Prespecialist perceptions of three-dimensional heart models in anatomical education.

PURPOSE: This article aims to discuss the use of three-dimensional (3D) printed models of vascular variation cases as an educational tool for undergraduate and postgraduate anatomy students. METHODS: This advanced study involved ten anatomy assistants who were provided with five distinct cases of congenital cardiovascular variations, each accompanied by a computed tomography angiography (CT-A) and 1:1 solid model format. The residents were asked to generate perceptions for both formats and then compare these perceptions based on identifying the variation, defining the structural features, and evaluating relevant educational perspectives. RESULTS: The vascular origin measurement values compared to the statistically evaluated real values of the related cases showed that models were 1:1 identical copies. Qualitative assessment feedback from five stations supported the usefulness of 3D models as educational tools for organ anatomy, simulation of variational structures, and overall medical education and anatomy training. Models showcasing different anatomical variations such as aortic arch with Type 2 pattern, a right-sided aortic arch with Type 2 pattern, an aberrant right subclavian artery, arteria lusoria in thorax, and a left coronary artery originating from pulmonary trunk in an Alcapa type pattern allow for better analysis due to their complex anatomies, thus optimizing the study of variation-specific anatomy. The perception level in the 3D model contained higher points in all of the nine parameters, namely identification of cardiovascular variations, defining the vessel with anomaly, aortic arch branch count and appearance order, feasibility of using it in peers and student education. 3D models received a score 9.1 points, while CT-A images were rated at 4.8 out of 10. CONCLUSION: 3D printed anatomical models of variational cardiovascular anatomy serve as essential components of anatomy training and postgraduate clinical perception by granting demonstrative feedback and a superior comprehension of the visuospatial relationship between the anatomical structures.

Variations of the extracranial segment of vertebral artery as a bleeding risk factor.

BACKGROUND: Standart interventional procedures such as screw instrumentation, aortic arch endovascular surgery and cervical nerve blockade may be of fatal risk due to anatomic reason of variations in the proximal part of the vertebral artery (VA). The aim of this study is to study the VA variations of the extracranial segments to evaluate the frequency of the incident to demonstrate the importance of clinical condition strategy. METHODS: The prevalence of variations and morphometric measurements of the VA in three-dimensional computed tomographic angiography (3D-CTA) scans were studied. Total 400 VA was investigated for the aortic arch origin of the VA, diameter of the VA, its level of entry into the transverse foramen, the dominance sides, and related basilar artery course. RESULTS: 3D-CTA radiographs of 200 Anatolian patients (120 men and 80 women with age range 17-90 years). In most cases (approximately 94%), both sides of VA were the first branch of subclavian artery. While all the right VAs was branched from the subclavian artery, 6% of the left VAs were branched from the aortic arch. 2/3 of them originated from the proximal of the subclavian artery and 1/3 from the distal. The VA which were originating from the proximal of the classical anatomic pattern tended to enter the transverse foramen more distally than C6 level. VAs with a different level of entry than C6 are left-sided and aortic arch originated (out of 8 cases 3 had a level of entry at C5 and 2 at C4). The outer diameter ranges of the prevertebral part of the VA of subclavian origin and left VA of aortic arch origin were 3.2-3.6 mm and 3.2-3.6 mm, respectively. While the diameters of the right and left VAs were almost the same in approximately 20% cases, the left VA was dominant in up to 60% of cases. A significant relationship was found between the side of the dominant VA and in the course of the basilar artery. CONCLUSIONS: The relationship between the dominant side of VA and the course of the basilar artery of its own vessel has never been reported elsewhere. Such anatomical variations, routine preoperative 3D-CTA evaluation is mandatory to prevent the VA injury when C5-C2 instrumentation, anterior cervical decompression, cervical nerve blockade and aortic arch surgery are planned.

Perceptions of porta-celiac vascular models for hepatic surgery and their use in residency training.

