Validation of Gender Identification From Frontal Sinuses Using Yoshino's Classification: A Morphometric Radiographic Study.

INTRODUCTION: Gender determination of deceased individuals may become necessary in scenarios involving sudden and unforeseen fatalities like explosions, fires, transportation accidents, or instances of mutilation or decomposition, which frequently require medicolegal expertise. Forensic radiology is instrumental in identifying gender. The shape of the frontal sinus is considered distinct for every person, differing even among identical twins, much like individual fingerprints and establishing personal identity. AIMS AND OBJECTIVES: This study was designed to validate and determine gender identification by evaluating frontal sinus measurements using digital posteroanterior cephalograms with reference to Yoshino's classification and to determine gender based on measurements of frontal sinus size, bilateral asymmetry, the outline of the upper border of the frontal sinus, partial septa, and supraorbital cells of the frontal sinus. MATERIALS AND METHODS: A total of 300 digital posteroanterior cephalograms (150 males and 150 females) of age groups ranging from 18 to 30 years were collected from the records of the Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences & Research Centre, Hyderabad. The parameters that were assessed in a digital radiograph are Yoshino's frontal sinus pattern of the individual, which includes frontal sinus size, bilateral asymmetry, superiority of the side, outline of the upper border, partial septa, and supraorbital cells. The measurements were taken, tabulated, and compared with the standard values of the gender measurement. The values were subjected to statistical analysis. RESULTS: Results showed a statistically significant difference in the mean height (p=0.000), width (p=0.000), area (p=0.000), partial septa (p=0.002), and outline of the upper border on the right side (p=0.011) of the frontal sinus for both males and females. The mean values for length, width, and area of the frontal sinus were higher in males than females. No statistical difference is found on the outline of the upper border on the left side, superiority of the side, and supraorbital cells. The application of discriminative analysis to the data accurately identified gender in 65.3% of the cases. CONCLUSION: Thus, from the above study, the forensic application of frontal sinus morphology can be recommended as an adjunctive tool for gender determination.

Hand skeletal features of children and adolescents with different growth statuses and periods.

Background: The hand skeletal features of children and adolescents at different growth statuses and development periods, and the correlation between these skeletal features and hand asymmetric force are currently unclear. Thus, this study sought to investigate the hand skeletal features of children and adolescents at different growth statuses and at different periods of development, and the correlation between these skeletal features and asymmetric force in hands. Methods: A retrospective study was performed on subjects aged 4-20 years with good growth status (group A) or short stature (group B). Additional subjects aged 4-20, 21-40, and >40 years were enrolled in groups C, D, and E, respectively. All the subjects underwent left-hand posteroanterior X-ray radiography. Brachymesophalangia-V (BMP-V), conical epiphysis, epiphysis/metaphysis symmetry of the proximal phalanx (ESP), and the angle of the metacarpal-phalangeal axis were analyzed. Results: Of the 654 children and teenagers aged 4-20 years (median: 11 years) enrolled in the study, 432 were allocated to group A, of whom 237 (54.9%) were male and 195 (45.1%) were female, and 222 matched cases were allocated to group B, of whom 112 (50.5%) were male and 110 (49.5%) were female. The first to third ESPs were significantly (P<0.05) greater in group A than in group B, while the first to third angles of the metacarpal-phalangeal axis were significantly (P<0.05) smaller in group A than in group B. The correlation analysis revealed a highly significant (P<0.01) negative correlation between the ESP and angle of the metacarpal-phalangeal axis (r=-0.948, -0.926, -0.940, -0.885, and -0.848, respectively). The incidence of BMP-V was 15.4% in all patients, while that of conical epiphysis was 19.5%. The incidence of BMP-V and conical epiphysis was significantly (P<0.05) smaller in group A than in group B (11.1% vs. 23.8% for BMP-V and 16.6% vs. 25.2% for conical epiphysis, respectively). Additionally, 216 subjects were enrolled in group C (108 male and 108 female), 185 subjects were enrolled in in group D (93 male and 92 female), and 176 subjects were enrolled in in group E (104 male and 72 female). The second to fifth ESPs in group C were significantly (P<0.05) smaller than those in both groups D and E, while the second to fifth angles of the metacarpal-phalangeal axis were significantly (P<0.05) larger in group C than in both groups D and E. A BMP-V was present in 35 (16.2%) patients in group C, 8 (4.3%) in group D, and 2 (1.1%) in group E, and the difference among the three groups was statistically significant (P<0.05). Conclusions: The epiphyseal symmetry of the proximal phalanges is poor in short stature children and adolescents, and the angle between the metacarpal and phalangeal axes is larger in children and adolescents with short stature than those with normal height and good growth status. A negative correlation was found between the epiphyseal symmetry of the proximal phalanges and asymmetrical stress.

