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1.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461995

RESUMO

We report a child, diagnosed with Coffin-Siris syndrome (CSS), with chronic right otorrhoea. CT and DR-MRI were performed to further investigate, diagnose and determine relevant surgical anatomy. CT temporal bones assessment was performed, and the measurements compared with previously published data for normal temporal bone anatomy. These comparisons highlighted various differences which were not initially expected; it showed that there were multiple inner ear abnormalities in addition to middle ear disease. This case highlights the importance of considering temporal bone abnormalities in all children with CSS or any dysmorphia, when they may require mastoid procedures. Reviewing the management of this case provides relevant learning opportunities for both primary, secondary and tertiary care institutions.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/etiologia , Face/anormalidades , Deformidades Congênitas da Mão/diagnóstico por imagem , Deficiência Intelectual/diagnóstico por imagem , Imagem por Ressonância Magnética , Micrognatismo/diagnóstico por imagem , Pescoço/anormalidades , Osso Temporal/anormalidades , Tomografia Computadorizada por Raios X , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Criança , Face/diagnóstico por imagem , Deformidades Congênitas da Mão/complicações , Humanos , Deficiência Intelectual/complicações , Masculino , Micrognatismo/complicações , Pescoço/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem
2.
Angle Orthod ; 90(6): 857-865, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378518

RESUMO

OBJECTIVE: To investigate the differences in mandibular retromolar space among skeletal Class I subjects with different vertical divergence using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 123 skeletal Class I patients (aged 20-40 years) were categorized into hypodivergent, normodivergent, and hyperdivergent groups based on S-N/Go-Me and facial height index (FHI). Mandibular retromolar space was measured at four planes parallel to the occlusal plane along the sagittal line and molar cuspal line, respectively. The mandibular retromolar space was compared among the three vertical groups. RESULTS: The hyperdivergent group had a significantly smaller mandibular retromolar space compared with the other two groups, while the hypodivergent group had the largest retromolar space. In addition, the hyperdivergent group had a larger number of subjects whose roots contacted the lingual cortex of the mandibular body. CONCLUSIONS: The hyperdivergent group tends to exhibit the smallest mandibular retromolar space and highest risk of cortex contact. Clinicians should keep in mind that successful molar distalization requires sufficient retromolar space, especially for hyperdivergent subjects, which should be verified with CBCT.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Mandíbula , Adulto , Oclusão Dentária , Face/diagnóstico por imagem , Humanos , Mandíbula/diagnóstico por imagem , Dente Molar , Adulto Jovem
3.
Angle Orthod ; 90(6): 866-872, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378519

RESUMO

OBJECTIVES: To test the hypotheses that mechanobehavior scores (MBS) were correlated with mandibular ramus lengths (Co-Go) and differed between facial phenotypes. MATERIALS AND METHODS: Subjects gave informed consent to participate. Co-Go (mm), mandibular plane angles (SN-GoGn, °), and three-dimensional anatomy were derived from cephalometric radiography or cone beam computed tomography. Temporomandibular joint (TMJ) energy densities (ED) (mJ/mm3) were measured using dynamic stereometry and duty factors (DF) (%) were measured from electromyography, to calculate MBS (= ED2 × DF,) for each TMJ. Polynomial regressions, K-means cluster analysis, and analysis of variance (ANOVA) with Tukey post-hoc tests were employed. RESULTS: Fifty females and 23 males produced replete data. Polynomial regressions showed MBS were correlated with Co-Go (females, R2 = 0.57; males, R2 = 0.81). Cluster analysis identified three groups (P < .001). Dolichofacial subjects, with shorter normalized Co-Go, clustered into two subgroups with low and high MBS compared to brachyfacial subjects with longer Co-Go. SN-GoGn was significantly larger (P < .03) in the dolichofacial subgroups combined (33.0 ± 5.9°) compared to the brachyfacial group (29.8 ± 5.5°). CONCLUSIONS: MBS correlated with Co-Go within sexes and differed significantly between brachyfacial and dolichofacial subjects.


