Hussein, S.H.

Background: Sexual dimorphism in the facial skeleton is fundamental to aesthetics and gender perception. This study employs AI-assisted three-dimensional (3D) imaging to analyze morphological differences between males and females in the upper, mid, and lower facial regions. Methods: A retrospective analysis was conducted on 280 high-resolution craniofacial CT scans (147 females, 133 males) of adults aged 20 years and older. AI-assisted segmentation and modeling were performed using Materialise Mimics and 3-Matic software. The facial skeleton was divided into upper, mid, and lower regions for detailed morphometric evaluation. Statistical shape modeling (SSM) and heatmaps were used to visualize surface projection differences across age groups. Statistical comparisons were conducted to assess gender-based variation. Results: Significant sexual dimorphism was observed across all facial regions. In the upper face, males had greater interorbital width, frontotemporal brow width, inter-medial canthi distance, and more prominent frontal bossing. In the midface, males exhibited increased width, depth, and vertical height, with the most pronounced differences occurring in middle age. The lower face showed larger mandibular dimensions in males, including bigonial width, ramus height, and a sharper mental angle, while females had a more rounded chin and smoother mandibular contour. Heatmaps confirmed greater surface projection in male skeletons, particularly in the gonial and midfacial regions, with dimorphism decreasing with age. Conclusion: This represents the first large-sample CT study utilizing AI to comprehensively quantify facial skeletal dimorphism. Findings support the importance of gender-specific planning in facial reconstructive and aesthetic procedures.

OBJECTIVE Achieving submillimetric accuracy in stereotactic neurosurgery remains critical for safely targeting deep brain structures. Current workflows rely on intraoperative CT to register stereotactic frames to preoperative imaging, but this introduces additional radiation exposure, cost, and workflow complexity. Three-dimensional surface scanning (3DSS) potentially offers a fast radiation-free alternative capable of capturing detailed craniofacial anatomy and frame geometry. Therefore, the aim of this cadaveric study was to evaluate the feasibility, accuracy, and navigational compatibility of integrating 3DSS into stereotactic workflows as a potential replacement for intraoperative CT. METHODS A human cadaveric head was imaged with both thin-slice CT and structured-light 3DSS after mounting stereotactic frame components. CT, 3DSS, and computer-aided design (CAD) models were registered using a multistep point cloud alignment pipeline involving the fast point feature histogram, the random sample consensus method, and the iterative closest point algorithm. Accuracy was assessed using surface deviation error, root mean square error (RMSE), and fiducial registration error within a commercial neuronavigation platform. RESULTS Fusion of the 3D facial scan with CT provided a mean surface deviation error of approximately 0.4 mm. Registration of the 3DSS-derived N-bar localizer to its CAD reference model produced a frame alignment RMSE of 1.3 mm. Within the navigation system, the 3DSS-based workflow achieved a mean fiducial registration error of 0.14 mm (range 0.02–0.20 mm), outperforming the conventional CT-based method (mean error 0.20 mm, range 0.09–0.40 mm). CONCLUSIONS The 3DSS-based method enabled precise submillimetric stereotactic registration without the need for intraoperative CT, reducing radiation exposure and operative complexity. This workflow is fully compatible with existing navigation systems and could serve as a practical radiation-free alternative in stereotactic neurosurgery. Future work will focus on automating frame detection, incorporating artificial intelligence–driven fusion methods, and validating this approach in live surgical settings.

Summary: Umbilical piercings are popular among young individuals for aesthetic body enhancement. However, umbilical piercings can lead to complications such as infections, hypertrophic scarring, and epithelialized tracts that require surgical intervention. This case report presents a novel, minimally invasive technique using a lacrimal probe and iris scissors under local anesthesia to excise the epithelialized piercing tracts. A 23-year-old patient underwent the procedure, resulting in minimal scarring and high satisfaction at an 11-month follow-up. Compared with the existing methods, this approach ensures complete tract removal while preserving the natural umbilical contour. Given the limited literature, this technique offers an effective solution with excellent cosmetic outcomes.