BACKGROUND: Primary aspect of hepatic navigation surgery is the identification of source vascular details to preserve healthy liver which has a vascular anatomy quite challenging for the young surgeons. The purpose was to determine whether three-dimensional (3D) vascular pattern models of preoperative computed tomography (CT) images will assist resident-level trainees for hepatic surgery. METHODS: This study was based on the perception of residents who were presented with 5 different hepatic source vascular patterns and required to compare their perception level of CT, and 1:1 models in terms of importance of variability, differential of patterns and preoperative planning. RESULTS: All residents agree that models provided better understanding of vascular source and improved preplanning. Five stations provided qualitative assessment with results showing the usefulness of porta-celiac models when used as anatomical tools in preplanning (p = 0.04), simulation of interventional procedures (p = 0.02), surgical education (p = 0.01). None of the cases had scored less than 8.5. Responses related to understanding variations were significantly higher in the perception of the 3D model in all cases, furthermore 3D models were more useful for seniors in more complex cases 3 and 5. Some open-ended answers: "The 3D model can completely change the operation plan" One of the major factors for anatomical resection of liver transplantation is the positional relationship between the hepatic arteries and the portal veins. CONCLUSION: The plastic-like material presenting the hepatic vascularity enables the visualization of the origin, pattern, shape, and angle of the branches with appropriate spatial perception thus making it well-structured.

3D Brain Imaging in Vascular Segmentation of Cerebral Venous Sinuses.

The three-dimensional (3D) visualization of dural venous sinuses (DVS) networks is desired by surgical trainers to create a clear mental picture of the neuroanatomical orientation of the complex cerebral anatomy. Our purpose is to document those identified during routine 3D venography created through 3D models using two-dimensional axial images for teaching and learning neuroanatomy. Anatomical data were segmented and extracted from imaging of the DVS of healthy people. The digital data of the extracted anatomical surfaces was then edited and smoothed, resulting in a set of digital 3D models of the superior sagittal, inferior sagittal, transverse, and sigmoid, rectus sinuses, and internal jugular veins. A combination of 3D printing technology and casting processes led to the creation of realistic neuroanatomical models that include high-fidelity reproductions of the neuroanatomical features of DVS. The life-size DVS training models were provided good detail and representation of the spatial distances. Geometrical details between the neighboring of DVS could be easily manipulated and explored from different angles. A graspable, patient-specific, 3D-printed model of DVS geometry could provide an improved understanding of the complex brain anatomy. These models have various benefits such as the ability to adjust properties, to convert two-dimension images of the patient into three-dimension images, to have different color options, and to be economical. Neuroanatomy experts can model such as the reliability and validity of the designed models, enhance patient satisfaction with improved clinical examination, and demonstrate clinical interventions by simulation; thus, they teach neuroanatomy training with effective teaching styles.

Building Three-Dimensional Intracranial Aneurysm Models from 3D-TOF MRA: a Validation Study.

To create realistic three-dimensional (3D) vascular models from 3D time-of-flight magnetic resonance angiography (3D-TOF MRA) of an intracranial aneurysm (IA). Thirty-two IAs in 31 patients were printed using 3D-TOF MRA source images from polylactic acid (PLA) raw material. Two observers measured the maximum IA diameter at the longest width twice separately. A total mean of four measurements as well as each observer's individual average MRA lengths were calculated. After printing, 3D-printed anatomic models (PAM) underwent computed tomography (CT) acquisition and each observer measured them using the same algorithm as applied to MRA. Inter- and intra-observer consistency for the MRA and CT measurements were analyzed using the intraclass correlation coefficient (ICC) and a Bland-Altman plot. The mean maximum aneurysm diameter obtained from four MRA evaluations was 8.49 mm, whereas it was 8.83 mm according to the CT 3D PAM measurement. The Wilcoxon test revealed slightly larger mean CT 3D PAM diameters than the MRA measurements. The Spearman's correlation test yielded a positive correlation between MRA and CT lengths of 3D PAMs. Inter and intra-observer consistency were high in consecutive MRA and CT measurements. According to Bland-Altman analyses, the aneurysmal dimensions obtained from CT were higher for observer 1 and observer 2 (a mean of 0.32 mm and 0.35 mm, respectively) compared to the MRA measurements. CT dimensions were slightly overestimated compared to MRA measurements of the created models. We believe the discrepancy may be related to the Laplacian algorithm applied for surface smoothing and the high slice thickness selection that was used. However, ICC provided high consistency and reproducibility in our cohort. Therefore, it is technically possible to produce 3D intracranial aneurysm models from 3D-TOF MRA images.

Physical attractiveness: analysis of buttocks patterns for planning body contouring treatment.