Assuntos
Face , Mandíbula , Cefalometria , Face/anatomia & histologia , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Fenótipo , Articulação Temporomandibular
4.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(6): 1107-1111, 2020 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-33331322

RESUMO

OBJECTIVE: To assess the reproducibility of non-verbal facial expressions (smile lips closed, smile lips open, lip purse, cheek puff) in normal persons using dynamic three-dimensional (3D) imaging and provide reference data for future research. METHODS: In this study, 15 adults (7 males and 8 females) without facial asymmetry and facial nerve dysfunction were recruited. Each participant was seated upright in front of the 3D imaging system in natural head position. The whole face could be captured in all six cameras. The dynamic 3D system captured 60 3D images per second. Four facial expressions were included: smile lips closed, smile lips open, lip purse, and cheek puff. Before starting, we instructed the subjects to make facial expressions to develop muscle memory. During recording, each facial expression took about 3 to 4 seconds. At least 1 week later, the procedure was repeated. The rest position (T0) was considered as the base frame. The first quartile of expressions (T1), just after reaching the maximum state of expressions (T2), just before the end of maximum state of expressions (T3), the third quartile of expressions (T4), and the end of motion (T5) were selected as key frames. Using the stable part of face such as forehead, each key frame (T1-T5) of the different expressions was aligned on the corresponding frame at rest (T0). The root mean square (RMS) between each key frame and its corresponding frame at rest were calculated. The Wilcoxon signed ranks test was applied to assess statistical differences between the corresponding frames of the different facial expressions. RESULTS: Facial expressions like smile lips closed, smile lips open, and cheek puff were reproducible. Lip purse was not reproducible. The statistically significant differences were found on the T2 frame of the repeated lip purse movement. CONCLUSION: The dynamic 3D imaging can be used to evaluate the reproducibility of facial expressions. Compared with the qualitative analysis and two-dimensions analysis, dynamic 3D images can be able to more truly represent the facial expressions which make the research more reliable.


Assuntos
Expressão Facial , Fotogrametria , Adulto , Face/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Lábio/diagnóstico por imagem , Masculino , Reprodutibilidade dos Testes , Sorriso
5.
Cir. pediátr ; 33(4): 204-208, oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195133

RESUMO

Los neurofibromas plexiformes son una forma de presentación de la neurofibromatosis tipo 1 (NF1) que pueden originar grandes deformaciones faciales. El tratamiento de estas tumoraciones casi nunca es curativo, el abordaje quirúrgico tiene por objetivo mejorar la estética y la función. Requiere un abordaje multidisciplinar y suele necesitar cirugía por etapas. Se presenta el caso de un paciente varón con NF1 que presenta un neurofibroma plexiforme facial periorbitario y malar izquierdo con invasión intra y extraconal de crecimiento lento. Acude con 16 años a la consulta de cirugía plástica para corrección de las deformidades faciales de partes blandas. Se realiza exéresis mediante abordaje por subunidades estéticas, realizando cantopexia y reconstrucción de la cavidad orbitaria, resultando en una simetrización de la región facial. Con ello se obtiene una notable mejoría estética y funcional, facilitando la adaptación de la prótesis ocular. El uso posterior de selumetinib ha permitido estabilizar la lesión


Plexiform neurofibroma is a presentation of neurofibromatosis type 1 (NF1) which can cause great facial deformities. Treatment rarely has a healing effect, so the surgical approach is aimed at improving esthetics and function. It requires a cross-disciplinary approach and typically needs multi-stage surgery. This is the case of a 16-year-old male patient with NF1 presenting with left periorbital and malar facial plexiform neurofibroma with slow-growth intraconal and extraconal invasion. He presented at the plastic surgery consultation for facial soft tissue deformity correction. Removal was performed using an esthetic subunit approach, with canthopexy and orbital cavity reconstruction, resulting in facial region symmetrization. This allowed for remarkable esthetic and functional improvement, facilitating ocular prosthesis adaptation. The subsequent use of selumetinib allowed the lesion to be stabilized


