Reconstruction with the use of custom-made implants aims at optimal replacement of lost or damaged bone structures and restoration of their funkction. In this study the development and construction of a custom-made implant and the operative technique used for the treatment of an extensive tibial defect are described. The patient was a 65-year-old man treated for over 20 years for psoriatic arthritis and severe instability of the right knee, particularly in the frontal plane, with a worsening varus deformity. The radiogram showed an extensive destruction of the medial tibial condyle that also deeply involved the lateral condyle. The extent of defect made it impossible to use any commercial tibial augmentation. The geometry of the custom-designed implant for the medial tibial condyle was constructed on the basis of a 3D defect model and the shape of the medial tibial condyle of the collateral knee seen on CT scans. After its correct shape was verified on a plastic model, its coordinates were set in the software of a machine tool, and a titanium augmentation otherwise compatible with a standard knee replacement was produced.The use of such a custom implant to complete standard total knee arthroplasty has so far been demanding in terms of organisation and manufacture. Its production in the future could be facilitated by substituting titanium for plastic material such as poly-ether-ether-ketone (PEEK). Key words: custom-made implant, tibial augmentation, knee prosthesis.

• MeSH
• design s pomocí počítače MeSH
• lidé MeSH
• protézy - design MeSH
• protézy a implantáty MeSH
• psoriatická artritida chirurgie   MeSH
• senioři MeSH
• tibie chirurgie   MeSH
• totální endoprotéza kolene MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH

Bilateral complete cleft lip and palate (BCLP) is the most severe of the common orofacial clefts and is associated with the greatest deformity during development. The aim of this study was to use geometric morphometrics to evaluate palatal shape and size variability in patients with BCLP in comparison to nonclefted Czech boys. The variability of palatal size and shape in BCLP patients was greater when compared with the nonclefted population. Though palate variability in BCLP was wide, nonclefted palatal shapes were generally different (a high, wide and vaulted palate) and fell almost outside the range of BCLP variability. The palatal size and shape of BCLP patients (range from 12.1 to 16.5 years) was not correlated with age. A comparison of the mean shapes of the clefted and nonclefted groups showed that the BCLP palate is flatter and narrower. The most notable size difference was found in the area between the maxilla and premaxilla. This phenomenon is associated with the persisting separation of the premaxilla from the rest of the palate. The shape of the palatal configuration of the premaxilla and adjacent area was concave in the nonclefted group and convex in BCLP patients.

• MeSH
• analýza hlavních komponent metody   MeSH
• analýza metodou konečných prvků MeSH
• anatomická značka patologie   MeSH
• chirurgické laloky MeSH
• dítě MeSH
• kefalometrie metody   MeSH
• lasery MeSH
• lidé MeSH
• maxila patologie   MeSH
• mladiství MeSH
• ortodoncie korekční metody   MeSH
• patro patologie   MeSH
• počítačové zpracování obrazu metody   MeSH
• rozštěp patra patologie   terapie   MeSH
• zákroky plastické chirurgie metody   MeSH
• zobrazování trojrozměrné metody   MeSH
• zubní modely MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Facial development of patients with unilateral complete cleft lip and palate (UCLP) is associated with many problems including deformity of the palate. The aim of this study was to evaluate palatal morphology and variability in patients with UCLP compared with Czech norms using methods of geometric morphometrics. The study was based on virtual dental cast analysis of 29 UCLP patients and 29 control individuals at the age of 15 years. The variability of palatal shape in UCLP patients was greater than that in nonclefted palates. Only 24% of clefted palates fell within the variability of controls. The palatal form of UCLP patients (range from 11.8 to 17.2 years) was not correlated with age. Compared with control palates, palates of UCLP patients were narrower, more anteriorly than posteriorly. Apart from the praemaxilla region, they were also shallower, and the difference increased posteriorly. The UCLP palate was characterised by the asymmetry of its vault. The maximum height of the palatal vault was anterior on the clefted side, whereas it was posterior on the nonclefted side. The slope of the UCLP palate was more inclined compared with the control group. The praemaxilla was therefore situated more inferiorly.