BACKGROUND: As buttocks region is one of the most characteristic features of the ideal female body figure, the popularity of gluteal region contouring is on the rise. Perception of body form is influenced by its shape and size. Interventions to modify the form of this region are often difficult due to influence. The aim of this study is to investigate the attractiveness of various buttock shapes with the aid of a dedicated software. METHODS: Standard personal photographs of the lower body were obtained from 200 healthy volunteers. Linear analyses were made and anatomical perception was calculated according to reference points. RESULTS: Compared to males, all measurements concerning buttock dimensions were a significantly greater in females. Proportional assessments revealed that in females, the most attractive buttock waist-to-hip ratio was 0.75 from the posterior view. This ratio was 0.85 in males. From the lateral view, the most attractive buttocks have a waist-to-hip ratio of 0.70 in females. Positioning of the lateral prominence at the inferior gluteal fold was rated by 25% of the respondents as the most attractive in males from the posterior view. From the lateral view, the most prominent portion positioned at the midpoint (a 50:50 vertical ratio) was considered the most attractive for females. CONCLUSIONS: These results suggest that utilizing digitalized reference values for a given body region may be an invaluable tool for determination of the correct fat volume, thus individualization of body contouring procedures. With the help of certain software, this research has shown that it is possible to measure the parameters of buttock, which may in turn be used to offer the best solution for any individual in quest for an improved buttocks form. New ideal waist-to-hip ratios of 0.7 update the previous standards.

Anatomical landmarks of mandibular interforaminal region related to dental implant placement with 3D CBCT: comparison between edentulous and dental mandibles.

BACKGROUND: Anterior mandibular (interforaminal) region is important in implant applications as it serves a basis for neurovascular bedding and holds the prosthesis for patients. Treatment planning for dental implant patients is often complicated by the unknown extent of the anterior loop of the neurovascular bundle. Anatomical structures including mandibular incisive canal (MIC) and lingual foramen (LF) should also be examined as part of the detailed analysis for their neurovascular structures. This study aimed to detect the positions of LF and MIC as well as the prolongation of interforaminal region in Anatolian population to supply the reference data of the surgical safe zone in chin for the clinicians. MATERIALS AND METHODS: Mandibles of 70 adult specimens (35 edentulous + 35 dentate) were retrieved from the Department of Anatomy, Ege University. Images of the dry mandibles were obtained using a cone beam computed tomography unit applying a standardized exposure protocol. Afterwards, mandibles were sawn into vertical sections according to the respective tomographic cross-sections. Images were evaluated for the absence/presence of the MIC, its dimensions and antero-posterior length for both edentulous and dentate groups. In addition; the presence, number, location, labial canal and LF diameter and height of the LF were determined for both groups. RESULTS: The MIC was observed in 80 and 68.6% of the dentate and edentulous groups, consecutively (p > 0.05). The MIC continued towards the incisor region in a slightly downward direction. The LF was observed in all dentate mandibles (100%), while it was present in 94.3% of the edentulous mandibles (p > 0.05). For the dentate group, 62.9% of the specimens had two foramens and 20% had three foramens in the mandibular midline. Mean length of the MIC in dentate groups and edentulous groups was measured as 2.55 ± 0.809 and 3.08 ± 1.745 mm, respectively. Well-defined MIC mean diameter in dentate groups and edentulous groups were measured as 2.44 ± 0.702 and 2.35 ± 0.652 mm, respectively. Significant difference was found between dentate and edentulous group in most of the parameters except for the LF and the diameter of the MIC (p > 0.05). The correlation between observers' measurements ranged between 0.742 and 0.993 for all anatomical landmarks and mandible groups. CONCLUSION: The MIC and LF are associated with neurovascular bundle variations in number, location and size. Therefore, clinicians should determine each of these anatomical structures on a case-by-case basis to recognize their presence and to take measures for the possible implications of various treatment options. These guidelines included leaving a 2 mm safety zone between an implant and the coronal aspect of the neurovascular bundle. To avoid neurovascular injury during surgery in the interforaminal area, guidelines were developed with respect to validating the presence of an anterior loop of the neurovascular bundle.

Building 3D anatomical model of coiling of the internal carotid artery derived from CT angiographic data.