Accuracy of posteroanterior cephalogram landmarks and measurements identification using a cascaded convolutional neural network algorithm: A multicenter study.

Objective: : To quantify the effects of midline-related landmark identification on midline deviation measurements in posteroanterior (PA) cephalograms using a cascaded convolutional neural network (CNN). Methods: : A total of 2,903 PA cephalogram images obtained from 9 university hospitals were divided into training, internal validation, and test sets (n = 2,150, 376, and 377). As the gold standard, 2 orthodontic professors marked the bilateral landmarks, including the frontozygomatic suture point and latero-orbitale (LO), and the midline landmarks, including the crista galli, anterior nasal spine (ANS), upper dental midpoint (UDM), lower dental midpoint (LDM), and menton (Me). For the test, Examiner-1 and Examiner-2 (3-year and 1-year orthodontic residents) and the Cascaded-CNN models marked the landmarks. After point-to-point errors of landmark identification, the successful detection rate (SDR) and distance and direction of the midline landmark deviation from the midsagittal line (ANS-mid, UDM-mid, LDM-mid, and Me-mid) were measured, and statistical analysis was performed. Results: : The cascaded-CNN algorithm showed a clinically acceptable level of point-to-point error (1.26 mm vs. 1.57 mm in Examiner-1 and 1.75 mm in Examiner-2). The average SDR within the 2 mm range was 83.2%, with high accuracy at the LO (right, 96.9%; left, 97.1%), and UDM (96.9%). The absolute measurement errors were less than 1 mm for ANS-mid, UDM-mid, and LDM-mid compared with the gold standard. Conclusions: : The cascaded-CNN model may be considered an effective tool for the auto-identification of midline landmarks and quantification of midline deviation in PA cephalograms of adult patients, regardless of variations in the image acquisition method.

Comparative analysis of craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders: a cross-sectional study.

Objectives: The aim of the study was to quantify and compare craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders (TMDs). Materials and Methods: A total of 126 adult subjects were categorized into two groups (63 with a TMDs and 63 without a TMDs), based on detection of symptoms using the Temporomandibular Joint Disorder-Diagnostic Index (TMD-DI) questionnaire. Posteroanterior cephalograms of each subject were traced manually and 17 linear and angular measurements were analyzed. Craniofacial asymmetry was quantified by calculating the asymmetry index (AI) of bilateral parameters for both groups. Results: Intra- and intergroup comparisons were analyzed using independent t-test and Mann-Whitney U test, respectively, with a P<0.05 considered statistically significant. An AI for each linear and angular bilateral parameter was calculated; higher asymmetry was found in TMD-positive patients compared with TMD-negative patients. An intergroup comparison of AIs found highly significant differences for the parameters of antegonial notch to horizontal plane distance, jugular point to horizontal plane distance, antegonial notch to menton distance, antegonial notch to vertical plane distance, condylion to vertical plane distance, and angle formed by vertical plane, O point and antegonial notch. Significant deviation of the menton distance from the facial midline was also evident. Conclusion: Greater facial asymmetry was seen in the TMD-positive group compared with the TMD-negative group. The mandibular region was characterized by asymmetries of greater magnitude compared with the maxilla. Patients with facial asymmetry often require management of temporomandibular joint (TMJ) pathology to achieve a stable, functional, and esthetic result. Ignoring the TMJ during treatment or failing to provide proper management of the TMJ and performing only orthognathic surgery may result in worsening of TMJ-associated symptoms (jaw dysfunction and pain) and re-occurrence of asymmetry and malocclusion. Assessments of facial asymmetry should take into account TMJ disorders to improve diagnostic accuracy and treatment outcomes.

A comparison of the quadhelix and the nickel-titanium palatal expander in the treatment of narrow maxillary arches: A prospective clinical study.

