Congenital muscular torticollis (CMT) is a common postural disorder in infants, frequently accompanied by craniofacial asymmetry. Despite its prevalence, detailed characterization of the 3-dimensional (3D) craniofacial morphology in CMT remains limited. This study aimed to explore the craniofacial patterns in children with CMT using 3D computed tomography scan reconstruction and assess their relationship with clinical classifications. Forty-four children aged 5 to 92 months were included in this study. Ten craniofacial parameters were visually assessed by multiple raters, including medical and nonmedical professionals, and frontline and specialized clinicians. High reproducibility was observed for features such as mandibular tip deviation and parietal bone measurements. The sternocleidomastoid tumor and torticollis subgroups of CMT show similar craniofacial asymmetry profiles, and molded baby syndrome to a lesser extent. The postural torticollis subgroups showed different profiles. Multiple factor analysis followed by hierarchical clustering revealed 6 distinct morphologic groups that did not correspond to the clinical, sex, or age subgroups, highlighting the significant variability in craniofacial morphology in CMT. These results emphasize that imaging assessment provides complementary information but cannot replace a thorough clinical evaluation. Our study confirmed that CMT-associated craniofacial asymmetry is a 3D asymmetry that remains difficult to understand.

Understanding anatomy of breast connective tissue is critical in contexts such as surgery and biomechanical modeling of breast deformations. Current descriptions remain contradictory and fail to explain breast biomechanics. We described the anatomy of breast connective tissue based on Magnetic Resonance Imaging and surgical observations. This prospective study was conducted at the breast surgery department of Montpellier University Hospital. A total of 196 patients were consecutively included between March and May 2022; 10 had breast MRI in 3 different positions (supine, prone, and lateral). Superficial fascia (SF) creates a "pocket" surrounding the breast, both anteriorly and posteriorly, as a consequence of dorsal development in the anterior body wall. SF appears to delimit two compartments of adipose tissue: a superficial and a deeper one, both crossed by retinacula cutis (RC). There is no continuity between the RC of both layers and therefore no RC running from the pectoralis major to the skin. An "anchoring ring," corresponding to a dense zone of connective tissue around the periphery of the breast, where the SF and deep fascia meet, is the main adhesion of the breast to the chest wall. Breast is shaped by the superficial fascial system and anchored to the chest wall at its periphery. It does not seem to be two distinct layers of SF and suspensory ligaments running through the breast from pectoralis major to the skin. Further studies based on these findings could evaluate the impact on biomechanical model performances. Surgeons should consider this description in order to optimize cosmetic results. Trial Registration: ClinicalTrials.gov identifier: NCT05301998.

The objective was to assess fluctuating asymmetry (FA) and directional asymmetry (DA) of the petrous bone (PB) and the petromastoid V (PMV) in children using 3D morphometric data. CT scans of normal children (0 to 30 months) were included. After segmentation, the geometric characteristics were calculated (volume, three inertial semi-axes (ISA), centroid, distance, angle). The FA and DA were studied according to stages of postural development and sex. 116 CT scans were studied (70 boys, 46 girls). The two sides of the PB and PMV were symmetric (FA between 1.87

Breast geometric models constitute the foundation of biomechanical simulations. Most currently available models rely on patient-specific reconstructions derived from magnetic resonance imaging (MRI) or computed tomography (CT) scans. These approaches present several limitations, including requirement for patient-specific imaging data, need for manual or semi-automatic segmentation of images (both time-consuming and operator-dependent), and limited accuracy in biomechanical simulations due to large tissue deformations. The objective of this study was to develop a generic three-dimensional (3D) geometric breast model that can be easily adapted using only a limited set of morphological parameters, thus eliminating the need for image segmentation. This prospective study was conducted in the Breast Surgery Department of Montpellier University Hospital, France, between March 2022 and March 2025, and consisted of four steps: (1) definition of constitutive materials based on clinical observations; (2) development of geometric model; (3) evaluation of model validity through reproductions of clinical cases; (4) construction of a numerical model. The proposed simplified geometric model was subdivided into five compartments: (1) chest wall; connective tissue, modeled as a cone composed of three compartments: (2) cone base (anchoring ring), (3) the surface enveloping the glandular tissue, and (4) the nipple-areolar complex ring; (5) glandular/adipose tissue volume. This 3D model was able to represent various breast morphologies and conditions. Based on these observations, a numerical 3D geometric model was developed, using a mass-spring system. Further validation of the biomechanical accuracy of the model in simulating breast deformations is still required. This will be addressed in a future study comparing model outputs with breast MRI acquisitions obtained in three different positions. Trial Registration: Clinicaltrials.gov: NCT05301998.

