Estimation of legal age using calcification stages of third molars in living individuals.

The increased number of adolescents and young adults with unknown or inaccurately given date of birth is a current issue in justice and legal medicine. The objective of this study was to determine the extent to which third molar calcification stages assessed on panoramic X-rays could be useful as additional criteria for forensic age estimation in living individuals, focusing on the legally important ages 17 and 18. In a retrospective multi-center study, the developmental stage of each individual's third molar was analyzed using Demirjian's scale in 2360 cases. Additionally, sex, age and ancestry were assessed. Individuals with the lowest calcification stage of all present molars in stage H were ≥18 years with a likelihood of ≥99.05% in the female (n=388), and ≥99.24% in the male (n=482) population. The lowest calcification stage of all present third molars proved to be useful as an additional reliable criterion for the determination of an age ≥18 years.

Clinical classification of infant nonsynostotic cranial deformity.

OBJECTIVE: Based on a pilot study including >400 children and a comprehensive database analysis of >2500 children, we sought to define the craniofacial norm and to objectify the categorization of positional head deformity. STUDY DESIGN: A database was created containing clinical information on children assessed for nonsynostotic cranial deformity. The findings of standardized anthropometric measurements were compared with data from a group of 401 healthy children with a normal head shape collected in terms of a prospective pilot study. Using a statistical analysis of all anthropometric craniofacial measurements, cut-off percentiles for discriminating different groups of deformation and severity classes were generated. RESULTS: Normative percentiles for all dimensions in cranial vault anthropometric measurements during the first year of life were calculated. Children with definite nonsynostotic head deformity could be clearly allocated into 3 different groups: positional plagiocephaly (abnormal Cranial Vault Asymmetry Index), positional brachycephaly (abnormal Cranial Index), and combined positional plagiocephaly and brachycephaly (abnormal Cranial Vault Asymmetry Index and Cranial Index). Additionally, a reliable 3-level severity categorization (mild, moderate, and severe) for each group of cranial deformation could be obtained according to age and sex. CONCLUSIONS: Our results allow a meaningful and reliable classification of nonsynostotic early childhood cranial deformity.

Sinusoidal coronal incision.

BACKGROUND: The coronal incision is a standard surgical approach in craniofacial surgery. For pediatric patients, it holds a certain risk for unbeneficial aesthetic outcome due to a broadening of the scar in the fast-growing infant skull. METHODS: We readopted the coronal approach over the last decade and developed a sinusoidal type of incision based on the "stealth incision" by Munro and Fearon. We present a calculative standardization of our approach. RESULTS: The sinusoidal coronal approach assures superior aesthetical results with equivalent skeletal exposure. The surgical procedure is simplified and standardized. Even in the fast-growing infant skull, broadening of the scar or vertical divergence is avoided.

About the operative management and post-operative neural development of patients with cloverleaf skull deformity.

INTRODUCTION: We present our treatment concept for cloverleaf skull deformity on the basis of two representative cases that had been presented to our multidisciplinary skull deformity board. METHODS: Perioperatively, we monitored electrophysiologic parameters with median nerve somatosensory-evoked potentials (SSEP), tibial nerve (T) SSEP, brainstem acoustic-evoked potential and flush-elicited visual-evoked potential, as well as intracranial pressure. Both patients underwent decompressive bilateral vault craniectomy, frontal and occipital reshaping at an age of four months. RESULTS: Secondary fronto-orbital advancement and cranial vault reshaping was performed after maximal vault reossification was reached at an age of 8 and 12 months, respectively. Additionally, one of the patients underwent treatment of a Chiari malformation via suboccipital decompressive craniectomy and tonsillary resection, as well as ventriculoperitoneal shunting for hydrocephalus. DISCUSSION: The patients showed nearly unrestrained neural and neurophysiological development over a follow-up period of 5 years.

Three-dimensional photographic analysis of outcome after helmet treatment of a nonsynostotic cranial deformity.

