Topographic Landmarks Research Articles

Analyzing Alignment Error in Tibial Tuberosity–Trochlear Groove Distance in Clinical Scans Using 2D and 3D Methods

Background: Tibial tuberosity–trochlear groove distance (TT-TG) is often used as a primary metric for surgical decision-making in the treatment of patellofemoral instability (PFI), particularly when considering tibial tubercle transfer. Although TT-TG has high interrater reliability, it is prone to measurement differences caused by the alignment of the patient's leg in a scanner gantry, potentially influencing surgical decision-making. Quantification of this error within the clinical literature remains limited. Purpose: To quantify and specify the error in TT-TG caused by leg-scanner alignment by using detailed topographical landmarks and 3-dimensional (3D) analysis of computed tomography scans of patients with PFI. Study Design: Controlled laboratory study. Methods: Three-dimensional models of knees with PFI were created from computed tomography scans and used to identify TT-TG landmarks. TT-TG was measured using the established 2-dimensional (2D) and 3D methods. A model to estimate the differences between these 2 methods was created, and the orientation of the patients’ legs in relation to scanner longitudinal axis was measured to validate this model via linear regression. Interrater reliability was calculated via intraclass correlation coefficients (ICC). Results: A total of 44 knees of patients with PFI were analyzed. Differences between the 2D and 3D methods ranged from -4.0 to 14.7 mm (mean ± SD, 2.7 ± 4.1 mm) with a root mean square difference of 4.8 mm. The TT-TG distance of the 2D method (19.8 ± 7.2 mm) was significantly (P = .045) longer than that of the 3D method (17.1 ± 4.9 mm). The variance of the 2D method was significantly larger than that of the 3D method. In total, 13 (29.5%) of the knees had a difference of >5 mm between 2D and 3D TT-TG. The estimation model had an adjusted r2 value of 1.00 and a resulting root mean square difference of 0.21 mm. 3D TT-TGs interrater reliability was good to excellent (ICC, 0.94 [95 CI%, 0.81-0.98]). Conclusion: 3D TT-TG can be used to correct scanner-leg alignment errors, some of which are substantial when using only 2D TT-TG measurements. Clinical Relevance: The findings in this study suggest a need for caution and awareness of the potential effects of differences in alignment of the axes of the leg and scanner when using purely 2D TT-TG as a basis for surgical planning.

Anatomical and topographic substantiation of various accesses to the proximal epiphysis of the tibia

One of the most frequently performed accesses in the practice of an orthopedic veterinarian is access to the proximal epiphysis of the tibia. Access to the proximal epiphysis of the tibia is necessary in many cases of treatment of pathologies of the musculoskeletal system in cats and dogs and can be used in such surgical pathologies. The aim of the study was to consider options for surgical access to the proximal epiphysis of the tibia to perform osteosynthesis of fractures according to the Salter–Harris type, and osteotomy leveling the slope of the tibial plateau (TPLO) with anatomical and topographic justification. The study was conducted in the Network of veterinary centers "Kotonai" and the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine. The object of the study was dogs of small and medium breeds in the number of twelve individuals. The average age of the patients ranged from 6 months to 12 years. The study involved 5 intact females and 7 intact males. The average weight at the time of the study ranged from 2.5 to 21.0 kg. In the process of collecting the life history of all patients, the presence of chronic diseases, allergies and infectious diseases is excluded. The initial examination of the animal included: collection of anamneses of life and illness, general clinical examination, thermometry, neuroorthopedic examination, auscultation of the heart and lungs, X-ray examination under sedation. General clinical examination, thermometry and auscultation of the heart and lungs did not reveal pathological changes in all cases. According to the results of the study, it was found that there were no severe postoperative complications requiring repeated treatment in the studied patients. With the observance of clear anatomical and topographic landmarks in the formation of accesses, a good understanding of the anatomy of the medial and cranial surfaces of the tibia, visualization in the wound during surgical interventions (osteosynthesis of SalterHarris fractures, TPLO osteotomy) in the area of the proximal epiphysis of the tibia is convenient and safe.

