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At least 1,153 records · Page 64Linked to original sources
PubMed2004

[Sonography as a training tool for screening of dubious midfacial fractures].

BACKGROUND: In uncertain midfacial fractures, sonography is an alternative first-line imaging modality to conventional radiographs. Patients with sonographically confirmed fractures can then be directly admitted to three-dimensional imaging, resulting in decreased radiation exposure since the conventional radiographs are omitted. MATERIAL AND METHODS: Using a high-frequency linear and curved array scanner in a healthy proband, images of the zygomatic arch, anterior maxillary sinus wall, infraorbital rim, and lateral orbital wall were obtained. For identification and anatomical allocation corresponding navigated ultrasound images of a reference skull were generated and fused with a segmented CT data set. Navigated sonography was reproduced in a patient with orbitozygomatical fracture of the left side. Therefore, the CT data set, performed during preoperative diagnostics, was fused with the ultrasound images. RESULTS: Because of different coupling shapes, the high-frequency linear array scanner was subjectively found to be more suitable for sonography in the field of the zygomatic arch, anterior maxillary sinus wall, and infraorbital rim, and the curved array scanner was better suited for transbulbar sonography of the orbital walls. After coupling sonography with the navigation system and referencing the scanner, it was possible to verify ultrasound findings objectively by navigation of the scanner and fusion with the CT data set. Using the reference skull, ultrasound images corresponding to normal findings were obtained and with the fused CT data, providing colored segmentation of the facial bones, an anatomically correct identification was possible. Clinical application of this tool is described in a patient with left-sided orbitozygomatical fracture. CONCLUSION: By fusion of ultrasound images and corresponding CT data with the help of a navigation system, a sonographic training tool for preliminary evaluation of midfacial fractures is available.

Diagnosis, Computer-Assisted↗
PubMed2003

CT of orbital trauma.

In a patient with acute orbital trauma, visual acuity and extraocular muscle motility are the two most important ophthalmologic functions to be evaluated emergently. The assessment of these capabilities may sometimes be difficult due to the severity of the head injury, the extent of periorbital soft tissue edema, inadequate cooperation in alert patients, and a reduced level of consciousness in obtunded individuals. Consequently, computed tomography (CT) has come to play a major role in the orbital examination of acute trauma patients. In this study, in conjunction with clinical evaluation, we have sought to utilize CT to determine the various prevalences of the causes of decreased visual acuity and extraocular muscle motility resulting from orbital trauma. We retrospectively reviewed the records of all patients admitted to our emergency facility who, having suffered head trauma, underwent a CT study for diagnosis. CT examinations of the head using a multidetector scanner were performed from the base of the skull to the vertex at 5-mm intervals. Orbital CT was obtained when a routine CT of the head showed periorbital soft tissue edema and/or facial bone fractures. The orbital CT examination was performed using axial 1-mm and coronal 3-mm slices. Coronal reformation images were prepared if the patient was unable to tolerate the prone position for direct coronal imaging. The imaging findings were correlated with ophthalmologic observations. The orbit floor was the most common and the orbital roof the least common site of fracture of the bony coverings of the eye. Twenty-three patients suffered decreased visual acuity. In order of declining frequency, the causes of reduced vision consequent to trauma were retrobulbar hemorrhage, optic nerve thickening presumably secondary to edema, intraorbital emphysema, optic nerve impingement, detached retina and ruptured globe. Five patients had visual impairment without demonstratable radiographic abnormalities. The most common finding associated with diminished extraocular muscle motility was muscle impingement by fracture fragments, followed in decreasing frequency by thickened muscle due to edema or contusion, intraconal emphysema, muscle entrapment, and retrobulbar fat herniation. Six patients with decreased extraocular muscle activity had no abnormalities demonstrated on CT images. The overwhelming majority of patients with decreased visual acuity or reduced extraocular muscle motility consequent to trauma had abnormalities demonstrated by orbital CT. Hence, CT examinations should play a major role in the evaluation of the intraorbital contents in patients with orbital trauma.

Adolescent↗
PubMed2006

Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure.

