Correlation analysis of airway-facial phenotype in Crouzon syndrome by geometric morphometrics: A promising method for non-radiation airway evaluation.

AIM: This study aimed to verify the correlation of the airway-facial phenotype and visualize the morphological variation in Crouzon syndrome patients. Additionally, to develop a non-radiation methodology for airway assessments. METHOD: In this study, 22 patients diagnosed with Crouzon syndrome (Age: 7.80 ± 5.63 years; Gender distribution: 11 females and 11 males) were analysed. The soft tissue surface and airway were three-dimensionally reconstructed, and the entire facial phenotype was topologized and converted into spatial coordinates. Geometric morphometrics was employed to verify the correlation and visualize dynamic phenotypic variation associated with airway volume. A total of 276 linear variables were automatically derived from 24 anatomical landmarks, and principal component analysis (PCA) identified the 20 most significant parameters for airway evaluation. Correlation analyses between parameters and airway volume were performed. Then, patients were classified into three groups based on airway volume, and the differences among the groups were compared for evaluating the differentiating effectiveness of parameters. RESULTS: The facial phenotype was strongly correlated with the airway (coefficient: 0.758). Morphological variation was characterized by (i) mandibular protrusion and anticlockwise rotation; (ii) midface retrusion; (iii) supraorbital frontward and (iv) lengthening of the facial height. All the anthropometric parameters were strongly associated with the airway, and the differences among the groups were statistically significant. CONCLUSION: This study confirmed the strong correlation between facial phenotype and airway parameters in Crouzon syndrome patients. Despite the development of the airway, pathological midface retrusion was still aggravated, suggesting that surgical intervention was inevitable. Three-dimensional facial anthropometry has potential as a non-radiation examination for airway evaluation.

How Does Social Media Correlate With Clinical Appointments: A Quantitative Analysis.

Social media has become an important part of plastic surgeons' practices. Is it true that the more followers, the more efficient it is to the plastic surgeon's branding? This study is to verify the quantitative correlation between social media and clinical appointments and to optimize its utilization. One hundred and five plastic surgeons were divided into 3 groups according to titles. WEIBO served as a targeted platform and descriptive data, including numbers of followers and clinic appointments were collected for analysis. The promotive effect was quantified as and correlation analysis was conducted to quantify the relationship between followers and outpatient appointments. From this research, it was found that 62% of participants were social media users, while 38% were not. No statistical significance was found between them by comparing the number of clinic appointments. For surgeons with social media, a positive correlation was proven between followers and clinic appointments, whose Pearson's correlation was 0.266 (attending: 0.557, associate consultant: 0.315, consultant: 0.060). Meanwhile, the conversion rates in this study were 22.49±44.67% (attending), 13.10±24.57% (associate consultant), and 18.88±36.05% (consultant). Outpatient consultations of senior surgeons without social media (2652±14492) were significantly higher than young surgeons with social media (1800±1718, P <0.05). The regression equation was Clinical Appointments=ln (Followers)×316.906-992.588 ( R2 =0.270, P =0.023). In conclusion, this study proved that social media positively influenced clinic appointments but the traditional personal brandings like reputations, academic pedigree, and word of mouth still played an indispensable role in career development. Young surgeons benefited most from social media. The promotive effect of social media would reach its saturation when the followers were up to ∼50,000.

Three-dimensional Measurement of the Zygomatic-maxillary Complex in the Class III Malocclusion Patients with Maxillary Retrusion.

This study investigated the anatomic features of the zygomatic-maxillary complex in patients with maxillary retrusion without clefts. Individuals were grouped, and craniofacial measurements were performed for 21 individuals with skeletal Class III malocclusion with maxillary retrusion (CIII) and 48 individuals from the control group (CG). We evaluated the predetermined hard-tissue and soft-tissue points of the facial profile in each group. Independent sample t -tests were performed to determine the differences between groups (significance set at P <0.05). Multiple points on the midface, including the most posterior point on the contour of the maxillary alveolar process, lowest point of the zygomaticomaxillary suture, furthest point to the zygomatic self-base plane, superior point in the infraorbital foramen, and lowest point of the inferior margin of the orbit to the coronal plane were smaller in CIII than in CG (all P <0.05). The soft tissue thickness in these regions was significantly increased compared with that in the normal group. In summary, for class III malocclusion patients with maxillary retrusion, the deficiency in the midface gradually decreased going upward, with the deficiency at the maxillary alveolar level being the most serious. To some extent, soft tissues compensate for the deficiencies in the facial skeleton, and standard Le Fort I osteotomy advancement was sufficient to achieve a harmonious appearance.