Assuntos
Humanos , Masculino , Adolescente , Neurofibroma Plexiforme/diagnóstico por imagem , Neurofibroma Plexiforme/cirurgia , Face/cirurgia , Olho Artificial , Face/diagnóstico por imagem , Face/patologia , Tomografia Computadorizada por Raios X , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia
6.
Am J Orthod Dentofacial Orthop ; 158(4): 518-526, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988567

RESUMO

INTRODUCTION: This study aimed to evaluate the effects of 3 different fixed or removable functional appliances on the soft tissue changes in patients with Class II Division 1 malocclusion using 3-dimensional images. METHODS: A total of 60 patients with Class II Division 1 malocclusion (38 girls and 22 boys; mean age, 12.35 ± 1.01 years) were treated with 3 different functional appliances, namely, Twin-block (TB) (group TB, n = 20), mono-block (MB) (group MB, n = 20), or Herbst (H) (group H, n = 20) for 9.55 ± 1.46 months. Three-dimensional photographs of each patient were taken at the baseline and the end of the therapy with a 3dMD Face system (3dMD, Atlanta, Ga). Statistical analyses were performed using the dependent samples t test, 1-way analysis of variance, Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests. RESULTS: No statistically significant differences were detected for soft tissue changes except for the lower facial width found, at least in group H (P <0.05). Volumetric differences in the mandible were similar between the groups (P >0.05). A statistically significant decrease in total facial height and an increase in convexity angle and facial depth were detected in all groups after treatment compared with the baseline (P <0.05). The upper and lower facial height, lower lip height, and nasal width were statistically significantly increased in the TB and MB groups after treatment compared with the baseline (P <0.05) and similar to those in group H (P >0.05). CONCLUSIONS: TB, MB, and H appliances may promote the facial soft tissue profile, including volumetric improvement, in the mandibular region.


Assuntos
Face/anatomia & histologia , Face/diagnóstico por imagem , Má Oclusão de Angle Classe II/diagnóstico por imagem , Má Oclusão de Angle Classe II/terapia , Adolescente , Cefalometria , Criança , Feminino , Humanos , Lábio/diagnóstico por imagem , Masculino , Mandíbula
7.
PLoS One ; 15(9): e0238427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936816

RESUMO

In Graeco-Roman times in the Lower-Egyptian Fayoum region, a painted portrait was traditionally placed over the face of a deceased individual. These mummy portraits show considerable inter-individual diversity. This suggests that those portraits were created separately for each individual. In the present study, we investigated a completely wrapped young infant mummy with a typical mummy portrait by whole body CT analysis. This was used to obtain physical information on the infant and provided the basis for a virtual face reconstruction in order to compare it to the mummy portrait. We identified the mummy as a 3-4 years old male infant that had been prepared according to the typical ancient Egyptian mummification rites. It most probably suffered from a right-sided pulmonary infection which may also be the cause of death. The reconstructed face showed considerable similarities to the portrait, confirming the portrait's specificity to this individual. However, there are some differences between portrait and face. The portrait seems to show a slightly older individual which may be due to artistic conventions of that period.


Assuntos
Face/diagnóstico por imagem , Múmias/diagnóstico por imagem , Retratos como Assunto/história , Arte , Pré-Escolar , Egito , Face/anatomia & histologia , História Antiga , Humanos , Imageamento Tridimensional , Lactente , Masculino , Múmias/história , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Imagem Corporal Total
8.
Zhonghua Shao Shang Za Zhi ; 36(9): 853-860, 2020 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-32972071