Cranial asymmetries due to nonsynostotic deformation of the skull have been reported with increasing frequency during the last decade. Conservative approaches using helmets and physiotherapy have been shown to be effective in their treatment. Traditionally, documentation has been carried out using anthropometric caliper measurements. The present study evaluates the use of a new three-dimensional photographic system in the improved validation of changes in head deformities. This prospective analysis introduces a new technique for digital anthropometric measurement. The study series comprised 181 children with nonsynostotic head deformities. Three-dimensional photographs were obtained before and after treatment with an orthotic helmet device. The oblique head diagonals and head width and length were measured from three-dimensional photographs using 3dMD customer software. The cranial vault asymmetry index, cranial vault asymmetry, and cranial index were compared before and after treatment. The measurements obtained on three-dimensional images were able to demonstrate significant improvement in early infant cranial deformity after treatment with an orthotic helmet. The cranial vault asymmetry index in plagiocephaly was reduced by 7.16%, and cranial vault asymmetry was reduced by 0.86 cm. The cranial index in brachycephaly decreased by 7.32%. In children with combined plagiocephaly and brachycephaly, the cranial vault asymmetry index improved by 5.77%, cranial vault asymmetry improved by 0.71 cm, whereas the cranial index changed by 5.48%. Three-dimensional photogrammetry can support treatment control in patients with deformational plagiocephaly. This new technology offers several advantages such as easy acquisition of images, detection of landmarks without patient movement, repeatable measurements without patient discomfort, and the opportunity for unbiased evaluation.

Accuracy of photographic assessment compared with standard anthropometric measurements in nonsynostotic cranial deformities.

OBJECTIVE: Anthropometric landmarks of the skull have traditionally been used to describe cranial deformities resulting from nonsynostotic plagiocephaly or brachycephaly. Recently, digital photography has become an important tool for characterizing facial and cranial pathologies. The purpose of this study was to compare standard anthropometric cranial measurements with measurements taken from cranial photographs. PATIENTS: Standardized digital images in the supracranial view and cranial anthropometric measurements were obtained from 122 children between the ages of 3 and 15 months. The photographs were assessed using Quick Ceph® software. The cephalic index and cranial vault asymmetry index were used to indicate the degree of cranial deformity. Children were classified into plagiocephaly, brachycephaly, and the combination of both. To determine interobserver variability, two clinicians separately measured the cephalic index and cranial vault asymmetry index from digital photographs in 70 infants of the plagiocephalic group. RESULTS: To compare interassay reliability for these methods of obtaining the cephalic index and cranial vault asymmetry index, the differences between photographically and anthropometrically derived values were plotted against anthropometrically derived values alone (Bland-Altman plots). The photographic method satisfied the limits of agreement (cephalic index, 7.51%; cranial vault asymmetry index, 6.57%) and showed slightly lower values represented by the respective bias (cephalic index, 1.79%; cranial vault asymmetry index, 3.03%). Comparison between observers revealed excellent agreement, detected by the intraclass correlation coefficient of .982 for the cephalic index and .946 for the cranial vault asymmetry index. CONCLUSION: Our results demonstrate that digital photography is a reliable tool for quantifying cranial deformities. Furthermore, it is rapid, noninvasive, and reproducible. However, we continue to use both methods in clinical practice.

Long-Term Influence of Platelet-Rich Plasma (PRP) on Dental Implants after Maxillary Augmentation: Implant Survival and Success Rates.

The atrophic maxilla often requires bone augmentation before implant placement to ensure long-term implant success. A previous prospective clinical trial examined the use of platelet-rich plasma (PRP) during maxillary augmentation. The short-term results showed no positive effect of PRP. The aim of this study was to evaluate the same patient collective of the previous study regarding the PRP long-term impact on the survival and success of dental implants. Fifty-three patients from the previous study diagnosed with maxillary atrophy and augmented with autologous bone grafts from the iliac crest and dental implants, were included in this study. Treatment was carried out on both sides in 34 patients with a split-mouth-design in which one randomly chosen side was treated additionally with PRP, the other side was the control-side. Nineteen patients were treated only on one side and were assigned to the PRP-or the control group randomly. Implant follow-up of the patients from the previous study was performed after an average time of 13 years. Implant success was evaluated using two different success criteria. Thitry-seven patients (25 women and 12 men) were investigated in this study. Seventeen patients (12 female, 5 male) were included in the PRP group, while 20 patients (13 female, 7 male) participated in the control group. A total of 210 implants were inserted. Of these, 102 implants (48.57%) were placed in the PRP group and 108 implants (51.42%) in the control group. Out of 102 investigated implants in the PRP group, 6 were removed (survival rate 94.1%). While two of the 108 implants in the control group were loss (survival rate 98.1%). In the PRP group, the cumulative probability of survival after 15.1 years was 94.1% and in the control group, was 98.1%, with no significant difference between the two groups. Higher significant difference for the control group was found in the cumulative success probability using Albrektson criteria (p = 0.05). Positive impact of PRP on long-term implant survival and success could not be found.

