Search Results (308)

Cleft lip with or without cleft palate (CL/P) is one of the most common congenital craniofacial anomalies worldwide and presents significant functional, esthetic, and psychosocial challenges. Despite advances in multidisciplinary care and surgical reconstruction, complications such as impaired wound healing, scar formation, and growth disturbances warrant the development of novel regenerative and surgical strategies, which heavily rely on animal models at the pre-clinical stage. For the current narrative review, the literature search was performed by combining cleft phenotype terms with modeling-approach terms in six databases and was supplemented by manual review of reference lists from full-text articles. The included articles were summarized based on cleft type and the methods for cleft induction (chemically induced, genetically engineered, and surgically created). Particularly, chemical teratogens such as retinoic acid, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), corticosteroids, and 6-aminonicotinamide have been widely used to induce cleft phenotypes and elucidate environmental influences on palatogenesis, whereas genetic models have clarified the roles of key molecules and signaling pathways, including Sonic hedgehog (SHH), bone morphogenetic protein (BMP), and transforming growth factor-β (TGF-β), in the development of lip and palate. Meanwhile, the surgical models have focused on the alveolar cleft in skeletally mature animals for evaluating novel grafting materials. By comparing the strengths and limitations of existing models, this review highlights opportunities for improving experimental design and translational relevance in future cleft research. Overall, despite a wide range of CL/P animal models available, few replicate clinically relevant defect anatomy and the postnatal craniofacial deformation observed in CL/P patients, underscoring the need for the development of new models. Full article

Background/Objectives: Peri-implant diseases, encompassing peri-implant mucositis and peri-implantitis, affect 43% and 18.8–23% of implant-bearing patients, respectively, representing significant clinical challenges in implant dentistry. While mechanical debridement remains foundational, biologically active materials offer promising adjunctive regenerative strategies. This narrative review synthesises current evidence regarding five biologically active materials: enamel matrix derivative (EMD), platelet-rich fibrin (PRF), fibroblast growth factor-2 (FGF-2), recombinant human platelet-derived growth factor-BB (rhPDGF-BB/GEM 21S^®), and polynucleotide–hyaluronic acid combinations (Regenfast^®). Methods: The relevant literature was identified using electronic databases, including MEDLINE, PubMed, Scopus, and Google Scholar. This review focused on clinical studies and randomised controlled trials with a minimum follow-up of six months investigating biologically active materials in peri-implant disease management. Material mechanisms, clinical efficacy, therapeutic limitations, and evidence quality were systematically evaluated. Attention was directed toward identifying genuine biological distinctions between peri-implant and periodontal disease contexts. Results: EMD demonstrates efficacy exclusively within multimodal surgical protocols, with isolated application yielding limited benefits. rhPDGF-BB shows superior periodontal regenerative capacity; however, dedicated peri-implantitis trials remain absent. FGF-2 exhibits paradoxical osteogenic suppression despite bone fill achievement, limiting peri-implant applicability. PRF and Regenfast^® demonstrate a mechanistically sound rationale yet lack substantive peri-implant disease validation. The critical findings revealed that peri-implant regeneration fundamentally differs from periodontal regeneration: implants lack periodontal ligament anatomy, rendering ligamentogenic differentiation-promoting agents biologically inappropriate. Conclusions: Contemporary biologically active materials demonstrate compelling periodontal efficacy yet remain inadequately validated for peri-implantitis management. This disparity reflects authentic biological distinctions rather than insufficient investigation. Until multicentre randomised controlled trials stratify efficacy across distinct peri-implant disease presentations, practitioners must prioritise evidence-based surgical fundamentals—meticulous decontamination, strategic grafting, and optimised wound healing—integrating biologically active materials judiciously within comprehensive, anatomy-respecting treatment protocols. Full article

