Reconstruction of facial defects due to war injuries using vascularized pedicled galeal and parietal bone grafts

Combat wounds are basically extensive and destructive. Such injuries cause defects of soft and bone structures of the face and neck. During primary surgical management of maxillofacial combat wounds the principle of minimal bone and soft tissue debridment was respected. Definitive reconstruction of the defect was performed after two or three months, when infection was cured and adjacent tissues were restituted. Each combat wound leaves behind fibrous changes in surrounding tissues. Success of the reconstructive procedures is more certain if flaps with its own blood supply are used, either arterial or vascularized grafts from the other parts of body (by microvascular technique). This paper presents our experiences with galeal flap in reconstruction of facial soft tissue defects, as well as galea, together with external table of parietal bone in reconstruction of soft and bony tissues of maxillofacial in 15 patients.     

Radiographic assessment of facial soft tissue thickness in South Indian population – An anthropologic study

Facial reconstruction is a technique used in forensic anthropology to identify an unknown person. Various methods used for facial reconstruction are drawings, sculpture and computer aided image building which is mainly based on facial soft tissue thickness measurement. Several methods have been established for measuring facial soft tissue thickness (FSTT) with each one having certain limitations. There is limited data available on FSTT among South Indian population. Hence the present study was ventured to determine the FSTT among South Indian adults and also to find FSTT difference between male and female.308 subjects of South Indian origin (18–27years) having full set of permanent dentition who require orthodontic treatment were included in the study. Subjects were assessed for Body Mass Index (BMI) and diagnostic digital x-ray of lateral cephalogram (LC), Lateral oblique (LO) view and posterior-anterior (PA) view was obtained. The digital image was transferred to Adobe Photoshop CS4 software and 23 different soft tissue points were measured.Mean FSTT was more in males compared to females except for three landmarks. Statistically significant difference was observed in 20 landmarks when height and weight was compared in males, whereas in females only 12 landmarks showed significant difference. BMI showed good correlation with FSTT in both males and females, which was confirmed by linear regression. The best regressor in terms of estimating FSTT in association with age/sex/BMI were nasion, sub nasale, labial superioris, labrale inferius, gnathion, inferior border of zygomatic, right and left gonion. Stepwise discriminant analysis using all variables showed 94.8% of overall accuracy in sex determination.The observation of present study suggests that LO and PA view along with LC gives information regarding mean FSTT among South Indian population. Even though BMI plays a dominant role in determining FSTT, but age, sex, height and weight should also be considered with care while facial reconstruction. Additionally the present regression equation contributes towards increase in the specificity of the tissue depths and can be used in real cases by allowing the practitioners to calculate individual tissue depth.     

Pilot study to establish a nasal tip prediction method from unknown human skeletal remains for facial reconstruction and skull photo superimposition as applied to a Japanese male populations

Skull-photo superimposition is a technique used to identify the relationship between the skull and a photograph of a target person: and facial reconstruction reproduces antemortem facial features from an unknown human skull, or identifies the facial features of unknown human skeletal remains. These techniques are based on soft tissue thickness and the relationships between soft tissue and the skull, i.e., the position of the ear and external acoustic meatus, pupil and orbit, nose and nasal aperture, and lips and teeth. However, the ear and nose region are relatively difficult to identify because of their structure, as the soft tissues of these regions are lined with cartilage.We attempted to establish a more accurate method to determine the position of the nasal tip from the skull. We measured the height of the maxilla and mid-lower facial region in 55 Japanese men and generated a regression equation from the collected data. We obtained a result that was 2.0 ± 0.99 mm (mean ± SD) distant from the true nasal tip, when applied to a validation set consisting of another 12 Japanese men.     

Gesichtsweichteilrekonstruktion mithilfe einer Open-Source-Software

Background

The identification of an unknown deceased person is an important task in forensic anthropology. There are various methods for identification, such as fingerprinting, odontostomatology and genetic fingerprinting, which presuppose the existence of reference material of the missing person; however, if there is no evidence of a person’s identity the only possibility is often the use of forensic facial soft tissue reconstruction. This method is based on the high recognition level of a human face on the basis of bony structures of the skull and its anatomical features.

Aim

The aim of this study was the design and application of a novel process for a computer-aided 3D facial soft tissue reconstruction on the basis of digital photographs of a skull.

Material and methods

The facial soft tissue reconstruction was carried out on a selected forensic case and based on open source software.

Results

A complete facial soft tissue reconstruction of the deceased person was created based on 76 photographs of the skull taken with a Nikon D7100 SLR digital camera. The results show that for actual comparison images similar reconstruction results can be achieved. In addition, a model library for facial features was created.

