Forensic age assessment of living adolescents and young adults at the Institute of Legal Medicine, Münster, from 2009 to 2018.

Due to high migration inflows to Europe, forensic age assessment of living persons has clearly gained importance. If there is a legal justification for X-ray examinations without a medical indication, the Study Group on Forensic Age Diagnostics (AGFAD) recommends the combination of a physical examination with anamnesis, an X-ray examination of the hand and a dental examination with evaluation of an orthopantomogram for age assessments of adolescents and young adults. If the development of the hand skeleton has been completed, an additional CT examination of the clavicles is to be performed. To demonstrate the outcome of forensic age assessments according to AGFAD recommendations with regard to migrants of doubtful minority declaration, this study analyzes the expert reports carried out at the Institute of Legal Medicine, Münster, from 2009 to 2018. A total of 597 age assessments were performed during the study period. A total of 227 age assessments were issued on behalf of youth welfare offices in the legal area of social law, 282 in family law proceedings, 76 in criminal proceedings, and 12 age assessments in immigration law proceedings. In 211 out of 597 cases, the stated age was compatible with the findings of the age assessment. In the remaining 386 cases, the average difference between the stated age and the minimum age was 1.9 years. The average difference between stated age and most probable age was 5.1 years. Of the 521 age assessments carried out outside criminal proceedings, 197 unaccompanied minors with questionable age minority (37.8%) have reached the age of majority beyond doubt. A total of 388 unaccompanied minors (74.5%) have most probably reached the age of majority. Forensic age assessments with the AGFAD methodology make an important contribution to legal certainty, the welfare of the child, and the fair distribution of resources.

Evolución hacia la era digital de la cirugía ortognática: experiencia en un centro universitario / Evolution towards the digital era of orthognatic surgery: experience in a university center

Resumen Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la cefalometría 3D. Materiales y Método: Se realizó una revisión retrospectiva de pacientes operados de cirugía ortognática durante el período enero de 2011 a agosto de 2018. Se registraron datos demográficos, quirúrgicos, tipo de planificación quirúrgica, complicaciones y resultados a largo plazo. Resultados: 21 pacientes requirieron cirugías ortognáticas. Se realizaron 16 cirugías bimaxilares (76%), 3 cirugías de avance maxilar superior (14%) y 2 cirugías de osteotomía sagital de rama (10%). Las principales etiologías fueron: 67% maloclusión clase III (n = 14), 28% maloclusión clase II (n = 6) y 5% desviación mandibular (n = 1). La planificación prequirúrgica virtual fue utilizada en 11 pacientes (52%). La tasa de complicaciones Clavien-Dindo > III fue 4,8% (n = 1). Conclusiones: En nuestra experiencia, las técnicas de cirugía ortognática son seguras. Las complicaciones de la serie fueron escasas y bien toleradas por los pacientes. Durante los últimos años y, de acuerdo a los avances tecnológicos, la incorporación de la planificación quirúrgica virtual 3D favoreció el desarrollo de la cirugía ortognática en nuestro centro.

Introduction: Technological advances have been incorporated into cranio-maxillo-facial surgery changing the clinical practice of surgeons. Aim: The aim of this article is to describe our experience in orthognatic surgery in the last 9-years, with the incorporation of 3D cephalometry. Materials and Method: A retrospective chart review was performed from January 2011 to August 2018 on patients undergoing Orthognatic Surgery. Demographic and surgical data, type of surgical planning, complications and long-term results were recorded. Results: A total of 21 patients underwent orthognatic surgery. Average age was 28 years (DE 8.1), 11 men (52.3%) and 10 women (47.61%). The principal surgeries performed were: 16 (76%) bimaxillary, 3 maxillary advancement surgery 3 (14%) and bilateral sagital split osteotomy 2 (10%). Ethiologies were: 14 patients (this 67%) with malocclusion class III, 6 patients (28%) with malocussion class II, and 1 patient (5%) with mandibular deviation. Virtual 3D presurgical planning was used in 11 patients (52%). The total of complications Clavien-Dindo > III was 4.8% (n = 1). None patient required reoperation. Satisfaction rate with the procedure was high. Conclusions: Based on our experience, orthognatic surgery techniques are safe. The complication rate was lower and well tolerated by patients. The introduction of virtual planning provided a better scenario to develop maxillo-facial surgery.