RESUMO

Objective: To observe the differences in normal facial skin thickness and echo density by different ages and sites of healthy adults of the same sex using 50 MHz high-frequency ultrasound. Methods: From January to June 2019, 200 healthy adult volunteers with normal facial skin who were from Sichuan, Yunnan, Guizhou, and Chongqing and met the inclusion criteria were recruited by the Affiliated Hospital of Southwest Medical University with simple random sampling method, and then were included in this cross-sectional investigation study. Then 50 MHz high-frequency ultrasound was used to obtain skin ultrasonogram of volunteers' forehead, canthus, eyelid, and cheek. According to the ages, 100 female volunteers were divided into 20-29 years old (30 females), 30-39 years old (25 females), 40-49 years old (20 females), and 50-70 years old (25 females) groups; 100 male volunteers were divided into 20-29 years old (30 males), 30-39 years old (25 males), 40-49 years old (20 males), and 50-70 years old (25 males) groups. The thickness of full-skin, the upper dermal echo density, and the lower dermal echo density of the female and male volunteers'forehead, canthus, eyelid, and cheek were recorded respectively. Data were statistically analyzed with one-way analysis of variance, analysis of variance for repeated measurement, least significant difference test, and Bonferroni correction. Results: (1) The thickness of full-thickness skin in forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old group were (1.86±0.26), (1.36±0.11), (1.24±0.25), and (1.90±0.21) mm, (2.45±0.37), (1.64±0.19), (1.44±0.16), and (2.53±0.26) mm, respectively, in 30-39 years old group were (1.98±0.24), (1.43±0.13), (1.15±0.15), and (2.12±0.13) mm, (2.34±0.27), (1.63±0.27), (1.50±0.38), and (2.43±0.40) mm, respectively, in 40-49 years old group were (1.90±0.21), (1.43±0.18), (1.24±0.27), and (1.98±0.12) mm, (2.14±0.24), (1.54±0.25), (1.28±0.14), and (2.39±0.36) mm, respectively, in 50-70 years old group were (1.64±0.25), (1.36±0.19), (1.16±0.12), and (1.89±0.29) mm, (2.28±0.27), (1.73±0.25), (1.58±0.18), and (2.38±0.32) mm, respectively. There were no statistically significant differences between female volunteers in the 4 groups and male volunteers in the 4 groups in thickness of full-thickness skin in canthus, eyelid, and cheek (F=0.677, 0.666, 0.136, 0.697, 0.294, 0.888, P>0.05). The thickness of full-thickness skin in forehead and cheek of the female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), and was significantly higher than that of canthus and eyelid (P<0.05). The thickness of full-thickness skin in canthus and eyelid of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old group was similar (P>0.05), while thickness of full-thickness skin in canthus and eyelid of male volunteers in the 4 groups was similar (P>0.05). (2) The upper dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly lower than that in 20-29 years old and 30-39 years old groups (P<0.05). The upper dermal echo density of forehead, canthus, eyelid, and cheek of male volunteers in 50-70 years old group was significantly lower than that in 20-29 years old group (P<0.05). The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old and 30-39 years old groups was similar (P>0.05). The upper dermal echo density of forehead and cheek of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P<0.05). The echo density of upper dermis of cheek of male volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P<0.05). The upper dermal echo density of canthus and eyelid of female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), the upper dermal echo density of forehead and cheek was similar (P>0.05). (3) The lower dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly higher than that in 20-29 years old and 30-39 years old groups (P<0.05). The lower dermal echo density of forehead, canthus, eyelid, and cheek of male volunteers in 50-70 years old group was significantly higher than that in 20-29 years old group (P<0.05). The echo density of the lower dermis of forehead, eyelid, and cheek of female and male volunteers in 20-29 years old, 30-39 years old, and 40-49 years old groups was similar (P>0.05). The lower dermal echo density of forehead and cheek of female volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P<0.05). The lower dermal echo density of forehead and cheek of male volunteers in 30-39 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P<0.05). The lower dermal echo density between canthus and eyelid and between forehead and check of female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05). Conclusions: The 50 MHz high-frequency ultrasonography shows that the thickness of full-thickness skin of canthus, eyelid, and cheek is similar in all age groups of female and male adult volunteers with normal facial skin. In the same age group, the thickness of full-thickness skin of forehead and cheek of male and female volunteers is significantly higher than that of canthus and eyelid. The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers shows a decreasing trend with age, while the lower dermal echo density shows an increasing trend with age. In addition, the echo density of upper and lower dermis of canthus and eyelid was significantly higher than that of cheek in all the four age groups.