Background and Clinical Significance: Carcinoid heart disease (CHD) is an uncommon valvular manifestation of neuroendocrine tumours, usually affecting right-sided cardiac valves. Left-sided involvement is rare and is generally associated with bronchopulmonary carcinoid, right-to-left shunting, or markedly elevated circulating vasoactive substances. Therapeutic decision-making is particularly challenging in advanced disease when severe tricuspid regurgitation occurs in patients at prohibitive surgical risk. Case Presentation: We report the case of a 61-year-old male patient with progressive dyspnoea, abdominal distension, lower-limb oedema, facial flushing, and 15 kg of unintentional weight loss. Transthoracic and transoesophageal echocardiography demonstrated torrential tricuspid regurgitation caused by thickened, retracted, and immobile leaflets, with additional mitral and aortic valve involvement, raising strong suspicion of CHD. An agitated-saline contrast study demonstrated delayed right-to-left shunting without patent foramen ovale, suggesting an extracardiac, likely intrapulmonary, shunt. Somatostatin receptor PET/CT identified a pancreatic lesion with metastatic disease, and bone marrow biopsy confirmed neuroendocrine tumour infiltration. Owing to prohibitive surgical risk, as reflected by a Tricuspid Regurgitation Impact Score (TRI-SCORE) with an estimated in-hospital mortality of 65%, unfavourable tricuspid anatomy for repair, and refractory venous congestion, heterotopic bicaval valve implantation was performed (TricValve system -P&F). Discussion: This case highlights the role of echocardiography in recognising the characteristic phenotype of CHD, detecting occult right-to-left shunting, and supporting selection of a palliative transcatheter intervention. It also illustrates the value of a multimodality diagnostic strategy integrating echocardiography, functional oncological imaging, and histopathology in tumour-related cardiac disease. Conclusions: In selected inoperable patients with advanced carcinoid-related tricuspid regurgitation, heterotopic bicaval valve implantation may represent a feasible strategy for reducing venous congestion and improving functional status. Full article

Background: Correct performance of rhinoseptoplasty often requires osteotomy, the effectiveness and safety of which depend on precise knowledge of nasal anatomy, particularly the shape, length, and thickness of the nasal bones. Aim: The aim of this study was to assess the morphometry of the nasal bone and nasal pyramid in adult patients based on three-dimensional computed tomography (CT) using Slicer 3D software. Materials and Methods: A retrospective analysis was performed on data from 87 patients (44 women and 43 men; mean age 50.64 SD ±16.7 years) who underwent head CT between 1 January 2024 and 31 December 2025 because of trauma (to exclude intracranial hemorrhage) or dizziness (to diagnose central causes). Results: The comparative analysis demonstrated statistically significant differences in the dimensions of the nasal bony structures between women and men, with women showing lower values for all assessed parameters. For point 1L, the mean value was 6.29 in women compared with 8.07 in men (p = 0.0056). For point 4L, the values were 2.07 vs. 2.55, respectively (p = 0.009), whereas for point 5L they were 1.52 vs. 1.66 (p = 0.01). A similar relationship was also noted on the right side: for point 1R, the values were 5.95 vs. 8.02 (p = 0.03), and for point 5R they were 1.54 vs. 1.89 (p = 0.03), confirming consistently smaller dimensions of the bony structures in women in the analyzed study group. Conclusions: The obtained results may have important practical significance in planning osteotomy during rhinoseptoplasty procedures, enabling a more precise and safer surgical procedure. Full article

Background/Objectives: Implant placement in transnasal and paranasal regions of the severely atrophic maxilla is challenged by complex anatomy and proximity to critical structures, particularly the nasolacrimal duct (NLD). While cortical anchorage is considered important for implant stability, structured methods for evaluating anatomical eligibility and anatomical risk during planning remain limited. This proof-of-concept study aimed to describe a segmentation-assisted workflow for anatomical assessment of potential paranasal implant trajectories. Methods: A single-case proof-of-concept workflow was developed using CBCT imaging and multi-component anatomical bone segmentation (MCABS). Segmented anatomical structures were used to selectively visualize cortical pathways within the anterior maxilla. Implant planning was performed using axial, non-tilted trajectories. Particular attention was directed toward visualization of the spatial relationship between the planned implant pathway and the nasolacrimal duct. Workflow feasibility was further explored through study-model fabrication, guided implant insertion, and axis-based verification. Results: The proposed workflow enabled selective visualization of cortical structures and facilitated identification of anatomically favorable implant trajectories within the paranasal region. The relationship between the planned implant pathway and the nasolacrimal duct could be directly assessed using the segmented anatomical model. Guided insertion in the study model demonstrated concordance between planned and executed implant axes, supporting the technical feasibility of the workflow. Conclusions: Within the limitations of a single-case proof-of-concept study, the proposed segmentation-assisted workflow may contribute to preoperative anatomical assessment of potential paranasal implant trajectories and their relationship to adjacent anatomical structures. The workflow should be regarded as a methodological demonstration rather than a validated clinical protocol. Further anatomical, reproducibility, biomechanical, and clinical studies are required before broader clinical adoption can be considered. Full article