The objective of this study was to compare two different scanning protocols in patients suspected to have multiple trauma using multidetector 16-row computed tomography (CT) to better define scanning time, imaging quality and radiation exposure. Forty-six patients, between March 2004 and March 2005, with suspected multiple trauma (cerebral, spine, chest, abdominal and pelvis) were evaluated with two different protocols: Protocol "A" 26 patients; Protocol "B" 20 patients. Protocol A consists of a single-pass continuous whole-body acquisition (from vertex to pubic symphysis), whereas Protocol B of conventional segmented acquisition with scanning of body segments individually. Both protocols were performed using a multidetector 16-rows CT (Light-Speed 16, General Electric Medical System, Milwaukee, WI, USA) with the same technical factors. Radiation dose was evaluated in two ways: computer tomography dose index (CTDI) = dose measured in central and peripheral region of the subjects as a direct result of a CT section acquisition of T millimeters thick (independent from the two protocols) and dose length product (DLP) = total dose deposited over the length of the acquisition (dependent from the two protocols). Image quality was rated according to the following scores: 1, excellent; 2, good; 3, satisfactory; 4, moderate and 5, poor. The results were compared using Wilcoxon's test to identify significant difference in terms of image quality, scanning time, radiation exposure and presence of artifacts, assuming significance at a p value of <0.05. In the single-pass scanning, DLP was 2.671 mGy x cm and a total scan time of 35 s. In whole-body protocols, we have seen artifacts due to arm adduction in thorax and less image quality in brain. In the conventional segmented study, DLP was 3.217 mGy x cm and a total scan time of 65 s; this protocol offered less extraction capabilities of off-axial on focused images of the entire spine, aorta, facial bones or hip without rescanning. Protocol A revealed a significant decrease in scan time (35 vs 65 min, p < 0.05), time in the CT examination room (21.7 vs 31.6 min.; p < 0.05), and final image analysis (83.7 vs 102.9 min; p < 0.05) and radiation dose compared to protocol B (p < 0.05). No significant difference was found for patient transport time, image reconstruction time and imaging quality. Reconstruction and isotropic reformation of axial image acquired by whole-body, single-pass protocols due to entire spine evaluation, aortic and splanchnic CT angiography eliminate additional studies. The whole-body, single-pass protocols, compared with segmented acquisitions protocols, resulted in a reduced total radiation dose without relevant loss of diagnostic image information.

Adolescent↗
PubMed1995

The nature and source of the head injuries sustained by restrained front-seat car occupants in frontal collisions.

The paper examines the types of head injury sustained by restrained front-seat car occupants in frontal collisions. Injuries are classified into soft tissue, diffuse and focal brain injuries and facial bone or skull fractures. Survivors seldom sustain focal injuries although these are common amongst fatalities. The contact sources within the car are described. Intruding structures and high crash severities are typically associated with high rates of the more severe injuries from steering wheel contact, although some are sustained with intrusion below 11 cm. Low-speed impact testing on nondeployed airbag-equipped wheels is suggested. Toughened glass windscreens are overrepresented amongst those sustaining injuries from glazing materials. Test procedures to reduce injuries from pillar contacts should take account of the dynamic effects of an intruding pillar. Contacts with objects outside the car caused higher rates of severe fractures and brain injury; however, the total numbers are greater from interior contacts.

Abbreviated Injury Scale↗
PubMed1981

Orbital tuberculosis.

A 37-year-old man had epistaxis, headache, intermittent swelling of the periorbital region, proptosis, epiphora, and chronic sinusitis. X-ray films showed marked erosion of the midline facial bones, total opacification of both maxillary sinuses, and clouding of the sphenoid and left ethmoid sinuses. He also had a cutaneous-maxillary sinus fistula and a purulent discharge. A histopathologic examination disclosed areas of acute and chronic inflammation with occasional noncaseating granulomas. Biopsy specimens and postoperative sputum cultures grew Mycobacterium tuberculosis, although the patient had no obvious signs of systemic disease. Because tuberculosis of the orbit is rare in developed countries, it is often overlooked in the diagnosis of granulomatous inflammation of the orbit. This can lead to exacerbation of the disease by corticosteroid treatment.

