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Purpose: Traditional CT acquisition planning is based on scout projection images from planar anterior-posterior and lateral projections where the radiographer estimates organ locations. Alternatively, a new scout method utilizing ultra-low dose helical CT (3D Landmark Scan) offers cross-sectional imaging to identify anatomic structures in conjunction with artificial intelligence based Anatomic Landmark Detection (ALD) for automatic CT acquisition planning. The purpose of this study is to quantify changes in scan length and radiation dose of CT examinations planned using 3D Landmark Scan and ALD and performed on next generation wide volume CT versus examinations planned using traditional scout methods. We additionally aim to quantify changes in radiation dose reduction of scans planned with 3D Landmark Scan and performed on next generation wide volume CT. Methods: Single-center retrospective analysis of consecutive patients with prior CT scan of the same organ who underwent clinical CT using 3D Landmark Scan and automatic scan planning. Acquisition length and dose-length-product (DLP) were collected. Data was analyzed by paired t-tests. Results: 104 total CT examinations (48.1 % chest, 15.4 % abdomen, 36.5 % chest/abdomen/pelvis) on 61 individual consecutive patients at a single center were retrospectively analyzed. 79.8 % of scans using 3D Landmark Scan had reduction in acquisition length compared to the respective prior acquisition. Median acquisition length using 3D Landmark Scan was 26.7 mm shorter than that using traditional scout methods (p < 0.001) with a 23.3 % median total radiation dose reduction (245.6 (IQR 150.0–400.8) mGy cm vs 320.3 (IQR 184.1–547.9) mGy cm). CT dose index similarly was overall decreased for scans planned with 3D Landmark and ALD and performed on next generation CT versus traditional methods (4.85 (IQR 3.8–7) mGy vs. 6.70 (IQR 4.43–9.18) mGy, respectively, p < 0.001). Conclusion: Scout imaging using reduced dose 3D Landmark Scan images and Anatomic Landmark Detection reduces acquisition range in chest, abdomen, and chest/abdomen/pelvis CT scans. This technology, in combination with next generation wide volume CT reduces total radiation dose.

Objective: This study aimed to identify which lumbar vertebral level above a lumbosacral transitional vertebra (LSTV) demonstrated the longest transverse process (TVP) lengths., Methods: In this exploratory quantitative osteological cohort study using a digital Vernier caliper, dried human cadaveric lumbar TVPs were measured for linear horizontal length at each lumbar vertebra, left and right sides. Data collection was conducted in South Africa at the Raymond A. Dart Collection of Modern Human Skeletons and the Pretoria Bone Collection. The LSTV cohort consisted of 110 spinal columns and an LSTV-free control cohort of a sex-balanced randomized selection of 30 male and 30 female spinal columns., Results: Compared with the control cohort, the LSTV cohort demonstrated longer TVPs for every vertebral level, particularly L3, while the left side demonstrated longer TVPs overall. There were no statistical differences in TVP length within the LSTV cohort when comparing all levels (P > 0.05). The L3 TVPs demonstrated the longest mean lengths in both control (65%) and LSTV (58%) cohorts. The general trend was that the TVPs of L3 had the longest mean length for both the left and the right sides in both cohorts and both sexes., Conclusions: In the absence of whole-spine imaging, these findings indicate that L3 TVPs may offer an alternative bony landmark, which may aid in spinal enumeration estimation in the setting of LSTV. This is of value for radiograph appraisal and may aid with correct-level intervention., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: For bone morphology and biomechanics analysis, landmarks are essential to define position, orientation, and shape. These landmarks define bone and joint coordinate systems and are widely used in these research fields. Currently, no method is known for automatically identifying landmarks on virtual 3D bone models of the radius and ulna. This paper proposes a knowledge-based method for locating landmarks and calculating a coordinate system for the radius, ulna, and combined forearm bones, which is essential for measuring forearm function. This method does not rely on pre-labeled data., Validation: The algorithm is validated by comparing the landmarks placed by the algorithm with the mean position of landmarks placed by a group of experts on cadaveric specimens regarding distance and orientation., Results: The median Euclidean distance differences between all the automated and reference landmarks range from 0.4 to 1.8 millimeters. The median angular differences of the coordinate system of the radius and ulna range from -1.4 to 0.6 degrees. The forearm coordinate system's median errors range from -0.2 to 2.0 degrees. The median error in calculating the rotational position of the radius relative to the ulna is 1.8 degrees., Conclusion: The automatic method's applicability depends on the use context and desired accuracy. However, the current method is a validated first step in the automatic analysis of the three-dimensional forearm anatomy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: to provide anatomic confirmation that standard methods which practitioners skilled in palpation use, can reliably identify the most likely site of emergence of the greater occipital nerve in most patients. The location and frequency of subcutaneous emergence of the greater occipital nerve and occipital artery with respect to the external occipital protuberance-mastoid line are reported., Methods: The external occipital protuberance and the mastoid processes were identified by palpation bilaterally on 57 body donors and the medial trisection point of a line connecting these bony landmarks was identified. A 4 cm circular dissection guide divided into 4 quadrants was centered on the trisection point and used to guide the removal of a circle of skin. The in-situ location of the nerve and artery were exposed by deep dissection within the circle. The frequency of the emergence and occurrence of the nerve and artery by quadrant were analyzed., Results: In 114 total dissections the greater occipital nerve was found to emerge within the circle 96 times (84%) and the occipital artery 100 times (88%). The nerve (90%) and artery (81%) emerged from the two inferior quadrants most of the time with no difference noted between male and female donors. The greater occipital nerve and occipital artery were found to emerge together most commonly in inferior lateral quadrant. Branches of the nerve and artery traveled together most frequently through the two lateral quadrants., Conclusion: This study confirmed that the medial trisection point of the external occipital protuberance-mastoid line can be located via palpation and reliably used to pinpoint the subcutaneous emergence of the greater occipital nerve and occipital artery in most individuals. When relying on palpation alone to identify the trisection point in the clinic, infusion of nerve block inferior and lateral to this point is most likely to bathe the greater occipital nerve in anesthetic., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Image-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referrals or equipment. An optimal technique would be safe and accurate and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization., Methods: A consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. The time required to perform the injection, the precise location of the needle tip, and factors that affected the accuracy of the injection were also assessed., Results: A standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery, and the location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by sports medicine and shoulder/elbow fellowship-trained orthopedic surgeons was confirmed in 93.8% (76/81) of patients. The average time to complete the procedure was 24.8 ​s. There were no patient-related variables associated with nonintra-articular injections in the cohort., Conclusions: This study demonstrated that the technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 ​s to perform. This method is safe, yields similar accuracy to image-guided procedures, has improved cost and time efficiency, and requires less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting., Level of Evidence: Level 5. IRB: Approved under Stanford IRB-56323., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Geoffry Abrams, MD reports a relationship with Orthofix Medical Inc that includes: funding grants. Geoffrey Abrams, MD reports a relationship with Smith and Nephew Inc that includes: funding grants. Geoffrey Abrams, MD reports a relationship with Sparta Bio that includes: equity or stocks. Geoffrey Abrams, MD reports a relationship with AxGen that includes: equity or stocks. Geoffrey Abrams, MD reports a relationship with Cytonics Inc that includes: equity or stocks and non-financial support. Geoffrey Abrams, MD reports a relationship with Arthrex Inc that includes: non-financial support. Geoffrey Abrams, MD reports a relationship with Stryker Orthopedics that includes: non-financial support. Geoffrey Abrams, MD reports a relationship with RobiconMD that includes: non-financial support. Geoffrey Abrams, MD reports a relationship with Bioventus that includes: non-financial support. Michael T. Freehill, MD reports a relationship with Conmed that includes: funding grants. Michael T. Freehill, MD reports a relationship with Smith and Nephew Inc that includes: consulting or advisory. MIchael T. Freehill, MD reports a relationship with Stryker Orthopedics that includes: consulting or advisory. Michael T. Freehill, MD reports a relationship with Sparta Bio that includes: equity or stocks. Tim Wang, MD reports a relationship with Overture Orthopedics that includes: equity or stocks. Tim Wang, MD reports a relationship with Micah that includes: non-financial support., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Registering the head and estimating the scalp surface are important for various biomedical procedures, including those using neuronavigation to localize brain stimulation or recording. However, neuronavigation systems rely on manually-identified fiducial head targets and often require a patient-specific MRI for accurate registration, limiting adoption. We propose a practical technique capable of inferring the scalp shape and use it to accurately register the subject's head. Our method does not require anatomical landmark annotation or an individual MRI scan, yet achieves accurate registration of the subject's head and estimation of its surface. The scalp shape is estimated from surface samples easily acquired using existing pointer tools, and registration exploits statistical head model priors. Our method allows for the acquisition of non-trivial shapes from a limited number of data points while leveraging their object class priors, surpassing the accuracy of common reconstruction and registration methods using the same tools. The proposed approach is evaluated in a virtual study with head MRI data from 1152 subjects, achieving an average reconstruction root-mean-square error of 2.95 mm, which outperforms a common neuronavigation technique by 2.70 mm. We also characterize the error under different conditions and provide guidelines for efficient sampling. Furthermore, we demonstrate and validate the proposed method on data from 50 subjects collected with conventional neuronavigation tools and setup, obtaining an average root-mean-square error of 2.89 mm; adding landmark-based registration improves this error to 2.63 mm. The simulation and experimental results support the proposed method's effectiveness with or without landmark annotation, highlighting its broad applicability., Competing Interests: Declaration of competing interest GS is also affiliated with Apple; this work is not related to such affiliation. AVP is inventor on patents and patent applications on transcranial magnetic stimulation (TMS) technology; has equity options and serves on the scientific advisory board of Ampa; and has received patent royalties, research funding, travel support, consulting fees, equipment loans, hardware donations, and/or patent application support from Rogue Research, Magstim, MagVenture, BTL Industries, Soterix Medical, Magnetic Tides, and Ampa. JMDM is a consultant for Restor3d. SMG is inventor on patents and patent applications on transcranial magnetic stimulation (TMS) technology. The remaining authors declare that they do not have competing financial interests or personal relationships that could influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To synthesize the terminology utilized in nerve-sparing surgical literature and propose standardized and nonconflicting terms to allow for consistent vocabulary., Design: We performed a literature search on PubMed using the search terms "pelvis" and "nerve-sparing." Nongynecologic surgery and animal studies were excluded. A narrative review was performed, focusing on nerves, fasciae, ligaments, and retroperitoneal spaces. Terms from included papers were discussed by all authors, who are surgeons versed in nerve-sparing procedures and one anatomist, and recommendations were made regarding the most appropriate terms based on the frequency of occurrence in the literature and the possibility of overlapping names with other structures., Results: 224 articles were identified, with 81 included in the full-text review. Overall, 48% of articles focused on cervical cancer and 26% on deeply infiltrating endometriosis. Findings were synthesized both narratively and visually. Inconsistencies in pelvic anatomical nomenclature were prevalent across publications. The structure with the most varied terminology was the rectal branch of the inferior hypogastric plexus with 14 names. A standardized terminology for pelvic autonomic nerve structures, fasciae, ligaments, and retroperitoneal spaces was proposed to avoid conflicting terms., Conclusion: Surgeons and anatomists should use consistent terminology to facilitate increased uptake of nerve-sparing techniques in gynecologic surgery through a better understanding of surgical technique description. We have proposed a standardized terminology believed to facilitate this goal., Competing Interests: Conflict of Interest NL: Advisory Board for Integra LifeSciences Inc.; Speaker honoraria for Pfizer Inc. and Medtronic Inc. MFB: National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) under Award Number NS123206-01., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objectives: Perform radiologic measurements and analysis of normal brain computed tomography (CT) scans; delineate a new ventricular entry point from cutaneous landmarks, highlighting the potential surgical implications of these findings., Methods: Six radiologic distances (AR; BR; AL; BL, C, and D) were measured in normal brain CT scans using Horos software. Statistical analysis of the measurements was performed with minitab18 software based on age, sex, and side., Results: 132 brain CT scans were analyzed, yielding the following mean results: AR distance: 2.1 cm; BR distance: 7 cm; AL distance: 2.1 cm; BL distance: 7.1 cm; C distance: 12.4 cm; D distance: 7 cm; new ventricular entry point: 12.4 cm posterior to the nasion, and 2.1 cm lateral to the midline., Conclusions: The freehand technique for accessing the lateral ventricles is a common neurosurgical procedure but is often accompanied by complications. To address this, we suggest a novel entry point for ventricular access, determined by cutaneous reference points. This point is situated 12.4 cm posterior to the nasion along the midline and 2.1 cm lateral to the midline. Although our findings may play a role in presurgical planning for ventricular pathologies, future prospective studies are warranted., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Forensic facial reconstruction is the last recourse to establish the identity of an unknown skull. The facial soft-tissue thickness (FSTT) is required to reconstruct various facial features on a skull. Unlike other facial features, the nose is made of cartilaginous tissue except for a small nasal bone. A large cavity (pyriform aperture) exists on the skull in place of the nose, which makes it a challenging job for reconstruction. The nose is a vital feature for the recognition of a face. Any change in the shape or size of the nose can alter the original aesthetic of the face. The present study proposes angles and regression functions on the bony structure to predict the various parts of the soft nose. A sample of computed tomography (CT) images of 100 males and 100 females aged between 18 and 45 years were included in the study. Apart from measuring fourteen linear parameters with three angles, simple linear regression models were derived for five pairs of parameters. Pearson's correlation coefficients for most of the parameters ranging between 0.221 and 0.872 were found to be significant at p ≤ 0.05 level. FSTT at three anatomical landmarks of the nose was also measured. A morphological observation study was undertaken to find the most frequent direction of the bony anterior nasal spine (ans) and its relation with the position of the pronasale (prn) on the soft nose. The devised parameters proposed in the study may also prove useful for reconstructing the nose in other populations., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Accurate landmark detection in medical imaging is essential for quantifying various anatomical structures and assisting in diagnosis and treatment planning. In ultrasound cine, landmark detection is often associated with identifying keyframes, which represent the occurrence of specific events, such as measuring target dimensions at specific temporal phases. Existing methods predominantly treat landmark and keyframe detection as separate tasks without harnessing their underlying correlations. Additionally, owing to the intrinsic characteristics of ultrasound imaging, both tasks are constrained by inter-observer variability, leading to potentially higher levels of uncertainty. In this paper, we propose a Bayesian network to achieve simultaneous keyframe and landmark detection in ultrasonic cine, especially under highly sparse training data conditions. We follow a coarse-to-fine landmark detection architecture and propose an adaptive Bayesian hypergraph for coordinate refinement on the results of heatmap-based regression. In addition, we propose Order Loss for training bi-directional Gated Recurrent Unit to identify keyframes based on the relative likelihoods within the sequence. Furthermore, to exploit the underlying correlation between the two tasks, we use a shared encoder to extract features for both tasks and enhance the detection accuracy through the interaction of temporal and motion information. Experiments on two in-house datasets (multi-view transesophageal and transthoracic echocardiography) and one public dataset (transthoracic echocardiography) demonstrate that our method outperforms state-of-the-art approaches. The mean absolute errors for dimension measurements of the left atrial appendage, aortic annulus, and left ventricle are 2.40 mm, 0.83 mm, and 1.63 mm, respectively. The source code is available at github.com/warmestwind/ABHG., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Landmark detection is a crucial task in medical image analysis, with applications across various fields. However, current methods struggle to accurately locate landmarks in medical images with blurred tissue boundaries due to low image quality. In particular, in echocardiography, sparse annotations make it challenging to predict landmarks with position stability and temporal consistency. In this paper, we propose a spatio-temporal graph convolutional network tailored for echocardiography landmark detection. We specifically sample landmark labels from the left ventricular endocardium and pre-calculate their correlations to establish structural priors. Our approach involves a graph convolutional neural network that learns the interrelationships among landmarks, significantly enhancing landmark accuracy within ambiguous tissue contexts. Additionally, we integrate gate recurrent units to grasp the temporal consistency of landmarks across consecutive images, augmenting the model's resilience against unlabeled data. Through validation across three echocardiography datasets, our method demonstrates superior accuracy when contrasted with alternative landmark detection models., Competing Interests: Declaration of competing interest All authors disclosed no relevant relationships., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: To quantify the accuracy of Dolphin Imaging software in predicting soft tissue changes of Class II Division 1 incisor relationship treated by all first premolar extraction compared with actual changes., Methods: Pretreatment and post-treatment lateral cephalograms of 30 young adult subjects (25 females and 5 males; age range of 16 to 21 years) were imported and traced in Dolphin Imaging software (version 11.95). Tracings of actual treatment results and the Dolphin predicted treatment outcome were superimposed to calculate the prediction errors. The mean difference for the Holdaway soft tissue analysis and at each landmark was measured in both the X and Y axes. Paired t test was used to compare the statistical differences in Holdaway soft tissue analysis parameters., Results: There were significant differences between the predicted and actual values in three parameters of the Holdaway soft tissue analysis (P < 0.05). The overall accuracy of estimation was better in vertical direction than horizontal. Prediction of upper and lower lip landmarks was overestimated horizontally and underestimated vertically, whereas that belonging to chin was underestimated horizontally and overestimated vertically. Soft tissue nasion and soft tissue A-point were most accurately predicted, whereas the least accuracy was found in soft tissue chin region., Conclusions: Dolphin Imaging Software (version 11.95) can be accurate enough for use in patient communication and education but should be used with caution. It is most accurate in predicting soft tissue changes in the nasion and A-point regions, but least accurate in chin region., (Copyright © 2024 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To measure the impact of superimposition methods and the designated comparison area on accuracy analyses of dentate models using an ISO-recommended 3-dimensional (3D) metrology-grade inspection software (Geomagic Control X; 3D Systems; Rock Hill, South Carolina; USA)., Materials and Methods: A dentate maxillary typodont scanned with a desktop scanner (E4; 3 Shape; Copenhagen; Denmark) and an intraoral scanner (Trios 4; 3 Shape; Copenhagen; Denmark) was used as reference. Eight groups were created based on the core features of each superimposition method: landmark-based alignment (G1); partial area-based alignment (G2); entire tooth area-based alignment (G3); double alignment combining landmark-based