Shape Prediction of Nasal Bones by Digital 2D-Photogrammetry of the Nose Based on Convolution and Back-Propagation Neural Network

In rhinoplasty, it is necessary to consider the correlation between the anthropometric indicators of the nasal bone, so that it prevents surgical complications and enhances the patient’s satisfaction. The penetrating form of high-energy electromagnetic radiation is highly impacted on human health, which has often raised concerns of alternative method for facial analysis. The critical stage to assess nasal morphology is the nasal analysis on its anthropology that is highly reliant on the understanding of the structural features of the nasal radix. For example, the shape and size of nasal bone features, skin thickness, and also body factors aggregated from different facial anthropology values. In medical diagnosis, however, the morphology of the nasal bone is determined manually and significantly relies on the clinician’s expertise. Furthermore, the evaluation anthropological keypoint of the nasal bone is nonrepeatable and laborious, also finding widely differ and intralaboratory variability in the results because of facial soft tissue and equipment defects. In order to overcome these problems, we propose specialized convolutional neural network (CNN) architecture to accurately predict nasal measurement based on digital 2D photogrammetry. To boost performance and efficacy, it is deliberately constructed with many layers and different filter sizes, with less filters and optimizing parameters. Through its result, the back-propagation neural network (BPNN) indicated the correlation between differences in human body factors mentioned are height, weight known as body mass index (BMI), age, gender, and the nasal bone dimension of the participant. With full of parameters could the nasal morphology be diagnostic continuously. The model’s performance is evaluated on various newest architecture models such as DenseNet, ConvNet, Inception, VGG, and MobileNet. Experiments were directly conducted on different facials. The results show the proposed architecture worked well in terms of nasal properties achieved which utilize four statistical criteria named mean average precision (mAP), mean absolute error (MAE), R -square ( R 2 ), and T -test analyzed. Data has also shown that the nasal shape of Southeast Asians, especially Vietnamese, could be divided into different types in two perspective views. From cadavers for bony datasets, nasal bones can be classified into 2 morphological types in the lateral view which “V” shape was presented by 78.8% and the remains were “S” shape evaluated based on Lazovic (2015). With 2 angular dimension averages are 136.41 ± 7.99 and 104.25 ± 5.95 represented by the nasofrontal angle (g-n-prn) and the nasomental angle (n-prn-sn), respectively. For frontal view, classified by Hwang, Tae-Sun, et al. (2005), nasal morphology of Vietnamese participants could be divided into three types: type A was present in 57.6% and type B was present in 30.3% of the noses. In particular, types C, D, and E were not a common form of Vietnamese which includes the remaining number of participants. In conclusion, the proposed model performed the potential hybrid of CNN and BPNN with its application to give expected accuracy in terms of keypoint localization and nasal morphology regression. Nasal analysis can replace MRI imaging diagnostics that are reflected by the risk to human body.

Are we mindful of nasal dorsal integrity during septal surgery? An imaging study of nasal keystone area

Objectives: Review of radiological images of the keystone area to assess risk of disruption to the nasal dorsum when separating the osseo-cartilaginous junction in septoplasty. Methods: A Cross sectional radiological study of adults who underwent CT scan of paranasal sinuses. Outcome measures included were: The Length of the keystone area (shorter length implies a higher risk of disruption) and a high-risk shape (high risk shape implies shorter keystone area) that can predispose to disruption of nasal dorsal integrity during septoplasty surgery. Certain nasal dimensions were evaluated to determine if they add risk to the dorsum. Results: CT scans of 343 patients were reviewed. The mean keystone area length was initially 10.42 mm that came down to 7.43 mm after adjustment in patients with high-risk shape. 31.5% of subjects were at risk of disruption to the dorsum due to short keystone area length <5 mm. Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.49%) were associated with a shorter keystone area length (P = 0.004). Age, gender, septal deviation are not risk factors as they did not significantly influence keystone area length. Conclusions: One third of our patients (31.5%) had short KSA length < 5mm which carries higher risk of disruption to the dorsum integrity upon complete detachment of osseo-cartilaginous junction. We recommend preoperative CT imaging for thorough evaluation and precise measurement of KSA. Patients with relatively shorter nasal bones detected on examination (and confirmed radiologically), need to be recognized as they are more likely to have shorter KSA