• MeSH
• anatomická variace MeSH
• anatomická značka patologie   MeSH
• dítě MeSH
• kefalometrie metody   MeSH
• lidé MeSH
• maxila patologie   MeSH
• mladiství MeSH
• patro patologie   MeSH
• počítačové zpracování obrazu metody   MeSH
• rozštěp patra patologie   MeSH
• rozštěp rtu patologie   MeSH
• uživatelské rozhraní počítače MeSH
• věkové faktory MeSH
• zákroky plastické chirurgie metody   MeSH
• zobrazování trojrozměrné metody   MeSH
• zubní modely MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Designing a cranial implant to restore the protective and aesthetic function of the patient's skull is a challenging process that requires a substantial amount of manual work, even for an experienced clinician. While computer-assisted approaches with various levels of required user interaction exist to aid this process, they are usually only validated on either a single type of simple synthetic defect or a very limited sample of real defects. The work presented in this paper aims to address two challenges: (i) design a fully automatic 3D shape reconstruction method that can address diverse shapes of real skull defects in various stages of healing and (ii) to provide an open dataset for optimization and validation of anatomical reconstruction methods on a set of synthetically broken skull shapes. We propose an application of the multi-scale cascade architecture of convolutional neural networks to the reconstruction task. Such an architecture is able to tackle the issue of trade-off between the output resolution and the receptive field of the model imposed by GPU memory limitations. Furthermore, we experiment with both generative and discriminative models and study their behavior during the task of anatomical reconstruction. The proposed method achieves an average surface error of 0.59mm for our synthetic test dataset with as low as 0.48mm for unilateral defects of parietal and temporal bone, matching state-of-the-art performance while being completely automatic. We also show that the model trained on our synthetic dataset is able to reconstruct real patient defects.

• MeSH
• lebka diagnostické zobrazování   MeSH
• lidé MeSH
• neuronové sítě * MeSH
• počítačové zpracování obrazu * MeSH
• protézy a implantáty MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION AND HYPOTHESIS: Quantitative characterization of the birth canal and critical structures before delivery may provide risk assessment for maternal birth injury. The objective of this study was to explore imaging capability of an antepartum tactile imaging (ATI) probe. METHODS: Twenty randomly selected women older than 21 years with completed 35th week of pregnancy and a premise of vaginal delivery were enrolled in the feasibility study. The biomechanical data were acquired using the ATI probe with a double-curved surface, shaped according to the fetal skull and equipped with 168 tactile sensors and an electromagnetic motion tracking sensor. Software package COMSOL Multiphysics was used for finite element modeling. Subjects were asked for assessment of pain and comfort levels experienced during the ATI examination. RESULTS: All 20 nulliparous women were successfully examined with the ATI. Mean age was 27.8 ± 4.1 years, BMI 30.7 ± 5.8, and week of pregnancy 38.8 ± 1.4. Biomechanical mapping with the ATI allowed real-time observation of the probe location, applied load to the vaginal walls, and a 3D tactile image composition. The nonlinear finite element model describing the stress-strain relationship of the pelvic tissue was developed and used for calculation of Young's modulus (E). Average perineal elastic modulus was 11.1 ± 4.3 kPa, levator ani 4.8 ± 2.4 kPa, and symphysis-perineum distance was 30.1 ± 6.9 mm. The pain assessment level for the ATI examination was 2.1 ± 0.8 (scale 1-4); the comfort level was 2.05 ± 0.69 (scale 1-3). CONCLUSIONS: The antepartum examination with the ATI probe allowed measurement of the tissue elasticity and anatomical distances. The pain level was low and the comfort level was comparable with manual palpation.

• MeSH
• dospělí MeSH
• elastografie * MeSH
• lidé MeSH
• mladý dospělý MeSH
• pánevní dno * diagnostické zobrazování   MeSH
• perineum diagnostické zobrazování   MeSH
• porod MeSH
• studie proveditelnosti MeSH
• těhotenství MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To assess modelled facial development of infants with unilateral cleft lip (CL) and cleft lip and palate (UCLP) compared to controls up to two years of age. DESIGN AND PARTICIPANTS: A total of 209 facial images of children (CL: n = 37; UCLP: n = 39; controls: n = 137) were obtained in four age categories (T0 = 0.2-0.5; T1 = 0.6-1.0; T2 = 1.1-1.5; T3 = 1.6-2.0 years) and were evaluated using stereophotogrammetry and geometric morphometry. All patients underwent lip surgery before T0, patients with UCLP underwent palatoplasty (T0, T1 before palatoplasty; T2, T3 after palatoplasty). RESULTS: In patients with CL, the forehead was significantly retracted (p ≤ 0.001), while the supraorbital and ocular regions were prominent (p ≤ 0.001). The oronasal region appeared convex (p ≤ 0.001). The lower lip and chin were non-significantly protruded. In patients with UCLP, a significantly retracted forehead and prominent supraorbital region were apparent (p ≤ 0.001). A retrusive oronasal region (p ≤ 0.001) was observed in the middle face. The chin was anteriorly protruded (p ≤ 0.01). No progression of deviations was found with increasing age. After the first year, a slight improvement in the morphological features became apparent. The shape variability of the clefts and controls overlapped, suggesting a comparable modelled facial development. CONCLUSIONS: The facial morphology of individuals with cleft was comparable to the norm. Shape deviation was apparent in the oronasal region, forehead, and chin, which minimised with increasing age even in complete clefts.