Assuntos
Face , Pele , Adulto , Idoso , China , Estudos Transversais , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pele/diagnóstico por imagem , Ultrassonografia , Adulto Jovem
11.
PLoS One ; 15(7): e0236425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726330

RESUMO

Craniofacial asymmetry, mandibular condylar modeling and temporomandibular joint disorders are common comorbidities of skeletally disproportionate malocclusions, but etiology of occurrence together is poorly understood. We compared asymmetry, condyle modeling stability and temporomandibular health in a cohort of 128 patients having orthodontics and orthognathic surgery to correct dentofacial deformity malocclusions. We also compared ACTN3 and ENPP1 genotypes for association to clinical conditions. Pre-surgical posterior-anterior cephalometric and panometric radiographic analyses; jaw pain and function questionnaire and clinical examination of TMD; and SNP-genotype analysis from saliva samples were compared to assess interrelationships. Almost half had asymmetries in need of surgical correction, which could be subdivided into four distinct morphological patterns. Asymmetric condyle modeling between sides was significantly greater in craniofacial asymmetry, but most commonly had an unanticipated pattern. Often, longer or larger condyles occurred on the shorter mandibular ramus side. Subjects with longer ramus but dimensionally smaller condyles were more likely to have self-reported TMD symptoms (p = 0.023) and significantly greater clinical diagnosis of TMD (p = 0 .000001), with masticatory myalgia most prominent. Genotyping found two significant genotype associations for ACTN3 rs1671064 (Q523R missense) p = 0.02; rs678397 (intronic SNP) p = 0.04 and one significant allele association rs1815739 (R577X nonsense) p = 0.00. Skeletal asymmetry, unusual condyle modeling and TMD are common and interrelated components of many dentofacial deformities. Imbalanced musculoskeletal functional adaptations and genetic or epigenetic influences contribute to the etiology, and require further investigation.


Assuntos
Actinina/genética , Deformidades Dentofaciais/genética , Predisposição Genética para Doença , Diester Fosfórico Hidrolases/genética , Pirofosfatases/genética , Transtornos da Articulação Temporomandibular/genética , Adulto , Queixo/diagnóstico por imagem , Modelos Dentários , Deformidades Dentofaciais/diagnóstico por imagem , Deformidades Dentofaciais/patologia , Deformidades Dentofaciais/cirurgia , Face/diagnóstico por imagem , Feminino , Estudos de Associação Genética , Humanos , Arcada Osseodentária/diagnóstico por imagem , Masculino , Má Oclusão/diagnóstico por imagem , Má Oclusão/genética , Má Oclusão/patologia , Má Oclusão/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/patologia , Côndilo Mandibular/cirurgia , Procedimentos Cirúrgicos Ortognáticos , Polimorfismo de Nucleotídeo Único/genética , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/cirurgia
12.
Leg Med (Tokyo) ; 47: 101743, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32659706