Background: Radiology underpins diagnosis and treatment across pediatrics, yet most artificial intelligence (AI) tools are developed for adults and validated on adult datasets only. Of more than 200 AI systems cleared by the United States (U.S.) Food and Drug Administration (FDA), only about 3% include pediatric validation. Because children differ from adults in anatomy, physiology, pathology, epidemiology, and imaging protocols, adult-trained models often perform sub-optimally in pediatric settings. Methods: A narrative review of peer-reviewed literature from 2000 to 2025 was conducted using PubMed, MEDLINE, Google Scholar, and Scopus. Studies involving AI applications in pediatric X-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), echocardiography, and point-of-care ultrasound with quantitative performance metrics were included. Findings were synthesized by imaging modality, clinical task, and differences between high-income countries (HICs) and low- and middle-income countries (LMICs). Results: AI demonstrated strong performance across multiple pediatric imaging tasks. In X-ray interpretation, AI detected fractures with area under the curve (AUC) values up to 0.96 (sensitivity, 90.8%; specificity, 88.7%). Pneumonia classification achieved 76.5% accuracy, and foreign body aspiration detection showed 95.3% specificity in HICs. In ultrasound, AI improved junior sonographers’ detection of intussusception (AUC 0.857 to 0.966) and reduced scan time by more than 50%. AI-assisted bone age estimation achieved a mean error of 0.39 years. In echocardiography, AI-derived ejection fraction showed excellent agreement with experts’ interclass correlation coefficient (ICC 0.983), and AI support improved atrioventricular septal defect detection (84.4% to 86.5%). In MRI, the use of AI enhanced lesion detection and supported quantitative analysis. Deep-learning models trained on routine T1- and T2-weighted sequences predicted liver stiffness across multi-site datasets, while advanced neuroimaging pipelines improved the identification of subtle epileptogenic lesions that are often missed on conventional pediatric MRI. However, adult-trained models showed limited generalizability to children. Still, excluding children under the age of two years improved the reading accuracy of pediatric chest X-rays (CXRs) by adult-trained models from 88% to 97%. AI faces challenges beyond the development of age-specific models. Substantial heterogeneity, limited pediatric-specific datasets, and unresolved medicolegal responsibility further restrict adoption worldwide. Challenges are amplified in LMICs, where unstable electricity, limited radiology resources, weak digital infrastructure, and scarce pediatric providers limit implementation. Additionally, many large language models underperform and lack inclusive algorithms suitable for pediatric radiology in many LMICs. Conclusions: AI can enhance diagnostic accuracy, efficiency, and access to pediatric imaging, particularly in resource-limited settings, through task-shifting and decision support. However, it cannot replace pediatric radiologists as of today. Safe adoption requires pediatric-specific model development, standardized validation metrics, diverse datasets that include LMIC populations, stronger digital infrastructure, robust radiologist training in AI capabilities, and the establishment of clear guidelines and medicolegal policies. Full article