Dynamic Morphological Growth Trajectory of Crouzon Population: A Geometric Morphometric Analysis.

This study is to visualize the morphological growth trajectory of the Crouzon population and provide a more comprehensive and perceptual understanding of pathologic aggregation in terms of maxillofacial and soft tissue surfaces. Twenty-two patients with Crouzon syndrome were included in this retrospective surgery. Preoperative computed tomography was segmented into maxillofacial and soft tissue surface morphologies. Fifty-two anatomical landmarks and a standardized template were used to extract the morphological phenotypes and transform them into spatial coordinates. Geometric morphometrics (GM) were applied to visualize the growth trajectory and estimate the morphological variation of the Crouzon population. Cephalometric analysis was conducted to validate the growth trajectory in a clinical aspect. It was found that both maxillofacial and soft tissue surface morphologies were strongly covaried with age. Morphological development of the Crouzon population was characterized by (1) maxillary retrusion and clockwise rotation, (2) mandibular counterclockwise rotation, (3) facial width narrowing and aggregated concave face, and (4) sunken nasal bone. Pathologic maxillary retrusion continuously existed from infancy to adulthood, and rapid aggravation took place at 3 to 6 years old. In conclusion, this study is the first to visualize the dynamic growth trajectories on both maxillofacial and soft tissue surface morphologies. More attention and monitoring of breathing, snoring, intelligence, and global development should be cast on Crouzon patients between 3 and 6 years old in family care. If any functional abnormalities occur during this period, professional consultations and evaluations should be conducted timely to avoid pathologic aggravation. Consistency between GMs and cephalometry validates the reliability of GM potentials in the clinical field, allowing a promising and revolutionary methodology for dynamically and qualitatively analyzing pathologic changes in some rare congenital diseases.

Self-Organization of Nonlinearly Coupled Neural Fluctuations Into Synergistic Population Codes.

Neural activity in the brain exhibits correlated fluctuations that may strongly influence the properties of neural population coding. However, how such correlated neural fluctuations may arise from the intrinsic neural circuit dynamics and subsequently affect the computational properties of neural population activity remains poorly understood. The main difficulty lies in resolving the nonlinear coupling between correlated fluctuations with the overall dynamics of the system. In this study, we investigate the emergence of synergistic neural population codes from the intrinsic dynamics of correlated neural fluctuations in a neural circuit model capturing realistic nonlinear noise coupling of spiking neurons. We show that a rich repertoire of spatial correlation patterns naturally emerges in a bump attractor network and further reveals the dynamical regime under which the interplay between differential and noise correlations leads to synergistic codes. Moreover, we find that negative correlations may induce stable bound states between two bumps, a phenomenon previously unobserved in firing rate models. These noise-induced effects of bump attractors lead to a number of computational advantages including enhanced working memory capacity and efficient spatiotemporal multiplexing and can account for a range of cognitive and behavioral phenomena related to working memory. This study offers a dynamical approach to investigating realistic correlated neural fluctuations and insights to their roles in cortical computations.

Application of Surgery-First Approach in Treating Skeletal Dentofacial Asymmetry with Orthognathic Surgery.

BACKGROUND: Skeletal dentofacial asymmetry decreases patient's attractiveness by deteriorating symmetry of facial appearance which is of great significance to individuals. Surgery-first orthognathic approach manifests its advantages of shortening treatment time and improving patient's quality of life. However, current literature on surgery-first approach mainly focuses on treating prognathism, overlooking its efficacy in improving facial symmetry of skeletal dentofacial asymmetry patients. This study aimed to assess SFA's efficacy in improving facial appearance by analyzing morphological features of asymmetric bone and facial soft tissue in a three-dimensional manner. METHODS: Thirty-four patients who received orthognathic surgery in a surgery-first fashion were included. Based on three-dimensional CT reconstruction, bilateral preoperative morphological features and postoperative symmetry of hard tissue were compared respectively. Efficacy of facial soft tissue symmetry restoration was evaluated using root mean square deviation (RMSD). RESULTS: Asymmetric features mainly located in menton, mandibular body length, angulation between ramus and midsagittal plane (MSP), distance between gonion and MSP and so on, which were significantly restored after the whole treatment. RMSD of facial soft tissue surface were significantly declined after the treatment and prognathism was corrected simultaneously if existed. CONCLUSIONS: Surgery-first orthognathic approach is proved to be capable of treating skeletal dentofacial asymmetry effectively and efficiently.

Application and Accuracy of Craniomaxillofacial Plastic Surgery Robot in Congenital Craniosynostosis Surgery.

OBJECTIVE: The objective of this study was to observe the accuracy and security of the craniomaxillofacial plastic surgery robot in congenital craniosynostosis surgery and to enhance and improve its performance. MATERIALS AND METHODS: We performed model surgical experiments on computed tomography data of 5 children with congenital craniosynostosis who were diagnosed and treated in our hospital, and model surgical experiments and animal experiments on the skulls of 3 Bama minipigs. RESULTS: There was no statistically significant difference shown either in model experiments or animal experiments in comparing the actual operation with the surgical simulation and inside the groups ( P >0.05). CONCLUSIONS: The craniomaxillofacial plastic surgery robot has achieved good security and accuracy in model surgery and animal experiments. Further studies are needed to be conducted to confirm its security and accuracy and to continuously improve and refine the robot's performance.

A Novel and Simplified Parameter for Mandible Angle Asymmetry Evaluation in Chinese Females.

AIM: To develop a novel and simplified parameter for mandible angle asymmetry (MAA) evaluation for facial countering surgeries in Chinese females. MATERIALS AND METHODS: A total of 250 craniofacial computer tomography of healthy Chinese individuals were collected in this retrospective study. Mimics 21.0 was applied for 3-dimensional anthropometry. The Frankfort and Green planes were set as referenced vertical and horizontal planes for measuring the distances to gonions. The differences in both orientations were analyzed to verify the symmetry. Mandible angle asymmetry (∠Go-N-ANS, MAA) which comprehensively represented horizontal and vertical placements was defined qas the novel parameter for asymmetric evaluation and quantitative analysis was conducted to generate referenced materials. RESULTS: Mandible angle asymmetry was divided into horizontal and vertical asymmetry. No significant differences were found in either horizontal or vertical orientations. The horizontal difference was 3.09±2.52 mm, the reference range was (0.28, 7.54) mm, whereas the±ertical difference was 2.59±2.48 mm, the reference range was (0.12, 6.34) mm. The difference of MAA was 1.74±1.30 degrees, and the reference range was (0.10,4.32）degrees. CONCLUSION: This study provided a novel parameter for asymmetric evaluation in the mandible angle region through quantitative 3-dimensional anthropometry, arousing plastic surgeons' attention to both aesthetics and symmetry in facial contouring surgery.

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.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Using a New Deep Learning Method for 3D Cephalometry in Patients With Cleft Lip and Palate.

Deep learning algorithms based on automatic 3-dimensional (D) cephalometric marking points about people without craniomaxillofacial deformities has achieved good results. However, there has been no previous report about cleft lip and palate. The purpose of this study is to apply a new deep learning method based on a 3D point cloud graph convolutional neural network to predict and locate landmarks in patients with cleft lip and palate based on the relationships between points. The authors used the PointNet++ model to investigate the automatic 3D cephalometric marking points. And the mean distance error of the center coordinate position and the success detection rate (SDR) were used to evaluate the accuracy of systematic labeling. A total of 150 patients were enrolled. The mean distance error for all 27 landmarks was 1.33 mm, and 9 landmarks (30%) showed SDRs at 2 mm over 90%, and 3 landmarks (35%) showed SDRs at 2 mm under 70%. The automatic 3D cephalometric marking points take 16 seconds per dataset. In summary, our training sets were derived from the cleft lip with/without palate computed tomography to achieve accurate results. The 3D cephalometry system based on the graph convolutional neural network algorithm may be suitable for 3D cephalometry system in cleft lip and palate cases. More accurate results may be obtained if the cleft lip and palate training set is expanded in the future.

Cadaveric Study and Micro-Computed Tomography of the Anatomy of Palatine Aponeurosis and its Link to the Soft Palate Muscles and Pharyngeal Muscles.