OBJECTIVES: The study aimed to compare the effects of quadhelix and nickel-titanium (NiTi) expander appliances on lower facial height, to quantify, and evaluate dentoalveolar and orthopedic changes in transverse plane, respectively, to estimate the difference in changes between these two appliances. MATERIALS AND METHODS: Twenty patients, ten for the quadhelix and NiTi expander in the two-appliance group, respectively, participated in this study. A total of 8 readings, 1 for clinical facial height, 2 for model analysis, and 5 for posteroanterior cephalometric analysis were recorded. The statistical tests used were, Student's unpaired and paired t-tests. RESULTS: Both appliances individually, produced statistically highly significant (p < 0.01) expansion every month in both premolar and molar areas with more uniform expansion for quadhelix and less expansion in NiTi palatal expander in the premolar region initially. The skeletal to dental change ratio showed that there was more dental change than skeletal with no inter-appliance differences statistically while assessing the PA cephalometric readings. CONCLUSIONS: This study infers that both appliances are equally efficacious maxillary expanders, which are primarily dentoalveolar and not skeletal (p < 0.05).

Comparison of the asymmetry index determined on digital panoramic radiographic images and on posteroanterior cephalometric images: a retrospective cross-sectional study.

OBJECTIVE: The purpose of this study was to compare the asymmetry index determined on digital panoramic radiographic (PR) images and posteroanterior cephalometric (PACR) images. METHODS: This study included 100 patients whose PR and PACR images were registered in a database. Condylar height, ramus height, and condylar height plus ramus height measurements were measured bilaterally. Condylar asymmetry, ramus asymmetry, and total asymmetry were evaluated. RESULTS: There was a statistically significant difference between the right and left side for all measurements when evaluated on the PR and also on the PACR images (p < 0.01). When calculating the asymmetry index, the resulting condylar asymmetry and ramus asymmetry values did not show significant differences between PR and PACR images. On the other hand, only the presence of total asymmetry showed a statistically significant difference between techniques (p = 0.013). CONCLUSION: Asymmetry indices can be reliably obtained from both PR and PACR images.

Spontaneous rupture of chemotherapy catheter diagnosed using chest X-ray oblique projections: An interventional radiology approach.

Totally implanted central venous port systems are widely used to access central veins for patients needing long-term therapy. These devices have low rates of complications and are commonly used to administer medications like chemotherapeutic agents. Spontaneous rupture of a catheter segment is a rare mechanical complication, usually belatedly diagnosed and presenting with complications. We present a case of a spontaneously ruptured chemotherapy catheter diagnosed using a novel approach via oblique projections on chest X-rays and successfully removed using an endovascular approach.

A fluoroscopic view for midshaft clavicular fracture reduction and internal fixation: posteroanterior 25° skyline projection.

BACKGROUND: Open reduction and internal fixation have been frequently applied for displaced midshaft clavicular fracture. Plate and screw fixation of clavicular fractures could provide rigid fixation and rotational control. Proper implant positioning in surgical fixation is critical to prevent iatrogenic complications. Fluoroscopy plays an important role in the intraoperative evaluation of implants. This study aimed to introduce a new fluoroscopic projection to evaluate the positioning of plates and screws. METHODS: Adult patients with a diagnosis of acute displaced midshaft clavicular fracture were included in this study. The slope angle of the midshaft clavicle was measured on sagittal reconstructions of preoperative computed tomography (CT) scans. The incidence of screw revision based on intraoperative standard posteroanterior (PA) and PA 25° cephalic skyline projections was compared. The interobserver agreement for the two projections was calculated. RESULTS: Twenty-nine patients with midshaft clavicular fractures were enrolled from January 2020 to June 2021. The PA 25° skyline projection could clearly display the tangential line of the plate and inferior border of the clavicle. The slope angle on the superior surface of the midshaft clavicle was 26.0 ± 5.8° (range: 18.5-38.3°). The incidence of screw revision using the PA projection (72.4%) was significantly different from that using the PA 25° skyline projection (34.5%) (P < 0.05). The concordance of the screw revision rate based on the standard PA and PA 25° skyline projections was strong, with kappa coefficients of 0.680 (95% CI: 0.394-0.968) and 0.776 (95% CI: 0.537-0.998). CONCLUSION: The PA 25° skyline projection corresponds to the slope angle of the midshaft clavicle. It can provide more accurate information regarding the proper screw length and be applied as a routine method for intraoperative evaluation.

Computational modeling of posteroanterior lumbar traction by an automated massage bed: predicting intervertebral disc stresses and deformation.

Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.

Using of panoramic and posteroanterior cephalometric radiographs to identify the optimal nasal passage for nasotracheal intubation.