alignment with entire tooth area-based alignment (G4); double alignment combining partial area-based alignment with entire tooth area-based alignment (G5); initial automated quick pre-alignment (G6); initial automated precise pre-alignment (G7); and entire model area-based alignment (G8). Diverse variations of each alignment and two regions for accuracy analyses (teeth surface or full model surface) were tested, resulting in a total of thirty-two subgroups (n = 18). The alignment accuracy between experimental and reference meshes was quantified using root mean square (RMS) error as trueness and its repeatability as precision. The descriptive statistics, a factorial repeated measures analysis of variance (ANOVA) and a post hoc Tuckey multiple comparison tests were used to analyze the trueness, and precision (α = 0.05)., Results: A total of 576 superimpositions were performed. The unique partial area-based superimposition method demonstrated the least precise alignment and was the sole group to exhibit a significant difference (p<.001). Automated initial pre-alignments demonstrated similar accuracy to other superimposition methods (p>.05). Double alignments did not result in accuracy improvement (p>.05). The designated comparison area displayed differences in both trueness (p<.001) and precision (p<.001), leading to an overall discrepancy of 8 ± 4 μm between selecting the teeth surface or full model surface., Conclusions: The superimposition method choice within the tested software did not impact accuracy analyses, except when the alignment relies on a unique and reduced area, such as the palatal rugae, a single tooth, or three adjacent teeth on one side., Clinical Significance: The superimposition method choice within the tested ISO-recommended 3D inspection software did not impact accuracy analyses., Competing Interests: Declaration of competing interest The authors have no conflict of interest to report pertaining to the conduction of this study., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Rhinoplasty enhances facial symmetry and functionality. However, the accurate and reliable quantification of nasal defects pre-surgery remains an ongoing challenge., Aim: This study introduces a novel approach for defect quantification using 2D images and artificial intelligence, providing a tool for better preoperative planning and improved surgical outcomes., Materials and Methods: A pre-trained AI model for facial landmark detection was utilised on a dataset of 250 images of male patients aged 18 to 24 who underwent rhinoplasty for cosmetic nasal deformity correction. The analysis concentrated on 36 different distances between the facial landmarks. These distances were normalised using min-max scaling to counter image size and quality variations. Post-normalisation, statistical parameters, including mean, median, and standard deviation, were calculated to identify and quantify nasal defects., Results: The methodology was tested and validated using images from different ethnicities and regions, showing promising potential as a beneficial surgical aid. The normalised data produced reliable quantifications of nasal defects (average 76.2%), aiding in preoperative planning and improving surgical outcomes and patient satisfaction., Applications: The developed method can be extended to other facial plastic surgeries. Furthermore, it can be used to create app-based software, assist medical education, and improve patient-doctor communication., Conclusion: This novel method for defect quantification in rhinoplasty using AI and image processing holds significant potential in improving surgical planning, outcomes, and patient satisfaction, marking an essential step in the fusion of AI and plastic surgery., Competing Interests: Declaration of Competing Interest The authors state that all the subjects have informed consent. The authors declare that there are no conflicts of interest., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Virtual reality-based learning of neuroanatomy is a new feasible method to explore, visualize, and dissect interactively complex anatomic regions. We provide a new interactive photorealistic three-dimensional (3D) model of sellar region microsurgical anatomy that allows side-by-side views of exocranial and endocranial surfaces to be explored, with the aim of assisting young neurosurgery residents in learning microsurgical anatomy of this complex region., Methods: Four head specimens underwent an endoscopic endonasal approach extended to the anterior and posterior skull base to expose the main bony anatomic landmarks of the sellar region. The same bony structures were exposed from a transcranial perspective. By using a photogrammetry method, multiple photographs from both endocranial and exocranial perspectives, different for angulations and depth, were captured, fused, and processed through dedicated software., Results: All relevant bony structures were clearly distinguishable in the 3D model reconstruction, which provides several benefits in neuroanatomy learning: first, it replicates bony structures with high degrees of realism, accuracy, and fidelity; in addition, it provides realistic spatial perception of the depth of the visualized structures and their anatomic relationships; again, the 3D model is interactive and allows a 360° self-guided tour of the reconstructed object, so that the learner can read the bones and their anatomic relationship from all desired points of view., Conclusions: Detailed knowledge of key surgical landmarks representing keyholes and/or anatomic structures to not violate is mandatory for safer surgery, especially for a complex region such as the skull base. Highly accurate virtual and functional neurosurgical models, such as photogrammetry, can generate a realistic appearance to further improve surgical simulators and learn neuroanatomy., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Cutaneous burns are commonly treated with autologous skin grafts. Following skin grafting, many patients complain of pain at the donor site. Donor sites are taken most commonly from the lateral thigh, which is innervated by the lateral femoral cutaneous nerve (LFCN). Use of a LFCN blocks should decrease nociception from the donor site., Methods: Our group began utilizing LFCN blocks in 2019. Utilizing anatomic landmarks, LFCN blocks were performed on all patients who received autologous skin grafts to reduce perioperative pain. A retrospective cohort study was performed on all patients with 10% or less total body surface areas burns who received an autologous skin graft. A similar cohort from 2016, prior to use of any local or regional analgesia, was used as a historical control. Post-operative enteral and parenteral narcotic analgesics were collected for each post-operative day up to day 5 or discharge (whichever came first) and converted to morphine milligram equivalents (MME) to quantify analgesia after surgery., Results: Chart review identified 55 patients in the 2020 cohort. Fifty-five patients from the 2016 cohort were matched based upon size of skin graft, total body surface area (TBSA) burned, gender, and age. There were no statistically significant differences between the two groups in terms of size of graft, TBSA burned, age, gender, or type of burn. When examining narcotics usage in the immediate perioperative period (days 0-2), we found no difference between the two groups for total MME (113 vs 133, p = 0.28) or IV MME (38 vs 33, p = 0.45). Similar relationships existed in the extended post-operative period (days 1-5) for total MME (149 vs. 188, t = 0.22) or IV MME (37 vs. 50, t = 0.25). Examining daily narcotic usage also yielded no statistically different values., Conclusion: Our data shows that use of