Delimitation of the risk area of the vertebral artery during the paramedian suboccipital approach

ObjectiveThe V3 segment of the vertebral artery (V3-VA) is at risk during diverse approaches to the craniovertebral junction. Our objective is to present a system of anatomic and topographic landmarks to identify the V3-VA during the paramedian suboccipital approach (PMSOA) with the help of minimal or basic tools. Material and methodsThe first was a retrospective analysis of the angiotomography (CTA) of 50 patients over 18-years old, and 9 anatomical dissections. A series of lines were defined between the different bony landmarks. Within this lines the risk area of the vertebral artery (RAsV3-VA) and the risk point of the vertebral artery (RPsV3-VA) were defined.The second stage was a prospective study, where the previously defined measurements were carried out by using neuronavigation in 10 patients (20 sides) operated with the PMSO approach in order to confirm the presence of the V3 segment in the RAsV3-VA and RPsV3-VA. ResultsIn the first stage, the V3 segment was found in the middle third of the X line in 96,6% of the cases. The distance between the inion and the UCP (percentile 5) was 20 mm and to the LCP (percentile 95) was 40 mm. In the range between the UCP and the LCP, in the middle third of the inion-mastoid line (RAsV3-VA), we found 90% of the V3-VA.The measurements taken during the second stage revealed that the artery was in the middle third of the X line in 97% of the cases. 85% of the patients presented the total of the V3s-VA on the RAsV3-VA and in 85% there was a direct relationship with the V3 segment and the RPV3s-VA. ConclusionWe propose an easy-to-implement system to delimit the risk area of the V3-VA during the PMSOA. We believe that these landmarks provide a practical, reliable, costless and useful tool that could decrease the risk of lesion of the V3-VA during this approach without the need of using.

Topographical landmarks for lateral calcaneal artery sensate flap- A cadaveric study

The lateral calcaneal artery (LCA) flap is used for treating skin defects of the foot. We aim to study the relationship between the LCA and the Sural Nerve (SN) with the lateral malleolus (LM) to delineate the topographical landmarks for identifying LCA and SN while designing the LCA flap. The foot was dissected to identify LCA and SN in 32 formalin-fixed lower limbs. The LCA and SN were identified and separated from the superficial fascia of the foot. Measurements such as the distance between the LCA and LM, SN and LM, and LCA and SN were taken in (a) horizontal plane, (b) 45º oblique plane passing, (c) vertical plane from the most prominent point on LM, including the luminal diameter of LCA.In the horizontal plane, the LCA and SN were present at a mean distance of 24.56±5.2 mm and 22.64±6.26 mm from the LM, respectively. In a 45° oblique plane, LCA and SN were present at a mean distance of 29.10±6.12 mm and 22.68±7.05 mm from the LM, respectively. In the vertical plane, the SN was present at a mean distance of 26.59± 8.87 mm from the LM.LCA was present in the horizontal plane and 45 oblique plane and was absent in the vertical plane in relation to LM; hence, the LCA flap should not extend beyond the 45 oblique plane, and the internal diameter of LCA should not be less than 1.02mm.

Myeloarchitectonic maps of the human cerebral cortex registered to surface and sections of a standard atlas brain.

