Cleft lip and palate in Scotland: a survey.

The aim of the survey was to assess midwives' experiences and knowledge of cleft lip and/or palate (CL+/-P), confidence in supporting the families and giving feeding advice, and to identify areas for input from the cleft team. In order to do so, questionnaires were sent to maternity units across Scotland. The results were as follows: 206 questionnaires were returned (42 per cent response rate). Forty one per cent of the midwives had helped a baby with CL+/-P to be born; 23 per cent knew the incidence of CL+/-P; 33 per cent were aware of the stages in treating CL+/- P; 99 per cent were aware that feeding difficulties are a potential complication. When asked about offering support to the families, 70 per cent were not confident and 60 per cent were not confident at giving feeding advice. Regarding cleft team input, 65 per cent would like a training day, 45 per cent requested small group teaching, 50 per cent would like a website and 57 per cent would like printed literature. Our recommendations are to implement training, for midwives, along with supporting websites and literature.

Revising Fourier-transform infrared (FT-IR) and Raman spectroscopy towards brain cancer detection.

Fourier-transform infrared (FT-IR) and Raman spectroscopy are being widely applied as sensor-based techniques in oncology, particularly in the diagnosis of brain cancers and their subtypes. Overtime, these techniques have become more sensitive; and, accuracies of over 90% have been observed in several studies. This is indication of their potential for clinical implementation. Herein, we present a mini-review by revisiting some fundamentals of FT-IR and Raman spectroscopy along with their applications towards brain cancer detection in the literature.

Raman hyperspectral imaging coupled to three-dimensional discriminant analysis: Classification of meningiomas brain tumour grades.

Meningiomas remains a clinical dilemma. They are the commonest "benign" types of brain tumours and, although being typically benign, they are divided into three WHO grades categories (I, II and III) which are associated with the tumour growth rate and likelihood of recurrence. Recurrence depends on extend of surgery as well as histopathological diagnosis. There is a marked variation amongst surgeons in the follow-up arrangements for their patients even within the same unit which has a significant clinical, and financial implication. Knowing the tumour grade rapidly is an important factor to predict surgical outcomes and adequate patient treatment. Clinical follow up sometimes is haphazard and not based on clear evidence. Spectrochemical techniques are a powerful tool for cancer diagnostics. Raman hyperspectral imaging is able to generate spatially-distributed spectrochemical signatures with great sensitivity. Using this technique, 95 brain tissue samples (66 meningiomas WHO grade I, 24 meningiomas WHO grade II and 5 meningiomas that reoccurred) were analysed in order to discriminate grade I and grade II samples. Newly-developed three-dimensional discriminant analysis algorithms were used to process the hyperspectral imaging data in a 3D fashion. Three-dimensional principal component analysis quadratic discriminant analysis (3D-PCA-QDA) was able to distinguish grade I and grade II meningioma samples with 96% test accuracy (100% sensitivity and 95% specificity). This technique is here shown to be a high-throughput, reagent-free, non-destructive, and can give accurate predictive information regarding the meningioma tumour grade, hence, having enormous clinical potential with regards to being developed for intra-operative real-time assessment of disease.

Three-dimensional assessment of early surgical outcome in repaired unilateral cleft lip and palate: Part 2. Lip changes.

OBJECTIVE: To evaluate three-dimensional lip morphology, following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous noncleft data. DESIGN: Prospective, cross-sectional, controlled study. SETTING: Glasgow Dental Hospital and School, University of Glasgow, U.K. PATIENTS AND PARTICIPANTS: Two groups of 3-year-old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a three-dimensional vision-based capture technique. METHODS: Three-dimensional images of the face were reflected so the cleft was on the left side to create a homogeneous group for statistical analysis. Three-dimensional coordinates of anthropometric landmarks were extracted from facial images. Three-dimensional, generalized Procrustes superimposition was implemented and a set of linear measurements were used to compare cleft and control subjects for right and left sides, adjusting for sex differences. RESULTS: Crista philtri on both the cleft and noncleft sides were displaced laterally and posteriorly; there was also a statistically significant increase in philtrum width. No significant differences between cleft and control regarding the cutaneous height of the upper lip. The lip in the cleft patients was flatter than in the noncleft individuals, with less prominence of labialis superioris. CONCLUSIONS: Stereophotogrammetry allows detection of residual dysmorphology following cleft repair. There was significant increase of the philtrum width. The lip appeared flatter and more posterior displaced in unilateral cleft lip and palate patients compared with controls.