The purpose of this study is to recreate live patient arterial anomalies using new recent application of three-dimensional (3D) printed anatomical models. Another purpose of building such models is to evaluate the effectiveness of angiographic data. With the help of the DICOM files from computed tomographic angiography (CT-A), we were able to build a printed model of variant course of the internal carotid artery (ICA). Images of coiling of the ICA taken by CT-A, were then converted into 3D images using Google SketchUp free software, and the images were saved in stereolithography format. Imaging helped us conduct the examination in details with reference to geometrical features of ICA, degree of curve, its extension, location and presence of loop. Challenging vascular anatomy was exposed with models of adverse curve of carotid anatomy, including highly angulated necks, conical necks, short necks, tortuous carotid arteries, and narrowed carotid lumens. It assisted us to comprehend spatial anatomy configuration of life-like models. 3D model can be very effective in cases when anatomical difficulties are detected through the CT-A, and therefore, a tactile approach is demanded preoperatively. 3D life-like models serve as an essential office-based tool in vascular surgery as they assist surgeons in preoperative planning, develop intraoperative guidance, teach both the patients and the surgical trainees, and simulate to show patient-specific procedures in medical field.

Web-based teaching video packages on anatomical education.

BACKGROUND: The aim of this study was to study the effect of web-based teaching video packages on medical students' satisfaction during gross anatomy education. The objective was to test the hypothesis that individual preference, which can be related to learning style, influences individual utilization of the video packages developed specifically for the undergraduate medical curriculum. METHODS: Web-based teaching video packages consisting of Closed Circuit Audiovisual System and Distance Education of Anatomy were prepared. 54 informative application videos each lasting an average 12 min, competent with learning objectives have been prepared. 300 young adults of the medical school on applied anatomy education were evaluated in terms of their course content, exam performance and perceptions. A survey was conducted to determine the difference between the students who did not use teaching packages with those who used it during or after the lecture. RESULTS: A mean of 150 hits for each student per year was indicated. Academic performance of anatomy has been an increase of 10 points. Positive effects of the video packages on anatomy education have manifested on the survey conducted on students. The survey was compiled under twenty different items including effectiveness, providing education opportunity and affecting learning positively. Additionally, the difference was remarkable that the positive ideas of the second year students on learning were statistically significant from that of the third year students. CONCLUSION: Web-based video packages are helpful, definitive, easily accessible and affordable which enable students with different pace of learning to reach information simultaneously in equal conditions and increase the learning activity in crowded group lectures in cadaver labs. We conclude that personality/learning preferences of individual students influence their use of video packages in the medical curriculum.

Computer-guided technique evaluation of the bony palate for planning individual implant placement.

OBJECTIVE: Different clinical problems may require a surgical approach to the dental arch, such as dentofacial orthopedics, implant-supported dental prothesis, maxillary orthodontics protraction, removable appliances, and posttraumatic dental reconstruction. The aim of this study is to analyze the dental arch size and type for supporting individual dental protheses. MATERIALS AND METHODS: In this study, the reference measurements on the length of the bony palate, maxillary intercanine width, maxillary intermolar width, and the ratio of the maxillary to the palatinal surface were studied in 120 bony palates using a computer software program. RESULTS: The average length of the bony palate, maxilla, and palatine was measured as 104.4 ± 30.3, 40.05 ± 4.05, and 15.00 ± 3.03 mm, respectively. The right and left sides of average width of intermaxillary distances were measured as 13.75 ± 1.50 and 12.51 ± 1.50 mm, respectively. The average width of intermolar distance was calculated as 19.82 ± 1.61 mm (right side) and 18.89 ± 1.69 mm (left side), respectively. The maxillary dentitions were classified as square (17%), round-square (63.5%), round (14.4%), and round V-shaped arches (5.1%). The round-square ones showed no prominent principal component. Among the maxillary arches, the round arches were characterized by small values and round V-shaped ones with the largest values. Asymmetry between the right and the left bony palate was observed. The areas with equal bony palate on both sides were present in 64.4% of the cases, and in 33.1% of the cases, bony palate was dominant on the right. CONCLUSIONS: The primary principle in reconstructive treatment should be describing geometrical forms and mathematical details of the bony palate. Three-dimensional reference values relative to the dental arch may increase the success of individual treatment of surgical procedures and reduce possible complications. With the help of certain software, this research has made possible to investigate the variability of the dental arch and calculate the variety in measurements and thereby determining the most appropriate implant position, optimizing the implant axis and defining the best surgical and prosthetic solution for the patient.

Study of frontal hairline patterns for natural design and restoration.