Long-Term Influence of Platelet-Rich Plasma (PRP) on Dental Implants after Maxillary Augmentation: Retrospective Clinical and Radiological Outcomes of a Randomized Controlled Clinical Trial.

: The long-term clinical and radiological outcomes of dental implants inserted in augmented bone treated with platelet-rich plasma (PRP) has not been well addressed in the literature yet. This study is based on a collection of patients from a randomized controlled trial (RCT) that did not report any short-term positive effects of PRP on bone healing after sinus lift surgery using autologous iliac crest bone graft. This study aimed to evaluate the long-term impact of PRP regarding clinical and radiological outcomes on the inserted implants in the previous RCT. For this evaluation, we considered the following variables: plaque index, probing depth, bleeding index, mobility grade, Periotest® values, and radiological bone loss. Out of 53 patients (n = 306 implants) included in the previous study we were able to reinvestigate 37 patients (n = 210 implants) in two centers (31 in Giessen, Germany and 6 in Erlangen, Germany). Clinical and radiographic parameters suggested overall healthy conditions of the peri-implant tissue. The PRP-group and the control group did not differ significantly in the majority of the parameters. The overall evaluation showed that result data of the PRP-group was inferior to the control group in 64 percent of the evaluated parameters. The present study cannot provide evidence of a positive effect of PRP on the long-term implant clinical and radiological outcomes. In fact, a tendency towards inferior long-term results in the PRP-group was detected without reaching a significant threshold. Further controlled trials need to be conducted to investigate this correlation.

Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study.

BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied. STUDY DESIGN AND METHODS: In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data. RESULTS: An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty-two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p < 0.01). In addition, transfusion triggers (Hct 0.22 or hemoglobin 7.5 g/dL) were also more often seen in cases with low calculated MBL (p < 0.05). CONCLUSIONS: In this study, an inappropriate transfusion practice in patients undergoing bimaxillary orthognathic osteotomies after preoperative autologous blood donation was detected. Calculation of the individual MBL should be used to help identify patients at high risk for transfusion and guide adequate methods to decrease the need of homologous blood.

Donor-site Morbidity after Retromolar Bone Harvesting Using a Standardised Press Fit Cylinder Protocol.

Precise fitting and immobilisation of bone transplants at the recipient site is of utmost importance for the healing process. With the help of the standardised Osseo Transfer System, the recipient site is adjusted to the graft, rather than vice versa as it is typically done. The aim of this study was to analyse donor-site morbidity after harvesting cylindrical bone grafts from the retromolar region using the Osseo Transfer System. The patient satisfaction with the surgical procedures was also evaluated. All patients treated with this standardised reconstruction method between 2006 and 2013 at the Department of Cranio-Maxillofacial Surgery, University Hospital Giessen, were included in this study. Complications were recorded and evaluated. Bone graft success and patient satisfaction were documented with a questionnaire, and then confirmed by clinical and radiological follow-up examinations. Fifty-four patients were treated and 64 harvested cylindrical autologous bone grafts were transplanted. In all cases, dental implants could be inserted after bone healing. One patient lost an implant, associated with failure of the bone graft. Six patients who were examined continued to show neurological disorders in locally limited areas. No complete or long-term damage of the inferior alveolar nerve occurred. More than 94% (n = 52) of the patients were 'very satisfied' or 'satisfied' with the results and would recommend this surgical treatment to other patients. The standardised Osseo Transfer was an effective treatment option for small and mid-sized alveolar ridge augmentations. A low donor-site morbidity rate and a high transplant success rate were verified. The Osseo Transfer System demonstrated to be a reliable surgical technique without major complications. We highly recommend this surgical augmentation procedure as a surgical treatment for local bone defects.

Oral Rehabilitation of Hypodontia Patients Using an Endosseous Dental Implant: Functional and Aesthetic Results.