Background and Aim: Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration. Materials and Methods: The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. Results: There was no significant association between the OT and nasal endoscopy results (P = 0.075). A significant association was found between the ST and nasal endoscopy results (P = 0.000), and between the radiological assessments and the nasal endoscopy results (P = 0.000). Compatibility with nasal endoscopy was 54% when the occlusion and ST were evaluated together, 75% when the OT and radiological assessments were evaluated together, and 86% when the ST and radiological assessments were evaluated together. The highest level of compatibility was 92% when all the tests were evaluated together. Conclusion: The simple tests alone were found to be inadequate for the selection of the optimal nasal passage. Evaluation of PR and PACR, which are commonly used in maxillofacial surgeries, together with simple anesthesiological examination tests would increase nasotracheal intubation success and decrease complications.

Differences in dentoskeletal and soft tissue changes due to rapid maxillary expansion using a tooth-borne expander between adolescents and adults: A retrospective observational study.

Objective: The purpose of this study was to compare the differences in dentoskeletal and soft tissue changes following conventional tooth-borne rapid maxillary expansion (RME) between adolescents and adults. Methods: Dentoskeletal and soft tissue variables of 17 adolescents and 17 adults were analyzed on posteroanterior and lateral cephalograms and frontal photographs at pretreatment (T1) and after conventional RME using tooth-borne expanders (T2). Changes in variables within each group between T1 and T2 were analyzed using Wilcoxon signed-rank test. Mann-Whitney U test was used to determine the differences in the pretreatment age, expansion and post-expansion durations, and dentoskeletal and soft tissue changes after RME between the groups. Spearman's correlation between pretreatment age and transverse dentoskeletal changes in the adolescent group was calculated. Results: Despite similar amounts of expansion at the crown level in both groups, the adult group underwent less skeletal expansion with less intermolar root expansion after RME than the adolescent group. The skeletal vertical dimension increased significantly in both groups without significant intergroup difference. The anteroposterior position of the maxilla was maintained in both groups, while a greater backward displacement of the mandible was evident in the adult group than that in the adolescent group after RME. The soft tissue alar width increased in both groups without a significant intergroup difference. In the adolescent group, pretreatment age was not significantly correlated with transverse dentoskeletal changes. Conclusions: Conventional RME may induce similar soft tissue changes but different dentoskeletal changes between adolescents and adults.

Relationships of Reference Points, Planes and Skull Symmetry on Posterior-anterior Cephalograms in Healthy Young Adults.

BACKGROUND: Radiological cephalometry is an important diagnostic tool for analyzing the shape and proportions of the skull. Standardized teleradiography of the skull in posterior-anterior (PA) projection provides orientation data on the symmetry and vertical relations of the skull. The comparison of individual findings with normal values places high demands on the selection of a control group. The aim of this study was to characterize a group to be used as a standard for cephalometric comparisons. PATIENTS AND METHODS: PA teleradiographs of 23 healthy young adults were analyzed. Distances from reference measuring points to the median sagittal plane and the orbital horizontal plane were made. All individuals showed ideal occlusion. None of the participants had been subjected to orthodontic therapy or craniomaxillofacial surgery. RESULTS: The measurement results showed a high degree of lateral symmetry of the skeletal reference points and planes. Comparison of the vertical reference lines confirmed the symmetrical constitution of the facial skeleton. CONCLUSION: The study group is suitable for comparison with the cephalometric evaluations of other study groups.

Landmark annotation and mandibular lateral deviation analysis of posteroanterior cephalograms using a convolutional neural network.

BACKGROUND/PURPOSE: Facial asymmetry is relatively common in the general population. Here, we propose a fully automated annotation system that supports analysis of mandibular deviation and detection of facial asymmetry in posteroanterior (PA) cephalograms by means of a deep learning-based convolutional neural network (CNN) algorithm. MATERIALS AND METHODS: In this retrospective study, 400 PA cephalograms were collected from the medical records of patients aged 4 years 2 months-80 years 3 months (mean age, 17 years 10 months; 255 female patients and 145 male patients). A deep CNN with two optimizers and a random forest algorithm were trained using 320 PA cephalograms; in these images, four PA landmarks were independently identified and manually annotated by two orthodontists. RESULTS: The CNN algorithms had a high coefficient of determination (R 2 ), compared with the random forest algorithm (CNN-stochastic gradient descent, R 2  = 0.715; CNN-Adam, R 2  = 0.700; random forest, R 2  = 0.486). Analysis of the best and worst performances of the algorithms for each landmark demonstrated that the right latero-orbital landmark was most difficult to detect accurately by using the CNN. Based on the annotated landmarks, reference lines were defined using an algorithm coded in Python. The CNN and random forest algorithms exhibited similar accuracy for the distance between the menton and vertical reference line. CONCLUSION: Our findings imply that the proposed deep CNN algorithm for detection of facial asymmetry may enable prompt assessment and reduce the effort involved in orthodontic diagnosis.