Background and Objectives: Percutaneous iliosacral screw fixation is a standard treatment for posterior pelvic ring instability and sacral insufficiency fractures. However, conventional transsacral S1 screw fixation is associated with notable complication rates, most commonly implant loosening; dysmorphic sacral anatomy increases the risk of iatrogenic L5 or S1 nerve root injury. This study presents a modified S1 trajectory to engage the high-density bone of the anterior and cranial S1 vertebral body (promontory) by transferring preoperative 3D planning to intraoperative 2D fluoroscopy. Materials and Methods: This retrospective study analyzed implant placements for posterior pelvic ring instability, including high-velocity trauma and fragility fractures of the pelvis (FFPs). Preoperative computed tomography (CT) multiplanar reconstruction defined a modified corridor from a posterior-caudal iliac entry point directed cranially and ventrally into the S1 promontory. The 3D trajectory was transferred intraoperatively using standard 2D fluoroscopy (lateral, anteroposterior, inlet, and outlet views) with the patient prone. In cases of reduced bone quality or intended sacroiliac fusion, 3D-printed titanium implants (triangular or cylindrical threaded, 10.0–13.5 mm outer diameter) were selected over 7.5 mm cannulated screws. Results: Overall, 137 implants were placed in 71 patients: 13 cannulated screws in high-velocity pelvic ring trauma, 72 triangular titanium sacroiliac fusion implants (iFuse Implant System^®, SI-Bone), and 52 threaded titanium fusion implants (iFuse TORQ^®, SI-Bone) in patients with FFP. The modified trajectory consistently engaged the anterior and cranial S1 vertebral body. Postoperative 3D CT confirmed accurate placement of all implants. No iatrogenic nerve injuries or revisions for implant malposition occurred. Mean follow-up was 12 ± 9 months. Conclusions: Preoperative 3D CT planning combined with standard 2D fluoroscopy guided a modified S1 trajectory toward the cranial S1 vertebral body. Accurate and safe implant placement was achieved in the prone position without navigation systems, providing a practical alternative when standard transverse trajectories are limited by narrow bony corridors or sacral or pelvic dysmorphy. Full article

Background: Primary malignant bone tumors of the pelvis account for 10–15% of all primary bone sarcomas, most commonly chondrosarcoma, osteosarcoma, and Ewing’s sarcoma. Although advances have shifted treatment toward internal hemipelvectomy, pelvic resections remain challenging due to the complex anatomy. The need for pelvic reconstruction is controversial, balancing potential stability against higher complication rates. This review evaluates the role of pelvic ring reconstruction, focusing on techniques, outcomes, and complications. Methods: A systematic literature review was performed in June 2025 using PubMed, MEDLINE and Cochrane Library as the primary databases, with the following search string: (hemipelvectomy) AND (orthopedic), acknowledging that this search strategy may be limited in scope. Studies published within the last five years were considered. After performing a full-text assessment of 80 studies, 14 studies were included in this review. Data regarding patients, methods, and outcomes were extracted and summarized. Results: Among the 14 included studies, seven investigated patient-specific three-dimensional (3D) printed pelvic reconstructions, four reported biological reconstruction techniques, two studies focused on non-reconstructive management and one study evaluated alternative stabilization using segmental spinal instrumentation. 3D printed and other reconstructive techniques were associated with improvements in the Musculoskeletal Tumor Society score, reduced pain, and demonstrated osseointegration with few mechanical failures. Although individual case series demonstrated good ambulation and stable fixation, complication rates, particularly wound and infection-related events, remained frequent. Type III reconstructions and personalized implants showed the highest functional gains but occasionally revealed asymptomatic fretting wear. In contrast, the only Level I evidence indicated significantly higher complication and infection rates in reconstructed patients and better functional outcomes in those managed without reconstruction when spinopelvic stability was preserved. Non-reconstructive strategies, including spinal instrumentation, supported early ambulation with low mechanical failure, while pediatric patients treated without reconstruction experienced a high complication rate but acceptable long-term oncologic outcomes. Conclusions: Current evidence suggests that routine pelvic ring reconstruction after internal hemipelvectomy may not be justified based on the currently available evidence. Patient-specific 3D-printed implants appear to provide consistent improvements in function, pain reduction, and mechanical stability, but are associated with a relevant risk of wound-related and infectious complications. In patients with preserved spinopelvic stability, non-reconstructive strategies may achieve comparable functional outcomes with lower morbidity. Therefore, pelvic reconstruction should be performed selectively, and further prospective multicenter studies are needed to better define appropriate patient selection and optimize reconstructive strategies. Full article

When pregnant patients undergo diagnostic and therapeutic radiological procedures, the unborn child is exposed to an increased risk due to the use of ionizing radiation; therefore, the fetal dose must be estimated and optimized. Tools and methods routinely used for fetal dose estimation lack better personalization of patients. To address this, we developed a software tool for creating phantoms at different pregnancy stages and with varying patient anatomies to further personalize fetal dose estimation using measurements and Monte Carlo simulations. The tool is developed and incorporated into 3DSlicer version 5.6.2 as a plugin. Phantoms are created based on a real patient phantom, Tena, and physiological data for use in radiological protection. Phantoms are developed with only soft, lung, and bone tissue substitutes, represented for the mother and unborn child. This enables the construction of segmented voxel models as well as mesh models (with the ability to export geometries to DICOM format) of the anatomical structures of pregnant women. Additionally, it allows real patient image registration to enable better personalization of the phantom. The tool can help decrease uncertainty in fetal dose estimation, as well as simplify and accelerate the process of fetal dose estimation. It is released publicly to enable further research. Full article