C. and O. Vogt had set up a research program with the aim of establishing a detailed cartography of the medullary fiber distribution of the human brain. As part of this program, around 200 cortical fields were differentiated based on their myeloarchitectural characteristics and mapped with regard to their exact location in the isocortex. The typical features were graphically documented and classified by a sophisticated linguistic coding. Their results have only recently received adequate attention and applications. The reasons for the revival of this spectrum of their research include interest in the myeloarchitecture of the cortex as a differentiating feature of the cortex architecture and function, as well as the importance for advanced imaging methodologies, particularly tractography and molecular imaging. Here, we describe our approach to exploit the original work of the Vogts and their co-workers to construct a myeloarchitectonic map that is referenced to the Atlas of the Human Brain (AHB) in standard space. We developed a semi-automatic pipeline for processing and integrating the various original maps into a single coherent map. To optimize the precision of the registration between the published maps and the AHB, we augmented the maps with topographic landmarks of the brains that were originally analyzed. Registration of all maps into the AHB opened several possibilities. First, for the majority of the fields, multiple maps from different authors are available, which allows for sophisticated statistical integration, for example, unification with a label-fusion technique. Second, each field in the myeloarchitectonic surface map can be visualized on the myelin-stained cross-section of the AHB at the best possible correspondence. The features of each field can be correlated with the fiber-stained cross-sections in the AHB and with the extensive published materials from the Vogt school and, if necessary, corrected. Third, mapping to the AHB allows the relationship between fiber characteristics of the cortex and the subcortex to be examined. Fourth, the cytoarchitectonic maps from Brodmann and von Economo and Koskinas, which are also registered to the AHB, can be compared. This option allows the study of the correspondence between cyto- and myeloarchitecture in each field. Finally, by using our "stripe" technology - where any other feature registered to the same space can be directly compared owing to the linear and parallel representation of the correlated cortex segments - this map becomes part of a multidimensional co-registration platform.

Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops.

Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires a thorough understanding of the relevant anatomy. This includes anatomic considerations related to, but not limited to, dissection and exposure of penoscrotal fasciae and tissues, corporal configuration, and abdominal structures. Insights obtained from pre-dissected anatomic specimens can obviate urethral injury, nerve damage, corporal perforation, inappropriate sizing, crossover, or implant malposition. We present penile implant-specific anatomic dissections and topographic landmarks identified over the last decade in the course of surgical training programs provided for IPP implantation.

Topographic localization of the sacroiliac joint and superior gluteal artery branches on the posterolateral ilium.

Latrogenic vascular injuries at the posterior ilium during sacroiliac screw placements are not uncommon. Though intra-operative imaging reduces the risk of such injuries, anatomical localization of the sacral segments using discrete topographical landmarks is not currently available. This descriptive study proposes the use of an anatomical grid system to localize the sacroiliac articulation on the posterolateral ilium. It also investigates the positional variability of the branches of the superior gluteal artery (SGA) within areas defined by the grid. 48 dried adult hip bones were examined to determine the position of the sacral articular surface on the posterolateral surface of the ilium. A novel grid-system was defined and used to map the positions of the articulation of the first two sacral segments on the posterolateral ilium. Superficial and deep branches of the SGA were dissected in donor cadavers and their courses were virtually overlayed on the grid system. The grid system localized the sacral articular surfaces within a defined area on the posterior ilium. Arterial distributions indicated the presence of the superficial branch of SGA more frequently over the screw insertion area (at an intermuscular plane), while the deep branch ran closer to the ilium but antero-inferior to the screw placement areas. This study proposes a new topographical perspective of visualizing SGA branches with respect to the cranial sacral segments. Precise localization of vascular anatomy may help to reduce potential risk of injury during sacroiliac screw placements.

Improving tailings dam risk management by 3D characterization from resistivity tomography technique: Case study in São Paulo – Brazil