OBJECTIVE: Hair loss is one of the most noticeable esthetic problems of the mankind. Hair transplantation has been a highly effective technique in reducing wide foreheads and recontouring the hairline. Creating a natural hairline is one of the most important elements of a successful hair transplant. This study aims at the requirements which are essential in designing hairline morphometrics and natural frontline. METHODS: Standard photographs of the forehead region were obtained from two hundred young Turkish adults participated in this study. The hairline contour was classified into five groups as round, M-shaped, rectangular, bell-shaped and triangular. Measurements of the forehead region, such as the height of the forehead, widths of the forehead and supraorbital region were calculated as reference points. RESULTS: In women, the average height of the forehead was 58.3 ± 6.6 mm, the average width of the forehead and the supraorbital region was 129 ± 14.4 mm and 125.3 ± 13.5 mm, respectively. The incidence of the hairline shapes was seen as; round (28%), M-shaped (19%), rectangular (30%), bell-shaped (5%), or triangular (18%). In men, the average height of the forehead was 61.4 ± 9.7 mm, the average width of the forehead and supraorbital region was 137.1 ± 18 mm and 133.9 ± 15.9 mm, respectively. The hairline contour among young male adults was classified as round in 27%, M-shaped in 46%, rectangular in 31%, bell-shaped in 4% and triangular in 2%. The rectangular and M-shaped hairlines resemble a more masculine appearance, whereas round shaped hairline resembles femininity. CONCLUSION: Ideal reconstruction of scalp defects relies on a comprehensive understanding of scalp anatomy and detailed information of patient factors. The classification of the hairline and measured forehead reference lengths will be beneficial in the correction of wide foreheads. There were significant gender differences in the esthetic rankings of the hairline contour. Compared to women, both of the measured average forehead reference lengths displayed a significantly greater value in men. Our results clearly showed that sex difference affected the predominance of the contour type. The M shape was the most common, and the triangular type was poorly classified in men, whereas the rectangular hairline was the most common type among women.

Computerized analysis of the greater palatine foramen to gain the palatine neurovascular bundle during palatal surgery.

OBJECTIVE: Investigation of the computerized dimensional anatomic location of the greater palatine foramen (GPF) and lesser palatine foramens (LPF) is important indicating site to collect palatal donor tissue, reconstructioning the orofacial area of the oncology patient and applying the greater palatine nerve block anesthesia. The aim of this study is to determine a patient-friendly landmark and to specify the precise location of the GPF in order to standardise certain anatomical marks of safe neurovascular bundle. MATERIALS AND METHODS: 120 bony palates were examined to detect the position of the GPF and the LPF related to adjacent anatomical landmarks using a computer software program. The GPF was assessed regarding the position, the diameter and the distances between each foramen and the midline maxillary suture (MMS), the inner border of alveolar ridge (AR), posterior palatal border (PBB), and incisive foramen (IF). RESULTS: The GPF was identified as single in 81 %, double in 16 %, triple in 2 % and absent in 2 % of the specimens. The mean distances between the GPF and the MSS, the GPF and the AR, the GPF and the PPB, the GPF and the IF were 16, 4, 4, and 40 mm, respectively. In majority of the cases, the GPF was seen between the distal surfaces of the third maxillary molar (78 %). Single LPF was observed in 53.45 % of the skulls, two LPF were observed in 31 % of the skulls bilaterally and five LPF were rare in 2.1 % of the specimens. The LPF was most commonly at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9 %). CONCLUSIONS: This study made possible to investigate the variability of the GPF and the feasibility of the greater palatine neurovascular bundle, and to calculate the lengths of some parameters with the help of certain software. To collect the donor tissue of the neurovascular greater palatine network, each distance among the AR-GPF-PPB were equal to 4 mm. To estimate the possible length of the graft, the incision was made along the third and the second molar to the IF as 4 cm. The data we obtained within this study have been presented to help the surgeons avoid unexpected hemorrhage during the palatinal procedures such as posttraumatic dental reconstruction, maxillofacial tumor resections, palatal micro-implants, and dentofacial orthopedic surgery.

Digitalized analysis of philtral anatomy for planning individual treatment.