Background/Objectives Auricular reconstruction poses significant surgical challenges in congenital and post-traumatic cases. Porous polyethylene (PPE) implants have emerged as a biocompatible alternative to the traditional autologous rib cartilage frames, offering less morbidity and a potentially stable framework. Here, we summarize the current evidence of the use of PPE auricular implants. Methods: A literature search was performed in accordance with PRISMA guidelines across several databases. Studies reporting outcomes of PPE implants in auricular reconstruction were included. Data were extracted on patient characteristics, operative details, and complication rates, along with any required interventions to address complications. Complications were classified as minor or major based on their management strategy. Results: Of 544 screened studies, 14 studies representing 1036 patients were included. PPE implant use was generally linked with favorable esthetic outcomes and high patient satisfaction (80%). Study-to-study variation in complication rates was notable, with some complication rates as high as 44% in the early 1990s. By the early 2000s, advancements in surgical methods—particularly the use of temporoparietal fascia (TPF) flaps and other flaps for optimal soft tissue coverage—had markedly reduced complication rates, with recent studies reporting rates as low as 7%. Implant exposure (6.7%) and implant fractures (ranging from 1.6% to 3.2%) were the most frequently reported problems. Conclusions: PPE auricular implants, despite decades of availability, have faced limited global adoption due to concerns over complications and longevity. Advances in surgical techniques have significantly reduced complication rates (<7%), making PPE implants a viable early intervention with favorable esthetics and negligible donor-site morbidity.

Abstract Introduction Abemaciclib is a selective CDK4/6 inhibitor approved for metastatic breast cancer. We report the clinical course of Abemaciclib-induced pneumonitis, emphasizing the need for vigilant monitioring for interstitial lung disease (ILD) in patients receiving this therapy. Case description An 85-year-old woman with a history of HR-positive, HER2-negative breast cancer, Atrial fibrillation, and stage 3 chronic kidney disease presented with cough and weakness and a temperature of 100.1° F. She was hypoxic, requiring 4 liters of oxygen, she was in atrial fibrillation with a heart rate of 114, and blood pressure was 98/46. Laboratory testing showed an NT-Pro BNP: 5768, leukocytes: 2900 with 420 lymphocytes and an acutely elevated creatinine of 1.83 mg/dL (basline 1.3-1.4 mg/dL). Her CRP was 245 mg/L. Chest X-Ray revealed diffuse interstitial opacities. She was treated for pneumonia with cefepime and azithromycin, volume resuscitation and subsequent diuresis. However, her hypoxia continued to worsen. A chest CTA excluded pulmonary embolism but revealed progression of diffuse ground-glass and reticular opacities with a basilar apical gradient and enlarged mediastinal and hilar lymph nodes. An echocardiogram showed a mildly enlarged right ventricle and elevated right ventricular systolic pressure of 60. Subsequent infectious and autoimmune workups were inconclusive, bronchoscopy evaluation was deferred due worsening respiratory status. Given the concern for drug induced pneumonitis she was started on a steroid taper with 2 mgs/kg of IV Methylprednisolone. Over two weeks, her condition improved, and she was discharged without supplemental oxygen. Discussion Pneumonitis is a rare adverse effect of abemaciclib likely driven from CDK4/6 inhibitors. In a safety analysis of the MONARCH 2&3 trials, the incidence of pneumonitis was 2-5%, compared to 0.4-0.6% in the placebo arms. In these trials, two and one patients died of pneumonitis respectively. Our patient received abemaciclib for 2 years and 10 months, during which her follow up PET CT scan few months after treatment initiation demonstrated a new ground-glass and reticular opacities that continued to worsen on subsequent surveillance PET CT scans with significant progression noted on admission CT. In the absence of other contributing factors, our patient was diagnosed with Grade 3 lung toxicity, and abemaciclib was discontinued. The progression of her imaging before admission highlights the need for close monitoring for interstitial lung disease in patients receiving abemaciclib, to determine if dose reduction or treatment adjustment is warranted.