Tailings dams are traditionally monitored by routine visual inspections combined with the use of instruments such as piezometers, topographical landmarks, and water level indicators. As they are structures that have high potential damage associated, the use of robust investigation methods is essential to ensure the operational safety of these dams. Geoelectrical methods have been successful in mapping humid zones inside the tailings dam structures, using the proper acquisition parameters and data sampling that these methods allow. This is a promising approach to investigating a tailings dam with a heterogeneous embankment made of limestone tailings, that has been in operation for 50 years in São Paulo state, Brazil. Considering its structural complexity, electrical resistivity sections were acquired with a tight profile spacing – of 10 to 15 m, processed, and modeled by applying a specific workflow. The Electrical Resistivity Tomography (ERT) operational workflow applied to the dataset obtained from two field campaigns, conducted in the embankment and the right abutment of the dam, performed well in mapping possible high water content zones inside the structure, defining a relevant element for the risk assessment. For this purpose, compartmentalization of the resistivity ranges, and three-dimensional modeling techniques were used, both constrained by the geotechnical instruments of the structure. The embankment campaign mapped zones of attention in the right abutment driving the decision to perform a follow-up survey dedicated to this region. The right abutment campaign mapped zones of high resistivity, associated with the natural terrain, composed of sandy soils, saprolite, and rock, as well as zones of low resistivity related to high moisture content regions. The geometry of these conductive zones made it possible to infer the depth of the water table in the region between the direct measurements from the instrumentation and to model zones with low resistivity values. The 3D modeling revealed that part of the conductive zones, present in the right abutment and extending to the embankment indicate a possible contribution of moisture from the natural terrain towards the embankment of the dam. Thus, the achieved results demonstrated that 3D modeling applied to the combination of the geotechnical and geophysical datasets contributes to expanding the knowledge of the internal structure of the dam and consequently the safety of the operations, especially where there is no instrumentation, improving the tailings dam risk management.

ПРОДЛЁННАЯ ПЛЕКСУСНАЯ БЛОКАДА ПРИ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ НА ВЕРХНИХ КОНЕЧНОСТЯХ

This article overviews the various prolonged plexus block (PB) methods. It discusses the indications and contraindications for this technique and the professional skills and equipment needed. The article also describes different approaches to a brachial plexus block (BPB): interscalene, supraclavicular, infraclavicular, and axillary. The article presents the rationale for using PB, its advantages and possible complications, and outlines the basic principles for its safe performance. Knowledge of anatomical and topographic landmarks, ultrasound navigation, and neurostimulation are utilized to determine needle position. Neurostimulation should be used to ensure the needle is placed correctly to achieve a muscle response with a current of 0.3-0.5 mA. A muscle response with a current of 0.2 mA occurs only when the needle tip is positioned intraneurally, which is unacceptable when performing plexus and nerve conduction blocks. This technique can provide prolonged anesthesia and postoperative pain relief by correctly and safely blocking nerve plexuses and trunks. It is an ideal option for anaesthesiologic support during surgical interventions and treating postoperative pain. This approach has many advantages and does not have the disadvantages associated with other types of local and general anesthesia. In this literature review, we used databases such as eLIBRARY, PubMed, and Google Scholar to search for articles related to regional anesthesia, specifically, BPB. We narrowed our search by using keywords including ultrasound navigation, neurostimulation, and catheter-based techniques. Keywords: Brachial plexus, regional anesthesia, prolonged plexus block, ultrasound navigation, neurostimulation, catheter-based techniques.

Accuracy of Catheter Positioning during Left Subclavian Venous Access: A Randomized Comparison between Radiological and Topographical Landmarks.

Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.

Two methods using topographic landmarks to identify and preserve the spinal accessory nerve during dermatologic surgery

Injury to the spinal accessory nerve (SAN) can cause shoulder pain, winged scapula, and difficulty abducting the arm.1 To avoid inadvertent injury to the SAN during procedures on the posterior triangle of the neck, surgeons may use topographic landmarks to approximate the course of the SAN, enabling them to anticipate and protect this nerve.

Improving the Stability of the Directional Room G 31-33, Horizon 210 - East, Ocnele Mari-Coceneṣti Salt Mine, By Reinforcement with Anchors and Shotcrete

Abstract The rock salt deposit from Ocnele Mari - Coceneşti was mined by the method with rooms and small square pillars, at the levels + 226m and + 210m. Although the saline is not deep, certain instability phenomena (cracks, exfoliations) have occurred in the resistance structures (pillars, ceilings), especially in the G31-33 directional room, horizon 210E. These instability phenomena were also highlighted following the 3D finite element numerical modelling. In order to prevent the degradation of the mining excavations and the resistance structures, the affected surfaces were supported with anchors and reinforced shotcrete. The ceiling of the consolidated section of the G31-33 directional room, horizon 210E is monitored by the systematic measurement, on topographic landmarks mounted on the ceiling, of the vertical and horizontal displacements.