On the constancy in composition of polystyrene and polymethylmethacrylate plastics.

Variations in the atomic composition, and mass and electron densities of polystyrene and polymethylmethacrylate (PMM) plastics were assessed from experimentally determined mass attenuation coefficients for 125I and 137Cs gamma rays. The means and standard deviations in the mass densities of 16 samples of PMM and 10 samples of polystyrene were found to be 1.174 +/- 1.4% and 1.042 +/- 0.6% g/cm3, respectively. Based upon transmission measurements on various solutions of ethyl alcohol in water, the standard deviations in the effective atomic numbers of PMM and polystyrene were determined to be 0.77% and 1.3%, respectively. Based upon experimentally determined mass attenuation coefficients for 137Cs, the standard deviations in electron density for PMM and polystyrene were 0.5% and 1.2% respectively. Similar measurements on tap water and two grades of distilled water failed to detect any differences in atomic composition.

Test objects for MRI quality assurance based on polymer gels.

Radiation-sensitive polymer gels have been adapted for making test objects that can be used to assess the imaging characteristics of magnetic resonance imaging (MRI) systems. The polymer gels contain acrylic monomers within a gel matrix, and when irradiated with x rays the constituents polymerize to produce highly cross-linked microparticles that dramatically affect water NMR relaxation rates where they form. The size of these effects depends on the radiation dose and composition of the mixture irradiated, while the spatial pattern of relaxation time changes can be precisely controlled by spatial modulation of the x-ray exposure. This permits the manufacture of complex test patterns free of susceptibility or edge effects, and overall image performance can be assessed by constructing contrast-detail diagrams using a singly irradiated gel containing areas of different sizes and contrasts. Polymer gels are stable and a variety of different tests objects can be constructed inexpensively. Such materials and test phantoms may find widespread application in diagnostic MRI quality assurance and testing programs.

Radiation therapy dosimetry using magnetic resonance imaging of polymer gels.

Further progress in the development of polymer gel dosimetry using MRI is reported, together with examples of its application to verify treatment plans for stereotactic radiosurgery and high dose rate brachytherapy. The dose distribution image produced in the tissue-equivalent gel by radiation-induced polymerization, and encoded in the spatial distribution of the NMR transverse relaxation rates (R2) of the water protons in the gel, is permanent. Maps of R2 are constructed from magnetic resonance imaging data and serve as a template for dose maps, which can be used to verify complex dose distributions from external sources or brachytherapy applicators. The integrating, three-dimensional, tissue-equivalent characteristics of polymer gels make it possible to obtain dose distributions not readily measured by conventional methods. An improved gel formulation (BANG-2) has a linear dose response that is independent of energy and dose rate for the situations studied to date. There is excellent agreement between the dose distributions predicted using treatment planning calculations and those measured using the gel method, and the clinical practical utility of MRI-based polymer gel dosimetry is thereby demonstrated.

The thermal defect of A-150 plastic and graphite for low-energy protons.

The thermal defects of A-150 plastic and graphite referenced to aluminium were determined for 800 keV protons scattered by a 2 micron nickel foil (mean transmitted energy = 550 keV). Composite cores of Al/A-150, graphite/A-150 and Al/graphite which could be irradiated from one side or the other were employed. The temperature increase of a core caused by 30-100 s of irradiation (3-6 nA of proton beam current) was detected by two thermistors mounted in opposite legs of a Wheatstone bridge. The thermal defect of A-150 plastic was determined to be 0.0421 +/- 0.0036 (SE) referenced to aluminium and 0.0402 +/- 0.0034 referenced to graphite. The thermal defect of graphite referenced to aluminium is 0.0043 +/- 0.0034. No change in the thermal defect of A-150 plastic was detected for accumulated doses up to 8 x 10(5) Gy.

Radiation dose distributions in three dimensions from tomographic optical density scanning of polymer gels: I. Development of an optical scanner.