RESUMO

The aim in this study was to evaluate the influence of skeletal class, facial type, and sex on soft tissue thickness (STT) of the craniofacial midline in a Brazilian subpopulation. Thus, 121 cone beam computed tomography (CBCT) scans (54 males and 67 females, age 21 to 40 yrs) composed the study sample. Patients were classified according to skeletal class (class I, II, and III) and facial type (brachycephalic, mesocephalic, and dolichocephalic), and STT was measured (mm) in 10 landmarks in the craniofacial midline for each CBCT scan. Multivariate analysis of covariance evaluated facial STT with regard to multiple independent variables (sex, age - covariate, facial type, and skeletal class). TEM and rTEM assessed the intra-examiner agreement. STT was significantly greater in males than in females for all regions measured (p < 0.05), except for the pogonion-pogonion' landmark (p>0.05). In general, class III individuals had significantly thicker soft tissue in the maxilla - subspinale-subnasale', prosthion-labrale superius', and incision-stomion' regions, while class II subjects had thicker soft tissue in the infradentale-labrale inferius' mandibular landmark (p < 0.05). Regarding facial type, dolichocephalic individuals showed significantly thicker soft tissue in the supramentale-supramentale' mandibular landmark, whereas brachycephalic subjects had thicker soft tissue in maxillary regions - prosthion-labrale superius' and incision-stomion' (p < 0.05). rTEM values were below 5% for most landmarks, and all TEM values were below 1 mm. Skeletal class and facial type influence STT, showing a soft tissue compensation, with deeper soft tissue in areas with lower skeletal development, and/or where bone is positioned more posteriorly.


Assuntos
Cefalometria/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Tecido Conjuntivo/anatomia & histologia , Tecido Conjuntivo/diagnóstico por imagem , Face/anatomia & histologia , Face/diagnóstico por imagem , Ossos Faciais/anatomia & histologia , Ossos Faciais/diagnóstico por imagem , Antropologia Forense/métodos , Odontologia Legal/métodos , Adulto , Brasil , Feminino , Humanos , Masculino , Caracteres Sexuais , Adulto Jovem
13.
Medicine (Baltimore) ; 99(28): e21048, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664117

RESUMO

A number of studies have evaluated the variable courses of facial artery. However, the results of these differed substantially from each other so not consistent relationships have yet been established. There has also yet to be a relevant study using conventional angiography.We assessed the variant branching pattern of the facial artery and its branches using conventional angiography.Two radiologists retrospectively reviewed 284 cases of angiographies of the external carotid artery in 198 patients. The courses of the facial artery and infraorbital branch of the maxillary artery were classified into 4 types and 2 types, according to the end branch.Among 284 cases of facial artery, type 1 (angular branch) made up 104 cases (36.6%), type 2 (lateral nasal branch) made up 138 cases (48.6%), type 3 (superior labial branch) made up 24 cases (8.5%), and type 4 (inferior labial branch) made up 18 cases (6.3%).Regarding the 284 total cases of maxillary artery, 163 cases (57.4%) had anastomosis with the angular artery or extended to the territory of the angular artery. In addition, 121 cases (42.6%) had nothing done in regard to the angular artery.The results may be helpful for avoiding complications related to facial and maxillary arteries during facial surgeries and cosmetic procedures.


Assuntos
Artérias/anatomia & histologia , Artérias/diagnóstico por imagem , Face/irrigação sanguínea , Face/diagnóstico por imagem , Angiografia , Artérias Carótidas/anatomia & histologia , Artérias Carótidas/diagnóstico por imagem , Humanos , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/diagnóstico por imagem , Nariz/irrigação sanguínea , Nariz/diagnóstico por imagem , Estudos Retrospectivos
15.
J Vis Exp ; (159)2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32510490

RESUMO

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve better results, even in the less experienced hand, or continue without it. As technology develops and becomes more user-friendly, we believe it is time to allow the surgeon the option to plan his/her operations and create his/her own patient-specific surgical guides and fixation plates allowing him full control over the process. We present here a protocol for 3D planning of the operation followed by 3D planning and printing of surgical guides and patient-specific fixation implants. During this process we use two commercial computer-assisted design (CAD) software. We also use a fused deposition modeling printer for the surgical guides and a selective laser sintering printer for the titanium patient-specific fixation implants. The process includes computed tomography (CT) imaging acquisition, 3D segmentation of the skull and facial bones from the CT, 3D planning of the operations, 3D planning of patient-specific fixation implant according to the final position of the bones, 3D planning of surgical guides for performing an accurate osteotomy and preparing the bone for the fixation plates, and 3D printing of the surgical guides and the patient-specific fixation plates. The advantages of the method include full control over the surgery, planned osteotomies and fixation plates, significant reduction in price, reduction in operation duration, superior performance and highly accurate results. Limitations include the need to master the CAD programs.


