Three-part mould technique for fabrication of hollow thumb prosthesis: A case report.

BACKGROUND: The purpose of this article is to describe a technique which helps in fabrication of glove-type hollow thumb prosthesis using three-part mould technique. CASE DESCRIPTION AND METHODS: Patient reported to the Department of Private dental clinic, Delhi, India with a chief complaint of missing partial left thumb and wanted to get it replaced. A complete clinical hand examination was carried out, which revealed a residual stump of 1 cm length. After ensuring the medical conditions to be normal, fabrication of hollow thumb prosthesis was planned using three-part mould technique. FINDINGS AND OUTCOMES: The prosthesis delivered to the patient was highly retentive because of its glove-type retention and lighter weight; feedback from the patient regarding retention was excellent. The prosthesis was aesthetically pleasing because of its excellent colour matching with the skin, and each and every part of the prosthesis could be colour customized because of easy retrieval of the third part of the mould, as well. CONCLUSION: A technique of hollow thumb prosthesis has been described in this article which helps in reduction in weight, easy packing of silicone material into the mould and easy colour customization at the knuckles area of the dorsal and ventral aspect of the prosthesis. CLINICAL RELEVANCE: This three-part mould technique helps to fabricate hollow prosthesis which increases retainability and at the same time allows easy packing of silicone material and easy colour customization at the knuckles area of the prosthesis.

An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic.

The quality of care delivered to 74 patients undergoing orthognathic surgery was assessed using a patient satisfaction questionnaire and data collected from hospital case records. Surgical complications, hospital services, patient satisfaction, and impact on quality of life, were the main aspects considered. The majority of patients reported that their treatment objectives had been achieved and that they were satisfied with the quality of care provided. The main concern of the patients regarding the clinic was the waiting time before an appointment could be offered. Eating and breathing difficulties and low mood after surgery were the main reported complications. Sixty-three patients experienced post-operative weight loss. The importance of a nutritious, high calorie soft diet should be emphasised and the use of menthol inhalations following maxillary osteotomies should be considered more frequently. Clinicians should be aware of post-operative low mood, which may require psychological support. We developed a sensitive assessment battery with comprehensive parameters to audit quality of orthognathic surgery service, and recommend that a similar approach should be considered by teams which undertake management of orthognathic patients.

Face bow and articulator for planning orthognathic surgery: 1 face bow.

Orthognathic surgery that involves movement of the maxilla relative to the skull is usually planned using casts mounted on an articulator. Accurate positioning of the maxilla relative to the skull is essential for reliable planning, but current methods of mounting casts on articulators are inaccurate and unreliable. We propose that the casts should be mounted using the relation between the horizontal plane and the resting head position to define the position of the skull. A photographic study of 10 subjects confirmed the reproducibility of the head position and its relation to the horizontal plane. A face bow incorporating a circular spirit level was used to transfer the relation between the horizontal and the maxillary dentition to a semiadjustable articulator. The angle between the horizontal and maxillary occlusal planes was measured from six lateral cephalograms and compared with those of casts mounted on a semiadjustable articulator using a face bow with either an orbital pointer or a spirit level. The face bow with a spirit level produced considerably more accurate results.

Face bow and articulator for planning orthognathic surgery: 2 articulator.

Patients who require orthognathic surgery may have asymmetry of the position of the temporomandibular joints relative to the maxilla, which is impossible to reproduce on the current semiadjustable articulators used for surgical planning. We describe a highly-adjustable spirit level orthognathic face bow that allows records to be made of patients with asymmetrical maxillae. The orthognathic articulator also allows the position of the condylar components of the articulator to be adjusted in three dimensions. The use of the new face bow and articulator made it possible to mount the dental casts of asymmetrical faces to reproduce their clinical appearance. The devices were evaluated by comparing the measurements of anatomical variables obtained from cephalometric radiographs with equivalent values obtained from the orthognathic articulator and casts mounted on the articulator. Although the measurements showed significant intersubject variability, the angle between the horizontal and maxillary occlusal plane, occlusal cant angle, and intercondylar widths, were not significantly different.

Olivo-cortico-nuclear localizations within crus I of the cerebellum.

Retrograde and anterograde tracers were microinjected into the folia of crus I of the cat cerebellum to investigate spatial localization in olivo-cerebellar and cortico-nuclear projections. The folia were shown to be mainly occupied in rostrocaudal succession by three zones receiving their olivo-cerebellar climbing fiber afferents from parts of, respectively, the dorsal lamella of the principal olive, the ventral lamella of the principal olive, and the rostral half of the medial accessory olive. These zones are presumably parts of the D(2), D(1), and C(2) cerebellar cortical zones, as earlier proposed by Rosina and Provini ([1982] Neuroscience 7:2657-2676). Their respective nuclear target territories were found to be in the rostroventral quadrant of nucleus lateralis, the caudoventral quadrant of nucleus lateralis, and the ventral half of nucleus interpositus posterior. The medial-to-lateral width of each zone was shown to be innervated by different groups of olive cells and to project respectively to medial and lateral parts of the nuclear territory for that zone, consistent with the existence in crus I of olivo-cortico-nuclear microcomplexes (cf. Ito [1984] New York: Raven Press). Parts of the length of each zone located within different folia were also shown to relate to different groups of olive cells and to different regions of the zone's overall nuclear territory. Interfolial localizations, which were heavily overlapping in nature, intersected orthogonally with those for zone width. The fine-grain topography implies that individual microzones exist within each of the zones present within crus I. The results also have implications for the possibility that lateral cerebellar pathways are involved in cognition.

3D stereophotogrammetric image superimposition onto 3D CT scan images: the future of orthognathic surgery. A pilot study.

The aim of this study was to register and assess the accuracy of the superimposition method of a 3-dimensional (3D) soft tissue stereophotogrammetric image (C3D image) and a 3D image of the underlying skeletal tissue acquired by 3D spiral computerized tomography (CT). The study was conducted on a model head, in which an intact human skull was embedded with an overlying latex mask that reproduced anatomic features of a human face. Ten artificial radiopaque landmarks were secured to the surface of the latex mask. A stereophotogrammetric image of the mask and a 3D spiral CT image of the model head were captured. The C3D image and the CT images were registered for superimposition by 3 different methods: Procrustes superimposition using artificial landmarks, Procrustes analysis using anatomic landmarks, and partial Procrustes analysis using anatomic landmarks and then registration completion by HICP (a modified Iterative Closest Point algorithm) using a specified region of both images. The results showed that Procrustes superimposition using the artificial landmarks produced an error of superimposition on the order of 10 mm. Procrustes analysis using anatomic landmarks produced an error in the order of 2 mm. Partial Procrustes analysis using anatomic landmarks followed by HICP produced a superimposition accuracy of between 1.25 and 1.5 mm. It was concluded that a stereophotogrammetric and a 3D spiral CT scan image can be superimposed with an accuracy of between 1.25 and 1.5 mm using partial Procrustes analysis based on anatomic landmarks and then registration completion by HICP.