Primary PCI for acute myocardial infarction in a patient with situs inversus totalis and dextrocardia.

Situs inversus totalis with dextrocardia is a rare congenital occurrence. Risk of coronary atherosclerosis and acute myocardial infarction in this subset is similar to that in the general population. Diagnosing myocardial injury in time, and executing primary percutaneous coronary intervention (PCI) successfully in these patients is challenging given that physicians are rarely attuned to recognizing the electrocardiographic changes of acute coronary syndromes in this anatomy and interventional cardiologists are not routinely accustomed to working with the angiographic projections in this unique subset. Here, we describe electrocardiogram identification and an approach to primary PCI in one such patient. We have also attempted to simplify and refine primary PCI in this subset by introducing postero-anterior projection single inversion technique for suitable lesions in suitable vessels in this unique subset. .

Chondrodysplasia, enchondromas and a chest deformity causing severe pulmonary morbidity in a boy with a PTHLH duplication: A case report.

Parathyroid hormone-like hormone (PTHLH) plays an important role in bone formation. Several skeletal dysplasias have been described that are associated with disruption of PTHLH functioning. Here we report on a new patient with a 898 Kb duplication on chromosome 12p11.22 including the PTHLH gene. The boy has multiple skeletal abnormalities including chondrodysplasia, lesions radiographically resembling enchondromas and posterior rib deformities leading to a severe chest deformity. Severe pulmonary symptoms were thought to be caused by limited mobility and secondary sputum evacuation problems due to the chest deformity. Imaging studies during follow-up revealed progression of the number of skeletal lesions over time. This case extends the phenotypic spectrum associated with copy number variation of PTHLH.

Evaluation of a multi-stage convolutional neural network-based fully automated landmark identification system using cone-beam computed tomographysynthesized posteroanterior cephalometric images.

OBJECTIVE: To evaluate the accuracy of a multi-stage convolutional neural network (CNN) model-based automated identification system for posteroanterior (PA) cephalometric landmarks. METHODS: The multi-stage CNN model was implemented with a personal computer. A total of 430 PA-cephalograms synthesized from cone-beam computed tomography scans (CBCT-PA) were selected as samples. Twenty-three landmarks used for Tweemac analysis were manually identified on all CBCT-PA images by a single examiner. Intra-examiner reproducibility was confirmed by repeating the identification on 85 randomly selected images, which were subsequently set as test data, with a two-week interval before training. For initial learning stage of the multi-stage CNN model, the data from 345 of 430 CBCT-PA images were used, after which the multi-stage CNN model was tested with previous 85 images. The first manual identification on these 85 images was set as a truth ground. The mean radial error (MRE) and successful detection rate (SDR) were calculated to evaluate the errors in manual identification and artificial intelligence (AI) prediction. RESULTS: The AI showed an average MRE of 2.23 ± 2.02 mm with an SDR of 60.88% for errors of 2 mm or lower. However, in a comparison of the repetitive task, the AI predicted landmarks at the same position, while the MRE for the repeated manual identification was 1.31 ± 0.94 mm. CONCLUSIONS: Automated identification for CBCT-synthesized PA cephalometric landmarks did not sufficiently achieve the clinically favorable error range of less than 2 mm. However, AI landmark identification on PA cephalograms showed better consistency than manual identification.

Clavicle Morphometry for Sexual Dimorphism and Bilateral Asymmetry: Radiographic Assessment.

BACKGROUND: The clavicle, modified long bone, presents morphological and bilateral variations. This may be due to genetic factors, hormones, or environmental and occupational influences. Anthropometric studies in clavicle of Nepalese population using radiograph has not been reported to best of our knowledge. This study, aimed to determine the sexual dimorphism and bilateral asymmetry of clavicle in Nepalese Population using Postero-Anterior Chest X Ray. METHODS: Chest x-rays with normal and clearly visible both clavicles of 1260 Nepalese adults (591 male, 669 female), aged above 20 years were utilized. Inbuilt software "Computed Radiography Fuji Computer System 7" was used for measurements (in centimeter) of sternal head length, acromial end length, mid shaft diameter and length of clavicle. Demarcating point and identification point were calculated. Patients having history of clavicles fractures in the past were excluded. RESULTS:   All the parameters in male is greater than female which is significant except Length/Mid Shaft Diameter. Similarly, all the parameters of right clavicle is significantly greater than left clavicle in both sexes except Sternal Head Length and Mid Shaft Diameter. Demarcating point calculated from length of the clavicle (right >16.17, left >16.10 for male and right <11.20, left <10.65 for female) and Mid Shaft Diameter (right >1.33, left >1.38 for male and right <0.66 and left <0.67 for female) are important parameters to determine sex.    Conclusions:The clavicle shows significant sexual dimorphism and bilateral asymmetry in Nepalese population. The result of this study is helpful to anthropologist and forensic medicine.

