搜索结果：Archives of craniofacial surgery

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 3 Viewpoints: COVID-19Free AccessTelemedicine in the Era of the COVID-19 Pandemic: Implications in Facial Plastic SurgeryTom Shokri and Jessyka G. LighthallTom Shokri*Address correspondence to: Tom Shokri, Department of Otolaryngology–Head and Neck Surgery, Penn State Health Milton Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA, E-mail Address: [email protected]Department of Otolaryngology–Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.Search for more papers by this author and Jessyka G. LighthallDepartment of Otolaryngology–Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.Search for more papers by this authorPublished Online:15 May 2020https://doi.org/10.1089/fpsam.2020.0163AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail The global COVID-19 pandemic has placed unprecedented restraints on resource allocation and patient care. The rapidity with which the pandemic has spread has resulted in the depletion of hospital resources and increased health expenditures.1 Additionally, the risk of occupational exposure for health care providers poses a significant barrier to the delivery of timely and effective patient care. Otolaryngologists, including facial plastic surgeons, are particularly at risk given the increased viral load within the upper aerodigestive tract and the aerosol-generating procedures performed.2 Many medical organizations have responded by deferring elective cases and ceasing of nonessential services. Various evidence-based guidelines have been published regarding practice modifications during this time of pandemic, and the literature is continually evolving.3 However, little is known regarding the length of time for which these precautions may be implemented. Physicians are therefore faced with the difficulty of complying with new regulatory restrictions while attempting to provide patient care.While it is important to mitigate risk of infection and further spread of this contagion, safe patient care must continue to be prioritized. This is difficult in the outpatient facial plastic surgery setting in which in-person evaluation and consultation is often instrumental in management. In light of this, alternative approaches toward care must be employed. Telemedicine, the provision of clinical services via the use of communication technology between patient and provider, is one such resource that may be effectively implemented during this time. Telemedicine may refer to transfer of static images or video between patients and physicians via mobile devices or the use of audiovisual telecommunications software to facilitate correspondence in real time.4 Implementation of such services has become progressively feasible with the corresponding increase in availability of smartphones, webcam-enabled personal computers, and high speed internet.The utility of telemedicine has previously been demonstrated in addressing health-care inequities in rural communities or during public health emergencies.4 In response to the current pandemic, the Centers for Medicare & Medicaid Services, as well as most commercial health plans, have amended policies including waiving co-pays in order to encourage utilization of telemedicine services. However, barriers to broad implementation of such services continue to exist, including equipment costs, provider training, and licensing as well as payment and regulatory services. Additionally, ethical considerations such as Health Insurance Portability and Accountability Act compliance must be taken into account. Although establishing these programs in an acute setting poses difficulties, many hospital-based health systems have leveraged already existing telemedical platforms in their response to COVID-19.4 Community-based facial plastic surgeons lacking immediate access to such programs may outsource telehealth services to providers such as American Well or Teladoc Health. These platforms provide synchronous real-time audiovisual-enabled visits and are easy to use for patients, providers, and staff scheduling appointments, allow for patient connectivity via computer, tablet, or smart phone, and abide by patient privacy laws.During the COVID-19 pandemic, additional professional evaluation and management codes have been approved for telemedicine visits. Physicians must obtain patient consent for the visit (often automated in existing platforms); document the type of visit (e.g., phone visit, synchronous face-to-face video visit, etc.); location of physician and patient; confirmation of identity; and components of the evaluation and management service performed. One key limitation is the ability to perform a comprehensive physical exam (palpation, intranasal or intraoral exam, scope evaluations, etc.). Due to this limitation, telemedicine visits are often billed based on the time spent with the patient, documenting the amount of time spent on counseling and coordination of care.Facial plastic surgeons are encouraged to familiarize themselves with the most effective means of integrating telemedical technology within their specific practice setting. For example, live teleconsultation requires coordination of patient and provider schedules, audiovisual equipment with the capacity to stream in a seamless manner, and access to high speed internet. This may be best utilized for initial consultations, in the postoperative settings to evaluate surgical site healing and patient concerns, or during more urgent issues to screen patients to determine whether they need an in-person evaluation. However, a more economical means of telecommunication, store-and-forward telemedicine, may be employed in nonurgent settings or when providers are not readily available.4 Store-and-forward telemedicine allows accumulation of relevant patient data, such as patient complaints or physical findings, through transfer of static images or stored video, which can be transmitted to the receiving consultant to review at a later time. This type of consultation may be most appropriate when implemented in nonurgent scenarios or routine patient follow-up.In our practice, initially only postoperative and follow-up patients would send photos and videos attached to a description of how they feel they are recovering. After review, patients were messaged electronically or set up for either a phone or urgent in-person visit based on the need. It was assumed that most facial plastic surgery patients would not be appropriate for telemedicine. However, our system transitioned to live visits via Zoom and now the American Well platform. We have found that many patients are happy with the experience and appreciate the continuity of obtaining care without having to risk their health by leaving the home during the pandemic. Currently, most patients are seen by synchronous real time audiovisual visits, including initial consultations and follow ups for cosmetic surgery, rhinoplasty, trauma, and cancer reconstructions. Through these platforms, there is also the ability to provide multidisciplinary care. For example, many patients in our facial nerve clinic are being seen during the same session by both the physician and facial therapist. Currently visits that are being deferred are those requiring a procedural component (e.g., chemodenervation, filler, scopes, etc.). Patients requiring urgent evaluation are still being seen in person with donning of appropriate personal protective equipment.Although it is not meant to replace in-person medical care, telehealth allows for mitigation of patient and provider exposure to potential contagions by facilitating compliance with home quarantine. Telemedical resources may also be used in the postoperative setting in order to reallocate hospital resources, decrease critical care utilization and overall hospital stay. Telemedicine has previously been employed within the scope of plastic surgery in the setting of flap monitoring5 and maxillofacial trauma.6 In patients that require extensive postoperative care, such as those undergoing free tissue transfer, programs implementing electronic intensive care unit monitoring may streamline patient care and facilitate the redistribution of health care workers and resources to more deplete areas.5 At this time of large-scale home quarantine, concerns regarding workplace capacity and limitation of subspeciality care may be addressed through application of telemedical protocols as well. These resources may provide rapid access to a facial plastic surgeon for triage of patients with craniomaxillofacial trauma, postoperative complications, or other potentially life-threatening conditions.In summary, telemedicine represents an invaluable tool for facilitating safe and timely patient communication and delivery of health care services for the facial plastic surgeon. While limitations exist, specifically with respect to the capacity to perform comprehensive physical exams or procedures, a generalized consultation with overview of patient concerns, and postoperative findings may be reasonably performed. This may allow for further triage in determining the acuity of concerns necessitating early intervention as well as a decrease in overutilization of health care resources. Physicians are therefore encouraged to familiarize themselves with telemedicine services, available vendors, and reimbursement protocols as detailed in the Centers for Medicare & Medicaid Services Telehealth or Telemedicine Tool Kit.7Author Disclosure StatementNo competing financial interests exist.Funding InformationThe authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.References1. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177–1179. Crossref, Medline, Google Scholar2. Bann DV, Patel VA, Saadi R, et al. Best practice recommendations for pediatric otolaryngology during the COVID- 19 pandemic. Otolaryngol Head Neck Surg. 2020 [E-pub ahead of print]. Google Scholar3. Gardiner S, Hartzell TL. Telemedicine and plastic surgery: a review of its applications, limitations and legal pitfalls. J Plast Reconstr Aesthet Surg. 2012;65(3):e47–e53. Crossref, Medline, Google Scholar4. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. 