OBJECTIVE: There have been few studies on the anatomy of palatine aponeurosis (PA). Herein, we elucidated the relationship between the PA and soft palate muscles and pharyngeal muscles. DESIGN: Two cadaveric specimens were dissected to observe the gross anatomy of the PA. Six cadaveric specimens were processed and scanned by micro-computed tomography to determine the elaborate anatomy. Images were exported to Mimics software to reconstruct a three-dimensional model. RESULTS: The PA covered the anterior (32.1%-38.8%) of the soft palate, extending from the tensor veli palatini (TVP) and connecting to 3 muscles: palatopharyngeus (PP), uvula muscle, and superior pharyngeal constrictor (SC). The SC and PP are attached to the PA on the medial side of the pterygoid hamulus. SC muscle fibers were attached to the hamulus, forming a distinct gap between the hamulus. Some muscle fibers of the PP and uvula originated from the PA. The PA extended from the TVP to the midline and the posterior edge of the hard palate. The PA was not uniformly distributed, which was complementary to the attached muscles in thickness. CONCLUSIONS: PA, as a flexible fibrous membrane, maintains the shape of the soft palate. It extends from the TVP and covers anteriorly about one-third of the soft palate. The PA provides a platform for the soft palate muscles and pharyngeal muscles, connecting to the PP, uvula muscle, and SC. These muscles are important for palatopharyngeal closure and middle-ear function. It is necessary to minimize the damage to the PA during surgical interventions.

Treatment of Asymmetric Crying Face by Fascia lata Grafting.

OBJECTIVE: To evaluate and discuss the plastic surgery treatment of asymmetric crying face. METHODS: From 2019 to 2022, 60 patients with asymmetric crying face were treated by fascia lata grafting. We evaluated the postoperative improvement, summarized experiences and reviewed literatures about the treatment of asymmetric crying face. RESULTS: 59 patients showed varying degrees of improvement in the movement of the affected corner of mouth, and no complications were found during the follow-up period of 6 months to 24 months. CONCLUSIONS: The cause of asymmetric crying face is still uncertain. Fascia lata grafting has shown a certain effect in the treatment of asymmetric crying face. This study evaluated this method with quite large sample. More researches are needed to explore the most appropriate treatment for asymmetric crying face.

Three-dimensional Anatomy of the Velopharyngeal Muscles in the Cleft Palate.

OBJECTIVE: We have used micro-computed tomography (CT) to elucidate the relationship between the muscle fibers in specimens with cleft palate. These findings could be useful for muscle reconstruction in cleft palate repair and to better understand cleft palate speech. DESIGN: Cadaveric anatomical study. PARTICIPANTS: This study included three specimens with cleft palate. INTERVENTION: The specimens were stained with phosphomolybdic acid and scanned by Micro-CT. MAIN OUTCOME MEASURE(S): The anatomy of the muscles. RESULTS: Using 2D projection images and 3D reconstruction models, subtle anatomical structures could be observed in the muscles. The attachment of the levator veli palatini (LVP) was not at the posterior edge of the hard palate or palatine aponeurosis (PA), but at the anterior 21.71-44.2% of the cleft edge. The palatopharyngeal (PP) was composed of two bundles: inferior and superior heads, which clasped the LVP. The uvularis was unevenly distributed, and located on both sides of the cleft edge, originating at the edge. The palatoglossus, superior constrictor of pharynx and anatomical structure around the pterygoid hamulus, were normal. The PA, PP and LVP were attached to the cleft edge from front to back, in that order. The position of the uvularis was not fixed. CONCLUSIONS: With the help of Micro-CT technology, detailed anatomical features and the relationship between muscles could be visualized. In the specimen with cleft palate, muscles in the soft palate were associated with the pharyngeal muscles, which formed the 3D "velopharyngeal muscles complex." These findings provide anatomical evidence for muscle reconstruction in cleft palate repair.

The Underappreciated Role of the Platysma Muscle in the Perioral Expressions in Young Adults.