In impedance imaging, the incompatibility and nonlinearity of the inverse problem lead to problems such as blurred boundaries and severe artifacts in the reconstructed images, making it difficult to meet the requirements for precise identification of multi-layer tissue structures in the legs. To this end, this paper proposes a post-processing algorithm for leg EIT that integrates the boundary attention mechanism, with a Wasserstein generative adversarial network as the training framework, cyclic residual U-Net as the generator, and the boundary attention module embedded in the RecurrentBlock. This leads to adaptive enhancement of the ability to extract organizational boundary features through a three-path fusion of spatial attention, channel attention, and learnable Laplacian edge enhancement. A leg anatomy prior constraint loss function was designed, integrating six constraints—pixel loss, edge loss, hierarchical tissue constraint, total variation regularization, structural similarity loss, and histogram matching—to guide the reconstruction results to conform to the multi-layered tissue structure features of the leg. A simulation dataset of leg sections containing multiple tissues such as skin, fat, muscle, bone, blood vessels, and nerves was constructed, and the pre-reconstructed images were obtained using the hybrid total variation regularization algorithm as the network input. The simulation results show that, under noise-free and different signal-to-noise ratio conditions, the proposed BAM-R2UNet algorithm achieves the best performance in RMSE, SSIM and PSNR metrics compared with HTV, DnCNN and standard U-Net algorithms, can remove artifacts, accurately restore the boundary and conductivity distribution of leg tissues, and has stronger anti-noise robustness. Full article

Background: Total knee arthroplasty (TKA) is a common procedure aimed at alleviating knee pain and restoring function in patients with degenerative joint diseases. Traditional implants are typically designed to restore mechanical knee alignment, but personalized implants have shown promise in improving clinical outcomes. The Origin^® individualized TKA system provides a tailored approach to knee reconstruction by utilizing preoperative 3D planning to create individualized implants and cutting guides based on each patient’s unique anatomy. Surgical Technique: The Origin^® system employs a preoperative computed tomography (CT) scan and Knee-Plan^® software to design individualized implants that optimize alignment and joint anatomy. The surgical technique involves the use of patient-specific cutting guides for precise bone resections and the insertion of either cruciate-retaining (CR) or posterior-stabilized (PS) implants, depending on individual patient needs. This process aims to replicate the pre-arthritic alignment and kinematics of the pre-arthritic knee. Postoperative Protocol: The postoperative protocol allows for immediate weight-bearing, and patients are guided through a structured rehabilitation program to ensure optimal recovery. Full range-of-motion exercises begin early to promote knee mobility and strength. Discussion: The individualized TKA system offers several advantages, including precise restoration of pre-arthritic anatomy, reduced bone resection, and improved implant fit. These benefits are particularly valuable in patients with unique anatomical challenges, such as deformities or previous surgeries. Despite the potential advantages, challenges remain, including the costs and time associated with individualized manufacturing, as well as increased radiation exposure from the required CT scans. Conclusions: The Origin^® individualized TKA system represents a significant advancement in knee arthroplasty by providing a tailored approach to patient care. Future studies are needed to further evaluate the long-term outcomes and cost-effectiveness of this personalized system compared to conventional TKA approaches. Full article