Spontaneous symptomatic lumbar intervertebral pseudoarthrosis associated with diffuse idiopathic skeletal hyperostosis treated with a combined posteroanterior fusion: a case report and review of literature.

Although diffuse idiopathic skeletal hyperostosis (DISH) is generally asymptomatic, in rare cases it involves multiple segments and can present with intervertebral pseudoarthrosis which requires treatment. We report a case of a 47-year-old female patient with intervertebral pseudoarthrosis and severe dynamic instability in the L4-5 intervertebral disc due to DISH and provide a brief review of literature. The patient developed severe lower back pain and intermittent claudication due to the instability in the only mobile part between multiple fused vertebrae from C7 to L4 and fusion segment from L5 to the ilium. We performed long-range posterior spinal and two-stage 360° fusion with L4-5 lateral interbody fusion. After the surgery the pain and intermittent claudication were improved and bony fusion was successful. Reports of intervertebral pseudoarthrosis in DISH with no history of trauma are extremely rare. We have only been able to find 5 cases. Compared to the previous reports, the present case describes a youngest patient, first case of female, and had the longest fusion due to DISH. Therefore, the patient required long-range fusion from T10 to the iliac bone in order to achieve adequate stabilization. Moreover, the present case is the first example of choosing a lateral interbody fusion, which provides even more robust consolidation.

Projected lung areas using dynamic X-ray (DXR).

BACKGROUND: Dynamic X-ray (DXR) provides images of multiple phases of breath with less radiation exposure than CT. The exact images at end-inspiratory or end-expiratory phases can be chosen accurately. PURPOSE: To investigate the correlation of the projected lung area (PLA) by dynamic chest X-ray with pulmonary functions. MATERIAL AND METHODS: One hundred sixty-two healthy volunteers who received medical check-ups for health screening were included in this study. All subjects underwent DXR in both posteroanterior (PA) and lateral views and pulmonary function tests on the same day. All the volunteers took several tidal breaths before one forced breath as instructed. The outlines of lungs were contoured manually on the workstation with reference to the motion of diaphragm and the graph of pixel values. The PLAs were calculated automatically, and correlations with pulmonary functions and demographic data were analyzed statistically. RESULTS: The PLAs have correlation with physical characteristics, including height, weight and BMI, and pulmonary functions such as vital capacity (VC) and forced expiratory volume in one second (FEV1). VC and FEV1 revealed moderate correlation with the PLAs of PA view in forced inspiratory phase (VC: right, r = 0.65; left, r = 0.69. FEV1: right, r = 0.54; left, r = 0.59). Multivariate analysis showed that body mass index (BMI), sex and VC were considered independent correlation factors, respectively. CONCLUSION: PLA showed statistically significant correlation with pulmonary functions. Our results indicate DXR has a possibility to serve as an alternate method for pulmonary function tests in subjects requiring contact inhibition including patients with suspected or confirmed covid-19.

Effect of Botulinum Toxin Injection on Asymmetric Lower Face with Chin Deviation.

The purpose of this study was to compare the efficacy of botulinum toxin (BoNT) in masseter muscle reduction depending on the amount of chin deviation. Exploring distinctive effects of BoNT relative to the characteristics of facial asymmetry will aid in planning and predicting treatment outcomes. Sixteen adult volunteers were classified into two groups according to the degree of menton deviation observed in posteroanterior cephalograms. Eight had a menton deviation of 3 mm or more and the other eight had less than 3 mm. A total of 25 Units of BoNT was injected into the unilateral masseter muscle of the prominent side for each participant. Changes in the volume and bulkiest height of the lower face on each side were measured with a 3D laser scan at four time points: before and 4, 8, and 12 weeks after the injection. Two-way mixed ANOVA was employed for analyses. The volume and bulkiest height of the injected side decreased over time in both types of asymmetry, with significant differences at each time point. The reductions in the volume and bulkiest height were significantly greater in subjects without chin deviation. The reductions in the volume and bulkiest height of the lower face using BoNT are more effective for subjects without chin deviation.