Adult↗
PubMed1977

Research on control of craniofacial morphogenesis: an NIDR State-of-the-Art Workshop.

To assess the wide clinical ramifications of control of craniofacial morphogenesis, a State-of-the-Art Workshop was conducted by the National Institute of Dental Research at the initiative of Richard L. Christiansen, Chief of the Craniofacial Anomalies Program. In conjunction with the authors listed above, the format for the workshop was developed and participants were selected. The workshop was designed to provide an in-depth review of present knowledge and to identify future goals and directions for research on guiding, altering, and thus controlling growth and development of the cranofacial skeleton. The agenda for discussion ranged from molecular biology to clinical arts such as orthopedics and surgery. It was evident during the workshop that the mechanisms and procedures for controlling craniofacial morphogenesis must be derived from many biologic, physical, and clinical fields of knowledge. It is hoped that there will evolve an interdisciplinary clinical art which is aimed at preventing and correcting craniofacial deformities. Substantial biologic information has already been accumulated on the craniofacial skeleton. The clinical art of correcting malocclusion through mechanical forces is now applicable to the entire skull. The outstanding technical accomplishments of radical surgery in the correction of congenital craniofacial anomalies show that the needed surgical skills are now available. When these resources are combined, an area of knowledge and a clinical discipline which might be called "orthocephalics" is already identifiable. The workshop was held at the National Institutes of Health in Bethesda, Maryland, on Feb. 12 and 13, 1974. The ideas exchanged were integrated and summarized by the planning committee to produce this report.

Animals↗
PubMed1977

Craniofacial templates for orthodontic case analysis.

1. Age-, sex-, and growth-type-specific craniofacial templates represent a practical approach to orthodontic case analyses and craniofacial growth. 2. The Burlington Growth Centre Cephalometric Analysis is a practical adjunct to treatment planning. 3. This cephalometric analysis, which combines many analyses, is an assessment of the relative proportions of the face in length, width, and height (static analysis) and an estimation of the future changes (dynamic analysis). 4. As an aid in diagnosis, the template and/or analysis in conjunction with a cephalogram, with provide information pertaining to (q) cranial base length angle, (b) upper and lower face height and maxillary and mandibular height, (c) size and proportions of the facial bones, both anteroposteriorly and in width, (d) denture relationship, both anteroposteriorly and in width, and (e) expected general growth changes.

Adolescent↗
PubMed1978

Prenatal growth patterns of the human mandible and masseter muscle complex.

Since experimental and clinical evidence supports some role of musculature in determining the form and size of facial bones during the active periods of growth after birth, this study addresses the same basic relationships between muscle and bone during the periods of active growth before birth. The relationship between the masseter muscle and the mandible, including its ramal and body components, was chosen as the model for study in nineteen human fetuses (ages 16 to 36 weeks). Cross-sectional cephalometric data indicated that, although increases in the size of the muscle and mandible were linearly related to increasing age, the ramal portion of the mandible was more closely related to changes in the masseter muscle than to changes in the mandibular body. Moreover, it appears that reorientation of the muscle anteriorly and downward precedes a similar reorientation of the ramus, with the combination of both fetal events leading to the typical relationships of the two structures expected after birth. Although this study does not get to cause-and-effect relationships, and although the fetal specimens cannot be monitored longitudinally over time, the parallelisms between our prenatal findings and those reported for postnatal periods certainly lend further support to the observation that many aspects of morphogenesis and growth are continual processes spanning the periods on either side of birth.

Body Height↗
PubMed1982

Morphologic alterations in Macaca mulatta following destruction of the motor nucleus of the trigeminal nerve.

In two adolescent male Macaca mulatta monkeys, small unilateral electrolytic lesions were produced in the motor nucleus of the trigeminal nerve. The side contralateral to the muscle paralysis served as the control side. The animals were killed 130 and 300 days postoperatively. One animal (animal A) was prepared as a dry skull preparation. Alterations in craniofacial form were noted clinically in both animals and included paralysis and atrophy of the muscles of mastication on the lesion side and mandibular asymmetry. In animal A (300 days postoperative survival), alterations in form included dental and mandibular asymmetry, the appearance of an anterior open-bite on the affected side, and a decrease in the size of the intratemporal fossa on the affected side. Remodeling changes were evident in the condylar process, the zygomatic arch, the orbit, and the zygomaticotemporal and zygomaticofrontal sutures on the lesion side but were not apparent on the contralateral side.