Исследование прохождения низкочастотных ультразвуковых колебаний через неоднородные биологические среды при ультразвуковой санации урологических катетеров

The purpose of this article is to study the features of the passage of ultrasonic vibrations through inhomogeneous biological media. To achieve the goal, a mathematical model for the propagation of ultrasonic vibrations in heterogeneous media has been developed, and clinical studies have been carried out. It is shown that the proposed calculation method can be used to evaluate the passage of ultrasonic vibrations through inhomogeneous biological media. Recommendations on the choice of topographic landmarks of ultrasound exposure for noninvasive sanitation of urological catheters are made.

Topographical Landmarks for the Identification of Branches of Mandibular Nerve and Its Surgical Implications: A Cadaveric Study.

IntroductionBasic knowledge of anatomy is crucial in providing predictable, safe, and efficacious mandibular anesthesia as the mandibular nerve is vulnerable to injury during dental procedures and other surgical manoeuvers. The lack of availability of the appropriate topographical bony landmarks for the location of the branches of this nerve often accounts for iatrogenic injuries and the failure to obtain adequate local anesthaesia. Hence we aimed to describe the topographical landmarks of the branches of the mandibular nerve and their variations in the infratemporal fossa.MethodologyIn 16 formalin-fixed cadavers, irrespective of the sex of the cadavers, bilateral dissection of the infratemporal fossa was done after identifying the necessary bony landmarks. The mandibular nerve and its branches were traced out and the required measurements were taken using the digital vernier caliper. The results were statistically analysed for mean, range, and standard deviation.ResultsThe masseteric nerve is 15.87+/-1.64 mm superior to the lowest point on the mandibular notch. The lingual nerve in the third molar area is at the depth of 24.75+/-2.38 mm from the angle of the mandible (gonion), making an angle of 50° with the base of the mandible. 20.13+/-3.1 mm inferior to the mandibular notch is the precise location of the mandibular foramen which allows access to the inferior alveolar nerve. The incidence of accessory mandibular foramen in the dissected samples is 9.37%.ConclusionThe topography of the masseteric nerve, lingual nerve, and inferior alveolar nerve was studied using constant and reliable bony landmarks in the cadaver which might aid effective dental and facio-maxillary surgical procedures. However, the outcome of this study could not be applied to paediatric patients as the subjects were restricted to adult cadavers.

Extracorporeal ultrasound exposure by the low-frequency acoustic amplitude-modulated signal on a ureteral stent for preventing its incrustation: experimental determination of optimal application points

Introduction. Incrustation and biofilms formation on the surface of ureteral stents are still the most significant complications of internal drainage of the upper urinary tract. There are much researchers conducted to combat these complications. The lack of a solution to this problem affects the ultimate results of treatment and economic losses. The issue of impact by physical methods on the ureteral stent, particularly the use of extracorporeal ultrasound acoustic exposure remains, promising and poorly covered.Purpose of the study. To determine the optimal application points of extracorporeal acoustic exposure by the low-frequency ultrasonic amplitude-modulated signal on a ureteral stent in an experiment.Materials and methods. The original device was designed. The main principle of its operation is the generation of an amplitude-modulated ultrasonic signal in two modes: pulsed and permanent. A sexually mature mongrel dog was an experimental animal. The ureteral stent was placed by laparotomy and cystotomy. Intraoperatively, the emitter of the developed device was applied to the skin of the animal, according to the previously indicated topographic and anatomical landmarks. At the same time, an ultrasonic wave noise analyzer was applied through the laparotomy wound to the appropriate level of the ureter. Measurements of ultrasound intensity indicators were performed three times in two operating modes of the device.Results. Pulsed mode: for the ureteral upper third, the highest ultrasonic intensity (123.67 dB) was achieved along the posterior axillary line. For the ureteral middle third, the best ultrasound intensity (115 dB) was obtained by the posterior axillary line. For the ureteral lower third, the highest ultrasound intensity (113.67 dB) was noted along the middle axillary line.Permanent mode: the best ultrasonic intensity in the projection of the ureteral upper, middle, and lower thirds was achieved along the posterior axillary line and was 118.67 dB, 117 dB and 116.67 dB, accordingly. However, there was an excessive heat effect, manifested by hyperemia and hyperthermia of the animal's skin, fascicular muscle contractions during the instrument functioned in the permanent mode, which can potentially lead to thermal burns and intolerance to the procedure.Conclusion. The pulsed mode of the device function is most safe. The optimal application points of the instrument emitter for the ureteral upper and middle thirds is the posterior axillary line, and for the ureteral lower third is the middle axillary line.