BACKGROUND: The platysma is involved in lower face movement, yet limited information on its functional role when making perioral expressions is available. OBJECTIVES: The aim of this study was to use 3-dimensional (3D) photogrammetry to analyze platysma activity when making expressions. METHODS: Standardized frontal-view 3D images were obtained from 54 volunteers. Three perioral expressions were analyzed: a full smile, mouth corner depression, and a grimace to show the lower teeth. Positive volume change in the "heat map" of the neck skin surface-determined by the superimposed image subtraction technique-served as a sensitive indicator of platysma contraction. RESULTS: When making the 3 expressions, the proportions of platysma contraction were 42.6%, 75.9%, and 92.6%, respectively. The platysma worked as a more critical dynamic force than expected. In most smiles involving the platysma, its upper portion contracted. With the laterally downward traction on the lower lip increasing, the upper and lower portions of the platysma contracted together and formed muscular bands. The platysma contracted extensively in the other 2 expressions. In some cases, platysma bands were observed to form due to vigorous contraction of muscle fibers. In addition, the platysma was found to be highly functionally active in young individuals. CONCLUSIONS: This study introduced a simple method that can sensitively identify the functional status of the platysma. The results showed the platysma's highly active function in perioral expressions in young adults. These findings may assist surgeons in personalized decision-making toward platysma muscle-weakening strategies and work as an objective tool for outcome evaluation.

Muscle Flap Reconstruction Based on Muscle Tension Line Groups to Repair the Philtrum of Patients With Microform Cleft Lip or Secondary Cleft Lip.

ABSTRACT: The muscle flap reconstruction technique was developed based on the concept of muscle tension line groups, which elucidates how nasolabial muscle tension helps maintain the shape of the philtrum. To investigate the operative effect, we reviewed 43 patients with microform cleft lip and 102 patients with secondary cleft lip treated with muscle flap reconstruction between January 2018 and June 2020. The patients were scanned using the digital three-dimensional stereophotogrammetry face system pre- and post-operatively, and comparative analysis of three-dimensional (3D) images was used to highlight variations of the philtrum. Visual analog scales were used to assess surgical outcomes. More than 6 months after the surgery, comparative 3D images of 37 patients (86.04%) with microform cleft lip and 86 patients (84.31%) with secondary cleft lip showed visible improvement in the prominence of the affected column. In addition, visual analog scale scores showed that 38 microform cleft lip patients (88.37%) and 89 secondary cleft lip patients (87.25%) had a good appearance. The postoperative prominence of the philtral column in both groups improved significantly compared to before surgery (P < 0.001 and P < 0.001, respectively). There was no significant difference in scores for philtrum prominence pre- and post-operatively between the 2 groups (P > 0.05). Muscle flap reconstruction is an effective means to create the 3D configuration of the philtrum. The biomechanical properties of muscles play a vital role in the morphological maintenance of the philtrum.

The Ideal Nasion in Chinese: A Preference Analysis of the General Population.

Augmentation rhinoplasty has gained popularity in China in the past decades and nasion profile is a key variable in aesthetic outcomes. The nasion is the deepest portion of the nasofrontal groove and its aesthetic preferences vary between different ethnic groups. At the time of this writing, there is limited research about ideal nasion measurements in the Chinese population. Therefore, we conducted an online survey of plastic surgeons and the public through social media. Participants were asked to rank nasion images according to their preferences. Images were created from a 3-dimensional scan of a Chinese Han female and modified to show various dimensions of nasion height, position, and forehead height. Nasion preferences were compared by age, sex, ethnicity, occupation, and whether had a history of plastic surgery. There were 777 respondents, including 461 (59.3%) women and 74 (9.5%) plastic surgeons. Nasion height of 8 and 10 mm ranked highest among all demographic groups. All respondents preferred nasion position to be level with the center of the pupil and forehead height of 4 mm above the nasion. Our study showed that the ideal Chinese nasion is in line with baseline ethnic characteristics. Therefore, plastic surgeons must be aware of these nasion preferences to guide preoperative discussions and achieve satisfactory outcomes.

Three-Dimensional Measurement of the Zygomatic-Maxillary Complex in Unilateral Cleft Lip and Palate Patients With Maxillary Retrusion.

ABSTRACT: The purpose of this study was to investigate the anatomical features of the zygomatic-maxillary complex in unilateral cleft lip and palate (UCLP) patients with maxillary retrusion. Individuals were grouped and craniofacial measurements were carried out for 34 individuals in the UCLP with maxillary retrusion group (UMRG) and 50 from a control group (CG). The authors measured the length, width, and height of the maxilla and zygoma and also measured predetermined regions on the midface in each group. Independent sample group t tests were performed to determine differences between groups (with significance set at P < 0.05). Multiple points on the midface (the most posterior point on the contour of the maxillary alveolar process, lowest point of the zygomaticomaxillary suture, furthest point to the zygomatic self-base plane, superior point in the infraorbital foramen, and lowest point of the inferior margin of the orbit) to the coronal plane were smaller in the UMRG than in the CG (all results P < 0.05). In addition, the maxillary length was significantly reduced in the UMRG than in the CG (P < 0.05). In summary, for the UCLP patients with maxillary retrusion, the deficiency in the midface gradually reduced going upward, with the deficiency in the maxillary alveolar level the most serious. The zygoma was influenced to a lesser extent.