2020 [Epub ahead of print]; DOI: 10.1056/NEJMp2003539. Google Scholar5. Varkey P, Tan NC, Girotto R, et al. A picture speaks a thousand words: the use of digital photography and the Internet as a cost-effective tool in monitoring free flaps. Ann Plast Surg. 2008;60(1):45–48. Crossref, Medline, Google Scholar6. Roccia F, Spada MC, Milani B, et al. Telemedicine in maxillofacial trauma: a 2-year clinical experience. J Oral Maxillofac Surg. 2005;63(8):1101–1105. Crossref, Medline, Google Scholar7. Centers for Medicare & Medicaid Services. General Provider Telehealth and Telemedicine Tool Kit. www.cms.gov/files/document/general-telemedicine-toolkit.pdf Accessed March 30, 2020. Google ScholarFiguresReferencesRelatedDetailsCited byAugmented Virtual Examination for Cosmetic and Functional Rhinoplasty Andre Shomorony, Rachel Weitzman, Yu Han Chen, David Liao, and Anthony P. Sclafani8 January 2024 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 26, No. 1A Knowledge Perception: Physician and Patient Toward Telehealth in COVID-1922 February 2024Telemedicine’s future in the post-Covid-19 era, benefits, and challenges: a mixed-method cross-sectional study26 October 2022 | Behaviour & Information Technology, Vol. 42, No. 15Forecasting cyber security threats landscape and associated technical trends in telehealth using Bidirectional Encoder Representations from Transformers (BERT)Computers & Security, Vol. 133Tele‐mental health during the COVID‐19 pandemic: A systematic review of the literature focused on technical aspects and challenges22 October 2023 | Health Science Reports, Vol. 6, No. 10A Survey on harnessing the Applications of Mobile Computing in Healthcare during the COVID-19 Pandemic: Challenges and SolutionsComputer Networks, Vol. 224Factors Shifting Preference Toward Telemedicine in the Delivery of Skin Cancer Reconstruction Care14 May 2022 | The Laryngoscope, Vol. 133, No. 2Analysis of Outpatient Adherence in 45,237 Patients Referred by an Emergency Department to Surgical Clinics25 October 2022 | World Journal of Surgery, Vol. 47, No. 2Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study22 May 2023 | JMIR Cancer, Vol. 9A Decade of Telemedicine for Facial Plastic Surgery: Tips and Techniques from 2000 Consultations before the COVID Pandemic25 October 2022 | Plastic & Reconstructive Surgery, Vol. 151, No. 1Primum non Nocere: How to ensure continuity of care and prevent cancer patients from being overlooked during the COVID ‐ 19 pandemic27 June 2022 | Cancer Medicine, Vol. 12, No. 2Fighting Against All Odds: The Case Study of the COVID-19 Pandemic in Iran4 October 2023Reflecting on Plastic Surgery Training During Early COVID-19 Pandemic: Resident Exposure and Telemedicine28 June 2022 | Journal of Craniofacial Surgery, Vol. 33, No. 6SAĞLIK BİLGİ TEKNOLOJİLERİNE YÖNELİK TUTUMLARIN BELİRLENMESİ: BİR ÜNİVERSİTE HASTANESİ ÖRNEĞİ29 July 2022 | Mehmet Akif Ersoy Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, Vol. 9, No. 2Pandemics and facial plastics and reconstructive surgeryOperative Techniques in Otolaryngology-Head and Neck Surgery, Vol. 33, No. 2Technology in the Era of COVID-19: A Systematic Review of Current EvidenceInfectious Disorders - Drug Targets, Vol. 22, No. 4Microfluidics-Based Point-of-Care Testing (POCT) Devices in Dealing with Waves of COVID-19 Pandemic: The Emerging Solution27 April 2022 | ACS Applied Bio Materials, Vol. 5, No. 5Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action Jenna Rose Stoehr, Alireza Hamidian Jahromi, Ezra Leigh Hunter, and Loren S. Schechter11 April 2022 | Transgender Health, Vol. 7, No. 2Best practices for the use of telemedicine25 March 2022 | AORN Journal, Vol. 115, No. 4Telemedicine in cleft surgery: Overcoming geographical barriers and improving health outcomes19 February 2022Telemedicine in Cleft Surgery: Overcoming Geographical Barriers and Improving Health Outcomes21 July 2022Emerging Paradigm of Smart Healthcare in the Management of COVID-19 Pandemic and Future Health Crisis3 June 2022The Benefit of Video Visits in Facial Plastic Surgery Private Practice Kylie Azizzadeh, Julia L. Kerolus, and Paul S. Nassif3 November 2021 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 23, No. 6Oculoplastic Surgeons’ Surgical, Clinical, and Management Experiences During the COVID-19 Crisis21 April 2021 | The American Journal of Cosmetic Surgery, Vol. 38, No. 4Construction and Application of an Intelligent Response System for COVID-19 Voice Consultation in China: A Retrospective Study23 November 2021 | Frontiers in Medicine, Vol. 8Plastic surgery education in the COVID-19 pandemic: hindrance or opportunity?22 May 2022 | Archives of Plastic Surgery, Vol. 48, No. 06Telemedicine as an Alternative Way to Provide Multidisciplinary Cleft Care During the COVID-19 PandemicThe Open Dentistry Journal, Vol. 15, No. 1Impact of COVID-19 on Aesthetic Plastic Surgery Practice in the United KingdomJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 74, No. 9A new interventional home care model for COVID management: Virtual Covid IPDiabetes & Metabolic Syndrome: Clinical Research & Reviews, Vol. 15, No. 5The digital doctor: telemedicine in facial plastic surgery25 May 2021 | Current Opinion in Otolaryngology & Head & Neck Surgery, Vol. 29, No. 4Telemedicine, Patient Satisfaction, and Chronic Rhinosinusitis Care in the Era of COVID-1928 October 2020 | American Journal of Rhinology & Allergy, Vol. 35, No. 4The impact of the COVID-19 pandemic on wellness among vascular surgeonsSeminars in Vascular Surgery, Vol. 34, No. 2The Doctor Will “See” You Now – Unmet Expectations of Telemedicine in Plastic Surgery11 March 2021 | Journal of Craniofacial Surgery, Vol. 32, No. 4Slowing the Spread and Minimizing the Impact of COVID-19: Lessons from the Past and Recommendations for the Plastic Surgeon6 May 2021 | Plastic & Reconstructive Surgery, Vol. 147, No. 6Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialtyAmerican Journal of Otolaryngology, Vol. 42, No. 3The Potential for Telemedicine to Reduce Bias in Patients Seeking Facial Plastic Surgery6 October 2020 | Otolaryngology–Head and Neck Surgery, Vol. 164, No. 5Implications of telehealth and digital care solutions during COVID-19 pandemic: a qualitative literature review29 November 2020 | Informatics for Health and Social Care, Vol. 46, No. 1Application of telemedicine and eHealth technology for clinical services in response to COVID‑19 pandemic14 January 2021 | Health and Technology, Vol. 11, No. 2Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic8 July 2020 | Irish Journal of Medical Science (1971 -), Vol. 190, No. 1Virtual Consultations: Young People and Their Parents’ Experience1 April 2021 | Adolescent Health, Medicine and Therapeutics, Vol. Volume 12Public Interest in Cosmetic Surgical and Minimally Invasive Plastic Procedures During the COVID-19 Pandemic: Infodemiology Study of Twitter Data16 March 2021 | Journal of Medical Internet Research, Vol. 23, No. 3Impact of COVID -19 Pandemic on Plastic Surgery Practices in a Tertiary Care Set Up in Southern IndiaNigerian Journal of Clinical Practice, Vol. 24, No. 10The Impact of COVID-19 on Patient Interest in Facial Plastic Surgery22 October 2021 | Plastic and Reconstructive Surgery - Global Open, Vol. 9, No. 10Telemedicine Practices of Facial Plastic and Reconstructive Surgeons in the United States: The Effect of Novel Coronavirus-19 Parsa P. Salehi, Sina J. Torabi, Yan Ho Lee, and Babak Azizzadeh6 November 2020 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 22, No. 6The Financial Impacts of the COVID-19 Crisis on the Practices of Cosmetic/Aesthetic Plastic Surgeons10 September 2020 | Aesthetic Plastic Surgery, Vol. 44, No. 6The rules for online clinical engagement in the COVID eraJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 73, No. 12Facial Surgery in the Era of SARS-CoV-2 and Beyond: Challenges, Considerations, and Initiatives20 November 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 11Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review30 September 2020 | International Archives of Otorhinolaryngology, Vol. 24, No. 04Simulated Video Consultations as a Learning Tool in Undergraduate Nursing: Students’ Perceptions20 August 2020 | Healthcare, Vol. 8, No. 3Outpatient Orthopedic Rehabilitation in New York State During the COVID-19 Pandemic: Therapist PerspectivesOrthopedics, Vol. 43, No. 5Implications for Telemedicine for Surgery Patients After COVID-19: Survey of Patient and Provider Experiences17 August 2020 | The American Surgeon, Vol. 86, No. 8Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study27 July 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 15Facial Plastic and Reconstructive Surgery During the COVID-19 Pandemic15 June 2020 | Annals of Plastic Surgery, Vol. 85, No. 2SEconomic implications of the COVID-19 pandemic on the plastic surgery communityJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 73, No. 7Increase in Video Consultations During the COVID-19 Pandemic: Healthcare Professionals’ Perceptions about Their Implementation and Adequate Management15 July 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 14Using Telemedicine and Infographics for Physician‐Guided Home Drain Removal4 June 2020 | OTO Open, Vol. 4, No. 2Interest in Plastic Surgery during COVID-19 Pandemic: A Google Trends Analysis1 October 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 10The Race for a COVID-19 Vaccine: Current Trials, Novel Technologies, and Future Directions1 October 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 10Plastic Surgery and COVID-19 in the GCC: Fears, Lessons Learned, and the Plan for the Future1 September 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 9 Volume 22Issue 3Jun 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Tom Shokri and Jessyka G. Lighthall.Telemedicine in the Era of the COVID-19 Pandemic: Implications in Facial Plastic Surgery.Facial Plastic Surgery & Aesthetic Medicine.Jun 2020.155-156.http://doi.org/10.1089/fpsam.2020.0163Published in Volume: 22 Issue 3: May 15, 2020Online Ahead of Print:April 16, 2020 TopicsCOVID-19e-health and telehealth caree-Health and telemedicine awareness programsReconstructive and cosmetic surgery PDF download