Conclusion

The presented workflow of a computer-aided 3D facial soft tissue reconstruction based on open source software is a cost-effective and flexible alternative to conventional reconstruction methods. It could be demonstrated that comparable reconstruction results can be achieved. Whether the reconstruction result actually leads to the recognition of the person depends on many other factors.

     

Will different sagittal and vertical skeletal types relate the soft tissue thickness: A study in Chinese female adults

Facial reconstruction is a classical technique in forensic anthropology to reestablish the contours of the soft tissues over the skull. The accurate facial soft tissue data plays an essential role in forensic facial reconstruction. However, according to previous studies, various skeletal types might relate to different thickness in facial soft tissue. Until now, there are few publications focusing on the relationship between facial soft tissue thickness (FSTT) and different skeletal types, and none of them analyze the FSTT according to various sagittal and vertical skeletal types. The aim of this study was to testify the possible existence of correlations between FSTT and different skeletal types. In order to exclude interference from age, sex, ethnicity and body mass index (BMI) factors, we collected lateral projection X-rays data of 270 Chinese female aged 19–26 years with nomal BMI and divided them into various skeletal groups. Soft tissue thickness measurements were mainly based on 10 anthropological landmarks of the skull and statistics were analyzed on the basis of different skeletal types. The greatest differences were observed in the upper lip region of maxilla and the mental region of mandible. The concave and hypodivergent skull types showed the thickest soft tissue in maxillary region, and the convex and hypedivergent skull types showed the thickest soft tissue in the mental region. This study provided a database for FSTT according to various skeletal types in Chinese female population, and our current studies demonstrated that considering various skeletal types will improve the accuracy of facial reconstruction.     

鼻唇沟螺旋桨皮瓣在面部皮肤软组织缺损中的应用

目的探讨鼻唇沟螺旋桨皮瓣在面部皮肤软组织缺损修复重建中的应用。方法选取2012年1月~2015年1月于台山市人民医院就诊因肿瘤、创伤等原因导致的面部软组织损伤患者34例,其中男性23例,女性11例;年龄29~67岁,平均47岁。平均面部缺损面积2.0cm×3.0cm;缺损部位包括面部、鼻部、唇部、脸颊部,采用鼻唇沟螺旋桨皮瓣进行修复重建。术后随访6个月,观察患者术后情况及皮瓣成活情况,同时记录患者术后并发症情况。结果 34例患者均一期愈合。随访期间30例患者肿瘤未见复发,皮瓣生存良好,成活率达97.1%;皮瓣色泽与周围组织基本一致,无面瘫、鼻通气功能及咀嚼功能障碍,外观形态满意,总体满意度达到91.2%,无严重手术并发症的发生。结论鼻唇沟螺旋桨皮瓣修复面部软组织缺损疗效好,满意度高,值得推广应用。     

Repeatability of facial soft tissue thickness measurements for forensic facial reconstruction using X-ray images

The repeatability of facial soft tissue thickness measurements at 10 standard anatomical landmarks was evaluated using lateral X-ray images obtained from 50 adult subjects. The intra-and inter-observer error rates were calculated after four practitioners took measurements using Denta Pacs 8.1 software. The results indicated high inter- and intra-observer repeatability, suggesting X-ray images can be used to measure facial soft tissue thicknesses for the purpose of craniofacial reconstruction and superimposition.     

Blindstudie zur plastischen Gesichtsrekonstruktion

If a body is found in a skeletonized condition, a determination of identity can be difficult and even more if no further findings are present which might assist identification. If all other methods for identification have failed, e.g. a comparative DNA analysis, a reconstruction of the face on the skull can be the only remaining possibility. A number of methods with varying results exist for soft tissue reconstruction. Any further findings can be helpful, because they might give indications of the unknown deceased persons facial appearance before death. If there are no indications of the physical condition during life, the spectrum of possible facial expressions can be very large. The study deals with the variety of facial appearances based on the same skeletal remains.     

In vivo facial soft tissue thickness measurements for Turkish Subadults

Facial soft tissue thicknesses are mainly used in facial reconstruction for the purpose of forensic identification. Several studies of facial soft tissue thickness (FSTT) in subadults have been published from different ancestral backgrounds such as Caucasoid, African-American, Hispanics and Japanese subjects. However, there is no existing available FSTT data for Turkish subadults. This study reports FSTT data in Turkish subadults of both sexes, aged between 3 and 18. FSTTs were measured at 31 anatomical points on the faces of 450 individuals. A table of mean FSTTs was developed for boys and girls divided into three age groups (3–8; 9–13; 14–18). Differences between boy and girl measurements in three age groups were compared using Student’s t-test. Significant differences were observed at some landmarks in each age group. In order to observe differences among age groups, an ANOVA (one-way analyses of variance) followed by a LSD (least significant difference) Post Hoc test was applied to the variances. The boys showed a general increase in tissue thickness with an increase at all the midline and cheek points. The girls showed increased tissue thickness with age at all points except supraglabella, upper lip, frontal eminence, lateral nasal, sub-orbital and supraglenoid.     