Assuntos
Desenho Assistido por Computador , Face/cirurgia , Impressão Tridimensional , Próteses e Implantes , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Osteotomia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Tomografia Computadorizada por Raios X
17.
Int J Oral Maxillofac Surg ; 49(11): 1392-1396, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32371179

RESUMO

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0-15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case-control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04-1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13-8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.


Assuntos
Linfadenite , Micobactérias não Tuberculosas , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Face/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Linfadenite/diagnóstico por imagem , Linfadenite/cirurgia , Ultrassonografia
18.
J Craniofac Surg ; 31(4): e426-e428, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32433137

RESUMO

There are patients with craniofacial deformity that can lead to extensive bone loss and severe disfigurement. Autologous reconstruction may be challenging in these patients, and it is usually associated with flap donor area morbidity and unfavorable aesthetic and functional results. A 51-year-old patient with human immunodeficiency virus infection, developed in the context of immunosuppression a fulminant fungal rhino-sinusitis with the need for surgical debridement, and in consequence extensive destruction of the nasal cavity and upper jaw, resulting in severe disfigurement due to nasal deformity and maxillary collapse. Human immunodeficiency virus disease was controlled and the complex craniofacial defect was posteriorly reconstructed with direct 3-dimensional (3D) printing combined with microsurgical free tissue transfer. The 3D facial implant, in titanium, was individualized and fabricated based on computed tomography images of the patient. A radial forearm free flap was used since a soft-tissue defect was anticipated after scar release and implant placement. It allowed simultaneous coverage of the palate, the anterior surface of maxilla and intranasal lining. The flap survived despite flap venous congestion in the postoperative period probably facilitated because of the complex 3D flap configuration and pedicle tunneling into the neck. After 9 months, the patient showed a tremendous aesthetic and functional improvement. The 3D printing was useful in our patient with craniofacial reconstruction. Its combination with free tissue transfer may improve the surgeon's armamentarium when dealing with complex patients.


Assuntos
Face/cirurgia , Impressão Tridimensional , Procedimentos Cirúrgicos Reconstrutivos , Cicatriz , Face/diagnóstico por imagem , Feminino , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Palato/cirurgia
20.
Proc Natl Acad Sci U S A ; 117(18): 10089-10096, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32321833

RESUMO

Synesthesia is a neurologic trait in which specific inducers, such as sounds, automatically elicit additional idiosyncratic percepts, such as color (thus "colored hearing"). One explanation for this trait-and the one tested here-is that synesthesia results from unusually weak pruning of cortical synaptic hyperconnectivity during early perceptual development. We tested the prediction from this hypothesis that synesthetes would be superior at making discriminations from nonnative categories that are normally weakened by experience-dependent pruning during a critical period early in development-namely, discrimination among nonnative phonemes (Hindi retroflex /d̪a/ and dental /ɖa/), among chimpanzee faces, and among inverted human faces. Like the superiority of 6-mo-old infants over older infants, the synesthetic groups were significantly better than control groups at making all the nonnative discriminations across five samples and three testing sites. The consistent superiority of the synesthetic groups in making discriminations that are normally eliminated during infancy suggests that residual cortical connectivity in synesthesia supports changes in perception that extend beyond the specific synesthetic percepts, consistent with the incomplete pruning hypothesis.


Assuntos
Cognição/fisiologia , Neuroimagem , Reconhecimento Visual de Modelos/fisiologia , Sinestesia/diagnóstico por imagem , Adulto , Face/diagnóstico por imagem , Face/fisiologia , Feminino , Humanos , Masculino , Estimulação Luminosa , Sinestesia/fisiopatologia
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