We present large scale facial model (LSFM)-a 3D Morphable Model (3DMM) automatically constructed from 9663 distinct facial identities. To the best of our knowledge LSFM is the largest-scale Morphable Model ever constructed, containing statistical information from a huge variety of the human population. To build such a large model we introduce a novel fully automated and robust Morphable Model construction pipeline, informed by an evaluation of state-of-the-art dense correspondence techniques. The dataset that LSFM is trained on includes rich demographic information about each subject, allowing for the construction of not only a global 3DMM model but also models tailored for specific age, gender or ethnicity groups. We utilize the proposed model to perform age classification from 3D shape alone and to reconstruct noisy out-of-sample data in the low-dimensional model space. Furthermore, we perform a systematic analysis of the constructed 3DMM models that showcases their quality and descriptive power. reveal that the proposed 3DMM achieves state-of-the-art results, outperforming existing models by a large margin. Finally, for the benefit of the research community, we make publicly available the source code of the proposed automatic 3DMM construction pipeline, as well as the constructed global 3DMM and a variety of bespoke models tailored by age, gender and ethnicity.

OBJECTIVEScaphocephaly secondary to sagittal craniosynostosis has been treated in recent years with spring-assisted cranioplasty, an innovative approach that leverages the use of metallic spring distractors to reshape the patient skull. In this study, a population of patients who had undergone spring cranioplasty for the correction of scaphocephaly at the Great Ormond Street Hospital for Children was retrospectively analyzed to systematically assess spring biomechanical performance and kinematics in relation to spring model, patient age, and outcomes over time.METHODSData from 60 patients (49 males, mean age at surgery 5.2 ± 0.9 months) who had received 2 springs for the treatment of isolated sagittal craniosynostosis were analyzed. The opening distance of the springs at the time of insertion and removal was retrieved from the surgical notes and, during the implantation period, from planar radiographs obtained at 1 day postoperatively and at the 3-week follow-up. The force exerted by the spring to the patient skull at each time point was derived after mechanical testing of each spring model—3 devices with the same geometry but different wire thicknesses. Changes in the cephalic index between preoperatively and the 3-week follow-up were recorded.RESULTSStiffer springs were implanted in older patients (p < 0.05) to achieve the same opening on-table as in younger patients, but this entailed significantly different—higher—forces exerted on the skull when combinations of stiffer springs were used (p < 0.001). After initial force differences between spring models, however, the devices all plateaued. Indeed, regardless of patient age or spring model, after 10 days from insertion, all the devices were open.CONCLUSIONSResults in this study provide biomechanical insights into spring-assisted cranioplasty and could help to improve spring design and follow-up strategy in the future.

Therapeutic, IV.

Both monobloc and in particular the facial bipartition distraction differentially advance the central part of the face more than the lateral areas. This bending of the face appears to have both cosmetic and functional advantages.

Background Spring-assisted cranioplasty has been proposed as an alternative to total calvarial remodelling for sagittal craniosynostosis. Advantages include its minimally invasive nature, reduced morbidity and hospital stay. Potential drawbacks include the need for a second procedure for removal and the lack of published long-term follow-up. We present a single institution experience of 100 consecutive cases using a novel spring design. Methods All patients treated at our institution between April 2010 and September 2014 were evaluated retrospectively. Patients with isolated non-syndromic sagittal craniosynostosis were included. Data were collected for operative time, anaesthetic time, hospital stay, transfusion requirement and complications in addition to cephalic index pre-operatively and at one day, three weeks and six months post-operatively. Results One hundred patients were included. Mean cephalic index was 68 pre-operatively, 71 at day 1 and 72 at 3 weeks and 6 months post-operatively. Nine patients required transfusion. Two patients developed a CSF leak requiring intervention. One patient required early removal of springs due to infection. One patient had a wound dehiscence over the spring and 1 patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodelling surgery. Conclusion Our modified spring design and protocol represents an effective strategy in the management of single-suture sagittal craniosynostosis with reduced total operative time and blood loss when compared to alternative treatment strategies. In patients referred within the first 6 months of birth this technique has become our procedure of choice. In a minority of cases especially in the older age groups further remodelling surgery is required

Priapism is a urological emergency; without prompt treatment the corpora cavernosa undergoes necrosis and fibrosis that may result in erectile dysfunction. Treatment initially involves conservative measures, such as corporeal aspiration and irrigation with saline or dilute phenylephrine. If this fails, embolization or surgical shunting is usually required. Hyperviscosity resulting from leukemia is a rare cause of priapism. We report a case of a 19-year-old man with an 18-hour history of priapism secondary to undiagnosed chronic myeloid leukaemia. We discuss the method of leukapheresis (mechanical white cell depletion) to reduce viscosity and achieve detumescence after failed aspiration.

No abstract

Therapeutic, IV.