Three-dimensional assessment of early surgical outcome in repaired unilateral cleft lip and palate: Part 1. Nasal changes.

OBJECTIVE: To evaluate three-dimensional nasal morphology following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous noncleft data. DESIGN: Prospective, cross-sectional, controlled study. SETTING: Glasgow Dental Hospital and School, Faculty of Medicine, Glasgow University. PATIENTS AND PARTICIPANTS: Two groups of 3-year-old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a three-dimensional, vision-based capture technique. METHODS: Three-dimensional images of the face were reflected so the cleft was on the left side to create a homogeneous group for statistical analysis. Three-dimensional coordinates of anthropometric landmarks were extracted from facial images by a single operator. A set of linear measurements was used to compare cleft and control subjects on right and left sides, adjusting for sex differences. RESULTS: The mean nasal base width and the width of the nostril floor on right and left sides differed significantly between control and unilateral cleft lip and palate groups. The measurements were greater in children with unilateral cleft lip and palate. The differences in the mean nasal height and mean nasal projection between the groups were not statistically significant. Mean columellar lengths were different between the left and right sides in children with unilateral cleft lip and palate. CONCLUSIONS: There were significant nasal deformities following the surgical repair of unilateral cleft lip and palate.

Cleft lip/palate: incidence of prenatal diagnosis in Glasgow, Scotland, and comparison with other centers in the United Kingdom.

OBJECTIVES: To determine the proportion of children with cleft lip and/or cleft palate diagnosed prenatally between 1999 and 2008 in those referred for treatment to the Royal Hospital for Sick Children in Glasgow, Scotland (RHSC); and to compare the percentage prenatally diagnosed in 2008 versus other cleft treatment centers in the U.K. METHOD: A retrospective study was performed using medical records of the 459 cleft patients born and referred to RHSC between 1999 and 2008. Comparable data for year 2008 were requested from other U.K. units. RESULTS: For the period studied, the percentage of all clefts diagnosed prenatally was 15%. This rose to 28% when only the cases of cleft lip with or without cleft palate (CL ± P) were considered. An increase was seen in prenatal detection of CL ± P from 11% in 1999 to 50% in 2008 (p = .011). Two of the six U.K. units that responded had a significantly higher percentage of CL ± P cases diagnosed prenatally compared with RHSC in 2008 (p < .05). CONCLUSIONS: The percentage of CL ± P cases diagnosed prenatally in this study is consistent with the literature and increased between 1999 and 2008. Routine ultrasound anomaly scanning is shown to significantly improve detection rates compared with scanning of high-risk pregnancies only. Cases of CL ± P where the alveolus or the palate is involved have significantly higher detection rates than those involving only the lip.

The clinical application of rhBMP-7 for the reconstruction of alveolar cleft.

In this study, radiographic assessment was performed to find out the effectiveness of bone regeneration following the application of recombinant human bone morphogenetic protein 7 (rhBMP-7) for the reconstruction of alveolar cleft defects in 11 cases: nine unilateral and two bilateral alveolar clefs. Reconstruction of the alveolar cleft was performed by using 3.5 mg of rhBMP-7 (Osigraft OP1) on a type I collagen carrier. Radiographs were taken 6 months post operation using a Gendex Intraoral Unit with Agfa Dentus M2 Comfort occlusal film. The amount of bony infill was graded on a Kindelan four-point scale. The patients were followed up for an average of 6.6 years. Based on the radiographic analysis, eight out of the nine unilateral alveolar cleft cases received a score of grade I and one patient had a grade II score, using the Kindelan scale. In the two bilateral alveolar clefts, only one side had bone formation. The radiographic appearance showed a normal trabecular pattern similar to the adjacent bone. Thus, rhBMP-7 was radiographically and clinically successful in regenerating the bone at the alveolar cleft which resulted in shortening of the operation time, absence of donor-site morbidity and a shorter hospital stay. The promising results of this preliminary study should encourage a phase II trial to compare bone grafts with BMP for the reconstruction of alveolar defects.

