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.

• Keywords
• 3D shape completion, Anatomical reconstruction, Convolutional neural networks, Cranial implant design, Generative adversarial networks,
• MeSH
• Skull diagnostic imaging   MeSH
• Humans MeSH
• Neural Networks, Computer * MeSH
• Image Processing, Computer-Assisted * MeSH
• Prostheses and Implants MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

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
• Computer-Aided Design * MeSH
• Humans MeSH
• Prosthesis Design * MeSH
• Prostheses and Implants * MeSH
• Arthritis, Psoriatic surgery   MeSH
• Aged MeSH
• Tibia surgery   MeSH
• Arthroplasty, Replacement, Knee * MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Case Reports 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
• Principal Component Analysis methods   MeSH
• Finite Element Analysis MeSH
• Anatomic Landmarks pathology   MeSH
• Surgical Flaps MeSH
• Child MeSH
• Cephalometry methods   MeSH
• Lasers MeSH
• Humans MeSH
• Maxilla pathology   MeSH
• Adolescent MeSH
• Orthodontics, Corrective methods   MeSH
• Palate pathology   MeSH
• Image Processing, Computer-Assisted methods   MeSH
• Cleft Palate pathology   therapy   MeSH
• Plastic Surgery Procedures methods   MeSH
• Imaging, Three-Dimensional methods   MeSH
• Models, Dental MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study 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.

• Keywords
• 3-D geometric morphometrics, Dense correspondence analysis, Palatal shape, Surface scanning, Unilateral cleft of lip and palate,
• MeSH
• Anatomic Variation MeSH
• Anatomic Landmarks pathology   MeSH
• Child MeSH
• Cephalometry methods   MeSH
• Humans MeSH
• Maxilla pathology   MeSH
• Adolescent MeSH
• Palate pathology   MeSH
• Image Processing, Computer-Assisted methods   MeSH
• Cleft Palate pathology   MeSH
• Cleft Lip pathology   MeSH
• User-Computer Interface MeSH
• Age Factors MeSH
• Plastic Surgery Procedures methods   MeSH
• Imaging, Three-Dimensional methods   MeSH
• Models, Dental MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study 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.

• Keywords
• 3D facial morphology, controls., geometric morphometrics, infants, neonatal cheiloplasty, unilateral cleft lip, unilateral cleft lip and palate,
• MeSH
• Photogrammetry * methods   MeSH
• Cephalometry MeSH
• Infant MeSH
• Humans MeSH
• Maxillofacial Development MeSH
• Face anatomy & histology   abnormalities   MeSH
• Child, Preschool MeSH
• Cross-Sectional Studies MeSH
• Cleft Palate * surgery   diagnostic imaging   pathology   MeSH
• Cleft Lip * surgery   pathology   MeSH
• Case-Control Studies MeSH
• Imaging, Three-Dimensional * MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article 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.

• Keywords
• Biomechanics of parturition, Elastography, Finite element model, Perineal elasticity, Tactile imaging,
• MeSH
• Adult MeSH
• Elasticity Imaging Techniques * MeSH
• Humans MeSH
• Young Adult MeSH
• Pelvic Floor * diagnostic imaging   MeSH
• Perineum diagnostic imaging   MeSH
• Parturition MeSH
• Feasibility Studies MeSH
• Pregnancy MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article 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.

• Keywords
• 3D print, facial surgery, foreign body, glass particles, inspections,
• Publication type
• Journal Article MeSH
• Case Reports 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.

• Keywords
• 3-D geometric morphometrics, Classical morphometrics, Early neonatal cheiloplasty, Unilateral cleft lip and palate, Upper dental arch,
• MeSH
• Principal Component Analysis MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Orthognathic Surgical Procedures * MeSH
• Image Processing, Computer-Assisted MeSH
• Prospective Studies MeSH
• Cleft Palate surgery   MeSH
• Cleft Lip surgery   MeSH
• Case-Control Studies MeSH
• Imaging, Three-Dimensional MeSH
• Models, Dental * MeSH
• Dental Arch growth & development   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Reptiles exhibit a large heterogeneity in teeth morphology. The main variability comprises the different tooth shape, the type of tooth attachment to the underlying bone, or the ability to replace the teeth. FINDINGS: Here, we provide full datasets of microtomography scans and 3D models of reptilian dentitions and skulls. We selected representative species for each of 9 reptilian families on the basis of their characteristic dental features. Because there are ≥4 different types of tooth-bone attachments, ranging from the mammalian-like thecodont attachment found in crocodilians to the simple acrodont implantation observed in some lizards, we aimed to evaluate species with different types of tooth-bone attachments. Moreover, another interesting feature varying in reptilian species is the complexity of tooth shape or the number of tooth generations, which can be associated with the type of tooth attachment to the jawbone. Therefore, selected model species also include animals with distinct tooth morphology along the jaw or different number of tooth generations. The development of tooth attachment and relationship of the tooth to the jaw can be further analysed in detail on a large collection of pre-hatching stages of chameleon. Next, we introduce different possibilities for how these datasets can be further used to study tooth-bone relationships or tooth morphology in 3D space. Moreover, these datasets can be valuable for additional morphological and morphometric analyses of reptilian skulls or their individually segmented skeletal elements. CONCLUSIONS: Our collection of microcomputed tomography scans can bring new insight into dental or skeletal research. The broad selection of reptilian species, together with their unique dental features and high quality of these scans including complete series of developmental stages of our model species and provide large opportunities for their reuse. Scans can be further used for virtual reality, 3D printing, or in education.

• Keywords
• 3D imaging, craniofacial bones, micro-CT, reptiles, skull, tooth replacement, tooth-bone attachment,
• MeSH
• Dentition MeSH
• Lizards * anatomy & histology   MeSH
• Skull anatomy & histology   diagnostic imaging   MeSH
• Humans MeSH
• X-Ray Microtomography MeSH
• Mammals MeSH
• Tooth * anatomy & histology   diagnostic imaging   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't 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
• Mitral Valve Annuloplasty * adverse effects   instrumentation   mortality   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Mitral Valve surgery   MeSH
• Mitral Valve Insufficiency * epidemiology   surgery   MeSH
• Postoperative Complications MeSH
• Prospective Studies MeSH
• Prosthesis Design MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH