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ObjectivesThe primary objective of this study was to use high-resolution micro-CT images to create accurate three-dimensional (3D) models of several intratemporal structures, and to compare several surgically important dimensions within the temporal bone. The secondary objective was to create a statistical shape model (SSM) of a dominant and non-dominant sigmoid sinus (SS) to provide a template for automated segmentation algorithms.MethodsA free image processing software, 3D Slicer, was utilized to create three-dimensional reconstructions of the SS, jugular bulb (JB), facial nerve (FN), and external auditory canal (EAC) from micro-CT scans. The models were used to compare several clinically important dimensions between the dominant and non-dominant SS. Anatomic variability of the SS was also analyzed using SSMs generated using the Statismo software framework.ResultsThree-dimensional models from 38 temporal bones were generated and analyzed. Right dominance was observed in 74% of the paired SSs. All distances were significantly shorter on the dominant side (p < 0.05), including: EAC – SS (dominant: 13.7 ± 3.4 mm; non-dominant: 15.3 ± 2.7 mm), FN – SS (dominant: 7.2 ± 1.8 mm; non-dominant: 8.1 ± 2.3 mm), 2nd genu FN – superior tip of JB (dominant: 8.7 ± 2.2 mm; non-dominant: 11.2 ± 2.6 mm), horizontal distance between the superior tip of JB – descending FN (dominant: 9.5 ± 2.3 mm; non-dominant: 13.2 ± 3.5 mm), and horizontal distance between the FN at the stylomastoid foramen – JB (dominant: 5.4 ± 2.2 mm; non-dominant: 7.7 ± 2.1). Analysis of the SSMs indicated that SS morphology is most variable at its junction with the transverse sinus, and least variable at the JB.ConclusionsThis is the first known study to investigate the anatomical variation and relationships of the SS using high resolution scans, 3D  models and statistical shape analysis. This analysis seeks to guide neurotological surgical approaches and provide a template for automated segmentation and surgical simulation.

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Objectives: There are numerous well-described benefits to breastfeeding to both infant and mother. Even in healthy children with an uncomplicated perinatal course, there may be significant struggles maintaining a breastfeeding relationship. Infants with a complicated clinical course have been shown to benefit even more from the provision of breastmilk, however they are seldom encouraged to feed directly at the breast. There are no reports of successful direct breastfeeding in an infant with a tracheostomy. Methods and Results: We present the case of a breastfeeding dyad including a trach-dependent infant with congenital idiopathic bilateral vocal fold immobility who successfully initiated and maintained an inclusive breastfeeding relationship. Conclusion: This case illustrates that successful direct breastfeeding can be achieved in an infant with a tracheostomy. If a patient is felt to be capable of oral feeding via bottle, there is no reason that there should not be a trial of direct feeding at the breast, for the benefit of both members of the breastfeeding dyad.

Background: Disruption in the medial longitudinal arch (MLA) of the foot can lead to pes cavus (high arched foot) or pes planus (low arched foot). The importance of the calcaneus in MLA structure can be inferred in the treatment of severe pes planus, where alteration of calcaneal length is performed if conservative treatments have failed. Purpose: To our knowledge, no previous study has investigated whether variations in calcaneal size can be correlated to MLA height. The purpose of this study was to compare calcaneal dimensions between pes cavus, normal MLA, and pes planus groups. Methods: Utilizing OsiriX software, several dimensions of 3D calcanei were compared between pes cavus, normal MLA, and pes planus subjects. Results: The pes cavus, normal MLA, and pes planus groups did not show any significant differences between group means for all calculated dimensions. Although not statistically significant, calcaneal length (p=0.140), talar articular surface width (p=0.228), and calcaneal tuberosity height (p=0.087) exhibited increasing size with increasing MLA height. This study should be repeated with a larger population to further verify this trend. Conclusion: There is no significant difference in these specific calcaneal dimensions between pes cavus, normal MLA, and pes planus groups. This study provides evidence that calcaneal lengthening procedures may be altering a normally sized calcaneus.