Multi-view stereophotogrammetry for post-mastectomy breast reconstruction.

A multi-view three-dimensional stereophotogrammetry system was developed to capture 3D shape of breasts for breast cancer patients. The patients had received immediate unilateral breast reconstruction after mastectomy by the extended latissimus dorsi flap and without contralateral surgery. In order to capture the whole breast shape including the inframammary fold, the patients were introduced to the imaging room and leaned over the imaging rig to open up the inframammary fold and to expose the entire area of each breast. The imaging system consisted of eight high-resolution ([Formula: see text] pixels) digital cameras and four flash units. The cameras were arranged in four stereo pairs from four different view angles to cover the whole surface of the breasts. The system calibration was carried out ahead of every capture session, and the stereo images were matched to generate four range images to be integrated using an elastic model proposed. A watertight breast mesh model was reconstructed to measure the volume of the breast captured. The accuracy of using the developed multi-view stereophotogrammetry system for breast volume measurement was 11.12cc with SEM 7.74cc, comparing to the measurements of the water displacement method. It was concluded that the 3D stereophotogrammetry image system developed was more reliable than the method of water displacement.

A sample method of measuring bone graft volume, technical note.

A simple method of measuring the volume of cortico-cancellous bone grafts is described. The method is quick and reliable. Only materials readily available in the operation theatre are used.

The importance of the pose in three-dimensional imaging of the ptotic breast.

INTRODUCTION: 3D imaging of the breast has recently emerged as a new method for objective breast assessment. However in the ptotic breast shape, which is seen in the majority of cases, the sub-mammary fold remains obscured when the breast is captured in an upright body posture. METHOD: A self-designed positioning frame for 3D breast capture was utilized as a safe positioning aide. Six volunteers stood on an adjustable standing step, leaning with the hips against a soft-coated hip roll while stretching forward with the upper body extending to a nearly horizontal position and reaching with the arms forward resting on arm pads. 3D breast capture was conducted simultaneously with eight digital cameras that were positioned to capture the right, left, anterior and inferior views of the breast. Capture was repeated three times at different time intervals. The reproducibility of the pose, captures and 3D measurements were investigated. RESULTS: The custom-made positioning frame allowed the complete capture of the breast, even in the ptotic shapes. The investigation of the reproducibility revealed a 6.25% standard deviation of the pose; this being the variable with the smallest variation compared with the variations obtained for reproducibility of captures and 3D measurements. The difference between the first and second pose was not significant at 95% CI (-77.3; 11.9), p = 0.119. CONCLUSION: The presented system used a self-designed positioning frame, by which the complete capture of the ptotic breast in near horizontal upper body posture was achieved. Reproducibility of the pose for 3D capture was satisfactory.

Subjective versus objective assessment of breast reconstruction.

BACKGROUND: To date breast assessment has been conducted mainly subjectively. However lately validated objective three-dimensional (3D) imaging was developed. The study aimed to assess breast reconstruction subjectively and objectively and conduct a comparison. METHODS: In forty-four patients after immediate unilateral breast reconstruction with solely the extended latissimus dorsi flap the breast was captured by validated 3D imaging method and standardized 2D photography. Breast symmetry was subjectively evaluated by six experts who applied the Harris score giving a mark of 1-4 for a poor to excellent result. An error study was conducted by examination of the intra and inter-observer agreement and agreement on controls. By Procrustes analysis an objective asymmetry score was obtained and compared to the subjective assessment. RESULTS: The subjective assessment showed that the inter-observer agreement was good or substantial (p-value: <0.0001). There was moderate agreement on the controls (p-value: <0.0001) and fair (p-values: 0.159, 0.134, 0.099) to substantial (p-value: 0.005) intra-observer agreement. The objective assessment revealed that the reconstructed breast showed a significantly smaller volume compared to the opposite side and that the average asymmetry score was 0.052, ranging from 0.019 to 0.136. When comparing the subjective and objective method the relationship between the two scores was highly significant. CONCLUSION: Subjective breast assessment lacked accuracy and reproducibility. This was the first error study of subjective breast assessment versus an objective validated 3D imaging method based on true 3D parameters. The substantial agreement between established subjective breast assessment and new validated objective method supported the value of the later and we expect its future role to expand.