Transposition Mucosal Flap Combined With Autologous Fat Transplantation to Repair Lip Defects Caused by Sclerotherapy of Hemangioma.

ABSTRACT: Infantile hemangiomas are the most common benign childhood tumors and can occur on any part of the human body. Sclerosing agents are used in the early stage of treatment of infantile hemangioma. Sometimes a lip defect remains after sclerosing agent treatment. We developed a simple technique to repair lip defects. The authors performed transposition mucosal flap and autologous fat transplantation surgery on patients who had lip defects caused by sclerosing agents. The flap was transposed 90° from the intraoral labial mucosa to the vermilion defect. Autologous fat was transplanted to the white lip defect. If necessary, a secondary fat transplantation may be performed every half year. All patients were followed up to evaluate the effect of the operation. Patients were asked to rate their satisfaction with the surgery between 1 and 10. Digital three-dimensional evaluation was performed. Sixteen patients underwent the surgery successfully, and the flaps were all viable. No complications occurred after surgery (5 males, 11 females; age range, 5-27 years; 12 upper lip, 3 lower lip, and 1 median lip). The patients were satisfied with the aesthetic outcome of surgery (mean score, 9). Seven patients wanted to undergo a second fat transplantation, whereas 9 patients felt it was unnecessary to transplant fat again. Transposition mucosal flap combined with autologous fat transplantation is reliable and minimally invasive. It is an effective method for repairing moderate lip defects mainly involving vermilion caused by a sclerosing agent.

Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus.

OBJECTIVE: Palatoplasty would involve the structures around the pterygoid hamulus. However, clinicians hold different opinions on the optimal approach for the muscles and palatine aponeurosis around the pterygoid hamulus. The absence of a consensus regarding this point can be attributed to the lack of investigations on the exact anatomy of this region. Therefore, we used micro-computed tomography to examine the anatomical structure of the region surrounding the pterygoid hamulus. DESIGN: Cadaveric specimens were stained with iodine-potassium iodide and scanned by micro-computed tomography to study the structures of the tissues, particularly the muscle fibers. We imported Digital Imaging and Communications in Medicine images to Mimics to reconstruct a 3-dimensional model and simplified the model. RESULTS: Three muscles were present around the pterygoid hamulus, namely the palatopharyngeus (PP), superior constrictor (SC), and tensor veli palatini (TVP). The hamulus connects these muscles as a key pivot. The TVP extended to the palatine aponeurosis, which bypassed the pterygoid hamulus, and linked the PP and SC. Some muscle fibers of the SC originated from the hamulus, the aponeurosis of which was wrapped around the hamulus. There was a distinct gap between the pterygoid hamulus and the palatine aponeurosis. This formed a pulley-like structure around the pterygoid hamulus. CONCLUSIONS: Transection or fracture of the palatine aponeurosis or pterygoid hamulus, respectively, may have detrimental effects on the muscles around the pterygoid hamulus, which play essential roles in the velopharyngeal function and middle ear ventilation. Currently, cleft palate repair has limited treatment options with proven successful outcomes.

Orbital Hypertelorism Correction With Inverted-U Osteotomy: Indications and Advantages.

ABSTRACT: This study aimed to explore the clinical effects of inverted-U osteotomy in correcting orbital hypertelorism and to further explore its indications and advantages; 4 patients with orbital hypertelorism and premature closure of unilateral coronal suture underwent inverted-U osteotomy. The interorbital distance was measured using three-dimensional digital technology pre- and postoperatively. Virtual preoperative planning and three-dimensional cutting guide were used to minimize surgical risk and increase the precision of periorbital osteotomy. The procedure was successfully performed on 4 patients; the average orbital medial wall distance was reduced from 34.9 mm to 23.1 mm. Inverted-U osteotomy is a modified surgical method especially applicable to orbital hypertelorism with premature closure of unilateral coronal suture. Advantages include less surgical trauma, a shorter operative time, and better correction results.