A new method of dosimetry of ionizing radiations has been developed that makes use of tissue-equivalent polymer gels which are capable of recording three-dimensional dose distributions. The dosimetric data stored within the gels are measured using optical tomographic densitometry. The dose-response mechanism relies on the production of light scattering microparticles which result from the polymerization of acrylic comonomers dispersed in the gel. The attenuation of a collimated light beam caused by scattering in the irradiated optically turbid medium is directly related to the radiation dose over the range 0-10 Gy. An optical scanner has been developed which incorporates an He-Ne laser, photodiode detectors, and a rotating gel platform. Using mirrors mounted on a translating stage, the laser beam scans across the gel between each incremental rotation of the platform. Using the set of optical density projections obtained, a cross sectional image of the radiation field is then reconstructed. Doses in the range 0-10 Gy can be measured to better than 5% accuracy with a spatial resolution approximately 2 mm using the current prototype scanner. This method can be used for the determination of three-dimensional dose distributions in irradiated gels, including measurements of the complex distributions produced by multi-leaf collimators, dynamic wedge and stereotactic treatments, and for quality assurance procedures.

Magnetic resonance imaging of radiation dose distributions using a polymer-gel dosimeter.

A new formulation of a tissue-equivalent polymer-gel dosimeter for the measurement of three-dimensional dose distributions of ionizing radiation has been developed. It is composed of aqueous gelatin infused with acrylamide and N, N'-methylene-bisacrylamide monomers, and made hypoxic by nitrogen saturation. Irradiation of the gel, referred to as BANG, causes localized polymerization of the monomers, which, in turn, reduces the transverse NMR relaxation times of water protons. The dose dependence of the NMR transverse relaxation rate, R2, is reproducible (less than 2% variation) and is linear up to about 8 Gy, with a slope of 0.25 s(-1)Gy(-1) at 1.5 T. Magnetic resonance imaging may be used to obtain accurate three-dimensional dose distributions with high spatial resolution. Since the radiation-induced polymers do not diffuse through the gelatin matrix, the dose distributions recorded by BANG gels are stable for long periods of time, and may be used to measure low-activity radioactive sources. Since the light-scattering properties of the polymerized regions are different from those of the clear, non-irradiated regions, the dose distributions are visible, and their optical densities are dependent on dose.

NMR relaxation enhancement in gels polymerized and cross-linked by ionizing radiation: a new approach to 3D dosimetry by MRI.

A new type of tissue-equivalent medium for magnetic resonance imaging of the dose distributions produced by ionizing radiation has been developed. Agarose gel is infused with acrylamide and N,N'-methylene-bis-acrylamide (Bis) comonomers, which are readily polymerized by free radical initiators in de-aerated aqueous solutions. Polymerization and cross-linking induced locally by free radical products of water radiolysis increase the rate of water proton spin relaxation gradually up to doses of about 15 Gy. The slopes of the dose-response curves at 64 MHz are 0.015 and 0.28 s-1 Gy-1 for R1 and R2, respectively. The agarose matrix as well as the high (50% by weight) relative concentration of the cross-linker (Bis) per total comonomer limit the spread of polymerization so that the spatial distribution of the radiation dose is faithfully represented in the resultant spatial distribution of relaxation rates. The gel can be imaged with conventional magnetic resonance imaging devices with high spatial resolution and accuracy. In addition, due to the well established effect of the precipitation of insoluble agglomerates of highly cross-linked acrylamide, the optical turbidity of the gel increases gradually with the absorbed dose. This may provide an additional means of visualizing the dose distribution in three dimensions. The major advantage of the acrylamide-Bis-agarose gels over those that depend on ionic chemical dosimeters, for example, Fricke-infused gels, lies in the lack of diffusion of radiation-induced chemical changes subsequent to or concurrent with irradiation.

[Percutaneous vertebroplasty]. / Perkutane Vertebroplastie.