Investigation into variation and errors of a three-dimensional breast imaging system using multiple stereo cameras.

BACKGROUND: Errors derive from the variability seen in the repeat volume measurements for a particular individual. The aim of this study was to evaluate the variation and errors of a three-dimensional (3D) multiple stereo camera system for objective breast assessment. It was also investigated whether there was any correlation between these errors and the size of the breast. METHODS: A prototype eight camera multiple stereophotogrammetry system was utilized. The volumes of nine plaster breast models were determined by 3D imaging and the correlation between the size of the models and the variability of the measurements was investigated after ten repeats. The breasts of six live volunteers were examined following a specific protocol. The breasts were captured six times, three times each on two different occasions; from each breast capture a three-dimensional model was built and the breast volume was measured three times with breast analysis tool (BAT) software. This allowed for an assessment of the variability introduced at each stage of the measurement procedure. The correlation between the size of the breast and the variability of the measurements was investigated. Results of volume measurements by water displacement method, repeated ten times with the plaster models and six times with the live models, were used for comparison. RESULTS: The correlation between the size of the plaster models and the variability of the measurements revealed a significant correlation (p = 0.033), indicating that the larger the model, the more variable were the results. The correlation between the size of the breasts in the live models and the variability of the results revealed a non-significant correlation (p = 0.342), but there was a visible trend that the larger breasts showed more variable results. The average variation in the repeated measurements on each individual was found to be 32.95 cc across the two different poses, 19.43 cc across the various captures, and 28.32 across the different volume calculations with the BAT software. The error is less than what is clinically visible with the human eye, which is about 50 cc variation in volume by subjective assessment. As a proportion of the mean volume, namely 6.9%, 4.0% and 5.9% respectably, the values are small and indicate that the reproducibility of the system is good. CONCLUSION: The 3D imaging system using multiple stereo cameras revealed a positive correlation between the size of plaster models and the breasts of live models and the reproducibility of the measurements, indicating that the variation was higher for the larger sizes. The relationship was significant in the plaster models but not in the live models, although a trend was observed. The assessment of the variation and errors of the system was part of the necessary procedure that should be considered for the validation of any new measurement technology for breast assessment.

Objective evaluation of the latissimus dorsi flap for breast reconstruction using three-dimensional imaging.

BACKGROUND: The latissimus dorsi muscle flap is a common method for the reconstruction of the breast following mastectomy. The study aimed to assess the quality of this reconstruction using a three-dimensional (3D) imaging method. The null hypothesis was that there was no difference in volume between the reconstructed breast and the opposite side. METHODS: This study was conducted in forty-four patients who had had immediate unilateral breast reconstruction by latissimus dorsi muscle flap. The breast was captured using the 3D imaging system. Ten landmarks were digitised on the 3D images. The volume of each breast was measured by the application of Breast Analysis Tool software. The symmetry of the breast was measured using Procrustes analysis. The impact of breast position, orientation, size and intrinsic shape on the overall breast asymmetry was investigated. RESULTS: The null hypothesis was rejected. The reconstructed breast showed a significantly smaller volume when compared to the opposite side, p < 0.0001, a mean difference of 176.8 cc and 95% CI (103.5, 250.0). The shape and the position of the reconstructed breast were the main contributing factors to the measured asymmetry score. CONCLUSIONS: 3D imaging was efficient in evaluating the outcome of breast surgery. The latissimus dorsi muscle flap on its own for breast reconstruction did not restore the volume and shape of the breast fully lost due to complete mastectomy. The modification of this method and the selection of other or additional surgical techniques for breast reconstruction should be considered. The asymmetry analysis through reflection and Procrustes matching was a useful method for the objective shape analysis of the female breast and presented a new approach for breast shape assessment. The intrinsic breast shape and the positioning of the breast were major components of postoperative breast asymmetry. The reconstructed breast was smaller overall than the un-operated breast at a significant level when assessing the breast volume using the surface area. 3D imaging by multiple stereophotogrammetry was a useful tool for volume measurements, shape analysis and the evaluation of symmetry.