The Journal of Bone and Joint Surgery. British volumeVol. 70-B, No. 4 ArticlesFree AccessDoes corrosion matter?J BlackJ BlackSearch for more papers by this authorPublished Online:1 Aug 1988https://doi.org/10.1302/0301-620X.70B4.3403590AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byPediatric fractures following implant removal: A systematic review10 November 2022 | Journal of Children's Orthopaedics, Vol. 6Effect of boron oxide on mechanical and thermal properties of bioactive glass coatings for biomedical applications7 March 2022 | Journal of the American Ceramic Society, Vol. 105, No. 6Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols21 January 2021 | International Journal of Molecular Sciences, Vol. 22, No. 3IN VITRO STUDY AND MECHANICAL CHARACTERISTICS OF DENTAL IMPLANTS MADE OF VARIOUS MATERIALS AND FABRICATION METHODS18 February 2021 | Journal of Mechanics in Medicine and Biology, Vol. 21, No. 01Coatings on orthopedic implants to overcome present problems and challenges: A focused reviewMaterials Today: Proceedings, Vol. 45Hardware removal rates after surgical treatment of proximal femur fractures21 January 2020 | Archives of Orthopaedic and Trauma Surgery, Vol. 140, No. 8Recent advancements in Fe-based biodegradable materials for bone repair19 October 2018 | Journal of Materials Science, Vol. 54, No. 3Mandibular Osteotomies1 August 2019Biodegradation of gold and platinum implants in rats studied by electron microscopy27 November 2019 | International Journal of Physics Research and Applications, Vol. 2, No. 1Artificial neural network based optimization of prerequisite properties for the design of biocompatible titanium alloysComputational Materials Science, Vol. 149Detection of Titanium Particles in Soft Tissues Adjacent to the Fixators in Patients with Facial Fractures and Bone Defects30 March 2018 | Journal of Diagnostics and Treatment of Oral and Maxillofacial Pathology, Vol. 2, No. 1Metal-on-Metal Hip Implants: Progress and Problems25 February 2018Dual-surface modification of titanium alloy with anodizing treatment and bioceramic particles for enhancing prosthetic devices21 April 2017 | Journal of Materials Science, Vol. 52, No. 15In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design1 July 2017 | Materials, Vol. 10, No. 7Influence of process parameters on plasma electrolytic surface treatment of tantalum for biomedical applicationsApplied Surface Science, Vol. 407Fabrication and apatite inducing ability of different porous titania structures by PEO treatmentMaterials Science and Engineering: C, Vol. 66Inorganic characterizations and filler particles morphology of self-adhesive cementsInternational Journal of Adhesion and Adhesives, Vol. 68Study of the bioactivity, wettability and hardness behaviour of the bovine hydroxyapatite-diopside bio-nanocomposite coatingJournal of the Taiwan Institute of Chemical Engineers, Vol. 60Chapter 4 Immune Response12 June 2016Tribocorrosion and TMJ TJR DevicesAnodisation and Sol–Gel Coatings as Surface Modification to Promote Osseointegration in Metallic Prosthesis10 August 2016Corrosion at the Head-Neck Taper Interface Affects the Prognosis of Hip Revision Surgery29 January 2016Is Taper Fretting Corrosion a Threat to the Clinical Performance of Large-Diameter Hips with Highly Crosslinked Polyethylene Bearings?29 January 2016In vivo electrochemical corrosion study of a CoCrMo biomedical alloy in human synovial fluidsActa Biomaterialia, Vol. 21Metal Removal29 October 2014Do Ceramic Femoral Heads Reduce Taper Fretting Corrosion in Hip Arthroplasty? A Retrieval StudyClinical Orthopaedics & Related Research, Vol. 471, No. 10Engineering biocompatible implant surfacesProgress in Materials Science, Vol. 58, No. 3Growth of calcium phosphates on magnesium substrates for corrosion control in biomedical applications via immersion techniques22 October 2012 | Journal of Biomedical Materials Research Part B: Applied Biomaterials, Vol. 101B, No. 1Cobalt from metal-on-metal hip replacements may be the clinically relevant active agent responsible for periprosthetic tissue reactionsActa Biomaterialia, Vol. 8, No. 10Calcium phosphate coatings on magnesium alloys for biomedical applications: A reviewActa Biomaterialia, Vol. 8, No. 1Titanium allergy: could it affect dental implant integration?20 January 2011 | Clinical Oral Implants Research, Vol. 22, No. 7Release of metals from osteosynthesis implants as a method for identification: post-autopsy histopathological and ultrastructural forensic study3 December 2009 | International Journal of Legal Medicine, Vol. 125, No. 1Evaluation of Metal Concentrations in Hair and Nail After Orthognathic SurgeryJournal of Craniofacial Surgery, Vol. 22, No. 1Study rationale and protocol: prospective randomized comparison of metal ion concentrations in the patient's plasma after implantation of coated and uncoated total knee prostheses14 October 2009 | BMC Musculoskeletal Disorders, Vol. 10, No. 1Influence of Zr content on phase transformation, microstructure and mechanical properties of Ti75−xNb25Zrx (x=0–6) alloysJournal of Alloys and Compounds, Vol. 486, No. 1-2Electrochemical behavior of Ti–Cr alloys in artificial salivaJournal of Alloys and Compounds, Vol. 487, No. 1-2Calcium phosphate coatings for bio-implant applications: Materials, performance factors, and methodologiesMaterials Science and Engineering: R: Reports, Vol. 66, No. 1-3Evidence-Based Analysis of Removal of Orthopaedic Implants in the Pediatric PopulationJournal of Pediatric Orthopaedics, Vol. 28, No. 7Metal-on-metal hip implants: do they impair renal function in the long-term? A 10-year follow-up study17 October 2007 | Archives of Orthopaedic and Trauma Surgery, Vol. 128, No. 9Comparative study of the oxide scale thermally grown on titanium alloys by ion beam analysis techniques and scanning electron microscopy31 January 2011 | Journal of Materials Research, Vol. 23, No. 8Laser surface processing of Ti6Al4V in gaseous nitrogen: corrosion performance in physiological solution4 October 2007 | Journal of Materials Science: Materials in Medicine, Vol. 19, No. 3Effect of nanosilica type on protective properties of composite ceramic coatings deposited on steel 316L by sol–gel techniqueJournal of Non-Crystalline Solids, Vol. 354, No. 15-16Biocompatibility studies of human fetal osteoblast cells cultured on gamma titanium aluminide28 June 2007 | Journal of Materials Science: Materials in Medicine, Vol. 19, No. 1Malignant Fibrous Histiocytoma Associated with Coxofemoral Arthrodesis29 January 2018 | Tumori Journal, Vol. 93, No. 5Can cobalt levels estimate in-vivo wear of metal-on-metal bearings used in hip arthroplasty?30 November 2007 | Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Vol. 221, No. 8Serum Metal Ion Exposure after Total Knee ArthroplastyClinical Orthopaedics & Related Research, Vol. 461Author’s replyJ. DANIEL, H. ZIAEE, C. PRADHAN, P. B. PYNSENT, D. J. W. McMINN1 July 2007 | The Journal of Bone and Joint Surgery. British volume, Vol. 89-B, No. 7Orthopaedic Implants in ChildrenJournal of Pediatric Orthopaedics, Vol. 26, No. 4Microstructure and elastic modulus of Ti–Nb–Si ternary alloys for biomedical applicationsScripta Materialia, Vol. 54, No. 5Development and problems of metal-on-metal hip arthroplasty22 March 2006 | Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Vol. 220, No. 2Intraspinal metalloma resulting in late paraparesis18 June 2005 | Archives of Orthopaedic and Trauma Surgery, Vol. 125, No. 6In vitro serum levels of metal ions released from orthopaedic implants23 December 2004 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 15, No. 2Quantitative analysis of macrophage apoptosis vs. necrosis induced by cobalt and chromium ions in vitroBiomaterials, Vol. 26, No. 15Metallic Implant Removal in ChildrenJournal of Pediatric Orthopaedics, Vol. 25, No. 1Biocompatibility of β-stabilizing elements of titanium alloysBiomaterials, Vol. 25, No. 26Hg2+ and Ni2+ alter induction