A personalized 3D breast model could present a real benefit for preoperative discussion with patients, surgical planning, and guidance. Breast tissue biomechanical properties have been poorly studied in vivo, although they are important for breast deformation simulation. The main objective of our study was to determine breast skin thickness and breast skin and adipose/fibroglandular tissue stiffness. The secondary objective was to assess clinical predictors of elasticity and thickness: age, smoking status, body mass index, contraception, pregnancies, breastfeeding, menopausal status, history of radiotherapy or breast surgery. Participants were included at the Montpellier University Breast Surgery Department from March to May 2022. Breast skin thickness was measured by ultrasonography, breast skin and adipose/fibroglandular tissue stiffnesses were determined with a VLASTIC non-invasive aspiration device at three different sites (breast segments I-III). Multivariable linear models were used to assess clinical predictors of elasticity and thickness. In this cohort of 196 women, the mean breast skin and adipose/fibroglandular tissue stiffness values were 39 and 3 kPa, respectively. The mean breast skin thickness was 1.83 mm. Only menopausal status was significantly correlated with breast skin thickness and adipose/fibroglandular tissue stiffness. The next step will be to implement these stiffness and thickness values in a biomechanical breast model and to evaluate its capacity to predict breast tissue deformations.

AIM:This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size. MATERIALS:The study sample was composed of 168 healthy children aged less than 4 years. Twenty-one measurements of distances and 6 angles were taken from 7 fixed landmarks set on the palatal vaults 3D surfaces reconstructed from CT-scans. To analyse only the shape evolution, the "sizefree" log-shape ratio of those measurements were computed and the global shape of the palatal vault and their transversal curve were plotted. Statistical analyses were performed to highlight the shape and size differences separately. CONCLUSION:The shape and size evolution of the palatal vault during the first years of life was not only correlated with deciduous dentition development. We assumed that the progressive orofacial muscles activation and tongue movements in the oral cavity may also explain these results as they induced strains on the palatal vault, warping it in various ways.

Introduction et objectifs Le micro-TDM est une technologie basée sur l’atténuation des rayons X avec une résolution iso tropique inférieure à 10 microns. Pour optimiser la visualisation des organes du fœtus au premier trimestre par le micro-TDM post-mortem, notre objectif était d’étudier les caractéristiques de diffusion et de déterminer la durée optimale du bain de contraste en fonction de la taille du fœtus. Au vu de la littérature [1] et de nos données préliminaires [2], nous avons choisi d’utiliser un bain de contraste fait d’un mélange équimolaire de paraformaldehyde à 4 % et de lugol iodine avec 63,25mg/mL d’iode. Matériels et méthodes Les fœtus inclus sont issus d’interruptions volontaires de grossesse avec consentement éclairé signé conformément au protocole de recherche approuvé par l’Agence française de la biomédecine [2]. Les fœtus préalablement fixés ont été placés dans le bain de contraste fraîchement réalisé, pendant différentes durées, puis scannés par micro-TDM avec d’une part, une analyse dynamique de la diffusion et d’autre part, l’étude du ratio contraste/bruit de l’image en fonction de la durée du bain et de la longueur cranio-caudale (LCC). Résultats Nous avons inclus 19 fœtus (7+3 à 14+2 semaines d’aménorrhée). La diffusion de l’agent de contraste suit une courbe exponentielle étirée [3] hormis dans le foie où elle peut être modélisée par une double fonction de Weibull [4]. L’agent de contraste induit un rétrécissement tissulaire touchant préférentiellement les parties molles. Le ratio contraste/bruit dans le foie et les poumons était significativement corrélé à la durée du bain et à la LCC. Nous avons ainsi établi une courbe permettant de déterminer la durée minimale de bain de contraste pour obtenir un contraste satisfaisant selon les critères de Rose [5]. Conclusion L’optimisation du contraste en micro-TDM du fœtus au premier trimestre passe par un bain d’une durée suffisante et corrélée à la LCC.