Investigation into accuracy and reproducibility of a 3D breast imaging system using multiple stereo cameras.

BACKGROUND: The aim of this study was to evaluate the validity of a three-dimensional (3D) multiple stereo camera system for objective breast assessment. METHODS: A multiple stereo camera system, which consisted of four pods and eight cameras, two cameras on each pod, developed by Glasgow University, was used. Nine specially shaped plaster breast models were captured once, 3Dmodels were constructed and the volume of each plaster model was measured 10 times by the breast analysis tool (BAT) software. A comparison was conducted with water displacement method, and measurements were repeated 10 times. The breast of six live volunteers was captured six times; from each breast capture, a 3D model was constructed and the volume was measured with BAT software. Breast volume assessment by the water displacement method was repeated six times. RESULTS: In all plaster casts, the discrepancies in volume measurements between 3D imaging and water displacement methods did not exceed 40 cc. The overall mean relative difference was 5%. The differences of the two methods were not significant at p = 0.189, overall mean difference: 11.1 cc and 95% confidence interval (CI) was (-6.732, 28.976). In the live models, the differences in breast volume measurements between the 3D imaging and water displacement methods were significant at p ≤ 0.017, overall mean difference: 207.05 cc and 95% CI (56.12, 357.98). Measurements by 3D imaging were consistently smaller. In the live models, 3D imaging overall was a more reproducible method for measuring breast volume than the water displacement method with a standard deviation of 36 units cc(-1) and 62.6 units cc(-1), respectively. CONCLUSIONS: The 3D breast imaging system using multiple stereo cameras was accurate for measuring the volumes of breast-shaped plaster models, and it was more reproducible than the water displacement method in live models. 3D imaging is a reliable method for the comparative assessment of breast volume.

Facial symmetry in unilateral cleft lip and palate following alar base augmentation with bone graft: a three-dimensional assessment.

OBJECTIVE: The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry. DESIGN: This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry. PATIENTS: This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented. RESULTS: Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p=0.005). CONCLUSIONS: 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.

Dorsal urethral fistula: case report and review of literature.

Urethral fistula is a rare, but recognized, entity. We report the case of a young diabetic patient who developed urethral fistula on the dorsum of penis after debridement for necrotizing fasciitis. This cause and location for urethral fistula is extremely rare, and we were unable to find a similar case in published studies. A brief literature search for various causes of urethral fistula was made, and the likely mechanisms for the cause of the fistula were explored.

Three-dimensional facial characteristics of Caucasian infants without cleft and correlation with body measurements.

OBJECTIVE: The aim of this study was to characterize the soft tissue facial features of infants without cleft and to report on the correlation between these with weight, length, and head circumference. DESIGN: This was a prospective study using a noninvasive three-dimensional (3D) stereophotogrammetry (C3D) system to capture the images of the participants. Landmarks were identified on the 3D facial images. Means and SDs were derived for facial distances and angles. A facial asymmetry score was calculated for each image. Two sample Student's t tests, Pearson's correlation coefficients and analysis of covariance were used to ascertain any gender differences and determine whether these could be explained by weight differences. PARTICIPANTS: Eighty-three infants, 41 boys and 42 girls, were captured at rest with their lips apart, at approximately 3 months of age. RESULTS: Significant sex differences, of 1 to 2 mm, were found in several facial dimensions, such as face height and nose width. The larger facial measurements correlated significantly with body measurements. Analysis of variance confirmed these differences could be explained by differences in weight. There were no sex differences in the nose/mouth width ratios or in any of the angles measured, suggesting that there may be little sex difference in shape. A slight degree of asymmetry in the faces of infants without cleft was detected. CONCLUSIONS: Comparisons between noncleft controls and infants with cleft should take cognizance of normal age and sex variations in height and weight that occur among infants.