PURPOSE: To describe the procedure of percutaneous vertebroplasty and to present our first clinical results of patients treated for benign or malignant painful vertebral body disease. MATERIAL AND METHODS: We performed percutaneous vertebroplasty in 31 painful lesions of the spine. Liquid bone cement was injected into the affected vertebral body using fluoroscopic guidance through a bilateral transpedicular approach. Etiology of the bone disease was assessed by biopsy. Pain intensity was assessed before and 1 week after the procedure by standardized catalogue. RESULTS: Percutaneous vertebroplasty was performed in 17 thoracic and in 14 lumbar spine bodies of benign (n = 23) or malignant (n = 8) disease; no clinically relevant complications occurred. All patients reported significant pain relief 1 week after the intervention. One week after treatment, patients were pain-free in 15/31 vertebral bodies, and reported mild residual pain not necessitating narcotic medication in 16/31 cases. CONCLUSION: In accordance with the literature, percutaneous vertebroplasty proved to be a highly effective, minimal invasive interventional procedure to treat severely painful bone lesions of benign and malignant origin.

Gluteoplastía de aumento con implantes de silicona con técnica XYZ: serie de casos / Augmentation gluteoplasty with silicone implants with XYZ technique

Resumen Objetivo: Describir las características clínicas, demográficas, resultados y complicaciones de una serie de pacientes operados de aumento de glúteo con implantes de silicona por medio de la técnica XYZ. Materiales y Método: Serie de casos retrospectiva de pacientes sometidos a gluteoplastía de aumento con implantes de silicona por medio de técnica intramuscular. Se describe la técnica quirúrgica, datos demográficos, antecedentes médico quirúrgicos y complicaciones posoperatorias. Resultados: Entre diciembre de 2014 y junio de 2017 se operaron 19 pacientes. La complicación más frecuente fue dehiscencia de herida operatoria, presentándose en 5 pacientes. Un paciente tuvo hematoma posoperatorio. Dos pacientes tuvieron seroma posoperatorio. Una paciente presentó rotación de un implante. Una paciente se perdió de seguimiento luego del control de retiro de puntos a la 6a semana. Una paciente necesitó reinternación para manejo del dolor. Ningún paciente necesitó reoperación. Ningún paciente presentó infección de herida operatoria. Ningún paciente presentó extrusión ni pérdida de implantes. Discusión: La técnica XYZ es un método efectivo para el tratamiento estético y reconstructivo de la región glútea especialmente en pacientes que no presentan zona dadora suficiente para injerto graso. Las complicaciones descritas son acordes a la literatura, por lo que se recomienda la técnica de gluteoplastía de aumento con prótesis de silicona intramuscular como una técnica reproducible y segura.

Objective: Describing the clinical features, demographics features, outcomes and complications from a serie of patients underwent buttock augmentation with silicone implants with XYZ technique. Material and Methods: Retrospective case series of patients underwent buttock augmentation with intramuscular technique. It Is described the surgical technique, demographics data, comorbidities and post operative complications. Results: Since December 2014 to June 2017 were operated 19 patients. The most frecuent complication was wound dehiscence, it was present in 5 patients. One patient had a postoperative hematoma. Two patients presented seroma. One patient presented implant rotation. One patient left controls after removal the suture in the sixth week. None of patients needed revisional procedures. None of patients presented wound infection. None of patients presented extrusión or implant removal. Discussion: The XYZ technique is a efective method to aesthetic and reconstructive treatment of buttock area, especially in patientes without a suficient donor area to fat graft. The complications described are accord with literatura, that is why buttock augmentation with intramuscular silicone implant is recomended as a reproducible and safe technique.

Dental age estimation based on third molar eruption in First Nation people of Canada.

Forensic age estimation of living subjects has become an increasing focus of interest in modern society. One main criterion for dental age estimation in the relevant age group is the evaluation of third molar eruption. The importance of ethnic variation in dental development requires population specific data for dental age evaluation. In the present study, we determined the stages of third molar eruption in 347 female and 258 male First Nations people of Canada aged 11 to 29 years based on radiological evidence from 605 conventional orthopantomograms. The results presented here provide data on the age of alveolar, gingival, and complete eruption of the third molars in the occlusal plane that can be used for forensic estimation of the minimum and most probable ages of investigated individuals.