Weapon identification using antemortem CT with 3D reconstruction,is it always possible? – A report in a case of facial blunt and sharp injuries using an ashtray

An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred.     

Geometric morphometric methods for three-dimensional virtual reconstruction of a fragmented cranium: the case of Angelo Poliziano

The process of forensic identification of missing individuals is frequently reliant on the superimposition of cranial remains onto an individual's picture and/or facial reconstruction. In the latter, the integrity of the skull or a cranium is an important factor in successful identification. Here, we recommend the usage of computerized virtual reconstruction and geometric morphometrics for the purposes of individual reconstruction and identification in forensics. We apply these methods to reconstruct a complete cranium from facial remains that allegedly belong to the famous Italian humanist of the fifteenth century, Angelo Poliziano (1454–1494). Raw data was obtained by computed tomography scans of the Poliziano face and a complete reference skull of a 37-year-old Italian male. Given that the amount of distortion of the facial remains is unknown, two reconstructions are proposed: The first calculates the average shape between the original and its reflection, and the second discards the less preserved left side of the cranium under the assumption that there is no deformation on the right. Both reconstructions perform well in the superimposition with the original preserved facial surface in a virtual environment. The reconstruction by means of averaging between the original and reflection yielded better results during the superimposition with portraits of Poliziano. We argue that the combination of computerized virtual reconstruction and geometric morphometric methods offers a number of advantages over traditional plastic reconstruction, among which are speed, reproducibility, easiness of manipulation when superimposing with pictures in virtual environment, and assumptions control. S. Benazzi and E. Stansfield contributed equally to this work.     

新型颌面部爆炸伤模型建立及损伤特点观察

目的：建立标准的颌面部爆炸伤模型，观察组织损伤特点，方法：实验选用点状爆炸源距新西兰白兔面部不同距离引爆致伤，选择合适的致伤模型，于伤后0．5，6、24、72小时，15天观察伤情，切取皮肤咬肌，面神经组织标本行光镜，透射电镜观察。结果：0．125gTNT当量炸药球距离兔左面部2mm处引爆，可致兔面部软组织挫裂伤，下颌骨粉碎性骨折，伤情可重复，动物存活，伤区皮肤坏死范围约3mm，肌肉组织坏死范围可达10mm，伤后动物出现面瘫症状，面神经水肿充血，髓鞘空泡样变性，雪旺细胞肿胀，炎细胞浸润。结论：0．125gTNT当量炸药球距离兔左面部2mm处引爆，为颌面部爆炸伤标准动物模型，爆炸可引起软组织骨、面神经损伤。     

Massive bone allograft: a salvage procedure for complex bone loss due to high-velocity missiles--a long-term follow-up

The treatment of high-velocity missile injury to the limbs is often associated with segmental bone loss, as well as damage to neurovascular and soft tissue. In such "limb threatening" cases, massive bone allograft can fill the bone defect and offer stability to the soft tissue reconstruction. The return of function in the affected limb is relatively rapid when using this method as a primary procedure. The indications for use of this technique and illustrative case reports are presented and discussed.     

耳后皮瓣的临床应用

1982年12月至1988年4月,应用耳后皮瓣修复面部软组织缺损和耳廓上半部缺损7例。其中以耳后动静脉为蒂的耳后皮瓣修复面部软组织缺损2例;以颞浅动静脉为蒂的耳后皮瓣修复面部软组织缺损2例,耳廓上半部映损3例,效果满意。耳后皮瓣具有皮肤薄,皮下脂肪少,肤色与面部接近,供区隐蔽,并易被头发遮盖等优点。     

A blind accuracy assessment of computer-modeled forensic facial reconstruction using computed tomography data from live subjects