Background: Mandible contour significantly influences facial appearance, framing the lower facial silhouette. Redefining mandibular contour is key for facial and neck rejuvenation. Yet, there is limited facial aging research across different lifespans and sexes. Here, we utilize artificial intelligence and advanced 3-dimensional (3D) analysis to elucidate mandibular aging patterns in male and female subjects. Methods: A retrospective analysis of facial computed tomography scans in White patients was conducted, categorizing subjects into 3 age groups (20–79 y) and stratifying them by sex. Artificial intelligence–assisted segmentation into 3D mandibles was done in Mimics v.25, and statistical shape modeling was used to create an average mandible for each group. Volume and linear measurements were assessed via 3D overlays. Results: Analysis of 280 mandibles demonstrated statistically significant aging changes in both sexes. Ramus height showed a marked decrease with age, by approximately 5.3 mm in women and 4.2 mm in men (P < 0.001). Interrami and intercondylar widths increased by a mean of 4–5 mm (P < 0.01). Women exhibited an increase in mandibular angle (P < 0.01), and bony resorption over the chin compared to men, who exhibited concentrated bone resorption at the gonion projection. Conclusions: Mandibular aging, independent of tooth loss, exhibits specific bone remodeling patterns by sex. Posteriorly, mandibular widths increase in both sexes, whereas ramus height decreases. Women experience more resorption at the anterior alveolar surface and chin than men. Statistical shape modeling effectively visualizes these patterns on a population level, bridging the gap between traditional aging research and current understanding.

Background: Despite increased adoption of virtual surgical planning (VSP) in various craniofacial indications, the incorporation of VSP/3DP into facial trauma care remains limited. Therefore, Expedited Preoperative Point of Care for Fracture Reduction to Normalized Anatomy and 3DP to Improve Surgical Outcomes (EPPOCRATIS) was introduced in 2021. This study evaluates our experience with EPPORATIS in craniomaxillofacial trauma over 10 years. Methods: A retrospective review of patients who underwent facial trauma repair between September 2014 and September 2024 was conducted. For each VSP/3DP case, a patient with similar facial trauma patterns, who was treated without VSP, was selected. Evaluation metrics included operative time, blood loss, length of stay, complication rates, and fracture reduction accuracy through 3D heatmap analyses. Operative metrics were normalized by implant (i.e., fracture plates and screws) count to account for fracture complexity. A value of p < 0.05 was deemed statistically significant. Results: The VSP group presented with more complex injuries and higher involvement of various surgical specialties (p < 0.5) and demonstrated longer operative times (p < 0.03). Although the difference was not statistically significant (p = 0.4), when adjusted for implant count, the VSP group had shorter operative times (median: 15.4 vs. 19.3 min/implant) and reduced blood loss compared to non-VSP cases (median: 3.4 mL/implant vs. 4.2 mL/implant). Complications, revision rates, and length of stay showed no significant differences. Conclusions: The use of VSP/3DP (EPPOCRATIS) in craniomaxillofacial trauma reconstruction demonstrated operative efficiency and accurate fracture reduction in complex cases. Further studies are needed to examine the feasibility and cost-effectiveness of point-of-care VSP/3DP in trauma centers.

BACKGROUND AND OBJECTIVES: A typical workflow for deep brain stimulation (DBS) surgery consists of head frame placement, followed by stereotactic computed tomography (CT) or MRI before surgical implantation of the hardware. At some institutions, this workflow is prolonged when the imaging scanner is located far away from the operating room, thereby increasing workflow times by the addition of transport times. Recently, the intraoperative O-arm has been shown to provide accurate image fusion with preoperative CT or MR imaging, suggesting the possibility of obtaining an intraoperative localization scan and postoperative confirmation. In this article, we aim to evaluate the compatibility of the stereotactic frame system with the intraoperative O-arm system regarding lead accuracy and surgical flow. METHODS: A total of 17 patients undergoing DBS surgery for movement disorders were evaluated. One patient underwent both the stereotactic CT and O-arm localization, while 16 patients underwent only intraoperative O-arm localization. Following lead placement, intraoperative O-arm imaging was obtained to evaluate the accuracy of the lead placement. Accuracy was defined as the error measured as the distance from the center of the planned trajectory to the cannula. RESULTS: Less than 0.1 mm difference was found between the O-arm imaging technique and CT image localization of the NaviNetics stereotactic head frame in DBS surgery. Of the 16 patients who underwent the intraoperative O-arm imaging alone, the targets included bilateral ventral intermediate nucleus (16 leads), bilateral globus pallidus internus (4 leads), and subthalamic nucleus (12 leads). The mean ± SD radial error in the probe's eye view was 0.71 ± 0.33 mm for n = 32 leads. No tract hemorrhage was observed. CONCLUSION: Intraoperative O-arm imaging can be used safely and effectively for stereotactic registration and lead placement confirmation with the stereotactic system in both awake and asleep DBS surgery.