Background: The development of robust artificial intelligence (AI) models for diagnosing Temporomandibular Disorders (TMDs) is severely constrained by data scarcity and patient privacy regulations. Cone-beam computed tomography (CBCT), the gold standard for assessing osseous changes in the temporomandibular joint (TMJ), inherently contains sensitive biometric facial features, making de-identification difficult without losing critical anatomical information. This study aims to develop and evaluate TMJCTGenerator, a specialized latent diffusion model (LDM) framework designed to synthesize high-fidelity, diverse, and anonymous TMJ CBCT images. We hypothesize that this LDM approach can achieve superior anatomical fidelity and diversity compared to traditional generative adversarial network (GAN)- and variational autoencoder (VAE)-based methods, specifically in capturing fine osseous details within sagittal and coronal views of the mandibular condyle. Methods: A training dataset comprising 348 anonymized CBCT volumes was obtained in this retrospective comparative study to extract high-resolution sagittal and coronal regions of interest of the mandibular condyle. An independent test set of 39 anonymized CBCT volumes was further included. We developed a class-conditional LDM that integrates a pre-trained VAE for perceptual compression with a conditional U-Net for iterative denoising in the latent space. Performance was evaluated via qualitative anatomical fidelity assessment, Fréchet Inception Distance (FID), and a blinded Visual Turing test conducted by experienced clinicians to determine the distinguishability of synthetic images from real data. Results: Qualitative analysis revealed that TMJCTGenerator produced images with superior sharpness and anatomical consistency compared to baseline models, successfully reconstructing fine bone structures essential for diagnosing degenerative joint disease. TMJCTGenerator achieved lower FID scores than both VAE and GAN baselines. In the visual Turing test, clinicians were unable to reliably distinguish the generated images from real scans, and non-inferiority analysis confirmed that the synthetic data were statistically non-inferior to real data. Furthermore, TMJCTGenerator demonstrated the capability to generate diverse pathological conditions, ranging from normal anatomy to severe osteoarthritic changes. Conclusions: The proposed LDM framework effectively addresses the data scarcity and privacy bottlenecks in TMJ AI research by generating realistic, fully anonymous medical imaging data. TMJCTGenerator outperforms traditional generative methods in both visual fidelity and diversity, offering a viable solution for training downstream diagnostic algorithms. The source code and pre-trained models of TMJCTGenerator have been made open-source. Full article

Objectives: To evaluate the relationship between anterior maxillary sinus wall position and nasal bone asymmetry, and to assess their association with patient-reported aesthetic and functional outcomes following septorhinoplasty. Methods: Preoperative and postoperative evaluations were performed using the Rhinoplasty Outcome Evaluation (ROE) and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires. Nasal bone dimensions were measured preoperatively using computed tomography (CT) scans. Results: A positive correlation was observed between anterior maxillary sinus wall position and nasal bone asymmetry, with significant nasal bone discrepancies contributing to nasal deviation. Conclusions: Anterior maxillary sinus wall position and nasal bone asymmetry are significantly associated with patient-reported outcomes following septorhinoplasty. Consideration of these anatomical parameters during surgical planning may improve aesthetic and functional results. Full article

Background/Objectives: Lisfranc joint injuries are complex midfoot pathologies frequently associated with subtle radiologic findings and delayed diagnosis. Although ligamentous disruption is considered the primary mechanism, the contribution of intrinsic osseous morphology remains insufficiently investigated. Previous studies have primarily relied on two-dimensional measurements and limited morphometric parameters. Therefore, this study aimed to provide a comprehensive three-dimensional (3D) computed tomography (CT) based morphometric evaluation of the medial and central columns of the Lisfranc joint and to determine whether specific bony parameters are associated with injury predisposition. Methods: A total of 48 CT scans, including 23 from patients with Lisfranc joint injuries and 25 from healthy controls without midfoot trauma, were retrospectively analyzed. For both groups, 3D models of the first three metatarsals (M1–M3) and cuneiforms (C1–C3) were reconstructed to measure bone length, articular surface areas, volumes, M1–M2/M2–M3 depth differences, and dorsal step-off (dorsal subluxation of M2 relative to C2). Correlations of these measurements with M2 length were additionally assessed in each group. Results: Comparisons between injury and healthy control groups revealed no significant differences in bony morphometrics (p > 0.05). Correlation analysis showed that a longer M2 were associated with greater cuneiform volumes and larger metatarsal articular surface areas (p < 0.05). Conclusions: This comprehensive 3D morphometric assessment of the Lisfranc joint indicates that intrinsic bony anatomy alone is unlikely to represent a primary predisposing factor for Lisfranc injuries. The observed positive relationship between M2 length and cuneiform articular surface areas and volumes demonstrates structural interdependence within the medial and central columns. Overall, injury susceptibility does not appear to be explained by variations in osseous morphology alone. Full article