimensional cranial shape measurements and growth maps were compared between the groups over time. Secondary treatment aspects were compared for the treatment groups. Both surgical techniques showed their strongest changes directly after surgery, with mean parietal three-dimensional growths up to 10 mm. At age 24 months, comparison of head shapes showed mean three-dimensional differences less than ±2 mm, with OCVR resulting in a lower vertex and longer cranial length when compared with EACS. At 48 months of age, no measurements were significantly different between treatment groups. Only the total head volume was somewhat larger in the male EACS group at age 48 months ( P = 0.046). Blood loss in EACS (mean, 18 mL; range, 0 to 160 mL) was lower than in OCVR (mean, 100 mL; range, 15 to 300 mL; P < 0.001). Median length of stay after surgery was shorter for EACS (mean, 2 days; range, 1 to 5 days) compared with OCVR (mean, 5 days; range, 3 to 8 days; P < 0.001). The authors conclude that EACS for scaphocephaly shows equal craniometric results at age 48 months and has a better surgery profile compared with OCVR. Early diagnostics and referral for suspected scaphocephaly to allow EACS is therefore recommended. Therapeutic, III.

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Frontotemporal and Orbitozygomatic Craniotomies.

Introduction Although many neuroanatomic atlases have been published, few have detailed complex cranial approaches and pertinent anatomic considerations in a stepwise fashion intended for rapid comprehension by neurosurgery students, residents, and fellows. Methods Five sides of formalin-fixed latex-injected specimens were dissected under microscopic magnification. The frontotemporal and orbitozygomatic approaches were performed by neurosurgical residents and fellows at different training levels with limited previous experience in anatomical dissection mentored by the senior authors (M.P.C. and M.J.L.). Meticulous surgical anatomic dissections were performed until sufficient visual and technical completion was attained, with parameters of effectively demonstrating key surgical steps for educational training purposes. Following the completion of dissection and three-dimensional photography, illustrative case examples were reviewed to demonstrate the relative benefits and optimal applications of each approach. Results The frontotemporal and orbitozygomatic approaches afford excellent access to anterior and middle skull base pathologies, as well as the exposure of the infratemporal fossa. Key considerations include head positioning, skin incision, scalp retraction, fat pad dissection and facial nerve protection, true or false MacCarty keyhole fashioning, sphenoid wing drilling and anterior clinoidectomy, completion of the craniotomy and accessory orbital osteotomy cuts, dural opening, and intradural neurovascular access. Conclusion The frontotemporal and orbitozygomatic approaches are core craniotomies that offer distinct advantages for complex cranial operations. Learning and internalizing their key steps and nuanced applications in a clinical context is critical for trainees of many levels. The orbitozygomatic craniotomy in particular is a versatile but challenging approach; operative-style laboratory dissection is an essential component of its mastery and one that will be powerfully enhanced by the current work.

The Impact of Alar Flare Reduction Goes Beyond Just the Ala.

Alar flare reduction (AFR) is a widely used technique in rhinoplasty. Although the impact of AFR on the alar base has been well studied, its effect on the surrounding tissues is largely unknown. This study aims to elucidate the potential effect of AFR on the overall nasal and perinasal anatomy. AFR was performed on cadavers ( n = 7) with sequential crescent-shaped alar excisions of 2, 4, and 6 mm. Two- and three-dimensional photographs were obtained at baseline and subsequent intervals. Analysis was performed with Adobe Photoshop and Vectra. Standardized landmarks were placed at the nasal tip point (NTP) and alar base point to quantify NTP vector distances, NTP surface distances, and alar crease angle. The surface and vector distances between the NTP and alar base point decreased for increasing AFR intervals. AFR created a surface decrease of 1.90 ± 1.60, 3.54 ± 1.85, and 4.91 ± 1.89 mm, respectively. AFR created a vector decrease of 1.50 ± 1.14, 2.83 ± 1.37, and 3.97 ± 1.38 mm, respectively. NTP projection decreased by 0.54 ± 0.31 mm for 6-mm excision. AFR led to cheek elevation of 0.87 ± 0.70, 1.25 ± 0.60, and 1.96 ± 0.48 mm, respectively. This alar crease elevation blunted the transition between the cheek and upper lip skin at the level of the alar rim with the angle of this transition increasing 26.62 ± 12.78 degrees from baseline to 6 mm. Three-dimensional analysis demonstrates the influence of AFR on the alar base and surrounding perinasal contour. AFR results in nasal tip deprojection, alar crease elevation, and alar flare width narrowing. Further investigation into the impact of modifying the alar base on surrounding structures is warranted.

Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis Using Curvature Analysis.

