The cranial vault asymmetry index (CVAI) and the cephalic index (CI) quantify infant head shape, but the convention for setting the height of the measurement plane varies across facilities. From a public statistical shape model of the infant head, 2000 synthetic shapes were generated, 500 in each of 4 classes. Taking the plane through the bilateral tragi and the sellion as reference, CVAI and CI were obtained at level 3, the third of 10 equal divisions to the vertex, at the eyebrow-height horizontal plane and from the top-view silhouette, and compared within each individual. Relative to level 3, the eyebrow-height plane gave a CI larger by 6.14 and a CVAI smaller by 0.75 in all 4 classes. Every individual showed the larger CI; 71% showed the smaller CVAI, with limits of agreement crossing 0. In sensitivity analyses, the sign of the CI difference remained consistent, whereas that of the CVAI reversed when the plane was raised to 20 mm above the canthus. The CVAI difference increased with deformation, behaving as compression (slope 0.833), not a fixed offset; regression removed the systematic deviation in a confirmation sample but narrowed the limits of agreement only from 5.72 to 4.77 points. The top-view silhouette lay close to level 3 rather than the eyebrow-height plane, with its CVAI differing by <0.5 and its CI by 1.59 at 40 cm. The measurement convention, including the plane, should be stated and unified; without a 3-dimensional device, a top-view photograph is the closest substitute. The height of the measurement plane systematically alters infant head shape indices; the effect scales with deformation, and a top-view silhouette approximates the conventional 3-dimensional plane.
Background: Orofacial clefts are the most common craniofacial malformations worldwide, and emerging evidence suggests that their burden in Ecuador may exceed global estimates. Although timely surgical care is essential for functional outcomes, geographic access to cleft surgical services in Ecuador has not been previously evaluated. Methods: The authors conducted a cross-sectional geospatial analysis of access to public orofacial cleft surgical centers in Ecuador. Geographic access was assessed at the canton level by calculating distance from each canton centroid to the nearest hospital. Road-network driving time from each canton centroid to the nearest hospital was also estimated, and cantons were classified according to 1-hour and 2-hour access. Results: A total of 3 public hospitals providing continuous surgical care for orofacial clefts were identified. Among 218 cantons, the median geodesic distance to the nearest hospital was 106.0 km (IQR, 69.3–140.4), and the median driving time was 157.5 minutes (IQR, 106.2–212.8). Overall, only 13 cantons (6.0%) had 1-hour access, and 46 cantons (21.1%) had 2-hour access to a hospital. The greatest burden was observed in the Amazon region, where the median distance was 138.9 km (IQR, 104.8–184.3), the median travel time was 227.6 minutes (IQR, 191.9–308.3), and no cantons had 1-hour or 2-hour access. Conclusion: Geographic access to public orofacial cleft surgical care in Ecuador is limited, particularly in the Amazon region. These findings highlight the need for targeted strategies to improve access to cleft surgical services in underserved areas.
Frontal sinus anterior-table setback is a technically demanding component of forehead feminization when simple burring is insufficient to achieve the desired contour. We describe a structured operative workflow in 4 Chinese transfeminine patients aged 20 to 32 years. Preoperative computed tomography (CT) and virtual surgical planning were performed with ProPlan CMF, and a patient-specific cutting guide was used to localize the frontal sinus boundaries and the anterior-table osteotomy line. After reduction of the brow and supraorbital region, the mobilized anterior-table was repositioned posteriorly according to its relationship with the adjacent reduced bony contour and stabilized with a RapidSorb 2.0 resorbable plate-and-screw system, avoiding permanent metallic hardware in this non-load-bearing region. The frontal sinus mucosa was preserved without curettage, sinus obliteration was not performed, and the nasofrontal outflow tract was preserved. All patients underwent postoperative day-5 CT to document the early anterior-table position and frontal bony contour and completed 6 months of clinical and photographic follow-up. Improvement in forehead contour was observed without major complications. Because concomitant facial procedures were performed in selected patients, overall facial appearance reflects the combined effects of these procedures. This report presents preliminary technical experience with resorbable rigid fixation for frontal sinus anterior-table reconstruction; larger series with longer clinical and radiographic follow-up are needed to assess long-term skeletal stability, frontal sinus-related outcomes, and fixation behavior after material resorption.
Objective: To evaluate the clinical efficacy and safety of three-dimensional (3D)-printed patient-specific polyetheretherketone (PEEK) implants for correcting nasal base depression in East Asians, and summarize standardized design principles. Methods: A retrospective study was conducted on 73 patients who underwent 3D-printed PEEK implant augmentation for nasal base depression from May 2024 to May 2025, including 19 cases of isolated alar base augmentation and 54 cases of combined alar-columellar base augmentation. Personalized implants were designed based on preoperative 3D-CT data and fixed with titanium screws intraoperatively. All patients were followed up for 6 months, and implant parameters, operative time, complications, and clinical outcomes were analyzed. Results: No severe complications such as hematoma, infection, or implant displacement occurred in all patients. Significant correction of nasal base depression was achieved in all cases, with 95.9% of patients reporting complete satisfaction at 6-month follow-up. Key design principles included the lateral border confined within the nasolabial fold, a safety distance of ≥5 mm from the gingiva, and screw holes avoiding dental roots and the maxillary sinus. Conclusions: Three-dimensional-printed patient-specific PEEK implants are safe, effective, and customizable for correcting nasal base depression in East Asians. Preoperative precise design combined with titanium screw fixation can achieve excellent bony adaptation and high patient satisfaction, serving as a reliable solution for individualized nasal base augmentation.
Background: Patients with cleft lip and palate (CLP) experience higher complication rates during Le Fort I osteotomy, particularly during pterygomaxillary disjunction. Although anatomic differences in cleft maxillae are well recognized, quantitative characterization of bone quality at critical osteotomy sites remains limited. This study compares cortical thickness, trabecular bone density, and palatal morphology in patients with CLP and noncleft controls. Methods: A retrospective review conducted between 2020 and 2023 identified patients who underwent Le Fort I osteotomy and had preoperative maxillofacial computed tomography. Twelve patients with CLP were matched to 12 noncleft controls with regard to age, sex, and occlusal class. Three-dimensional reconstructions were used to measure cortical thickness and trabecular bone density (HU) at the nasomaxillary buttress (NMB), zygomaticomaxillary buttress (ZMB), and pterygomaxillary junction (PMJ). Palatal dimensions were also assessed. Results: Compared with controls, patients with CLP demonstrated reduced cortical thickness at both the NMB and PMJ, with significantly decreased PMJ cortical width (4.234±1.086 versus 5.433±1.209 mm; P <0.05). Trabecular bone density was higher at the NMB (725.5±108.3 versus 596.1±118.5 HU; P <0.05) and ZMB in the CLP cohort. Cleft-sided analyses revealed higher trabecular bone density and reduced cortical thickness. Patients with CLP exhibited decreased intercanine width, palatal length, and palatal height ( P <0.05). Conclusions: Patients with CLP demonstrate thinner cortical bone, increased trabecular density, and reduced palatal dimensions at key Le Fort I osteotomy sites. These structural differences likely reflect scar-mediated remodeling and altered biomechanics, contributing to unpredictable fracture patterns. Quantitative assessment of bone quality may improve surgical planning and safety in this population.