• MeSH
• fotogrammetrie * metody   MeSH
• kefalometrie MeSH
• kojenec MeSH
• lidé MeSH
• maxilofaciální vývoj MeSH
• obličej anatomie a histologie   abnormality   MeSH
• předškolní dítě MeSH
• průřezové studie MeSH
• rozštěp patra * chirurgie   diagnostické zobrazování   patologie   MeSH
• rozštěp rtu * chirurgie   patologie   MeSH
• studie případů a kontrol MeSH
• zobrazování trojrozměrné * MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Autor na základě dlouholetých zkušeností se zlomeninami obličejového skeletu u dětí vysvětluje mechanismus vzniku mandibulární anomálie – zdvojení kondylu, kterou poprvé uvedl Dr. Aleš Hrdlička v r. 1941. Ve většině dosud publikovaných prací se zdá, že jde o následek dislokované zlomeniny kondylu v dětství. Dříve než v místě zlomeniny naroste chybějící část, většinou mediálně skloněného kondylu, zpomalí se růst příslušné poloviny mandibuly a vzniká typická poúrazová asymetrie, která je patrná i z obrázků v Hrdličkově práci. Mandibula má kratší a vertikálněji směrované rameno a uchýlenou bradu. K zdvojení dochází tehdy, když schopnost dosud funkční růstové chrupavky, nacházející se mezi kloubní hlavicí a ramenem mandibuly, popsané Doskočilem (3-5), převáží nad remodelačními procesy, takže dojde k tvorbě nového – sekundárního – kondylu dříve, než se původní stačí napřímit do původního postavení. Jeho kontaktem s lební spodinou vznikne další kloubní jamka, která tvarem i velikostí odpovídá oploštěné kloubní hlavici. Podobná situace nastane, když se dislokovaný kondyl, následkem ztráty kostního kontaktu a výživy, resorbuje. Po několika měsících dochází k nárůstu nového kondylu, který je kratší, má deformovanou hlavici s oploštěnou kloubní ploškou a do hrany vytaženými okraji. V období růstové akcelerace roste mediálně a anteriorně, přímo na kloubní hrbolek a rovněž i zde vytvoří kloubní jamku. Při tomto procesu hraje podstatnou roli po úrazu navyklé nezatěžování původně poraněné strany při mastikaci. Zkušenosti ukázaly, že při fyziologicky přípustném, dynamicky odstupňovaném přetěžování dochází k rychlejší a dokonalejší remodelaci původního kondylu, či tvorbě a formování kondylu nového.

Based on many years of his experience with facial skeleton fractures in children, author explains the mechanism leading to mandibular anomaly - the bifid condyle, for the first time mentioned by Dr. Aleš Hrdlička in 1941. In most published reports, it seems to be a consequence of dislocated fracture of the condyle in childhood. Before the missing part of usually medially inclined condyle can grow at the fracture site, the growth of respective half of the mandible is slowed down and there generates the typical post-traumatic asymmetry, which is also evident from the images in Hrdlička´s report. The mandible has shorter and more vertically directed ramus and deviated chin. The duplication occurs when the ability of still functional growth cartilage located between the articular head and ramus mandibuli, as described by Doskočil (3-5), outweighs the remodelling processes, so that the formation of a new, secondary condyle occurs earlier than the original one can straighten up its former position. Due to its contact with the base of the skull another articular fossa generates, which corresponds to the size and shape of flattened articular head. Similar situation occurs when the dislocated condyle resorbs due to the loss of bone contact and nutrition. After a few months there is an increase of the new condyle which is shorter, has deformed head with flattened articular surface and margins stroked to its edge. During the growth acceleration, it grows medially and anteriorly, directly on the articular tubercle and also here it forms an articular fossa. In this process, the non-loading of the originally injured part during mastication, accustomed after the injury, plays an important role. Experience has shown that the physiologically tolerable, dynamically stepped overloading leads to faster and more complete remodelling of original condyle, or creating and forming of a new condyle.