LFCN block by landmark technique did not reduce narcotic usage in patients that undergo skin grafting procedures. Future studies should consider ultrasound-guided LFCN blocks., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Objective: We examined the effectiveness and feasibility of the Mask Region-based Convolutional Neural Network (Mask R-CNN) for automatic detection of cephalometric landmarks on lateral cephalometric radiographs (LCRs)., Study Design: In total, 400 LCRs, each with 19 manually identified landmarks, were collected. Of this total, 320 images were randomly selected as the training dataset for Mask R-CNN, and the remaining 80 images were used for testing the automatic detection of the 19 cephalometric landmarks, for a total of 1520 landmarks. Detection rate, average error, and detection accuracy rate were calculated to assess Mask R-CNN performance., Results: Of the 1520 landmarks, 1494 were detected, for a detection rate of 98.29%. The average error, or linear deviation distance between the detected points and the originally marked points of each detected landmark, ranged from 0.56 to 9.51 mm, with an average of 2.19 mm. For detection accuracy rate, 649 landmarks (43.44%) had a linear deviation distance less than 1 mm, 1020 (68.27%) less than 2 mm, and 1281 (85.74%) less than 4 mm in deviation from the manually marked point. The average detection time was 1.48 seconds per image., Conclusions: Deep learning Mask R-CNN shows promise in enhancing cephalometric analysis by automating landmark detection on LCRs, addressing the limitations of manual analysis, and demonstrating effectiveness and feasibility., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Preprocedural, real-time, and computer-aided three-dimensional ultrasound has been widely used for neuraxial puncture; however, the optimal guidance is unclear. We examined the comparative efficacy of three ultrasound guidance and anatomical landmarks for neuraxial puncture in adults., Methods: We searched for randomised controlled studies comparing the efficacy of ultrasound guidance and anatomical landmarks for neuraxial puncture in adults using electronic databases and unpublished studies. The primary outcomes were first-pass success and patient satisfaction. A random-effects network meta-analysis (NMA) was used., Results: We identified 74 eligible studies (7090 patients). Preprocedural ultrasound and real-time ultrasound-guided neuraxial puncture improved first-pass success compared with anatomical landmarks (risk ratio [RR] 1.6; 95% credible interval [CrI] 1.3-1.9; RR 1.9; 95% CrI 1.3-2.9, respectively, moderate confidence). Computer-aided ultrasound-guided neuraxial puncture also increased first-pass success (RR 1.8; 95% CrI 0.97-3.3, low confidence), although estimates were imprecise. However, real-time ultrasound-guided neuraxial puncture resulted in minimal difference in first-pass success compared with preprocedural ultrasound (RR 1.2; 95% CrI 0.8-1.8, moderate confidence). Preprocedural ultrasound improved patient satisfaction slightly compared with anatomical landmark use (standardised mean differences 0.28; 95% CrI 0.092-0.47, low confidence)., Conclusions: This NMA provides evidence supporting ultrasound-guided neuraxial puncture compared with use of anatomical landmarks, including indirect comparisons. Among the three ultrasound guidance methods, preprocedural ultrasound appears to be a better adjunctive option., (Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: Radiographic measurements to study sagittal alignment in the setting of knee are frequently difficult to evaluate due the presence of a prosthesis or implant that obscures traditional radiographic landmarks. In this paper we present a novel method of determining sagittal femoral alignment in the presence of obscuring implants., Methods: 98 full-length femoral radiographs were reviewed and divided into two groups. In Group 1, the Distal Mechanical Point (DMP) was used to calculate the Distal Mechanical Ratio (DMR), defined as the ratio of the linear distance from the DMP to the anterior cortical axis divided by the distance from the anterior cortical axis to posterior condylar cortex. In group 2, the sagittal mechanical axis was measured using the true DMP (tDMP) and then separately measured using the DMR to find the calculated DMP (cDMP), and the angular variance between the calculated (cSMA) and true (tSMA) sagittal mechanical axis was calculated, as well as the linear distance between the tDMP and cDMP. Twenty additional patients with knee replacements were then selected and two observers used a cSMA to determine a femoral prosthesis flexion angle (FPFA), with intraobserver correlation calculated., Results: The mean DMR was found to be 0.24, with high intraobserver correlation and normal distribution. Validation of the model demonstrated angular variance between tSMA and cSMA less than 1 degree and linear distance between tDMP and cDMP less than 1 mm. Calculation of cCMA in the presence of total knee arthroplasty revealed very strong intraobserver correlation of 0.89., Conclusion: The Distal Mechanical Ratio reliably predicted the true Sagittal Mechanical Axis within 1 degree and true Distal Mechanical Point within 1 mm, indicating that it may be a valuable tool for evaluating sagittal femoral alignment in cases where anatomic landmarks may be absent or obscured., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To evaluate the relationship between the oculomotor nerve (CNIII) and the internal carotid artery (ICA) as a new anatomic-radiologic landmark for distinguishing the exact location of a paraclinoid intracranial aneurysm (IA)., Methods: Microanatomic dissections were performed in 20 cavernous sinuses to evaluate the ICA paraclinoid region. Based on anatomic observations, a new magnetic resonance (MRI) protocol to classify paraclinoid aneurysms was proposed. MRI of 42 IAs from 34 patients was independently analyzed and classified as intracavernous, extracavernous, or transitional by 2 neuroradiologists. To validate the proposed MRI protocol, each IA was classified by a three-dimensionally (3D) printed biomodel and agreement with the radiologic classifications was evaluated. Of 42 IAs, 23 undergoing microsurgeries were also classified by direct visualization., Results: We observed that the true cavernous sinus roof is defined by the carotid-oculomotor membrane, which has an intimate relationship with the intersection between the superior limit of the CNIII and the ICA. Based on this intersection, all 42 IAs were radiologically classified and agreement with the 3D printed biomodels was observed in 95% IAs. Concordance tests showed a statistically significant (P < 0.05) agreement between the classifications. All 23 IAs treated had the radiologic and 3D biomodel classification confirmed., Conclusions: The intersection between the ICA and the CNIII, which crosses it transversely in its entire diameter, is a reliable anatomic-radiologic landmark to correctly classify paraclinoid aneurysms. Through a new MRI protocol, it is possible to radiologically identify this intersection and to easily distinguish the intracavernous and extracavernous ICA paraclinoid aneurysms., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: This study aimed to investigate the midsagittal reference plane (MSP) reliability derived from the 3-dimensional characteristics of patients with or without facial asymmetry in the anterior cranial base (ACB)., Methods: We divided the cone-beam computed tomography (CBCT) images of 60 adult patients into maxillofacial symmetry and asymmetry groups. The ACB models were 3-dimensionally constructed, and then symmetrical characteristics were evaluated with surface asymmetry for each group. The