Hypodontia often leads to limited bone availability of the alveolar ridges. Oral rehabilitation of severe hypodontia patients is challenging. In this retrospective study, we evaluated the functional and aesthetic results after dental implants in hypodontia patients, corroborated by Albrektsson implant success criteria. Over a period of 15 years (2000-2015), a total of 43 patients were diagnosed with hypodontia and 165 dental implants were inserted. Six patients who received 10 implants were lost in the follow-up. We examined 155 implants in 37 patients between December 2015 and May 2017. Besides family history, patients evaluated the general satisfaction, functionality, and aesthetics of the implants. Study subjects were between 17 and 44 years old (mean ± SD: 21.4 ± 5.6). Hypodontia patients were missing one to five teeth (n = 28), whereas patients diagnosed with oligodontia (≥6 missing teeth, n = 9). In this study, 24 patients (64.9%) with hypodontia had a positive family history; the remaining 13 patients had no family member with hypodontia. The final follow-up time ranged between 5 and 189 months after implant placement. Orthodontic treatment was performed in 32 patients (86%) before implant placement. Rehabilitation resulted in 62% of the cases being treated with 1-2 implants and 38% treated with 3-15 implants. However, out of 155 inserted dental implants, 18 implants failed to meet Albrektsson criteria, under which two implants were removed. Only autografts were used for bone augmentation with 97 implants. More than two-thirds of the patients showed high general satisfaction and masticatory function (69.4%) as well as phonetic ability (80.6%). The aesthetic outcome was rated as excellent by 17 patients (47.2%). The findings emphasize the importance of interdisciplinary treatment of hypodontia, leading to a satisfactory, functional, and long-term fixed prosthodontics using dental implants.

Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants.

PURPOSE: Microvascular fibula flap surgery is a reliable and effective procedure for reconstructing the jaws after tumour surgery. This procedure allows the placement of dental implants after bone consolidation. This study was designed to evaluate the oral, functional, and aesthetic rehabilitation of tumour patients with immediate fibula transfer and dental implants and included assessment of diet, speech, and aesthetics. MATERIALS AND METHODS: The study included 34 patients who underwent ablative tumour surgery and immediate jaw reconstruction using a fibula free flap with consecutive rehabilitation by dental implants. In total, 134 implants were inserted into the transferred fibula. The functional and aesthetic results were assessed using a questionnaire. Implant loss and oral excursion were compared with diet type, speech ability, functionality, and patient satisfaction. RESULTS: Of the 34 patients included in this study, 33 completed the questionnaire. Twenty-six patients (76%) could eat normally without the limitation of a hard or soft diet, 73% could speak intelligibly, and 31 rated the aesthetic result from good to excellent. CONCLUSION: The fibula flap with the early application of endosseous implants allowed primary immediate reconstruction of the jaw, significantly leading to functional and aesthetic satisfaction in patients who underwent ablative tumour surgery.

Evaluation of Implant Success in Patients with Dental Aplasia.

INTRODUCTION: Dental aplasia is an anomaly in which the number of teeth is reduced. It is the most commonly occurring dental anomaly during tooth development. Treatment management of patients with dental aplasia is challenging. OBJECTIVES: The aim of this retrospective clinical study was to analyze the survival and success rates of dental implants placed in hypodontic patients, rated with different criteria. METHODS: Forty-three patients were diagnosed with dental aplasia and treated with dental implants between November 2000 and February 2016. The variables assessed included the plaque level, bleeding on probing, probing depth, implant mobility, implant stability, and implant loss. To analyze the peri-implant bone level, a panoramic X-ray of each patient was taken. The results were compared with X-rays taken immediately after implantation. RESULTS: Thirty-seven patients (16 males; 21 females) participated in this study. In total, 155 implants (86 maxillary; 69 mandibular) were inserted. Two of the 155 implants failed; the in situ survival rate was 98.7%. The success rate according to the criteria of Buser et al. was 96.8%, and that according to the criteria of Albrektsson et al. was 88.4%. CONCLUSION: The survival and success rates of dental implants in patients with congenitally absent teeth were very high and did not differ significantly from results achieved in an unaffected population. Dental implants are a reliable therapy for patients with dental aplasia.

High resolution imaging of craniofacial bone specimens by flat-panel volumetric computed tomography.