Background:Evaluation of the result on the nasal septum (NS) of primary anterior septoplasty in cleft surgery is lacking. The deviation in patients with a cleft between those with (S+) and without (S-) primary anterior septoplasty during a cleft lip repair was compared.Methods:This was a retrospective, descriptive, single-center study. The NS was evaluated on computed tomography scans obtained preoperatively from patients who underwent surgery for an alveolar cleft defect. Deviation of the NS was evaluated on the basis of 3-dimensional configuration of the NS; anterior, middle, or posterior severity of the NS deviation; location of the most projected point; and severity index.Results:The mean age at evaluation was 6.18 years. A total of 44 S- and 48 S+ patients were included. The NS was less prominent in the S+ than in the S- group (6.25% versus 25%, respectively). In the anterior part, the NS was normal in 79% (S+) and 1% (S-) of the patients. In the posterior region, the prominent deviation rate was approximately 7% in both groups. The greatest deviation point location was identical in both groups. The severity index was higher in the S- than in S+ group, except in the middle part of the NS.Conclusions:Primary anterior septoplasty corrects only the anterior aspect of the NS in most children with cleft lip or cleft lip and palate. However, the posterior aspect of the NS remains deviated. A posterior deviation is likely to lead to nasal obstruction; therefore, regular monitoring is required throughout the growing period.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

Introduction Dans le cadre du cancer du sein, les examens d’imagerie sont réalisés dans différentes positions très différentes de la situation peropératoire. L’utilisation d’un modèle 3D personnalisé du sein serait très utile pour aider le chirurgien à mieux appréhender la position tridimensionnelle des tumeurs en position opératoire et ainsi mieux planifier les incisions et la dissection du tissu mammaire, en préservant le maximum de tissu sain mais également en étant plus pertinent dans l’aspect carcinologique. Or, l’obtention d’un modèle du sein est très difficile en raison de la complexité et de la diversité de la géométrie 3D des structures et de leur caractère biomécanique hautement hétérogène. Une étude des caractéristiques de chacun des tissus est primordiale. Méthodes Au total, 200 patientes prises en charge dans le service de chirurgie gynécologique ont été incluses dans l’étude. Une mesure de l’épaisseur cutanée a été réalisée au niveau de trois quadrants du sein chez 196 patientes. À l’aide d’un dispositif développé par le laboratoire TIMC de Grenoble, nous avons également évalué l’élasticité de la peau et du tissu glandulograisseux au niveau de trois quadrants du sein. Enfin, nous avons détaillé l’anatomie des différents tissus du sein à partir des constations peropératoires des patientes opérées, d’IRM réalisées chez dix patientes en decubitus dorsal, ventral et latéral et de la bibliographie. Résultats L’épaisseur cutanée moyenne était de 1,83mm. L’élasticité de la peau et du tissu glandulograisseux était respectivement de 39kPa et 3kPa. Des dessins anatomiques ont été réalisés en collaboration avec une illustratrice médicale. À partir de cette réalité anatomique, nous avons pu concevoir une modélisation géométrique et paramétrique du sein. Conclusion Les premières étapes de la création d’un modèle 3D numérique et générique du sein ont pu être réalisées à savoir la description de l’anatomie et des propriétés biomécaniques du sein. La prochaine étape sera l’évaluation des capacités biomécaniques de notre modèle.

Introduction Le crâne est une structure modulaire complexe [1], [2] à évolution dynamique tout au long de l’ontogenèse. Il doit intégrer trois impératifs physiologiques vitaux : la croissance encéphalique, la ventilation et l’alimentation [3]. Le remodelage et le déplacement osseux présentent une hétérochronie en fonction des différents modules pour maintenir cet impératif. L’objectif était de modéliser et de visualiser les déplacements et remodelages du crâne en étudiant les trajectoires ontogéniques de points de repère osseux. Matériel et méthodes L’étude se base sur les données craniométriques de Fenart [4]. C’est une base de 142 points de repère en 3D à la fois anatomiques et géométriques pour neuf âges ontogéniques du fœtus à l’âge adulte sans distinction de sexe (5 mois fœtal, 7 mois fœtal, à la naissance, 8 mois et demi, 2ans, 4ans, 8ans et demi, 14ans et âge adulte). Il s’agit de valeurs moyennes sur un large échantillon de crânes étudiés de façon transversale. Les crânes ont été normalisés et placés d’un repère géométrique commun. Le déplacement géométrique des points a été calculé et visualisé en 3D avec une analyse en composante principale. Résultat Les trajets ontogéniques ont été visualisés de profil et de face. L’analyse des trajectoires montre deux modules de croissance distincts. Le crâne cérébral présente une croissance précoce avec une expansion radiale comme première composante avec une deuxième composante de rotation essentiellement occipitale plus tardive. Le crâne facial présente une croissance avec un axe oblique antéro-inférieur qui s’accélère à l’adolescence. Discussion L’analyse des trajectoires permet de mettre en évidence les déplacements et remodelages du crâne au cours de l’ontogenèse. La croissance peut être modélisée par deux modules, crâne cérébral et facial, avec pour chacun des remodelages régionaux fonctionnels propres, mais intégrée. C’est une aide à la prévision de croissance dans certaines déformations ou malformations crâniennes de l’enfant.