reliability of the MSP derived from the symmetry of the anterior cranial base (MSP ACB ) was assessed in comparison with the true craniofacial symmetry plane determined using the morphometric method., Results: The ACB was symmetrical, as demonstrated by slight surface asymmetry. The MSP ACB was reliable for maxillofacial asymmetrical analysis as the intraobserver and interobserver measurements using the MSP ACB were of excellent agreement, and there was no significant difference between MSP ACB and morphometric method in asymmetrical measurements in both groups. The MSP ACB remained stable (maximum deviation <0.32 mm) when cranial landmark identification errors (1 mm and 4 mm) were simulated., Conclusions: MSP ACB is reliable for patients with or without facial asymmetry in maxillofacial asymmetry analysis, which is beneficial to patients with severe midfacial asymmetry or trauma when conventional landmarks are displaced or disappear. When using MSP ACB for patients with cranial malformations or those whose ACBs differ from normal dimensions, caution should be taken., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Facial asymmetry is common and can be clinically related to dental malocclusion, facial bone development, muscular imbalance, and soft tissues thickness, which should be assessed during diagnosis to choose proper treatment options. This study aimed to quantify the amount of symmetry/asymmetry in previously defined symmetrical and asymmetrical subjects, analyzing full-face 3-dimensional images., Methods: Seventy-six orthodontic patients' 3-dimensional face images were obtained with the 3dMD Trio-system (Atlanta, Ga) and processed with the Geomagic Control (64-bit; 3D Systems, Rock Hill, SC) software. Patients were divided into symmetrical and asymmetrical groups through a surface-based technique. Sixteen facial landmarks were positioned, an asymmetry index was calculated for each landmark, and an evaluation diagram of facial asymmetry was created through the asymmetry index mean and standard deviation of symmetrical and asymmetrical landmarks., Results: The asymmetry index mean varied from 0.05 to 1.51 in the symmetrical group and from 0.05 to 2.84 in the asymmetrical group. This study suggests that landmarks located in the lower third of the face have a greater asymmetry index than other landmarks., Conclusions: The landmark-based technique does not exhibit statistically significant differences among asymmetrical and symmetrical patients for some landmarks. This approach provides useful information about the localization and the extension of asymmetry, in which bilateral landmarks showed a higher amount of asymmetry than median landmarks., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to evaluate the accuracy of auto-identification of the posteroanterior (PA) cephalometric landmarks using the cascade convolution neural network (CNN) algorithm and PA cephalogram images of a different quality from nationwide multiple centers nationwide., Methods: Of the 2798 PA cephalograms from 9 university hospitals, 2418 images (2075 training set and 343 validation set) were used to train the CNN algorithm for auto-identification of 16 PA cephalometric landmarks. Subsequently, 99 pretreatment images from the remaining 380 test set images were used to evaluate the accuracy of auto-identification of the CNN algorithm by comparing with the identification by a human examiner (gold standard) using V-Ceph 8.0 (Ostem, Seoul, South Korea). Pretreatment images were used to eliminate the effects of orthodontic bracket, tube and wire, surgical plate, and surgical screws. Paired t test was performed to compare the x- and y-coordinates of each landmark. The point-to-point error and the successful detection rate (range, within 2.0 mm) were calculated., Results: The number of landmarks without a significant difference between the location identified by the human examiner and by auto-identification by the CNN algorithm were 8 on the x-coordinate and 5 on the y-coordinate, respectively. The mean point-to-point error was 1.52 mm. The low point-to-point error (<1.0 mm) was observed at the left and right antegonion (0.96 mm and 0.99 mm, respectively) and the high point-to-point error (>2.0 mm) was observed at the maxillary right first molar root apex (2.18 mm). The mean successful detection rate of auto-identification was 83.3%., Conclusions: Cascade CNN algorithm for auto-identification of PA cephalometric landmarks showed a possibility of an effective alternative to manual identification., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: The sigmoid take-off (STO) was recently introduced as a preferred landmark, agreed upon by expert consensus recommendation, to discern rectal from sigmoid cancer on imaging. Aim of this study was to assess the reproducibility of the STO, explore its potential treatment impact and identify its main interpretation pitfalls., Methods: Eleven international radiologists (with varying expertise) retrospectively assessed n = 155 patients with previously clinically staged upper rectal/rectosigmoid tumours and re-classified them using the STO as completely below (rectum), straddling the STO (rectosigmoid) or completely above (sigmoid), after which scores were dichotomized as rectum (below/straddling STO) and sigmoid (above STO), being the clinically most relevant distinction. A random subset of n = 48 was assessed likewise by 6 colorectal surgeons. ., Results: Interobserver agreement (IOA) for the 3-category score ranged from κ0.19-0.82 (radiologists) and κ0.32-0.72 (surgeons), with highest scores for the most experienced radiologists (κ0.69-0.76). Of the 155 cases, 44 (28%) were re-classified by ≥ 80% of radiologists as sigmoid cancers; 36 of these originally received neoadjuvant treatment which in retrospect might have been omitted if the STO had been applied. Main interpretation pitfalls were related to anatomical variations, borderline cases near the STO and angulation of axial imaging planes., Conclusions: Good agreement was reached for experienced radiologists. Despite considerable variation among less-expert readers, use of the STO could have changed treatment in ±1/4 of patients in our cohort. Identified interpretation pitfalls may serve as a basis for teaching and to further optimize MR protocols., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Loss of knee extension causes significant impairment. Though nerve-based reconstruction is preferable in cases of femoral nerve palsy or injury, these surgeries are not always appropriate if the pathology involves the quadriceps muscles or presentation too late for muscle reinnervation. Muscle transfers are another option that has been underutilized in the lower extremity. We describe the successful restoration of knee extension by adductor magnus muscle transfer without functional donor morbidity, along with anatomical considerations., Methods: Ten fresh frozen cadaveric lower limbs were dissected at the groin and thigh. In addition, three patients presented with femoral nerve palsy for which nerve-based reconstruction was not appropriate because of late presentation. In these patients, adductor magnus muscle transfers were performed, along with sartorius, gracilis, and tensor fasciae latae transfers if available and healthy., Results: In cadavers, the pedicle for the adductor magnus is at the level of the gracilis and adequate for muscle transfer, with sufficient weavable tendon length. The only major structure at risk is the femoral neurovascular bundle, which is in a reliable anatomic position. Two patients recovered 4/5 active knee extension and ambulation without assistive devices. A third required reoperation for a loosened tendon weave, after which the noted improved