Lamb head as a training model for septoplasty and rhinoplasty

Background: Septoplasty and rhinoplasty are difficult operations to learn and teach. Many modalities have been proposed to make the teaching process of these operations easier. In this study, it was investigated if lamb heads were good training models to teach septoplasty and rhinoplasty to trainees or experienced surgeons. Methods: In the first part of the study, 21 lamb heads were dissected according to a dissection protocol and several anatomical distances were measured in order to compare them with human cadavers. In the second project 8 lamb heads were dissected and different preservation rhinoplasty techniques were practiced. Results: The study on 21 lamb heads used showed that the lateral crura were 17.8 x 11.6, average interdomal distance was 8.1 mm, average domal width was 3.7 mm. The average length of the upper lateral cartilages was 31.1 mm laterally and 21.2 medially. The average length of the nasal bones was 63.9 mm and the width was 16 mm. In the second part of the study 8 lamb heads were used to experience where high strip techniques were used in 5 and Cottle technique in 3. Conclusion: This study revealed that lamb head should be considered as an excellent training model for septoplasty and rhinoplasty. Its very low cost, ease of availability, and close similarity to the human cadavers can be counted as the main advantages. This study also proved that it was not only a tool for beginners, but also a very helpful tool for experienced surgeons to try new methods.

Morphometric study of nasal bones and piriform apertures in human skulls

The piriform aperture (PA) is the skeletal aperture located in the middle part of the face. There are many variations in morphometric measurements of nasal bones, piriform apertures and their shapes in different population. Objective of present study was to study morphological and morphometric features of nasal bone and piriform aperture. Adult human skulls available from collection of dried skulls were used for study purpose. Skull bones of unknown age and sex were obtained. Height, width of nasal bone, height, upper and lower width of piriform aperture, shapes of nasal bone and piriform aperture were observed. Height, upper width and lower width of piriform aperture were greater in male as compared to female. This difference was not statistically significant for upper width of piriform aperture (p=0.49) and for lower width of piriform aperture (p= 0.65) while the difference in height of piriform aperture was statistically significant. (p &#60;0.0001).Differences in Height and width of nasal bone were not statistically significant among male and female nasal bones. Most common shape of nasal bone observed was Type A followed by Type B and C. Most common shape of piriform aperture was triangular to oval (50.00) in both the gender. Majority finding of the present study are in concordance with Indian population studies while significant differences have been noted in comparison to the morphometric measurements of Turkish, Korean, Brazilian and Anatolian population. These variations might be because of differences in ethnicity.

Arhinia and Bilateral Anophthalmia: Report of a Rare Case and Review of Literature

Arhinia is an extremely rare condition reported in less than 100 cases so far. We report a case of arhinia with bilateral anophthalmia. In physical examination, only alar portions of the nose were partially formed. No septal, lower, upper lateral cartilages or nasal bones were detectable. Both nostrils were atretic. The orbital area was covered with skin, and eyebrows were partially formed. Bilateral complete cleft lip and palate were evident. Surgical interventions should be considered not only for reconstruction of the external nose but for timely creation of a lacrimal passage and repair of the accompanying cleft lip and palate.

THE POPULATION OF CHERNYAKHIV CULTURE, WHICH IS BURIED IN THE CEMETERY NEAR THE VILLAGE OF VELYKA BUGAIVKA, ACCORDING TO CRANIOLOGY

Cemetery of Chernyakhiv culture near the Velyka Buhaivka village was excavated in 1995—2005 by an expedition of O. V. Petrauskas and R. G. Shishkin. During the excavations the anthropological material was obtained. The male series is characterized by a medium-long, narrow, medium-high, dolichocranial cranium. The face is short, narrow, mesognathic. Horizontal face profiling is sharp. Orbits are medium high, the nose is medium wide. The angle of the nasal bones is on the border of medium and large values. The nose is of medium height. According to the results of statistical analysis, the group from Velyka Buhaivka is close to the series from the cemeteries of Romashki, Kurnyky, Ranzheve. The group is closer to the series of Welbark culture Maslomench, Grudek, a bit closer to the Welbark mixed series of the Lower Vistula, than to individual series of Chernyakhiv culture from the territory of Ukraine. The female group is characterized by a long, medium-wide on the border with a wide, medium-high, dolichokranny cranium. The face is medium-wide and medium-high, orthognathic. The orbits were medium high, the nose was medium wide. Horizontal profiling of the face at the upper level is on the border of sharp and moderate, its profiling at the zygomaxillary level is sharp. The angle of the nasal bones is medium, the epiglottis is medium high. According to the results of the analysis, the women’s series from Velyka Buhaivka is closest to the women from Chernyakhiv, Zhuravka, Popivka. From the groups of Polish Welbark culture the mixed group of Slovinsko-Drawska is close to the women from Velyka Buhaivka. The dolichocranium narrow-faced type was dominant in people buried by inhumation. It is recorded in the people buried in the graves accompanied by the grave goods of the phase C2, C2—C3, D1. This type is present both in burials directed with the head to the North, and to the West.