SUMMARY Congenital melanocytic nevi (CMN) and common acquired melanocytic nevi (AMN) are melanoma-predisposing skin conditions presenting excessive numbers of melanocytes but arising at different times in life. Appropriately weighted whole-genome methylation analysis can be used as a basis for further research in dermatopathology and as applied here provides new insights into nevus biology.

Idiopathic purpura fulminans (IPF) is a rare and severe form of purpura fulminans caused by acquired protein S deficiency. It can lead to severe thrombotic complications, such as large skin necrosis and amputation. The lesions almost exclusively affect the lower limbs, and their distribution is similar among patients with IPF, unlike classical purpura fulminans lesions. Our hypothesis is that vascular structures called perforasomes may be involved in IPF, possibly caused by protein S deficiency. We analyzed all case reports and case series published in the literature that provided sufficient data for an anatomical study of limb injuries. For precise localization of areas of necrosis, we examined each case using descriptions and images to determine whether they overlapped with vascular territories that include perforasomes. We analyzed twelve cases from the literature and identified six vascular territories: the anterolateral, anteromedial, and posterior territories of the upper leg, as well as the anterolateral, anteromedial, and posterolateral territories of the lower leg. For each territory, we described the most probable vascular damage and the corresponding perforasome. IPF is a complex multifactorial disease in which a direct involvement of perforating arteries may be suspected and taken into account in the surgical of lesions.

D'après les données de la littérature et la pratique courante, les connaissances en anatomie des internes seraient insuffisantes [1], [2], [3]. Le premier objectif de cette étude était d'évaluer les connaissances en anatomie pelvi-périnéale des internes en gynécologie–obstétrique et de les comparer aux connaissances des étudiants en médecine. Le second était d'évaluer l'impact d'un outil d'apprentissage en ligne sur les connaissances anatomiques des internes. Un questionnaire a été envoyé par mail aux internes en gynécologie–obstétrique ainsi qu'aux étudiants en troisième année de médecine. Les internes étaient ensuite randomisés dans le groupe « e-learning » ou le groupe « contrôle ». Le groupe « e-learning » avait un accès illimité à module d'e-learning, mis en place par la société iMAIOS sur sa plateforme internet. Une seconde évaluation des connaissances des internes a été réalisée 2 mois après la randomisation. Les internes (n = 23) avaient un score global significativement plus faible que les étudiants en médecine (n = 103) (22,1 %[±10,2] vs 43,8 %[±12,1], p < 0,0001). Deux mois après la randomisation, il n'y avait pas d'amélioration des résultats dans le groupe contrôle (3,6 %, p = 0,31), contrairement au groupe « e-learning » (10,6 %, p = 0,09). Il n'y a pas de différence significative sur le questionnaire post-intervention entre le groupe contrôle et le groupe « e-learning » (25,4 % vs 33 % respectivement, p = 0,34). Les connaissances en anatomie des internes en gynécologie–obstétrique sont faibles. L'outil d'e-learning a permis une amélioration des connaissances, qui restent cependant insuffisantes. Des méthodes d'enseignement traditionnelles et des solutions innovantes doivent être proposées tout au long des études de médecine et de l'internat afin de maintenir des connaissances anatomiques correctes et améliorer la satisfaction des étudiants/internes.