stability and strength with ambulation but did not regain strong active knee extension and continued to require a cane., Conclusions: We present a novel reconstructive approach for loss of quadriceps function in patients, which yields good clinical outcomes, with anatomic and technical details to demonstrate the utility of this technique. Ongoing evaluation of optimal technique and rehabilitation to maximize functional outcomes is still needed., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Current descriptions of the unilateral cleft lip and nasal deformity (uCLND) are based upon limited sample sets and subjective observations. While those descriptions are inconsistent and contradictory, theoretical models, including Hogan's "tilted tripod" and Fisher's "nasal arch forms", have never been tested. Given that favorable outcomes of treatment remain elusive, detailed study of the deformity is critical in devising better treatments. The purpose of this study was to develop a data-driven three-dimensional (3D) model of uCLND that spans the spectrum of presentation and involves a pervasive underlying mechanism., Methods: We studied 3D images of 100 infants with unrepaired cleft lip at 6 months of age. Objective assessment included the landmark positions, anthropometric dimensions, and shape-based measures. Cleft severity was stratified by the lateral displacement of subnasale, so that a model could be developed using linear regression., Results: With progressive deviation of subnasale, the non-cleft alar base moved lateral, the cleft alar base was left posterior, and the nasal dorsum followed the caudal septum (deviating towards the non-cleft side). The "twist" resulted in opposing cleft alar dome collapse, non-cleft alar ring constriction (the non-cleft nasal sill narrowed, lateral genu rose, and alar-cheek junction became more acute), and displacement of the philtrum from midline., Conclusions: Our study not only supports theoretical models of uCLND but also clarifies vectors of change and reveals significant non-cleft side alterations. On the basis of our findings, the objectives of treatment should involve centralization of the columella and philtrum and rebalancing the nose by untwisting the orthogonal displacement of the alar bases., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Fundamental principle in improving Dental and Orthodontic treatments is the ability to quantitatively assess and cross-compare their outcomes. Such assessments require calculating distances and angles from 3D coordinates of dental landmarks. The costly and repetitive task of hand-labelling dental models hinder studies requiring large sample size to penetrate statistical noise. We have developed techniques and a software implementing these techniques to map out automatically, 3D dental scans. This process is divided into consecutive steps - determining a model's orientation, separating and identifying the individual tooth and finding landmarks on each tooth - described in this paper. The examples to demonstrate the techniques, software and discussions on remaining issues are provided as well. The software is originally designed to automate Modified Huddard Bodemham (MHB) landmarking for assessing cleft lip/palate patients. Currently only MHB landmarks are supported, however it is extendable to any predetermined landmarks. The software, coupled with intra-oral scanning innovation, should supersede the arduous and error prone plaster model and calipers approach to Dental research, and provide a stepping-stone towards automation of routine clinical assessments such as "index of orthodontic treatment need" (IOTN)., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The Le Fort I maxillary advancement and rotational movement have been adopted to treat patients with cleft-related skeletal Class III pattern and anteromedial cheek soft tissue deficiency, but cleft-specific cheek soft tissue prediction data are insufficient. This 3D imaging-based study addressed the issue., Methods: 3D craniofacial soft tissue and bone models were created from 32 consecutive patients who received computer-aided two-jaw orthognathic surgery for the correction of cleft-related Class III deformity and cheek soft tissue deficiency. Using superimposed 3D models, the cheek volumetric change, the cheek sagittal movement, and the 3D cheek mass position were calculated. 3D data from orthognathic surgery-treated patients with no cleft (noncleft cohort) and individuals with no facial deformity (3D norm value) were retrieved for comparative analysis., Results: Surgical maxillary advancement (p < 0.001) but not maxillary clockwise rotation (p > 0.05) had a significant impact on the cheek soft tissue change, with prediction models showing that maxillary advancement elucidated 77 and 79% of this change on the cleft and noncleft sides, respectively. Cleft cohort (0.46±0.12) had a significantly (p < 0.001) smaller cheek soft-to-hard tissue ratio than that of the noncleft cohort (0.73±0.13). Cleft maxillary advancements >4 mm resulted in a 3D cheek mass position (2.1±1.1 mm) similar (p > 0.05) to the 3D norm value (2.2±1.2 mm), but different (p = 0.037) from the noncleft cohort (2.38±0.7 mm)., Conclusion: This study showed that maxillary advancement but not the maxillary rotation affects the cheek soft tissue change, and the predictive values and comparative data could assist the orthodontist-surgeon interaction during preoperative planning and patient counseling., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflict of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin: thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region., Materials and Methods: We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured., Results: There was no significant difference in the number of arterial pedicles across the three subregions: 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ± 2.1 cm and 1.07 ± 0.4 mm, respectively, without significant differences in the three subregions., Conclusions: The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The objective of the present study was to describe and evaluate the feasibility, mobility, and surface area provided by the simple and extended transorbital pericranial flap (TOPF). Furthermore, we compared this novel technique with the current practice of pericranial flap harvesting and insetting techniques. We also studied the adequacy of the TOPF in the reconstruction of postoperative anterior cranial fossa (ACF) defects., Methods: The TOPF was performed bilaterally in 5 alcohol-preserved, latex-injected human cadaveric specimens. The TOPF was harvested in 2 stages: the orbitonasal stage and the cranial stage. For the orbitonasal stage, a transorbital superior eyelid approach was used. We have described 2 harvesting techniques for creating 2 distinct TOPF types (simple and extended) according to the main vascular pedicle. The superficial flap areas offered by the simple and extended TOPF and the traditional bicoronal pericranial flap were calculated and compared. The distances from the supratrochlear and supraorbital arteries to specified anatomical landmarks were also measured. Additionally, the ACF defect area of relevant surgical cases performed using endoscopic transcribriform approaches were measured on immediate postoperative computed tomography head scans using radiological imaging software., Results: The harvest of both the simple and the extended TOPFs was efficient. As expected, the areas offered by simple and extended TOPFs were smaller than that offered by the traditional bicoronal flap. However, the surface area offered by either the simple or extended TOPF provides sufficient coverage for most ACF defects. A high spatial distribution was observed