of heat shock protein-72 in THP-1 human monocytes24 September 2003 | Journal of Biomedical Materials Research, Vol. 67A, No. 1TNF-α secretion and macrophage mortality induced by cobalt and chromium ions in vitro-Qualitative analysis of apoptosisBiomaterials, Vol. 24, No. 3Prosthetic implant associated sarcomas: A case report emphasizing surface evaluation and spectroscopic trace metal analysisAnnals of Diagnostic Pathology, Vol. 7, No. 1Histological and Electron Microscopic Identification and Analysis of Corrosion Products in Periprosthetic Tissue after Total Hip ReplacementElectrochemical characterization of cast titanium alloysBiomaterials, Vol. 24, No. 2Disseminated osteosarcoma arising in the pelvis after total hip arthroplastyThe Journal of Arthroplasty, Vol. 17, No. 3Failure Modes of Biomedical ImplantsJournal of the Mechanical Behavior of Materials, Vol. 13, No. 5-6Impact of a nickel-reduced stainless steel implant on striated muscle microcirculation: A comparativein vivo study1 January 2001 | Journal of Biomedical Materials Research, Vol. 57, No. 3Elemental release from dental casting alloys into biological media with and without proteinDental Materials, Vol. 17, No. 5Placas de aço inoxidável 316L aplicadas no reparo de fratura experimental diafisária do rádio e ulna de cãesArquivo Brasileiro de Medicina Veterinária e Zootecnia, Vol. 53, No. 1Relating nickel-induced tissue inflammation to nickel releasein vivo1 January 2001 | Journal of Biomedical Materials Research, Vol. 58, No. 5A Case of Metallosis.Nishi Nihon Hifuka, Vol. 63, No. 2Effect of silver, copper, mercury, and nickel ions on cellular proliferation during extended, low-dose exposures1 January 2000 | Journal of Biomedical Materials Research, Vol. 52, No. 2Wear and corrosion of sliding counterparts of stainless-steel hip screw-platesInjury, Vol. 31, No. 2Follow-up-Study—Based Wear Debris Reduction with Ceramic—Metal—Modular Hip ReplacementsFolgen artikularer TherapienReaktionsformen des organisierten BindegewebesEffect of Toothbrushing on Elemental Release from Dental Casting AlloysJournal of Prosthodontics, Vol. 8, No. 4Aggressive Wear-Debris Pseudotumor Following Total Hip ReplacementOrthopedics, Vol. 22, No. 3Pseudarthrosis following Slipped Capital Femoral EpiphysisThe Journal of Bone & Joint Surgery, Vol. 79, No. 10Adsorptive stripping voltammetric measurements of chromium accumulation in mice organs using mercury film microelectrodesElectroanalysis, Vol. 9, No. 12Lymphoreticular Dissemination of Metal Particles After Primary Joint ReplacementsClinical Orthopaedics and Related Research, Vol. 338Comparison of costs in ankle fractures treated with absorbable or metallic fixation devicesArchives of Orthopaedic and Trauma Surgery, Vol. 116, No. 4Detection of Titanium in Human Tissues after Craniofacial SurgeryPlastic and Reconstructive Surgery, Vol. 99, No. 4Routine Implant Removal after Fracture SurgeryThe Journal of Trauma: Injury, Infection, and Critical Care, Vol. 41, No. 5In-vitro corrosion and wear of titanium alloys in the biological environmentBiomaterials, Vol. 17, No. 22In vitro IL-1β and TNF-α release from THP-1 monocytes in response to metal ionsDental Materials, Vol. 12, No. 5-6Metal on Metal Bearings in Hip ArthroplastyClinical Orthopaedics and Related Research, Vol. 329Distribution of Cobalt Chromium Wear and Corrosion Products and Biologic ReactionsClinical Orthopaedics and Related Research, Vol. 329Immune Response to Synthetic MaterialsClinical Orthopaedics and Related Research, Vol. 326Drug Inhibition of the Macrophage Response to Metal Wear Particles In VitroClinical Orthopaedics and Related Research, Vol. 323Intraocular deposition of metallic fragments during phacoemulsification: Possible causes and effectsEye, Vol. 9, No. 4Metal ion release from wear particles produced by Ti-6Al-4V and Co-Cr alloy surfaces articulating against boneMaterials Letters, Vol. 24, No. 1-3Migration of corrosion products from modular hip prostheses. Particle microanalysis and histopathological findings.The Journal of Bone & Joint Surgery, Vol. 76, No. 9Intramedullary bone formation after polylactic acid wire implantationJournal of Materials Science: Materials in Medicine, Vol. 5, No. 6-7In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations. The effect of crevice, stress, motion, and alloy couplingJournal of Biomedical Materials Research, Vol. 27, No. 12The Rationale for Cemented Total Hip ArthroplastyOrthopedic Clinics of North America, Vol. 24, No. 4Current Concepts in Orthopaedic Biomaterials and Implant FixationThe Journal of Bone & Joint Surgery, Vol. 75, No. 7Evaluation of wear in an all-polymer total knee replacement. Part 2: Clinical evaluation of wear in a polyethylene on polyacetal total kneeClinical Materials, Vol. 14, No. 2Biodegradation of orthodontic appliances. Part I. Biodegradation of nickel and chromium in vitroAmerican Journal of Orthodontics and Dentofacial Orthopedics, Vol. 103, No. 1Acrylic bone cements: Residuals and extractability of methacrylate monomers and aromatic aminesJournal of Applied Biomaterials, Vol. 3, No. 1Observations on removal of metal implantsInjury, Vol. 23, No. 1The biologic responses to orthopedic implants and their wear debrisClinical Materials, Vol. 9, No. 3-4Severe metallosis due to abnormal abrasion of the femoral head in a dual bearing hip prosthesisThe Journal of Arthroplasty, Vol. 7Foreign-body reactions to polyglycolide screws8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 63, No. 2Genotoxicity of Acrylic Bone CementsPharmacology & Toxicology, Vol. 69, No. 5Dental implant materials. I. Some effects of preparative procedures on surface topographyJournal of Biomedical Materials Research, Vol. 25, No. 9Fracture-associated SarcomasVeterinary Clinics of North America: Small Animal Practice, Vol. 21, No. 4Systemic effects of implanted prostheses made of cobalt-chromium alloysArchives of Orthopaedic and Trauma Surgery, Vol. 110, No. 2CANCER RISK AFTER MCKEE-FARRAR TOTAL HIP REPLACEMENTOrthopedics, Vol. 14, No. 2Rigid Internal Fixation Facts Versus FallaciesOral and Maxillofacial Surgery Clinics of North America, Vol. 2, No. 4Metal materials biodegradation: a chronoamperometric studyJournal of Materials Science: Materials in Medicine, Vol. 1, No. 2Forearm fracture plates: To remove or not to removeThe Journal of Hand Surgery, Vol. 15, No. 2Niomaterials Highlights II. Materials for Biomedical Applications — High Long-Term Success Rates might pose new ProblemsAngewandte Chemie, Vol. 101, No. 7Materials for biomedical application- high long-term success rates might pose new problemsAdvanced Materials, Vol. 1, No. 7Blood Analysis for Trace Metals in Patients with Different Bearings in Total Hip ArthroplastyMandibular Osteotomies and Considerations for Rigid Internal Fixation Vol. 70-B, No. 4 Metrics History Published online 1 August 1988 Published in print 1 August 1988 InformationCopyright © 1988, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Three-dimensional carniofacial CT imaging has been developed and progressed during the past two decades. The advancement of the hardware and software has made the imaging study more convenient, user friendly, and affordable. Processing and analysis of the imaging data are readily performed on personal computers. Accuracy of the 3-dimensional measurement has been validated. Collaborative study can be achieved with other departments or disciplines, such as orthopedic, otolaryngologic, and dental departments, as well as mechanical engineering department. All the data should be adequately archived as medical imaging data bank for later use. The data can be transferred for production of rapid prototyping models to enhance clinical application. Inter-center sharing of imaging data can be done through common image format. Comprehensive morphological study and clinical information may help to improve or refine treatment planning, which in turn yield better treatment outcome.