A computer modeling system for facial reconstruction has been developed that employs a touch-based application to create anatomically accurate facial models focusing on skeletal detail. This article discusses the advantages and disadvantages of the system and illustrates its accuracy and reliability with a blind study using computed tomography (CT) data of living individuals. Three-dimensional models of the skulls of two white North American adults (one male, one female) were imported into the computer system. Facial reconstructions were produced by two practitioners following the Manchester method. Two posters were produced, each including a face pool of five surface model images and the facial reconstruction. The face pool related to the sex, age, and ethnic group of the target individual and included the surface model image of the target individual. Fifty-two volunteers were asked to choose the face from the face pool that most resembled each reconstruction. Both reconstructions received majority percentage hit rates that were at least 50% greater than any other face in the pool. The combined percentage hit rate was 50% above chance (70%). A quantitative comparison of the facial morphology between the facial reconstructions and the CT scan models of the subjects was carried out using Rapidform^™ 2004 PP2-RF4. The majority of the surfaces of the facial reconstructions showed less than 2.5 mm error and 90% of the male face and 75% of the female face showed less than 5 mm error. Many of the differences between the facial reconstructions and the facial scans were probably the result of positional effects caused during the CT scanning procedure, especially on the female subject who had a fatter face than the male subject. The areas of most facial reconstruction error were at the ears and nasal tip.     

Facial reconstruction using 3-D computerized method: A scoping review of Methods,current Status,and future developments

Facial reconstruction (otherwise known as facial approximation) is an alternative method that has been widely accepted in forensic anthropological and archaeological circumstances. This method is considered useful for creating the virtual face of a person based on skull remain. Three-dimensional (3-D) traditional facial reconstruction (known as sculpture or manual method) has been recognized for more than a century; however, it was declared to be subjective and required anthropological training. Until recently, with the progression of computational technologies, many studies attempted to develop a more appropriate method, so-called the 3-D computerized facial reconstruction. This method also relied on anatomical knowledge of the face-skull relationship, divided into semi- and automated based computational method. The 3-D computerized facial reconstruction makes it more rapid, more flexible, and more realistic to generate multiple representations of faces. Moreover, new tools and technology are continuously generating fascinating and sound research as well as encouraging multidisciplinary collaboration. This has led to a paradigm shift in the 3-D computerized facial reconstruction to a new finding and new technique based on artificial intelligence in academia. Based on the last 10-years scientific-published documents, this article aims to explain the overview of the 3-D computerized facial reconstruction and progression as well as an issue relating to future directions to encourage further improvement.     

The creation of inter-ethnic images for studies in applied psychology

The facial transformation programme, is an integral part of the computerised three-dimensional facial reconstruction system, employed at the University of Glasgow for forensic and historical cases. It was applied to the creation of inter-ethnic images for use in studies to assess the response of various groups to facial appearance in the assessment of racial stereotyping. We initially acquired a three-dimensional facial image from a young black (Negroid) male volunteer, using our optical laser scanning system. This image was then used as a template over a Caucasian skull to produce a reconstruction using facial criteria applicable to white (Caucasian) males. The other image used was that of the facial template of the black male. A commercially available electronic identikit system, E-FIT was then used to add appropriate hair styles and open eyes to both images. In addition, on the 'Caucasian reconstruction' we were able to reduce the contrast and lighting on the face. This was relatively straightforward as we were using greyscale images rather than colour. The shape of the nose and lips on the white male were also altered to be more in keeping with Caucasoid average measurements. The resulting images were shown to a group of second-year clinical psychology students and their responses are discussed. Similar images may also be used in studies of racial stereotyping in different categories of professionals such as police, prison personnel, probation officers, social workers, potential employers, doctors, and others, in order to assess the response to individuals by facial appearance.     

Anatomic anterior cruciate ligament reconstruction: the two-incision technique

This article describes the anatomical two-incision reconstruction of anterior cruciate ligament (ACL) of knee. The major part of currently single incision tibial endoscopic techniques attempts to reproduce the most isometric anteromedial bundle of ACL. Often a relatively vertical femoral tunnel, respect to the notch, is drilled, which is not really efficacious in providing rotatory stability. The single incision technique was developed to obviate the necessity of the lateral femoral incision and dissection. This technical note describes a two-incision ACL reconstruction using an instrumentation, which avoids a large lateral femoral soft tissue dissection, and discusses the rational use of the two-incision ACL reconstruction technique.     

Infantile fibromatosis of the mandible: a case report

We report an aggressive tumour in a 5-year-old girl causing facial disfigurement. Imaging confirmed a solid, diffusely enhancing mass at the right internal pterygoid muscle, infiltrating the adjacent bone. Surgical excision and reconstruction of the mandible were performed. Histology revealed aggressive infantile fibromatosis. No recurrence was noted 7 months later. Infantile fibromatosis may mimic malignancies and should be considered in aggressive mandibular soft tissue masses, in order to carefully plan biopsy and reconstructive surgery.