The nose and paranasal sinuses

The external nose is pyramidal and consists of a bony cartilaginous framework. The root/radix is continuous with the forehead an inferiorly terminates at the nasal tip. The dorsum of the nose is formed by two lateral surfaces that converge in the midline. The cartilaginous structure of the nose is formed by paired upper (lateral) cartilages that contribute to the internal nasal valve with the nasal bones, and lower lateral cartilages, combined with additional minor nasal cartilages that surround the ala. The nasal septum relies upon anastomoses from five vessels: two from the ophthalmic, two from the maxillary and one from the facial. Collectively, they form Kieselbach’s plexus. The paranasal sinuses are the frontal, sphenoidal, ethmoidal and maxillary – located within the bones of the same name. They are paired structures lined with mucosa that is continuous with the lateral nasal side wall into which they drain, facilitating clearance of mucus by way of the mucociliary escalator.

STUDY OF INCIDENCE OF THE CORONAL APPROACH IN CRANIOFACIAL TRAUMA AND ADVANTAGEOUS OF TITANIUM MESH IN RECONSTRUCTION OF CRANIOFACIAL DEFECTS.

INTRODUCTION: The coronal approach gives a broad exposure to the frontal bone, the calvaria, the nasal bones, the orbits, the subcondylar region, the zygoma and the zygomatic arch and gives ideal aesthetic results with less complication. The common craniofacial fractures are Nasal bones (45%), cranial bones (24%), Mandible (13%), Zygoma (13%), Orbital blowout (3%), Maxilla (2%). Common causes of fractures are Road trafc accident, Assault, Industrial accidents, Recreational accidents, Frontal bone fracture. METHOD: The study was carried out for a period of one year from March 2020 to March 2021. The study conducted in St Joseph dental college ELURU in the department of Oral and Maxillofacial Surgery. The age limit for this study was below 30 years. The number of subjects involved in this study was 5. Number of females was 3 and males were 2 in this study. RESULT: Number of female participants in this study was 3 and number of male participants was 2.Number of male participants with coronal incision were 1 and number of participants with pretrichial incision were 2.Out of 2 one for male participant and one for female participant. CONCLUSION: The coronal ap has recently become a preferred approach for access to the craniofacial skeleton and orbit. This method of exposure has become particularly useful with increased indications for rigid internal xation and primary bone grafting in the management of complex facial fractures.

Impact of video clinics in the management of fracture nasal bones in COVID times

Background: The COVID -19 pandemic created a panic situation where patient interaction with the other patients and health care staff had to be restricted to avoid spreading the disease. We planned an innovative strategy to restrict the inflow of patients to those who may need nasal bone manipulation by using Video Clinics (VC). Methods: All consecutive patients presenting to three units of Accident & Emergency (A & E) NHS sites of our trust with suspicion of fractured nasal bones were included in the study group for a period of three months. The impact of VC was studied by calculating the percentage of patients who could be discharged without a recall to the hospital from those attending it, the percentage who finally needed a fracture reduction, and the satisfaction scores of patients with VC. Results: Forty-two patients were offered appointments in VC. Thirty-one could attend VC, out of which thirteen (41.9%) were discharged without a recall. Twenty-three patients were recalled for F2F (Face2Face) clinic, out of which twelve (28.5% of 42) required fracture reduction, and 11 were discharged to home. Ten patients underwent fracture reduction under local anaesthesia, and two were booked for Septorhinoplasty later. Twenty-seven (87.1 %) patients expressed satisfaction with VC, two (6.4%) were lost to follow-up, and the remaining two (6.4%) were not satisfied. Conclusion: VC could effectively filter 41.9% of patients who did not need surgical intervention from the comfort of their homes or workplace by using the available multimedia facility without compromising outcomes and satisfaction scores. The satisfaction score was 87.1% with VC. The clinics helped prevent potential coronavirus exposure by staying safe, and they are recommended in emergencies like COVID -19.

Fractured nasal bones

Nasal fractures are a common sequelae of facial trauma. The anatomy of the nose is important to appreciate in allowing accurate assessment and appropriate treatment. The classification and management of nasal fractures are described in this chapter.