BACKGROUND: Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of orofacial clefts is prolonged; it typically commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults with a repaired cleft. Conventional orthognathic surgery, such as Le Fort I osteotomy, is often performed for the correction of maxillary hypoplasia. An alternative intervention is distraction osteogenesis, which achieves bone lengthening by gradual mechanical distraction. OBJECTIVES: To provide evidence regarding the effects and long-term results of maxillary distraction osteogenesis compared to orthognathic surgery for the treatment of hypoplastic maxilla in people with cleft lip and palate. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 February 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 1), MEDLINE Ovid (1946 to 16 February 2016), Embase Ovid (1980 to 16 February 2016), LILACS BIREME (1982 to 16 February 2016), the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) (to 16 February 2016), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 16 February 2016). There were no restrictions regarding language or date of publication in the electronic searches. We performed handsearching of six speciality journals and we checked the reference lists of all trials identified for further studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing maxillary distraction osteogenesis to conventional Le Fort I osteotomy for the correction of cleft lip and palate maxillary hypoplasia in non-syndromic cleft patients aged 15 years or older. DATA COLLECTION AND ANALYSIS: Two review authors assessed studies for eligibility. Two review authors independently extracted data and assessed the risk of bias in the included studies. We contacted trial authors for clarification or missing information whenever possible. All standard methodological procedures expected by Cochrane were used. MAIN RESULTS: We found six publications involving a total of 47 participants requiring maxillary advancement of 4 mm to 10 mm. All of them related to a single trial performed between 2002 and 2008 at the University of Hong Kong, but not all of the publications reported outcomes from all 47 participants. The study compared maxillary distraction osteogenesis with orthognathic surgery, and included participants from 13 to 45 years of age.Results and conclusions should be interpreted with caution given the fact that this was a single trial at high risk of bias, with a small sample size.The main outcomes assessed were hard and soft tissue changes, skeletal relapse, effects on speech and velopharyngeal function, psychological status, and clinical morbidities.Both interventions produced notable hard and soft tissue improvements. Nevertheless, the distraction group demonstrated a greater maxillary advancement, evaluated as the advancement of Subspinale A-point: a mean difference of 4.40 mm (95% CI 0.24 to 8.56) was recorded two years postoperatively.Horizontal relapse of the maxilla was significantly less in the distraction osteogenesis group five years after surgery. A total forward movement of A-point of 2.27 mm was noted for the distraction group, whereas a backward movement of 2.53 mm was recorded for the osteotomy group (mean difference 4.8 mm, 95% CI 0.41 to 9.19).No statistically significant differences could be detected between the groups in speech outcomes, when evaluated through resonance (hypernasality) at 17 months postoperatively (RR 0.11, 95% CI 0.01 to 1.85) and nasal emissions at 17 months postoperatively (RR 3.00, 95% CI 0.14 to 66.53), or in velopharyngeal function at the same time point (RR 1.28, 95% CI 0.65 to 2.52).Maxillary distraction initially lowered social self-esteem at least until the distractors were removed, at three months postoperatively, compared to the osteotomy group, but this improved over time and the distraction group had higher satisfaction with life in the long term (two years after surgery) (MD 2.95, 95% CI 014 to 5.76).Adverse effects, in terms of clinical morbidities, included mainly occlusal relapse and mucosal infection, with the frequency being similar between groups (3/15 participants in the distraction osteogenesis group and 3/14 participants in the osteotomy group). There was no severe harm to any participant. AUTHORS' CONCLUSIONS: This review found only one small randomised controlled trial concerning the effectiveness of distraction osteogenesis compared to conventional orthognathic surgery. The available evidence is of very low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes, distraction osteogenesis may produce more satisfactory results; however, further prospective research comprising assessment of a larger sample size with participants with different facial characteristics is required to confirm possible true differences between interventions.