INTRODUCTION: The prototype flat-panel volumetric computed tomograph (fpvCT) provides a new 3D imaging technology with detailed high resolution by using large-area flat-panel X-ray detectors. The object of this study was to evaluate the benefit of high resolution imaging using the experimental fpvCT to visualise different types of human craniofacial bone pathology. The study proved the feasibility of performing an intraoperative evaluation of free margins in bone malignancies using fpvCT. MATERIAL AND METHODS: In this study, 35 bone specimens of various pathological types were examined by fpvCT. fpvCT data were compared with pre-operative multislice clinical CT images as well as with post-operative histological findings. RESULTS: Bone tumours can be visualised with their specific pathological architecture and infiltration structure faster and more precisely by fpvCT than by multislice CT. The analysis of the resection margins supports the surgical procedure intraoperatively, especially when an immediate reconstruction with bone transplantation is carried out. DISCUSSION: The fpvCT has a superior image quality when compared with clinical CT systems. The imaging of the bone structure itself has been shown to be useful for the interpretation of osseous resection borders. Furthermore, it can facilitate the diagnosis of tumour progression, especially in areas that are difficult to access, such as the base of the skull.

Accuracy of various impression materials and methods for two implant systems: An effect size study.

PURPOSE: An accurate impression is required for implant treatment. The aim of this in-vitro study was to determine the effect size of the impression material/method, implant system and implant angulation on impression transfer precision. METHODS: An upper jaw model with three BEGO and three Straumann implants (angulations 0°, 15°, 20°) in the left and right maxilla was used as a reference model. One polyether (Impregum Penta) and two polyvinyl siloxanes (Flexitime Monophase/Aquasil Ultra Monophase) were examined with two impression techniques (open and closed tray). A total of 60 impressions were made. A coordinate measurement machine was used to measure the target variables for 3D-shift, implant axis inclination and implant axis rotation. All the data were subjected to a four-way ANOVA. The effect size (partial eta-squared [η2P]) was reported. RESULTS: The impression material had a significant influence on the 3D shift and the implant axis inclination deviation (p-values=.000), and both factors had very large effect sizes (3D-shift [η2P]=.599; implant axis inclination [η2P]=.298). Impressions made with polyvinyl siloxane exhibited the highest transfer precision. When the angulation of the implants was larger, more deviations occurred for the implant axis rotational deviation. The implant systems and impression methods showed partially significant variations (p-values=.001-.639) but only very small effect sizes (η2P=.001-.031). CONCLUSIONS: The impression material had the greatest effect size on accuracy in terms of the 3D shift and the implant axis inclination. For multiunit restorations with disparallel implants, polyvinyl siloxane materials should be considered. In addition, the effect size of a multivariate investigation should be reported.

Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction.

PURPOSE: Ablative oncological surgery to treat head-and-neck cancer often triggers a requirement for jaw reconstruction. Modern surgical procedures using free microvascular flaps afford acceptable outcomes in terms of restoration of bony and soft tissue defects. A fibula free flap is often the preferred flap, as the bone length is considerable and a two-surgeon approach is possible. Dental implants play important roles in functional rehabilitation. Our aim was to evaluate the survival of dental implants placed in reconstructed areas after transfer of fibula tissue to the jaw. MATERIALS AND METHODS: We retrospectively studied 34 patients who underwent ablative tumour surgery and jaw reconstruction using osteocutaneous fibula free flaps and who then received dental implants. We evaluated implant survival and success, survival of the fibula flap, and clinical and radiographic data. RESULTS: We included 34 patients, 23 of whom were diagnosed with squamous cell carcinoma. In total, 134 dental implants were inserted in transferred fibula bone. The cumulative implant survival rate was 81%. The survival rate of the 34 fibula flaps transplanted after surgical reconstruction was 97%. CONCLUSION: The insertion of endosseous implants after jaw reconstruction using vascularised fibula tissue yields successful dental rehabilitation in patients with oral cancers.

Ex corpore linguae: A cohort analysis after a unique surgical technique in oral cancer resection.