between the vascular pedicles and their respective foramen or notch., Conclusions: The TOPF represents a novel harvesting, tunneling, and insetting technique that offers a large, versatile, pedicled flap for coverage of most standard ACF defects after endoscopic surgery., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The measurement of anatomical structures is critical in plastic and reconstructive surgery. However, few detailed and standardized measurements have been widely used in the periorbital region. This study aimed to evaluate the feasibility of a novel detailed and standardized protocol with 2D and 3D technologies, and explore the relationship between them and direct measurements., Methods: Fifty healthy Caucasians (100 eyes) between 20 and 68 years old were recruited and captured for 3D photographs by VECTRA M3 3D Imaging System. Subsequently, 24 landmarks were located on each 3D photographs following a standardized protocol, and then 19 linear and 3 angular periorbital variables were measured. Furthermore, two-dimensional (2D) and direct measurements were conducted on each subject and compared with 3D measurements and one another., Results: The grand r means across all measurements were 0.77, 0.78, and 0.88 for direct vs. 2D values, direct vs. 3D values, and 3D vs. 2D values, respectively. The mean absolute differences were 1 mm (ranging from 0.2 mm to 3.7 mm) between direct and 3D measurements, 1 mm (ranging from 0.04 mm to 2.4 mm) between direct and 2D measurements, and 1 mm and 6.6° (ranging from 0.04 mm or 0.5° to 3 mm or 12.8°) between 2D and 3D measurements., Conclusions: This study verified the feasibility of this detailed and standardized landmark localization protocol for assessing the periorbital morphology with 2D and 3D technologies. This protocol may work as a bridge communicating with all studies involving any of the three technologies in the future., (Copyright © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Masseter injections for cosmetic or pathological reasons are increasingly common, as are filler injections using dual or multiplane techniques in the lateral facial regions or for jawline contouring. The occurrence of blindness following these procedures often remains unexplained. This study aimed to determine the anatomical explanation for this debilitating complication by investigating the transverse facial artery and its relation to the masseter. For this purpose, we dissected 35 cheek specimens with latex injections and 10 specimens without latex. The external carotid artery was dissected up to its bifurcation into the maxillary and superficial temporal arteries. Results showed that the transverse facial artery arose from the superficial temporal or external carotid artery that runs between the zygomatic arch and the parotid duct. Three types of transverse facial arteries were observed: type I: a short artery that did not extend beyond the masseter muscle; type II: a transverse artery that ran to the nasolabial fold and anastomosed to the facial artery; and type III: a sizable transverse artery that substituted the hypoplastic facial artery, continued as the angular artery, and then anastomosed to the dorsal nasal artery. Knowledge of these three types of transverse facial arteries is a prerequisite to study the vascular territory. Type III provides an explanation for the occurrence of blindness after lateral face injections. We consequently define a line that runs from the tragus to the outer quarter of the upper lip as the risk area, while the safe zone is located on either side of this line., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Ltd.)

The nasal aesthetic subunit principle has been widely accepted as the standard for nasal reconstruction with forehead flaps. However, in our experience, one's impression of a reconstructed face can easily be represented by the nose's entire appearance rather than a single nasal component. Accordingly, we hypothesized that total nasal reconstruction focusing more on the facial aesthetic subunit principle would be superior to focal nasal subunit partial reconstruction. Here, we investigated the indication range of total nasal reconstruction and analyzed its effectiveness. Between July 2006 and December 2017, 32 patients who underwent total or subtotal nasal reconstruction were recruited. The total nasal reconstruction group (n = 20) was treated according to our modified facial aesthetic unit concept, while the subtotal reconstruction group (n = 16) was treated according to the nasal aesthetic subunit principle. Using retrospective reviews, we compared surgical details and aesthetic, and functional outcomes with visual analog scale scores. In aesthetic evaluation, nose contour (p = 0.009), nasal symmetry (p = 0.001), and nostril shape (p = 0.041) were superior in the total nasal reconstruction group. Satisfaction regarding the nose (p = 0.036) was significantly higher than that regarding the forehead and labial folds in the total group. Regarding function, there were no significant intergroup differences in nasal airflow, snoring, or olfaction. We suggest that total nasal reconstruction is not a strategy to avoid because of its aggressive nature. For selected suitable patients, the use of the total nose reconstruction focusing on our one nose concept can be a successful surgical option, and the reconstructed nose can be visualized as a real part of the face., Competing Interests: Declaration of Competing Interest Nothing to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Imaging software has become critical tools in the diagnosis and decision making for the treatment of abdominal aortic aneurysms (AAA). However, the interobserver reproducibility of the maximum cross-section diameter is poor. This study aimed to present and assess the quality of a new fully automated software (PRAEVAorta) that enables fast and robust detection of the aortic lumen and the infrarenal AAA characteristics including the presence of thrombus., Methods: To evaluate the segmentation obtained with this new software, we performed a quantitative comparison with the results obtained from a semiautomatic segmentation manually corrected by a senior and a junior surgeon on a dataset of 100 preoperative computed tomography angiographies from patients with infrarenal AAAs (13,465 slices). The Dice similarity coefficient (DSC), Jaccard index, sensitivity, specificity, volumetric similarity (VS), Hausdorff distance, maximum aortic transverse diameter, and the duration of segmentation were calculated between the two methods and, for the semiautomatic software, also between the two observers., Results: The analyses demonstrated an excellent correlation of the volumes, surfaces, and diameters measured with the fully automatic and manually corrected segmentation methods, with a Pearson's coefficient correlation of greater than 0.90 (P < .0001). Overall, a comparison between the fully automatic and manually corrected segmentation method by the senior surgeon revealed a mean Dice similarity coefficient of 0.95 ± 0.01, a Jaccard index of 0.91 ± 0.02, sensitivity of 0.94 ± 0.02, specificity of 0.97 ± 0.01, VS of 0.98 ± 0.01, and mean Hausdorff distance per slice of 4.61 ± 7.26 mm. The mean VS reached 0.95 ± 0.04 for the lumen and 0.91 ± 0.07 for the thrombus. For the fully automatic method, the segmentation time varied from 27 seconds to 4 minutes per patient vs 5 minutes to 80 minutes for the manually corrected methods (P < .0001)., Conclusions: By enabling a fast and fully automated detailed analysis of the anatomic characteristics of infrarenal AAAs, this software could have strong applications in daily clinical practice and clinical research., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)