Visor flap: A solution for the reconstruction of large skin defects on the frontal and parietal parts of the skull.

BACKGROUND: Reconstruction of skin defects after oncological surgery for a cutaneous squamous cell carcinoma is often mandatory to facilitate adjuvant treatment and/or to prevent chronic wound problems. Some of the most challenging regions to reconstruct after resection of a skin tumor are the frontal and parietal parts of the skull. METHODS: This article describes three patients with large skin defects after oncological surgery that were reconstructed with the use of a (hemi) visor flap. RESULTS: The (hemi) visor flap is easy to harvest, resulting in a concise procedure and short hospitalization with maximum wound control. CONCLUSION: The (hemi) visor flap is a safe and reliable option for the closure of large skin defects on the skull. Especially in the older and frail patient group.

Advancements in diagnosing oral potentially malignant disorders: leveraging Vision transformers for multi-class detection.

OBJECTIVES: Diagnosing oral potentially malignant disorders (OPMD) is critical to prevent oral cancer. This study aims to automatically detect and classify the most common pre-malignant oral lesions, such as leukoplakia and oral lichen planus (OLP), and distinguish them from oral squamous cell carcinomas (OSCC) and healthy oral mucosa on clinical photographs using vision transformers. METHODS: 4,161 photographs of healthy mucosa, leukoplakia, OLP, and OSCC were included. Findings were annotated pixel-wise and reviewed by three clinicians. The photographs were divided into 3,337 for training and validation and 824 for testing. The training and validation images were further divided into five folds with stratification. A Mask R-CNN with a Swin Transformer was trained five times with cross-validation, and the held-out test split was used to evaluate the model performance. The precision, F1-score, sensitivity, specificity, and accuracy were calculated. The area under the receiver operating characteristics curve (AUC) and the confusion matrix of the most effective model were presented. RESULTS: The detection of OSCC with the employed model yielded an F1 of 0.852 and AUC of 0.974. The detection of OLP had an F1 of 0.825 and AUC of 0.948. For leukoplakia the F1 was 0.796 and the AUC was 0.938. CONCLUSIONS: OSCC were effectively detected with the employed model, whereas the detection of OLP and leukoplakia was moderately effective. CLINICAL RELEVANCE: Oral cancer is often detected in advanced stages. The demonstrated technology may support the detection and observation of OPMD to lower the disease burden and identify malignant oral cavity lesions earlier.

The Impact of Structured and Standardized Documentation on Documentation Quality; a Multicenter, Retrospective Study.

The reuse of healthcare data for various purposes will become increasingly important in the future. To enable the reuse of clinical data, structured and standardized documentation is conditional. However, the primary purpose of clinical documentation is to support high-quality patient care. Therefore, this study investigated the effect of increased structured and standardized documentation on the quality of notes in the Electronic Health Record. A multicenter, retrospective design was used to assess the difference in note quality between 144 unstructured and 144 structured notes. Independent reviewers measured note quality by scoring the notes with the Qnote instrument. This instrument rates all note elements independently using and results in a grand mean score on a 0-100 scale. The mean quality score for unstructured notes was 64.35 (95% CI 61.30-67.35). Structured and standardized documentation improved the Qnote quality score to 77.2 (95% CI 74.18-80.21), a 12.8 point difference (p < 0.001). Furthermore, results showed that structured notes were significantly longer than unstructured notes. Nevertheless, structured notes were more clear and concise. Structured documentation led to a significant increase in note quality. Moreover, considering the benefits of structured data recording in terms of data reuse, implementing structured and standardized documentation into the EHR is recommended.

3-Dimensional CBCT analysis of mandibular asymmetry in unilateral condylar hyperplasia.