OBJECTIVE: Resection of posteriorly located oral squamous cell carcinomas (OSCCs) remains challenging for head and neck surgeons. However, several surgical techniques, such as lip and mandibular splitting, as well as submental "visor drop-down" of intraoral soft tissues, have been proposed for this purpose. Merrick et al. suggested that a pedicled genial drop-down surgical approach should be used to resect dorsally located OSCCs. Our study investigated patient outcomes following this surgical procedure, as no previous study has analyzed long-term follow-up data. MATERIAL AND METHODS: All patients who underwent surgery using the pedicled genial "visor drop-down" approach at the Maxillofacial Department of the University Hospital Giessen in Germany between 1995 and 2010 were included in this study. In addition, our study required that patients diagnosed with OSCC had no history of other intraoral malignancy or any other form of malignancy. A preliminary questionnaire was completed for each patient based on retrospective analysis of available data from medical reports. RESULTS: A total of 51 patients fulfilled all inclusion and exclusion criteria and were evaluated retrospectively. In total, 32 patients were excluded from the study due to OSCC recurrence or acquisition of a different type of malignancy. The male to female distribution of patients in our study was 30 to 21 (58.8%-41.2%), and the mean ages of female and male patients were 57.7 (SD 14.3) and 55.7 (SD 14.4) years, respectively. Approximately 76.5% of tumors were located along the dorsal aspect of the tongue, 17.6% were along the floor of the mouth, 3.9% were in the dorsal mandibular region, and 1.9% were in the dorsal palatal region. The mean overall operation time was 6.25 h, and 28 patients received microvascular flaps for reconstruction. Results of final histopathological examination suggested primary in-sano resection of the tumor in 84.3% of patients. Overall, the 5-year postoperative survival rate was 52.9%; 31.3% of the patient cohort was not followed up for the full 5-year period. In addition, 15.7% of the patients included in our study died during the study period. Unimpaired functional outcomes in terms of swallowing and speech were observed in 86.3% of patients. CONCLUSION: The pedicled genial "visor drop-down" approach, also known as the ex corpore linguae, is a suitable method for the radical resection of dorsally located OSCCs, with a promising 5-year survival rate and satisfactory postoperative oral function.

Comparison between flat-panel volume computed tomography and histologic assessments of bone invasion of maxillofacial tumors: utility of an instantaneous radiologic diagnostic tool.

OBJECTIVE: The aim of this study was to compare the accuracy of flat-panel volume computed tomography (fpVCT) to histopathologic evaluation of excised tumors of the jaws in the detection of the degree of tumor infiltration, the presence of tumor at the resection margins, and the sizes of lesions. STUDY DESIGN: This preliminary study included 47 patients undergoing jaw resection for tumor invasion of bone. The specimens were examined by histology and 3-dimensional fpVCT, and the parameters of bone infiltration, resection margins, and tumor size were determined. RESULTS: In 95.7% of cases, the fpVCT results of tumorous bone infiltration were in accordance with the histologic findings. An examination of the resection margins showed 100% concordance between the 2 methods, and all resection margins were found to be clear in both fpVCT and the histologic examination. Identical pathologic and nonpathologic results were seen with the use of both diagnostic methods. Radiologic estimates of tumor size were larger than histologic measurements in the case of small tumors but the true sizes of the larger lesions were underestimated. CONCLUSIONS: The intraoperative diagnostic gap can be closed by using fpVCT to investigate bone destruction, allowing one-step resections and reconstructions to become more reliable.

Standards for digital photography in cranio-maxillo-facial surgery - Part I: Basic views and guidelines.

Clinical photography is an essential facility to support the work of cranio-maxillo-facial surgical departments. This paper highlights the requirements to ensure the highest quality and consistency of photographs taken and provides a standardized set of both facial and intra-oral views that fit the needs of accurate digital photo-documentation in cranio-maxillo-facial surgery. Furthermore it gives assistance in the selection of equipment, archival storage and error avoidance. These guidelines have been approved in November 2005 by the Council of the European Association for Cranio-Maxillo-Facial Surgery and are to be understood as a proposal to all our colleagues in Maxillofacial Surgery.

Standards for digital photography in cranio-maxillo-facial surgery--part II: additional picture sets and avoiding common mistakes.

As stated in the first part of this publication standardized clinical photographs are essential for planning, documentation and demonstration of surgical procedures in cranio-maxillo-facial surgery (Ettorre et al., 2006). This article expands the previously defined standards in facial digital photography. Additional picture sets for special topics are introduced and some common mistakes are discussed. Guidance for the prevention of pitfalls is provided and the photographic principles are reviewed. Finally the authors give recommendations for dealing with structured data storage and protection of medical photographs. The use of asset management systems such as Cumulus and Portfolio is introduced and recommended.