The genetic basis of human facial variation and craniofacial birth defects remains poorly understood. Distant-acting transcriptional enhancers control the fine-tuned spatiotemporal expression of genes during critical stages of craniofacial development. However, a lack of accurate maps of the genomic locations and cell type-resolved activities of craniofacial enhancers prevents their systematic exploration in human genetics studies. Here, we combine histone modification, chromatin accessibility, and gene expression profiling of human craniofacial development with single-cell analyses of the developing mouse face to define the regulatory landscape of facial development at tissue- and single cell-resolution. We provide temporal activity profiles for 14,000 human developmental craniofacial enhancers. We find that 56% of human craniofacial enhancers share chromatin accessibility in the mouse and we provide cell population- and embryonic stage-resolved predictions of their in vivo activity. Taken together, our data provide an expansive resource for genetic and developmental studies of human craniofacial development.

Quantitative analysis of craniofacial morphology is of interest to scholars working in a wide variety of disciplines, such as anthropology, developmental biology, and medicine. T1-weighted (anatomical) magnetic resonance images (MRI) provide excellent contrast between soft tissues. Given its three-dimensional nature, MRI represents an ideal imaging modality for the analysis of craniofacial structure in living individuals. Here we describe how T1-weighted MR images, acquired to examine brain anatomy, can also be used to analyze facial features. Using a sample of typically developing adolescents from the Saguenay Youth Study (N = 597; 292 male, 305 female, ages: 12 to 18 years), we quantified inter-individual variations in craniofacial structure in two ways. First, we adapted existing nonlinear registration-based morphological techniques to generate iteratively a group-wise population average of craniofacial features. The nonlinear transformations were used to map the craniofacial structure of each individual to the population average. Using voxel-wise measures of expansion and contraction, we then examined the effects of sex and age on inter-individual variations in facial features. Second, we employed a landmark-based approach to quantify variations in face surfaces. This approach involves: (a) placing 56 landmarks (forehead, nose, lips, jaw-line, cheekbones, and eyes) on a surface representation of the MRI-based group average; (b) warping the landmarks to the individual faces using the inverse nonlinear transformation estimated for each person; and (3) using a principal components analysis (PCA) of the warped landmarks to identify facial features (i.e. clusters of landmarks) that vary in our sample in a correlated fashion. As with the voxel-wise analysis of the deformation fields, we examined the effects of sex and age on the PCA-derived spatial relationships between facial features. Both methods demonstrated significant sexual dimorphism in craniofacial structure in areas such as the chin, mandible, lips, and nose.

OBJECTIVE: Speech-correcting surgeries (pharyngoplasty) are performed to correct velopharyngeal insufficiency (VPI). This study aimed to analyze the need for speech-correcting surgery in children with isolated cleft palate (ICP) and to determine differences among cleft extent, gender, and primary technique used. In addition, we assessed the timing and number of secondary procedures performed and the incidence of operated fistulas. DESIGN: Retrospective medical chart review study from hospital archives and electronic records. PARTICIPANTS: These comprised the 423 consecutive nonsyndromic children (157 males and 266 females) with ICP treated at the Cleft Palate and Craniofacial Center of Helsinki University Hospital during 1990 to 2016. RESULTS: The total incidence of VPI surgery was 33.3% and the fistula repair rate, 7.8%. Children with cleft of both the hard and soft palate (n = 300) had a VPI secondary surgery rate of 37.3% (fistula repair rate 10.7%), whereas children with only cleft of the soft palate (n = 123) had a corresponding rate of 23.6% (fistula repair rate 0.8%). Gender and primary palatoplasty technique were not considered significant factors in need for VPI surgery. The majority of VPI surgeries were performed before school age. One fifth of patients receiving speech-correcting surgery had more than one subsequent procedure. CONCLUSION: The need for speech-correcting surgery and fistula repair was related to the severity of the cleft. Although the majority of the corrective surgeries were done before the age of 7 years, a considerable number were performed at a later stage, necessitating long-term observation.

Oral and craniofacial tissues are uniquely adapted for continuous and intricate functioning, including breathing, feeding, and communication. To achieve these vital processes, this complex is supported by incredible tissue diversity, variously composed of epithelia, vessels, cartilage, bone, teeth, ligaments, and muscles, as well as mesenchymal, adipose, and peripheral nervous tissue. Recent single cell and spatial multiomics assays-specifically, genomics, epigenomics, transcriptomics, proteomics, and metabolomics-have annotated known and new cell types and cell states in human tissues and animal models, but these concepts remain limitedly explored in the human postnatal oral and craniofacial complex. Here, we highlight the collaborative and coordinated efforts of the newly established Oral and Craniofacial Bionetwork as part of the Human Cell Atlas, which aims to leverage single cell and spatial multiomics approaches to first understand the cellular and molecular makeup of human oral and craniofacial tissues in health and to then address common and rare diseases. These powerful assays have already revealed the cell types that support oral tissues, and they will unravel cell types and molecular networks utilized across development, maintenance, and aging as well as those affected in diseases of the craniofacial complex. This level of integration and cell annotation with partner laboratories across the globe will be critical for understanding how multiple variables, such as age, sex, race, and ancestry, influence these oral and craniofacial niches. Here, we 1) highlight these recent collaborative efforts to employ new single cell and spatial approaches to resolve our collective biology at a higher resolution in health and disease, 2) discuss the vision behind the Oral and Craniofacial Bionetwork, 3) outline the stakeholders who contribute to and will benefit from this network, and 4) outline directions for creating the first Human Oral and Craniofacial Cell Atlas.