Animals↗
PubMed1983

A functional approach to treatment of skeletal open bite.

In general orthopedics the relationship between postural behavior and skeletal deformities has long been recognized. The primary therapeutic problem in functional orthopedics is to overcome functional disorders. In this article the applicability of this functional concept to orofacial orthopedics is discussed on the basis of a longitudinal study of skeletal open bite. A comparison of a series of lateral cephalograms of thirty patients with skeletal open bite who were treated with functional regulators developed by Fränkel and those of eleven untreated open bite cases suggests that some dentofacial deformities in the skeletal open bite cases can be corrected to the average norms. In addition, as a result of overcoming the poor postural pattern of the orofacial musculature and re-establishment of a competent lip seal, a considerable change in the soft-tissue profile occurred.

Activator Appliances↗
PubMed1984

Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration.

The present experiment was designed to test whether specific recordable changes in the neuromuscular system could be associated with specific alterations in soft- and hard-tissue morphology in the craniofacial region. The effect of experimentally induced neuromuscular changes on the craniofacial skeleton and dentition of eight rhesus monkeys was studied. The neuromuscular changes were triggered by complete nasal airway obstruction and the need for an oral airway. Alterations were also triggered 2 years later by removal of the obstruction and the return to nasal breathing. Changes in neuromuscular recruitment patterns resulted in changed function and posture of the mandible, tongue, and upper lip. There was considerable variation among the animals. Statistically significant morphologic effects of the induced changes were documented in several of the measured variables after the 2-year experimental period. The anterior face height increased more in the experimental animals than in the control animals; the occlusal and mandibular plane angles measured to the sella-nasion line increased; and anterior crossbites and malposition of teeth occurred. During the postexperimental period some of these changes were reversed. Alterations in soft-tissue morphology were also observed during both experimental periods. There was considerable variation in morphologic response among the animals. It was concluded that the marked individual variations in skeletal morphology and dentition resulting from the procedures were due to the variation in nature and degree of neuromuscular and soft-tissue adaptations in response to the altered function. The recorded neuromuscular recruitment patterns could not be directly related to specific changes in morphology.

Animals↗
PubMed1984

Associations between anterior temporal, masseter, and orbicularis oris muscle activity and craniofacial morphology in children.

In a sample of children with Class I (n = 18), Class II, Division 1 (n = 25) and Class II, Division 2 (n = 12) malocclusions, the relationship between jaw muscle activity and specific craniofacial variables has been quantified. Muscle data were obtained from the temporal, masseter, and orbicularis oris muscles at rest, in maximum intercuspation, and during clenching, jaw opening, and swallowing. Contrasts in means of the three skeletal groups identified differences in both the craniofacial and muscle variables. Orbicularis oris muscle amplitude was greater at rest and in maximum intercuspation in Class II, Division 2 subjects. Anterior temporal amplitude during clenching was significantly lower in Class II, Division 1 subjects. A principal component analysis reduced the data base, and three canonical correlations were identified at the 0.05 level of significance. Significant canonical correlations could not be found between the cephalometric data and clench, swallow, or jaw-opening tasks, which suggests no dependency between these factors. Two canonical correlations were found for the rest position data. A linear combination of masseter and orbicularis oris activity and incisor separation was correlated (r1 = 0.758) with a linear combination of mandibular unit length, upper and lower central incisor angulation, and SNOP. The second rest canonical correlation (r2 = 0.733) involved the anterior temporal muscle and a series of sixteen cephalometric variables. For the maximum intercuspation data, orbicularis oris amplitude was correlated with a linear combination of upper incisor angulation and SNOP variables (r1 = 0.727). The multivariate statistical analysis extracted a clinically significant association between orbicularis oris muscle activity and incisor position.

Cephalometry↗