PURPOSE: Three-dimensional quantification of asymmetry in UCH has not been reported yet, but would be useful for diagnosing and evaluating the degree of deformity in this disease. It enables profound decision-making and timing of surgery. Unilateral condylar hyperplasia (UCH) can subjectively be classified in hemimandibular elongation (HE), hemimandibular hyperplasia (HH) and a combination of these two (hybrid form). The main purpose of this study was to quantify mandibular asymmetry in UCH patients with a reliable and reproducible method. Secondly, it was evaluated whether the existing classification can be confirmed. MATERIALS AND METHODS: 37 UCH-patients with progressive mandibular asymmetry, supported by a positive bone scan and/or such clinical progression that condylectomy was performed, were included in this retrospective study. A group of healthy subjects, matched for age and gender, was used as the control group. Cone-beam computed tomography (CBCT) scans were imported in Maxilim® software. Each mandibular half was divided into three skeletal segments (condyle, ramus, and body). Linear and volumetric measurements were calculated for these skeletal units on the affected and unaffected side, for both patients and controls. RESULTS: Significant differences between affected and unaffected sides in the patient group were found in condylar, ramus, and body segments for linear (p < 0.01) as well as for volumetric quantitative measurements (p < 0.0040). A mean linear difference between affected and unaffected sides in the condylar region of the UCH patient group was found of 3.6 mm (sd 2.9) versus 0.2 mm (sd 1.5) in controls. For volumetric measurements there was a mean difference between the left and right condyle of 718 mm3 (sd 638) in the patient group versus 8 mm3 (sd 225) difference in the control group. The condyle was the most affected segment. Differences between sides were significantly larger in the patient group than in the control group (p < 0.001). It was not possible to objectify differences between HE and HH. CONCLUSION: CBCT is a useful and accurate modality for quantification and evaluation of mandibular asymmetry in UCH. It enables objective monitoring. The existing classification in HE and HH could not be confirmed.

Quantification of facial asymmetry: A comparative study of landmark-based and surface-based registrations.

OBJECTIVE: To compare the validity and reproducibility of four different methods for the quantification of soft tissue facial asymmetry. MATERIAL AND METHODS: Twenty 3D-photographs were randomly selected from the healthy control database. To assess the validity of the one landmark-based and three surface-based methods for measuring asymmetry, artificial facial asymmetry was created on two 3D photographs. The discrepancy between the artificial facial asymmetry and the asymmetry quantified by different methods was calculated. To evaluate the reproducibility of the methods, they were applied three times by two independent observers. The intraobserver and interobserver variations were calculated. RESULTS: The mean absolute differences between the measured asymmetry and the artificial asymmetry for the landmark-based method, forehead method, 5 mm method and 1 mm method were 1.4 mm, 0.3 mm, 0.09 mm and 0.06 mm respectively. The intraobserver and interobserver variations for the forehead, 5 mm and 1 mm methods were between 0.18 mm and 0.34 mm. CONCLUSION: The surface-based methods were valid and highly reproducible in comparison to the landmark-based method for the quantification of soft tissue facial asymmetry. The 1 mm surface-based method can be implemented in a clinical and research setting to quantify facial asymmetry.

Unilateral condylar hyperplasia: a 3-dimensional quantification of asymmetry.

PURPOSE: Objective quantifications of facial asymmetry in patients with Unilateral Condylar Hyperplasia (UCH) have not yet been described in literature. The aim of this study was to objectively quantify soft-tissue asymmetry in patients with UCH and to compare the findings with a control group using a new method. MATERIAL AND METHODS: Thirty 3D photographs of patients diagnosed with UCH were compared with 30 3D photographs of healthy controls. As UCH presents particularly in the mandible, a new method was used to isolate the lower part of the face to evaluate asymmetry of this part separately. The new method was validated by two observers using 3D photographs of five patients and five controls. RESULTS: A significant difference (0.79 mm) between patients and controls whole face asymmetry was found. Intra- and inter-observer differences of 0.011 mm (-0.034-0.011) and 0.017 mm (-0.007-0.042) respectively were found. These differences are irrelevant in clinical practice. CONCLUSION: After objective quantification, a significant difference was identified in soft-tissue asymmetry between patients with UCH and controls. The method used to isolate mandibular asymmetry was found to be valid and a suitable tool to evaluate facial asymmetry.