This study investigates a comprehensive model of bone regeneration capacity of dypiridamole-loaded 3D-printed bioceramic (DIPY-3DPBC) scaffolds composed of 100% beta-tricalcium phosphate (β -TCP) in an immature rabbit model through the time of facial maturity. The efficacy of this construct was compared to autologous bone graft, the clinical standard of care in pediatric craniofacial reconstruction, with attention paid to volume of regenerated bone by 3D reconstruction, histologic and mechanical properties of regenerated bone, and long-term safety regarding potential craniofacial growth restriction. Additionally, long-term degradation of scaffold constructs was evaluated. At 24 weeks in vivo, DIPY-3DPBC scaffolds demonstrated volumetrically significant osteogenic regeneration of calvarial and alveolar defects comparable to autogenous bone graft with favorable biodegradation of the bioactive ceramic component in vivo. Characterization of regenerated bone reveals osteogenesis of organized, vascularized bone with histologic and mechanical characteristics comparable to native bone. Radiographic and histologic analyses were consistent with patent craniofacial sutures. Lastly, through application of 3D morphometric facial surface analysis, our results support that DIPY-3DPBC scaffolds do not cause premature closure of sutures and preserve normal craniofacial growth. Based on this novel evaluation model, this DIPY-3DPBC scaffold strategy is a promising candidate as a safe, efficacious pediatric bone tissue engineering strategy.

Craniofacial deformities (CFDs) develop following oncological resection, trauma, or congenital disorders. Trauma is one of the top five causes of death globally, with rates varying from country to country. They result in a non-healing composite tissue wound as they degenerate in soft or hard tissues. Approximately one-third of oral diseases are caused by gum disease. Due to the complexity of anatomical structures in the region and the variety of tissue-specific requirements, CFD treatments present many challenges. Many treatment methods for CFDs are available today, such as drugs, regenerative medicine (RM), surgery, and tissue engineering. Functional restoration of a tissue or an organ after trauma or other chronic diseases is the focus of this emerging field of science. The materials and methodologies used in craniofacial reconstruction have significantly improved in the last few years. A facial fracture requires bone preservation as much as possible, so tiny fragments are removed initially. It is possible to replace bone marrow stem cells with oral stem cells for CFDs due to their excellent potential for bone formation. This review article discusses regenerative approaches for different types of craniofacial diseases.

Growth hormone (GH) secretion affects bone and cartilage physiology. This study investigated the effect of GH on the size of the craniofacial structures and their angular relationship. Three different models of mice with a genetically altered GH axis were used: GH excess (giant), dwarf GH antagonist (dwarf-Ant), and dwarf GH receptor knockout (dwarf-KO) mice. Each model was compared with the corresponding wild type (Wt). Five craniofacial distances were analysed: craniofacial length, upper face height, mandibular anterior height, mandibular ramus length, and mandibular corpus length. In addition, upper and lower incisor lengths and four angular relationships, nasal bone with cranial base, maxillary plane with cranial base, mandibular plane with cranial base, and the angle of the mandible, were determined. Data were analysed by one-way ANOVA. Craniofacial length, upper face height and mandibular corpus length were significantly increased in the giant mice and significantly reduced in the dwarf mice. Mandibular anterior height and mandibular ramus length were significantly affected in the dwarf-KO mice but not in the giant mice. The length of both the upper and lower incisors was significantly increased and reduced in the giant and dwarf-KO mice, respectively. In addition, the angle of the mandible was significantly increased in the giant mice and significantly reduced in the dwarf mice. It is concluded that GH plays a major role in the growth and development of the craniofacial complex by directly and indirectly modulating the size and the angular relationships of the craniofacial structures, including the incisor teeth.

Background: Artificial Intelligence (AI) holds promise for transforming healthcare, with AI models gaining increasing clinical use in surgery. However, new AI models are developed without established standards for their validation and use. Before AI can be widely adopted, it is crucial to ensure these models are both accurate and safe for patients. Without proper validation, there is a risk of integrating AI models into practice without sufficient evidence of their safety and accuracy, potentially leading to suboptimal patient outcomes. In this work, we review the current use and validation methods of AI models in clinical surgical settings and propose a novel classification system. Methods: A systematic review was conducted in PubMed and Cochrane using the keywords “validation”, “artificial intelligence”, and “surgery”, following PRISMA guidelines. Results: The search yielded a total of 7627 articles, of which 102 were included for data extraction, encompassing 2,837,211 patients. A validation classification system named Surgical Validation Score (SURVAS) was developed. The primary applications of models were risk assessment and decision-making in the preoperative setting. Validation methods were ranked as high evidence in only 45% of studies, and only 14% of the studies provided publicly available datasets. Conclusions: AI has significant applications in surgery, but validation quality remains suboptimal, and public data availability is limited. Current AI applications are mainly focused on preoperative risk assessment and are suggested to improve decision-making. Classification systems such as SURVAS can help clinicians confirm the degree of validity of AI models before their application in practice.

INTRODUCTION: Cleft palate is among the most common birth abnormalities. The success of primary surgery in the early months of life is crucial for successful feeding, speech, hearing, dental development and facial growth. Over recent decades, age at palatal surgery in infancy has reduced. This has led to palatal closure in one-stage procedures being carried out around the age of 12 months, but in some cases as early as 6 months. The primary objective of the Timing Of Primary Surgery for Cleft Palate (TOPS)trial is to determine whether surgery for cleft palate performed at 6 or 12 months of age is most beneficial for speech outcomes. METHODS AND ANALYSIS: Infants with a diagnosis of non-syndromic isolated cleft palate will be randomised to receive standardised primary surgery (Sommerlad technique) for closure of the cleft at either 6 months or 12 months, corrected for gestational age. The primary outcome will be perceived insufficient velopharyngeal function at 5 years of age. Secondary outcomes measured across 12 months, 3 years and 5 years will include growth, safety of the procedure, dentofacial development, speech, hearing level and middle ear function. Video and audio recordings of speech will be collected in a standardised age-appropriate manner and analysed independently by multiple speech and language therapists. The trial aims to recruit and follow-up 300 participants per arm. Data will be analysed according to the intention-to-treat principle using a 5% significance level. All analyses will be prespecified within a full and detailed statistical analysis plan. ETHICS AND DISSEMINATION: Ethical approval has been sought in each participating country according to country-specific procedures. Trial results will be presented at conferences, published in peer-reviewed journals and disseminated through relevant patient support groups. TRIAL REGISTRATION NUMBER: NCT00993551; Pre-results.