Mapping 216 Perforator Flaps Using Highly Portable Tablet-Based Color Doppler Ultrasound (PT-CDU).

The first reports of using color Doppler ultrasound for evaluation of the microvasculature were in the 1990s. Despite the early reports of its efficacy, color Doppler ultrasound did not achieve popularity nor general usage in part due to the cumbersome size, cost and poor resolution. This is the first study to demonstrate the potential utility of a new, highly portable, tablet-based color Doppler ultrasound (PT-CDU) system for imaging perforator flaps. The deep inferior epigastric artery (DIEP), lateral arm (LA), anterolateral thigh (ALT), thoracodorsal artery (TDAP), and the medial sural artery (MSAP) perforator flaps were imaged within classic topographic landmarks to visualize and measure variables related to perforator flap anatomy. The Philips Lumify L12-4 linear array probe attached to the Samsung Galaxy Tab A tablet was the system used for all examinations. A total of 216 flaps were scanned in 50 healthy adult volunteers: 44 DIEP, 44 LA, 40 ALT, 48 TDAP, and 40 MSAP. Precise anatomic information regarding perforator size, number, and location was obtained. Overall, the percent of flaps having at least 1 perforator within the specified topographical landmarks was 89% for the DIEP, 84.1% for the LA, 72.5% for the ALT, 50% for the TDAP, and 30% for the MSAP (p = 2.272e-09). The percent of patients having an asymmetry (right versus left) in the number of perforators was 72.7% (ALT), 65% (DIEP), 59.1% (LA), 41.7% (TDAP), and 30% (MSAP) (p = 0.0351). Portable, tablet-based color Doppler ultrasound offers high-resolution images of perforators and represents a facile technology that may be of interest to microsurgeons in the planning of perforator flaps. Variations in vascular anatomy were well-demonstrated. This surgeon-driven imaging technology may represent an excellent alternative to other imaging modalities.

CHOICE OF OSTEOFIXATION OF EPITHESIS IN TOTAL DEFECT OF THE MAXILLOFACIAL REGION

RETRACTED ARTICLE Relevance. Surgical treatment of neoplasms, various genetic disorders and facial trauma often contribute to a violation of the general aesthetic perception of a person and the development of dysfunctions [1]. The main difficulty of reconstructive treatment in the maxillofacial area is a clear understanding of the anatomical and topographic landmarks and three-dimensional relationships of organs and tissues from each other. Purpose. Development of an algorithm for the use of various types of extraoral implants for various total facial defects. Materials and methods. The collection and analysis of clinical material was carried out in the Department of Maxillofacial Surgery on the basis of the Samara Regional Clinical Hospital named after V.I. V.D. Seredavina. From 2015 to the present, we have installed 104 extraoral implants of various designs for the rehabilitation rehabilitation of fifty patients suffering from total facial defects of various lengths. Conclusions. The analysis of our study showed that the use of extraoral implants of various designs for total facial defects of various lengths, taking into account individual anatomical and topographic features, the etiology of the total defect, has demonstrated its clinical effectiveness.