Hiperplasia de cóndilo mandibular: reporte de doce casos / Hyperplasia of the mandibular condyle: considerations in a series of 12 patients

Introducción: La hiperplasia condilar (HC) se define como un crecimiento patológico no neoplásico que afecta tanto al tamaño como a la morfología del cóndilo mandibular. Objetivo: Evaluar la eficacia y riesgos del tratamiento quirúrgico de la HC. Material y método: Estudio descriptivo, serie de casos. Se incluyó a todos los pacientes con diagnóstico de HC tratados en el Hospital Clínico de la Pontificia Universidad Católica de Chile entre enero de 2010 y febrero de 2014. Resultados: Doce pacientes fueron operados en nuestra institución por HC. El promedio de edad fue 19,3 ± 3,4 años. La forma de presentación más frecuente fue presencia de asimetría facial. Todos los pacientes fueron estudiados con SPECT que evidenció diferencia de captación mayor a 50% ± 3,1% entre ambos cóndilos. Todos los pacientes fueron tratados con condilectomía mandibular alta del lado afectado y en 3 casos, se realizó además cirugía ortognática en el mismo tiempo para corrección de maloclusión dental. La mediana de seguimiento fue de meses 16 (5 a 54 meses). En todos los pacientes se evidenció una mejora en la oclusión dental y simetría facial, con desaparición de la disfunción articular previa. Conclusiones: La HC es una entidad de poca frecuencia. La cirugía es eficaz y segura para el tratamiento de la HC.

Introduction: Condylar hiperplasia is defined as a pathological non neoplastic growth which compromises both size and shape of the mandibular condyle and is characterized by progressive facial asymmetry. Aim: To evaluate the efficacy and risks of surgical treatment of HC. Material and method: Descriptive study, cohort of cases. All patients between 2010 and February 2014 with diagnosis of condylar hyperplasia at Hospital Clínico P. Universidad Católica de Chile were included. Results: Twelve patients were operated at our institution because of condylar hyperplasia. Age average was 19.3 ± 3.4 years. The most frequent presentation was facial asymmetry. All patients were studied with single photon emission computed tomography (SPECT) with differential intake more than 50 ± 3.1% between both condyles. All patients were treated with mandibular condylectomy of the affected site and in 3 cases orthognatic surgery was performed at the same time of the condylectomy to correct dental malocclusion. Average follow up was 16 months (5 to 54 months). All patients recovered facial symmetry and occlusion with absence of the previous joint dysfunction. Conclusions: Condylar hyperplasia is an unfrequent condition and surgery is efficient and safe for the treatment of the deformity.

Studies of the chronological course of wisdom tooth eruption in a German population.

Forensic age estimation in living subjects has gained increasing significance in recent years. In dental age estimation, tooth eruption is a parameter of developmental morphology that can be analyzed by either clinical examination or by evaluation of dental X-rays. In the present study, we determined the stage of wisdom tooth eruption in 144 male and 522 female German subjects aged 12-26 years based on radiological evidence from 666 conventional orthopantomograms. The results presented here provide useful data on the age of alveolar, gingival, and complete emergence of the third molars in the occlusal plane that can be utilized for the forensic estimation of the minimum and most probable ages of individuals under investigation.

Studies of the chronological course of wisdom tooth eruption in a Japanese population.

The importance of forensic age estimation in living subjects has grown over the last few years. In dental age estimation, tooth eruption is a parameter of developmental morphology that can be analyzed by either clinical examination or by evaluation of dental X-rays. In the present study, we determined the stage of wisdom tooth eruption in 549 male and 751 female Japanese subjects aged 14-26 years based on radiological evidence from 1300 conventional orthopantomograms. The results presented here provide useful data on the age of alveolar, gingival, and complete emergence of the third molars in the occlusal plane that can be utilized for forensic estimation of the minimum and most probable ages of investigated persons.

Comparative study on the effect of ethnicity on wisdom tooth eruption.

The current knowledge base for evaluating the influence of ethnic origin on wisdom tooth eruption is still inadequate. We therefore analyzed and compared the chronology of wisdom tooth eruption in three ethnic populations-German, Japanese, and black South African-based on evidence from 2,482 conventional orthopantomograms. The investigated German population ranked in the middle in terms of the age of wisdom tooth eruption. The black South African population was the fastest and the Japanese population the slowest in terms of reaching the respective eruption stages. Population-specific reference data should be used when evaluating wisdom tooth eruption for the purpose of forensic age estimation.