Objective: This study involved very early post-mortem (PM) examination of human fetal anatomy at 8 weeks of gestation (WG) using whole-body multimodal micro-imaging: micro-CT and high-field MRI (HF-MRI). We discuss the potential place of this imaging in early first-trimester virtual autopsy.Methods: We performed micro-CT after different contrast-bath protocols including diffusible iodine-based contrast-enhanced (dice) and HF-MRI with a 9.4 T machine with qualitative and quantitative evaluation and obtained histological sections.Results: Nine fetuses were included: the crown-rump length was 10-24 mm and corresponded to 7 and 9 WG according to the Robinson formula. The Carnegie stages were 17-21. Dice micro-CT and HF-MRI presented high signal to noise ratio, >5, according to the Rose criterion, and for allowed anatomical phenotyping in these specimens. Imaging did not alter the histology, allowing immunostaining and pathological examination.Conclusion: PM non-destructive whole-body multimodal micro-imaging: dice micro-CT and HF-MRI allows for PM human fetal anatomy study as early as 8 WG. It paves the way to virtual autopsy in the very early first trimester. Obtaining a precision phenotype, even regarding miscarriage products, allows a reverse phenotyping to select variants of interest in genome-wide analysis, offering potential genetic counseling for bereaved parents.

There is still no consensus on the optimal age for alveolar grafting. In order to decide on the success of this graft, the best known radiographic assessments lacks precision. Kamperos recently proposed a 3D CBCT score that simultaneously assesses alveolar bone height and thickness, as well as the nasal floor level. The aim of this study was to apply this new score and compare it between an early secondary alveolar grafting « ESAG » (4-7 y) and a late secondary alveolar grafting « LSAG » (8-11 y) surgery group. A total of 32 cases of ESAG and 17 of LSAG were analysed. On 3D imaging, the median age of ESAGs was 10 years and 15 years for LSAGs. In the ESAGs, 78% of the permanents canines were not on the arch compared to 18% in the LSAGs. In both groups, the reconstruction of the nasal floor was very adequate but the height and thickness appeared less good in the ESAGs. The final score was higher in LSAG (Chi2, P < 0.005). The analysis of the alveolar bone with the Kamperos score is accurate and relevant but it should preferably be performed in the permanent dentition phase. This is because the area of rhizalysis of the primary teeth and the follicular sac of the erupting permanent teeth influence the presence of effective bone.

The present Dataset contains the micro-CT scan of the head of an anonymous 54 year old female donor, at a voxel resolution of 145µm.The skin of the face has been masked in order to avoid the donor to be recognized.

IntroductionIdiopathic purpura fulminans (IPF) is a rare and severe coagulation disorder, associated with transient anti-protein S (anti-PS) antibodies in the context of post-viral infection such as varicella. Anti-protein S antibodies are frequently found in the context of varicella, in contrast with the rarity of IPF. Other factors such as anti-phospholipid antibodies (APL) and inherited thrombophilia may be associated with severe vascular complication.MethodThis is an ancillary study of a French multicenter retrospective series and systematic review of literature. We analyzed patients who were tested for inherited thrombophilia, namely antithrombin, protein C, protein S deficiency; prothrombin gene G20210A polymorphism (FII:G20210A),Factor V R506Q polymorphism (FV:R506Q); and/or for APL (lupus anticoagulant (LA), anti-cardiolipin antibodies (ACL), or anti-beta 2-GPI antibodies (A beta 2GP1).ResultsAmong the 25 patients tested for inherited thrombophilia, 7 (28%) had positive results. Three had FV R506Q, two FII:G20210A, one compound heterozygote FV:R506Q associated to FII:G20210A, and one protein C deficiency. APL testing was performed in 32 patients. It was positive in 19 patients (59%): 17 ACL (53%), 5 LA (16%), 4 A beta 2GP1 (13%). The risk of severe complications was not associated with presence of inherited thrombophilia or APL presence, with RR: 0.8 [95% CI: 0.37-1.71], p = 1 and RR: 0.7 [95% CI: 0.33-1.51], p = 0.39, respectively. We found a high prevalence of inherited thrombophilia or APL in a population of patients with IPF. However, we do not find an association with the occurrence of severe vascular complications or venous thromboembolism.

KEY POINTS An unfavorable insertion of the middle turbinate for cryotherapy was present in 74.2% of cases. Placing cryoprobe 15-30 mm above the nasal floor targets the nerves in 95.8% of cases. Centering the cryoprobe 38 mm behind the inferior turbinate axilla targets the nerves in 94.6% of cases.