OBJECTIVE: Restoration of the philtral region following traumatic, cleft, and tumor surgeries is often difficult due to influence of this feature to whole facial beauty. The aim of this study is to investigate the types and measurements of the philtrum and its relationship with the upper lip using a software. METHODS: Standard personal photographs of the philtral region were obtained from 200 young adults participated in this study. Linear analyses (the lengths of philtral column and dimple; the philtral width) and angular analyses (apex and central angles of Cupid's bow) were measured as reference points. As for the shape of the philtral column, it was categorized as four distinct types: parallel, triangular, concave, and unclear type. RESULTS: The philtral width was 11.37 ± 1.9 mm in males, 10.21 ± 1.80 mm in females. The length of the philtral dimple was 18.16 ± 3.6 mm in males, 18.16 ± 3.6 mm in females. Compared with women, both of the measured average philtral reference lengths displayed a significantly greater value in men. In the meanwhile, compared to women, the angular measurements of Cupid's bow (i.e., the apex and central angle of Cupid's bow) were smaller in men. It was 127.47 ± 12.74° mm in males, 134.1 ± 11.38° mm in females. The triangular and concave types were associated with a substantial fraction in men, whereas the triangular and parallel types were predominant in women. There were significant gender differences in the esthetic rankings of philtral column shapes. CONCLUSIONS: These results suggest digitalized reference values relative to the philtral column which may increase the success of the individual reconstructive treatment of the surgical procedures and reduce possible asymmetrical appearance. With the help of certain software, this research has made possible to investigate the ideal parameters of philtral construction in defining the best surgical solution for the patient.

Relationship of stylohyoid chain and cervical internal carotid artery detected by 3D angiography.

OBJECTIVE: The calcification of the stylohyoid chain (SHC), elongated styloid process (SP), larger SP' angle and its shortened distance of cervical internal carotid artery (CICA) are risk factors for bony compression and the stylocarotid syndrome. METHODS: 3D-CTAs of 125 patients were analyzed in terms of the SP length, its angulations, type of the SHC and relationships of its proximity to the CICA. RESULTS: Elongated SP was observed frequently both in females (47%) and males (55%). The mean distance of the CICA to the SP was calculated as 8.2 ± 3.3 mm. This short distance between the CICA and the SP was observed more frequently in males (28.1%) and females (10.7%). The anterior and medial angulations of the SP were calculated as 71.2 ± 4.3°, and 57.3 ± 9.3°, respectively. In the present study, the SHC was determined as normal SP (54.2%), absence of the SP (1%), duplication of the SP (1%), elongated SP (26%), complete ossification of the SHC (1%), segmentation of the SHC (9%), fracture of ossification of the SHC (1.6%) and pseudo articulations of the SHC (5.6%). CONCLUSION: 3D-CTA was the most appropriate radiological investigation analyzing and measuring SHC (elongated, larger angle, shorter distances with CICA) and identifying types (duplicated, segmented, complete and fractured) resulting from pressures on the CICA. Our study also revealed the pressure on the artery not only arose from the tip of the SP but could also result from types stretching over the artery wall. In those specimens, there is a higher probability of formation of the stylocarotid syndrome due to the long-term pressure on the sympathetic chain around the CICA.

Creating vascular models by postprocessing computed tomography angiography images: a guide for anatomical education.

BACKGROUND: A new application of teaching anatomy includes the use of computed tomography angiography (CTA) images to create clinically relevant three-dimensional (3D) printed models. The purpose of this article is to review recent innovations on the process and the application of 3D printed models as a tool for using under and post-graduate medical education. METHODS: Images of aortic arch pattern received by CTA were converted into 3D images using the Google SketchUp free software and were saved in stereolithography format. Using a 3D printer (Makerbot), a model mode polylactic acid material was printed. RESULTS: A two-vessel left aortic arch was identified consisting of the brachiocephalic trunk and left subclavian artery. The life-like 3D models were rotated 360° in all axes in hand. CONCLUSIONS: The early adopters in education and clinical practices have embraced the medical imaging-guided 3D printed anatomical models for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between the anatomical structures. Printed vascular models are used to assist in preoperative planning, develop intraoperative guidance tools, and to teach patients surgical trainees in surgical practice.

Redesign and treatment planning orbital floor reconstruction using computer analysis anatomical landmarks.

Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to their weak anatomical structure. Restoration of the orbital floor following a traumatic injury or a tumor surgery is often difficult due to inadequate visibility and lack of knowledge on its anatomical details. The aim of this study is to investigate the locations of the inferior orbital fissure (IOF), infraorbital groove (G), and infraorbital foramen (Fo) and their relationship with the orbital floor using a software. Measurements from the inferior orbital rim (IOR) using the Fo, the IOF, G, and the optic canal (OC) were calculated in 268 orbits as reference points. The surgical landmarks from the G and the OC, the G and the IOF, the G and the intersection point were measured as 31.6 ± 6, 12.9 ± 4, and 12 ± 5 mm, respectively. The mean distances between the G and the IOR, the Fo and the IOF, and the Fo and the OC were found as 8.3 ± 2.1, 28.7 ± 3.5, and 53.6 ± 5.9 mm, respectively. The mean angles were calculated as OC-IOF-G 68.1° ± 16.4°; intersection-G-IOF as 61.4° ± 15.8°; IOF-OC-G as 19° ± 5.5°; OC-G-intersection as 31.5° ± 11.9°, G-intersection-OC as 129.5°, IOF-intersection-G as 50.5°. Furthermore, variable bony changes on the orbital floor which may lead to the differences at intersection point of the G and Fo were determined. In 28 specimens (20.9 %), unilateral accessory Fo (AcFo) was present. In 27 specimens, AcFo was situated supermaedially (96.4 %) on the main aperture. In one specimen, two intraorbital canals and Fo emerged from different points and coursed into different apertures. The measured mean distances of the AcFo-IOR and the AcFo-Fo were as 7 ± 2 and 7.3 ± 3.2 mm, respectively. The primary principle in the oculoplastic treatment of orbital floor reconstructions must be repositioning the herniated orbital aperture by maintaining the infraorbital artery and the nerve in the orbital floor. The IOF and the G were recommended as the more reliable oculoplastic surgical landmarks for identifying the orbital floor. To avoid pinching of the orbital floor structures, the triangle (IS-G-IOF) should be equilateral with an exigence of a 70° angle within it. Among each distance of the intersection-IOF, IOF-G, G-intersection should be equal. With the help of certain software, this study made possible to investigate the variability of the orbital floor structures, observe the variety in measurements and calculate the parameters which are crucial in implementing personalized reconstruction and implanting support.

Anatomocosmetic implication rules of the corrugator supercilii muscle for youthful eye appearance.

The dynamic balance of the eyebrows is maintained by the frontal muscle which acts as a brow elevator, and the brow depressors include corrugator supercilii muscle (CSM), procerus, depressor supercilii, and orbicularis oculi muscles. The glabellar rhytids might appear as a result of negative emotions, such as anger, anxiety, fatigue, fear, or disapproval. For youthful and calmer eyes, CSM may restore the muscle balance more safely and effectively for the treatments of forehead rejuvenation. In 50 cadaver hemibrows, CSM was dissected to investigate the location, position, muscle patterns, and its relationships to other muscles. The location of the CSM was variable; five different CSM patterns were defined. Pattern 1: rectangular-shaped classical type was observed with the frequency of 42.5 %. Also, three bellies were present in 25 %, and duplicate muscle in 12.5 %. Irregular flat (15 %) and hypoplastic types (5 %) were introduced as previously unidentified patterns. In muscle specimens, 30 % had complete symmetry, 45 % complete asymmetry, and 25 % semi-assymetry. Mean CSM thickness, length, and width were measured as 1.62 ± 0.4, 29.24 ± 6.4, and 12.62 ± 3.3 mm, respectively. The distances of the medial origo of the CSM-midline and the lateral origo of the CSM-midline were measured as 5.54 ± 4.89 and 14.62 ± 4.17 mm. The different patterns of the CSM were undefined previously. The findings manifest the necessity of botox treatment peculiar to each individual. As, insertion points have been releasing fibres to the peripheral muscles, it is an evidence of its complicated structure. The muscles in the glabella are difficult to demarcate precisely from surface anatomy due to overlapped muscles with intermingled borders, where they are attached as individual patterns. Hence, it might be disadvantageous that different patterns may lead to the risk of asymmetry of the face and brow ptosis in the postinjection period.

Computer-assisted analysis of anatomical relationships of the ethmoidal foramina and optic canal along the medial orbital wall.