Obstructive sleep apnea (OSA) is caused by temporary partial or complete constriction of the upper airway during sleep which leads to reduced blood oxygen and cardiovascular risks. Main symptoms vary between adults and children leading to misdiagnosis or delayed patient identification. To improve early diagnosis, lateral cephalograms can provide craniofacial measurements associated with a higher risk of OSA. In order to identify the most relevant craniofacial measurements, a systematic literature review with meta-analysis was conducted combining the terms 'orthodontic*', 'craniofacial', 'cephalometr*', 'cephalogram', 'OSA*', 'UARS', 'SDB', 'sleep disordered breathing', 'sleep apnea' and 'sleep apnoea'. Of 3016 publications, 19 were included in the systematic review and meta-analysis, 15 with adult patients and four with children. A total of 16 measurements (six angles, 10 distances) were compared, nine showed a possible influence in patients with OSA compared to controls: NSBa angle (-0.28°), ANB angle (+0.33°), ML-NSL angle (+0.34°), Me-Go-Ar angle (+0.33°), SN distance (-0.70 mm), N-ANS distance (-0.36 mm), MP-H distance (+1.18 mm), uvula length (+1.07 mm) and thickness (+0.96 mm). Posterior airway measurements were not sufficiently described or comparably measured to be statistically analysed. There is some evidence for altered craniofacial anatomy in patients with OSA compared to controls. Lateral cephalograms should be screened for these aspects routinely to improve early diagnosis of OSA and craniofacial orthopaedics should complement the interdisciplinary treatment plan for young patients with OSA.

BACKGROUND: In order to gain a better understanding of how growth of the alveolar bone is linked to the vertical development of the face, the purpose of this study was to investigate if there is an association between the cross-sectional morphology of the maxillary and mandibular bodies with the craniofacial height, using images from cone beam computed tomography (CBCT). METHODS: From 450 pre-treatment CBCT scans, 180 were selected to be included in the study. Lateral head images were generated from the CBCT scans and were used to categorise subjects into three groups based on their vertical craniofacial height. Cross-sectional images from CBCT volumes were reformatted of the maxillary and mandibular bodies at five locations in the maxilla and five in the mandible. Each image was measured at one height and two width measurements. Statistical analysis performed was the one-way analysis of variance with a Tukey post hoc test. A significance level of 5% was used in all comparisons. RESULTS: Patients with large vertical craniofacial height had a significantly higher cross-sectional area both in the maxilla and in the mandible. In the same group, the cross-sectional area was significantly thinner in the mandible compared with the other two groups, especially in the anterior region. CONCLUSIONS: This study further highlights the close relationship between craniofacial height and alveolar bone dimensions and contributes with important knowledge for planning and follow-up of comprehensive dental- and orthodontic treatments.

The purpose of this study was to provide more information about the morphological characteristics of the craniofacial complex in mandibular prognathism. Forty young adult males having mandibular prognathism were compared with 40 having normal occlusion. This was conducted to carry out geometric morphometric assessments to localize alterations, using Procrustes analysis and thin-plate spline analysis, in addition to conventional cephalometric techniques. Procrustes analysis indicated that the mean craniofacial, midfacial and mandibular morphology was significantly different in prognathic subjects compared with normal controls. This finding was corroborated by the multivariate Hotelling T(2)-test of cephalometric variables. Mandibular prognathism demonstrated a shorter and slightly retropositioned maxilla, a greater total length and anterior positioning of the mandible. Thin-plate spline analysis revealed a developmental diminution of the palatomaxillary region anteroposteriorly and a developmental elongation of the mandible anteroposteriorly, leading to the appearance of a prognathic mandibular profile. In conclusion, thin-plate spline analysis seems to provide a valuable supplement for conventional cephalometric analysis because the complex patterns of craniofacial shape change are visualized suggestive by means of grid deformations.

Recent advances in the field of geometric morphometrics allow for powerful statistical hypothesis testing for effects of biological and environmental variables on anatomical shape. This study used partial least-squares regression (PLSR) and the recently developed bootstrapped response-based imputation modelling (BRIM) algorithm to test for sexual dimorphism in the craniofacial shape of 1-year-old humans. We observed a recession of the forehead in boys relative to girls, and differences in the nose, consistent with adult dimorphism. Results also suggest that the degree to which individuals express dimorphic traits is continuous throughout the population. This is also seen in adult dimorphism but in 1-year-olds the amount of overlap between groups is much higher, indicating the strength of dimorphism between sexes is lower. Our results demonstrate early sexual dimorphism that is not attributable to the influx of sex hormones at puberty. This highlights the need to look at very early ontogeny for the origins of sexual dimorphism. We suggest that future work look at potential mediating effects of this early dimorphism on the later impact of puberty. The subtle shape differences we have detected, may also be applied to sexing fossilised crania. A common artefact in 3D images of faces of young children is that they often have their mouths open to varying degrees, introducing variability in the data unrelated to anatomy. We describe two PLSR-based methods of correcting this. These methods may facilitate surgical planning and assessment of young children based on 3D images.

OBJECTIVE: To identify inherited craniofacial morphologic features in individuals at high risk for cleft of the lip, cleft palate, or both. SUBJECTS: Twins without cleft from 33 pairs of monozygotic twins discordant for cleft lip, cleft palate, or both were studied. There were 17 males and 16 females of Caucasian origin, ranging from 3 to 18 years (15 with cleft lip and palate [CLP], 10 with cleft lip [CL], and 8 with cleft palate [CP]), collected from five craniofacial centers (United States and Canada). DESIGN: The twin without cleft (noncleft) from each set was compared with an age- and sex-matched control individual from the Burlington Growth Centre, Toronto, Ontario. Posteroanterior and lateral cephalograms were traced and digitized using a computer custom analysis. Descriptive statistics, Student's t tests, and analysis of variance were used to test 40 variables in a pilot study comparing the noncleft twin groups with the controls. Preliminary analysis permitted pooling of the CLP and CL groups (n = 25). To minimize false-positive significance, only 14 variables (from the maxillofacial area) were tested. RESULTS: Using the raw probabilities, eight variables showed significant differences between the pooled noncleft CLP and CL (CL[P]) twin group and the controls. However, when the level of significance was adjusted, only four (nasal width [p < .01], cranial base length [p < .05], cranial base width/length ratio [p < .001], and maxillary width/length ratio [p < .05]) were significantly different. No significant differences were confirmed between the noncleft CP twin group and the controls. CONCLUSIONS: The noncleft member of a discordant monozygotic pair has a number of facial characteristics that differ from the general population. These may predispose to the formation of a cleft lip or palate and may result from a deficiency or distortion of the mesenchyme that forms the craniofacial structures.

Axenfeld-Rieger syndrome (ARS) (OMIM Nr.: 180500) is a rare autosomal dominant disorder (1 : 200000) with genetic and morphologic variability. Glaucoma is associated in 50% of the patients. Craniofacial and dental anomalies are frequently reported with ARS. The present study was designed as a multidisciplinary analysis of orthodontic, ophthalmologic, and genotypical features. A three-generation pedigree was ascertained through a family with ARS. Clinically, radiographic and genetic analyses were performed. Despite an identical genotype in all patients, the phenotype varies in expressivity of craniofacial and dental morphology. Screening for PITX2 and FOXC1 mutations by direct DNA-sequencing revealed a P64L missense mutation in PITX2 in all family members, supporting earlier reports that PITX2 is an essential factor in morphogenesis of teeth and craniofacial skeleton. Despite the fact that the family members had identical mutations, morphologic differences were evident. The concomitant occurrence of rare dental and craniofacial anomalies may be early diagnostic indications of ARS. Early detection of ARS and elevated intraocular pressure (IOP) helps to prevent visual field loss.