CHOICE OF OSTEOFIXATION OF EPITHESIS IN TOTAL DEFECT OF THE MAXILLOFACIAL REGION

RETRACTED ARTICLE Relevance. Surgical treatment of neoplasms, various genetic disorders and facial trauma often contribute to a violation of the general aesthetic perception of a person and the development of dysfunctions [1]. The main difficulty of reconstructive treatment in the maxillofacial area is a clear understanding of the anatomical and topographic landmarks and three-dimensional relationships of organs and tissues from each other. Purpose. Development of an algorithm for the use of various types of extraoral implants for various total facial defects. Materials and methods. The collection and analysis of clinical material was carried out in the Department of Maxillofacial Surgery on the basis of the Samara Regional Clinical Hospital named after V.I. V.D. Seredavina. From 2015 to the present, we have installed 104 extraoral implants of various designs for the rehabilitation rehabilitation of fifty patients suffering from total facial defects of various lengths. Conclusions. The analysis of our study showed that the use of extraoral implants of various designs for total facial defects of various lengths, taking into account individual anatomical and topographic features, the etiology of the total defect, has demonstrated its clinical effectiveness.

Two Immersive Virtual Reality Tasks for the Assessment of Spatial Orientation in Older Adults with and Without Cognitive Impairment: Concurrent Validity, Group Comparison, and Accuracy Results.

Spatial disorientation is common in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI), and preclinical individuals with AD biomarkers. However, traditional neuropsychological tests lack ecological validity for the assessment of spatial orientation and to date, there is still no gold standard. The current study aimed to determine the validity and accuracy of two virtual reality tasks for the assessment of spatial orientation. We adapted two spatial orientation tasks to immersive virtual environments: a "survey to route" task in which participants had to transfer information from a map to their body position within a maze [Spatial Orientation in Immersive Virtual Environment Test (SOIVET) Maze], and an allocentric-type, route learning task, with well-established topographic landmarks (SOIVET Route). A total of 19 MCI patients and 29 cognitively healthy older adults aged 61-92 participated in this study. Regular neuropsychological assessments were used for correlation analysis and participant performances were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for accuracy. The SOIVET Maze correlated with measures of visuoperception, mental rotation, and planning, and was not related to age, educational level, or technology use profile. The SOIVET Route immediate correlated with measures of mental rotation, memory, and visuoconstruction, and was influenced only by education. Both tasks significantly differentiated MCI and control groups, and demonstrated moderate accuracy for the MCI diagnosis. Traditional neuropsychological assessment presents limitations and immersive environments allow for the reproduction of complex cognitive processes. The two immersive virtual reality tasks are valid tools for the assessment of spatial orientation and should be considered for cognitive assessments of older adults.

Anatomo-sonographic identification of the longissimus capitis and splenius cervicis muscles: principles for possible application to ultrasound-guided botulinum toxin injections in cervical dystonia

ObjectiveThe main objective of this study was to define and verify anatomo-sonographic landmarks for ultrasound-guided injection of botulinum toxin into the longissimus capitis (LC) and splenius cervicis (SC) muscles.Methods and resultsAfter a preliminary work of anatomical description of the LC and SC muscles, we identified these muscles on two cadavers and then on a healthy volunteer using ultrasound and magnetic resonance imaging (MRI) to establish a radio-anatomical correlation. We defined an anatomo-sonographic landmark for the injection of each of these muscles. The correct positioning of vascular glue into the LC muscle and a metal clip into the SC muscle of a fresh cadaver as verified by dissection confirmed the utility of the selected landmarks.DiscussionFor the LC muscle, the intramuscular tendon of the cranial part of the muscle appears to be a reliable anatomical landmark. The ultrasound-guided injection can be performed within the cranial portion of the muscle, between the intra-muscular tendon and insertion into the mastoid process at dens of the axis level. For the SC muscle, the surface topographic landmarks of the spinous processes of the C4–C5 vertebrae and the muscle body of the levator scapulae muscle seem to be reliable landmarks. From these, the ultrasound-guided injection can be carried out laterally by transfixing the body of the levator scapulae.ConclusionThe study defined two cervical anatomo-sonographic landmarks for injecting the LC and SC muscles.