Typically, the medial orbital wall contains an anterior ethmoidal foramen (EF) and a posterior EF, but may also have multiple EFs transmitting the arteries and nerves between the orbit and the anterior cranial fossa. The aim of this study is to determine a patient-friendly landmark of the medial orbital wall and to specify a precise location of the ethmoidal foramens (EF) in order to standardize certain anatomical marks as safe ethmoidal arteries. Orientation points on the anterior ethmoidal foramen (AEF), posterior ethmoidal foramen (PEF) and middle ethmoidal foramen (MEF) were investigated in 262 orbits. Using a software program, distances between each foramen and the midpoint of the anterior lacrimal crest (ALC), the optic canal (OC), and some important angles were measured. The EFs were identified as single in 0.8%, double in 73.7%, triple 24,4% and quadruple in 1.1% specimens. The mean distances between ALC and AEF, ALC and PEF and ALC and MEF were 27.7, 10.6, and 12.95 mm, respectively. The distances from ALC-AEF, AEF-PEF, and PEF-OC were 27.7 ± 2.8, 10.6 ± 3.3, 5.4 ± 1 mm. The angles from the plane of the EF to the medial border of the OC were calculated as 13.2° and 153°, respectively. The angle from the AEF to the medial border of the OC was based on the plane between the ALC and AEF was 132°. The occurrence of multiple EF with an incidence of 25% narrows the borders of the safe region in the medial orbital wall. Safe distance of the ALC-EF was measured as 22.1 mm on medial wall. The line of the location of the EF was calculated 16.2 mm. In this study, it was possible to investigate the variability of the orbital orifice of the EF and the feasibility of the EA, to observe various angles of the orbital wall bones and to calculate the lengths of some parameters with the help of certain software.

Three-dimensional evaluation of the danger zone of ethmoidal foramens on the frontoethmoidal suture line on the medial orbital wall.

INTRODUCTION: It is clear that the importance of the ethmoidal foramen (EF) is based on its vascular contents. The frontoethmoidal suture (FS) line is recommended as more reliable navigational landmark for identifying the EF. MATERIALS AND METHODS: The vertical orientation between the EF and the FS line was studied in 188 orbits using a computer software program. RESULTS: 146 anterior EFs (77.7 %) and 42 anterior EFs (22.3 %) were situated in the FS line as intrasutural and extrasutural, respectively. 146 posterior EFs (77.25 %) and 8 posterior EFs (4.25 %) were presented as intrasutural and extrasutural, respectively. Although accessory EFs were detected in 25.5 % specimen exhibited an extrasutural location. Majority of the EFs (1-4 EFs) were situated on the FS line. The mean distances from the FS and the anterior EF, the posterior EF and the accessory EF were measured as 2.1 ± 0.5, 2.0 ± 1.5 and 2.3 ± 1.2 mm, respectively. The range of the distances from the FS to the anterior EF, posterior EF and accessory EF were -1.2 to 3.32 , -1.02 to 5.76 and -1.1 to 3.65 mm, respectively. CONCLUSION: The ranges of EF changed within 1-6 mm. As the FS is not a single point, it is more suitable to make the incision 7 mm above the suture line. The data from this study to help the orbital surgeons explain and avoid unexpected hemorrhage during the orbital procedures such as posttraumatic orbital reconstruction, orbital tumor resections, anterior skull base reconstruction, and orbital decompression surgery.

Measurement accuracy of foramen of vesalius for safe percutaneous techniques using computer-assisted three-dimensional landmarks.

The presence and description of anatomical findings about the foramen of Vesalius (FV) is important in the surgical procedure on the trigeminal nerve and/or trigeminal ganglion. This is an evaluation area for percutaneous techniques. A morphological analysis of the FVs was made in a total of 344 sides of the basis cranii of adult skulls by computerized photogrammetry using standardized digital photographs. The FV was identified in 60 specimens (34.8%). The FV was observed to be present bilaterally in 16 specimens (9.3%). The incidence of unilateral FV was 25.5% of the skulls, of which in 26 specimens (15.1%) it occurred on the left side, and in 18 specimens (10.4%) on the right side. The FV was observed to present a double opening in two specimens. The diameters of the FV were found to be 0.86 ± 0.21 (right) and 1.07 ± 0.37 mm (left). The incidence of openings with a diameter of FV 0.5 mm or more was found to be 45%. The area of the FV was calculated as 1.09 ± 0.51, and 1.4 ± 0.83 mm(2) on the right and the left, respectively. The mean distances of FV to the foramen ovale were measured as 2.30 ± 1.14 mm (right) and 2.46 ± 0.89 mm (left). The mean distances of FV to foramen spinosum were found to be 10.76 ± 1.26 mm (right) and 10.42 ± 1.29 mm (left). The findings suggest that the diameter of FV as <0.5 mm was safer to work with, while the opening types bigger than 0.5 mm opening types were highly risky for percutaneous techniques on the foramen ovale. In our study, a clear standardization has been achieved. The findings were the data obtained through computer-assisted three dimensional landmarks, appropriate for use in three dimensional planning.