Morphometry of paranasal sinus anatomy in chronic rhinosinusitis: a pilot study.

OBJECTIVES: To test the null hypothesis that there is no relationship between anatomical variations around the ostiomeatal complex and a predisposition to chronic rhinosinusitis and to define such variations with increased precision. DESIGN: Case-control study of anatomical variations in diseased and normal sinuses. Eight homologous landmarks defining the ostiomeatal complex were located on coronal computed tomographic scans, and their x and y coordinates were digitized using image analysis. SUBJECTS: Ten patients with unilateral sinus disease and 10 subjects without sinus disease (scanned for facial pain) who were selected retrospectively by case-note analysis. RESULTS: Logistic regression showed that the only significant spatial change predictive of a person with rhinosinusitis was the vertical position of the middle turbinate (P=.04), although this was not confirmed by Wilcoxon testing (P>.10). When examined by sinus, however, the horizontal position of the uncinate process was more laterally placed in persons with rhinosinusitis (P=.01), confirmed on Wilcoxon testing (P=.04), but there was no significant difference when compared with sinuses in persons without rhinosinusitis. CONCLUSIONS: Our findings suggest that there are no anatomical differences within the ostiomeatal complex between patients with and without rhinosinusitis. Patients with rhinosinusitis, however, are more likely to develop it in the side with a more laterally positioned uncinate process. Further studies, with more patients and more advanced techniques, including thin-plate spline analysis, are indicated.

Optical disguising of orbital deformity with prism and cylinder lenses.

This paper describes the way in which prism and cylinder lenses may be used to disguise orbital dystopia when the affected eye is blind. The lenses used can correct the height of the eye, the opening of the eyelids or the rotation or slant of the eye. Four cases are presented to illustrated this technique, which may be used either instead of, or as an adjunct to orbital surgery. An investigation of these effects is described using a mannikin head fitted with an optician's trial frame, with measuring by the reflex metrograph. This revealed that an inferiorly displaced eye may be elevated by 4 to 5 mm, that the vertical eyelid opening may be widened (or narrowed) by just under 20% and that an adverse slant of the eye may be rotated in either direction by about 4 degrees.

A little distal archery.

Two instances are described in which the cutting of distal sections of archwires using current clinical methods has proved hazardous.

Method errors recorded by inexperienced operators of the reflex microscope.

The Reflex Microscope has become a standard instrument for the precision measurement of orthodontic record models. In this study, 31 individuals with no previous experience of the microscope were assessed for their precision at identifying well defined landmarks. Considerable initial variation existed in the precision of landmark identification, but despite only a limited training period, some of the novices tested achieved a high standard of precision. Mean errors were greatest in the z axis, i.e. along the axis of the eye, and astigmatism was common amongst those recording the greatest errors in this axis. A group of individuals who performed poorly initially, were retested after additional training and practice with the microscope. Method errors were significantly reduced for the majority of those retested, but the test apparatus identified two individuals for whom further measurement with the microscope would be inadvisable.

Facial growth in patients with unilateral clefts of the lip and palate: a two-center study.

Two groups of 10-year-old patients with complete unilateral clefts of the lip and palate were examined in this study. Two centers; Bristol, U.K. and Oslo, Norway, who had different treatment regimens were used. The groups comprised 40 patients from Oslo and 32 from Bristol. The groups were matched, in proportion to the size of the groups, for age, sex, and presence of Simonart's bands. In Oslo, a Millard lip repaired was performed at 3 months of age with a von Langenbeck palatal repair at 18 months, no presurgical orthopedics was employed and there was no primary nasal correction. The Bristol center also repaired the lip at 3 months with a Millard type repair but also performed a radical nasal correction at the same time. The palate was repaired at 6 months with a Veau repair, and presurgical orthopedics using a pinned arch orthopedic plate was carried out. In addition, the volume of primary repairs per surgeon was much higher in Oslo, and a much stricter treatment protocol was used compared with Bristol. Lateral cephalograms obtained within 1 year of the child's tenth birthday were digitized, and the craniofacial morphology of the two groups was compared. Significant differences in maxillary growth and soft tissue profile were noted with a much more retruded mid-face and flatter nasiolabial angle in the Bristol group. The main factors for the better results in Oslo are suggested to be the absence of presurgical orthopedics, no radical nasal correction, the high volume of operations performed per surgeon, and the stricter protocol.