Sagittal craniosynostosis results in varying degrees of frontal bossing and bilateral temporal pinching. This study assessed the three-dimensional changes in these regions using curvature analysis and volumetric analysis before and 1 year after extended sagittal strip craniectomy (ESC) with postoperative helmet therapy. A retrospective review of three-dimensional photographs of 50 subjects treated with ESC with postoperative helmet therapy and 50 age-matched controls was performed. Images were collected preoperatively and 1 year postoperatively. Forehead convexity and temple concavity were quantified. Computed tomographic scans of subjects with and without sagittal synostosis were analyzed to assess the percentage of total intracranial volume (ICV) in the anterior cranial fossa before and after ESC with postoperative helmet therapy. Forehead convexity in the ESC with postoperative helmet therapy group preoperatively (24.49 ± 3.16 m -1 ) was significantly greater than controls (22.48 ± 3.84 m -1 ; P = 0.005). Forehead convexity significantly decreased after ESC with postoperative helmet therapy (18.79 ± 2.43 m -1 ; P < 0.001) and did not differ from controls (19.67 ± 3.08 m -1 ; P = 0.115). The ESC group had more concave temples preoperatively (-10.27 ± 4.37 m -1 ) as compared with controls (-6.99 ± 3.55 m -1 ; P < 0.001). Temple concavity significantly decreased after ESC (-4.82 ± 3.17 m -1 ; P < 0.001) and did not differ from controls (-5.64 ± 3.27 m -1 ; P = 0.075). In the ESC group, the percentage ICV in the anterior cranial fossa decreased from 22.03% to 18.99% after surgery, whereas the anterior volume in controls was stable (17.74% to 16.81%). The ESC group had significantly greater forehead convexity, temple concavity and anterior cranial fossa volume compared with controls. One year after ESC with postoperative helmet therapy, forehead convexity, temple concavity, and percentage ICV in the anterior fossa were comparable to controls. Therapeutic, IV.

Three-Dimensional Analysis of Tear Trough Volume After Lower Blepharoplasty with Midface Lift.

Background: This study aims to evaluate three-dimensional stereophotogrammetry measured volume changes in the tear trough area after lower blepharoplasty with midface lift with or without orbital fat manipulation. Objective: Among patients undergoing midface lift surgery, volume change by three-dimensional photography in the tear trough region was compared between those having no orbital fat manipulation, fat transposition, or fat resection. Methods: This is a prospective study of 260 eyelids of 130 patients who underwent cosmetic midface surgery. All patients had an external skin muscle flap midface lift. During the procedure, medial inferior orbital fat was resected, repositioned to a preperiosteal dissection pocket, or not manipulated. Forty-six patients (35.4%) had no fat manipulation, 42 patients (32.3%) had fat preservation with repositioning to the preperiosteal pockets on the medial inferior orbital rim, and 42 patients (32.3%) had fat resection without repositioning. Results: All patients had volume gain in tear trough volume. The amount was not statistically significantly different between fat treatment groups. Mean follow-up time was 12 months (range 6-20 months). Conclusions: Midface lifting improved tear trough volume irrespective of how fat was manipulated.

Conventional and three-dimensional photography as a tool to map distribution patterns of in-transit melanoma metastases on the lower extremity.

In melanoma, in-transit metastases characteristically occur at the lower extremity along lymphatic vessels. The objective of this study was to evaluate conventional or three-dimensional photography as a tool to analyze in-transit metastasis pattern of melanoma of the lower extremity. In addition, we assessed risk factors for the development of in-transit metastases in cutaneous melanoma. In this retrospective, monocentric study first we compared the clinical data of all evaluable patients with in-transit metastases of melanoma on the lower extremity (n = 94) with melanoma patients without recurrence of disease (n = 288). In addition, based on conventional (n = 24) and three-dimensional photography (n = 22), we defined the specific distribution patterns of the in-transit metastases on the lower extremity. Using a multivariate analysis we identified nodular melanoma, tumor thickness, and ulceration as independent risk factors to develop in-transit metastases ITM (n = 94). In patients with melanoma on the lower leg (n = 31), in-transit metastases preferentially developed along anatomically predefined lymphatic pathways. In contrast when analyzing in-transit metastases of melanoma on the foot (n = 15) no clear pattern could be visualized. In addition, no difference in distance between in-transit metastases and primary melanoma on the foot compared to the lower leg was observed using three-dimensional photography (n = 22). A risk-adapted follow-up of melanoma patients to detect in-transit metastases can be applied by knowledge of the specific lymphatic drainage of the lower extremity. Our current analysis suggests a more complex lymphatic drainage of the foot.

The Average Facial Expressions: A Range of Motion Analysis for Different Sex and Age Groups.

Three-dimensional photographs were taken from healthy subjects in rest, maximum closed smile, and pouting. Displacement for both exercises of perioral landmarks was analyzed with MATLAB as absolute displacement and as the ratio of mouth width. Additionally, displacement in three planes was analyzed for each landmark. Averages were calculated for both genders in four age groups: 4-8, 8-12, 12-16, and >16 years. In total, 328 subjects were included. Oral landmarks predominantly moved forward and backward for both exercises. Nasal landmarks predominantly moved vertically. Growing up, oral landmark displacement decreased for smiling, whereas nasal landmark displacement increased. For pouting, oral landmark displacement increased while growing up, whereas nasal landmark displacement decreased. The present study creates reference values for movement of perioral structures for different sex and age groups, for two facial expressions. These data are of great value for the assessment of mimic function and give insight into the development of facial animation over time.