• MeSH
• lidé MeSH
• paleodontologie MeSH
• počítačová rentgenová tomografie MeSH
• processus condylaris mandibulae * abnormality   patofyziologie   radiografie   MeSH
• rentgendiagnostika panoramatická metody   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVES: This prospective morphometric study evaluated the growth of the upper dental arch in UCLP patients after early neonatal cheiloplasty and compared the selected dimensions with published data on non-cleft controls and on later operation protocol patients. METHODS: The sample comprised 36 Czech children with nonsyndromic complete UCLP (cUCLP) and 20 Czech children with nonsyndromic incomplete UCLP (UCLP + b). 2-D and 3-D analyses of palatal casts were made at two time points: before neonatal cheiloplasty at the mean age of 3 days (±1 day), and 10 months after surgery at the mean age of 10 months (±1 month). RESULTS: The upper dental arch of cUCLP and UCLP + b patients showed similar developmental changes, but the cleft type influenced growth significantly. The initial high shape variability in cUCLP patients diminished after 10 months, and approached the variability in UCLP + b patients. Both the width and length dimensions increased after surgery. Important growth concerned the anterior ends of both segments. The width and length dimensions illustrated similar growth trends with non-cleft controls and UCLP patients who underwent later cheiloplasty. CONCLUSION: Early neonatal cheiloplasty caused no reduction in the length or width dimensions during the first year of life. Our data suggest a reconstructed lip has a natural formative effect on the actively growing anterior parts of upper dental arch segments, which cause narrowing of the alveolar cleft.

• MeSH
• analýza hlavních komponent MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• ortognátní chirurgické výkony * MeSH
• počítačové zpracování obrazu MeSH
• prospektivní studie MeSH
• rozštěp patra chirurgie   MeSH
• rozštěp rtu chirurgie   MeSH
• studie případů a kontrol MeSH
• zobrazování trojrozměrné MeSH
• zubní modely * MeSH
• zubní oblouk růst a vývoj   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: The Profile 3D annuloplasty ring is a complete, rigid, saddle-shaped ring indicated for reconstruction and/or remodelling of the pathological mitral valve (MV) in patients with mitral insufficiency. METHODS: This prospective, non-randomized, observational, postmarket release study characterized the patient population for which the study ring was chosen for MV repair, assessed the relief from MV dysfunction and determined the level of mitral regurgitation (MR) at follow-up (6-12 months postimplant). RESULTS: Between February 2013 and July 2015, 151 patients were enrolled at 7 centres; data were excluded for 3 patients. The mean age of the remaining 148 patients was 63.8 ± 12.3 years, and 85 patients (57.4%) were men. Ischaemic cardiomyopathy was present in 15 patients (10.1%) and dilated cardiomyopathy in 12 patients (8.1%). MR was severe in 86 of 145 patients with available data (59.3%). Implantation was successful in 141 of 147 attempted procedures. Two deaths (n = 148, 1.4%) occurred within 30 days, and 1 death (0.7%) occurred >30 days after implant. Analysis of patients with data from both visits (n = 111) demonstrated that MR was none or mild in 94.5% of patients, moderate in 3.6% and moderate to severe in 1.8% at follow-up. Nearly all (104 of 109, 95.4%) patients were in New York Heart Association Class I/II. Among patients with ischaemic cardiomyopathy or dilated cardiomyopathy preoperatively, 16 of 19 patients with available data (84.2%) had no or mild MR at follow-up. CONCLUSIONS: MV repair using the Profile 3D annuloplasty ring is a safe and effective treatment for MR. Further investigation is warranted to determine whether patients with ischaemic cardiomyopathy or dilated cardiomyopathy derive unique benefit from this saddle-shaped ring. Clinical trial registration number: www.clinicaltrials.gov, NCT01112566.

• MeSH
• anuloplastika mitrální chlopně * škodlivé účinky   přístrojové vybavení   mortalita   statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň chirurgie   MeSH
• mitrální insuficience * epidemiologie   chirurgie   MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• protézy - design MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

KEY CLINICAL MESSAGE: In the anatomically complex terrain of the head and neck, the use of 3D intraoperative models serves as an effective verification tool, determining the size, shape, and number of foreign bodies. This allows the main operator to maximize their capacities for careful wound revision and receive real-time information about the remaining content of the sought-after bodies. ABSTRACT: Penetrating foreign bodies of various origins in the head and neck are uncommon, but potentially hazardous injuries. Complete removal of foreign bodies from soft tissues is essential for optimal healing, minimizing complications, and significantly reducing the risk of the need for reoperation. Despite various technological systems and safeguards available, unintentionally retained surgically placed foreign bodies remain difficult to eliminate completely. A 34-year-old female patient with a cut on the right side of her face who was initially treated with sutures at a general surgical clinic presented for a follow-up examination. A foreign body was verified subcutaneously on the anterior-posterior x-ray image on the right side. Computed tomography confirmed a total of 7 foreign bodies with a density corresponding to dental enamel, distributed subcutaneously, subfascially, and intramuscularly in the right temporal region. As part of the preoperative preparation and analysis, the bone segment of the right temporal fossa with the zygomatic bone and the glass fragments were segmented from the CT data and printed on an SLA printer. The physical 3D models were autoclave sterilized and present during surgery. The position, shape, and number of each individual glass fragment was compared with 3D-printed one. The benefits of producing 3D models of foreign bodies are undeniable, particularly in their perioperative comparison with the removed foreign bodies from wounds.

• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH