British authors are the natural heirs to Charles Dickens and Graham Greene.) Nevertheless there are advantages to British readers in a British book especially, for instance, in the chapter on social paediatrics and occasionally as regards therapeutics. The new Forfar and Arneil is, like its predecessors, a good book. There are many new authors and much of it has been completely rewritten. Each chapter has a long list of references, many of them to further reading in books and important 'landmark' papers rather than to very recent original work, and that seems appropriate for a textbook of this nature. It is up to date, including references to topics such as oesophageal pH monitoring in gastrooesophageal reflux, the value of steroids in bacterial meningitis, a full account of the peroxisomal disorders, the significance of dystrophin in muscular dystrophy, the importance of vitamin A in reducing mortality in third world countries, and the use of sumatriptan in migraine and of vigabatrin and lamotrigine in epilepsy. Surprisingly, neither in this nor in Nelson's textbook could I find any reference to Angelman's syndrome. Some topics chosen at random such as Prader-Willi syndrome or haemolytic uraemic syndrome were discussed more fully in the British textbook. There is a surprising omission, however, and that is the chapter on disorders ofear, nose, and throat. Adenoids, glue ear or secretory otitis media, tonsillitis, and tonsillectomy have all been dropped from the index and deafness is dealt with in the chapter on neurology. If you look up 'tonsils' you will be referred to any entry which reads: 'Tonsils: size, presence of infection, exudate, pitting, peritonsillar swelling?'. The index entry 'ear, nose and throat problems' refers to a brief account of such problems in children with cleft palate. It is one of those crazy facts of modern life that the American book costs £60, the British £125. Who will read this new edition? I shall, and I suppose many other consultant paediatricians will also use it as a standard reference book. Undergraduate students will need a more compact text for their basic reading but should use it to look up specific topics, and doctors studying for the MRCP in paediatrics should make a systematic assault on it to provide them with a personal database to be supplemented by journals and monographs. As a textbook of British paediatrics it has no competition and it remains an excellent work of reference which must be available in all paediatric departments in Britain, but the absence of the chapter on ear, nose, and throat disorders must surely be an error and there is clearly a marketing problem for British publishers faced with American competition. If we want British textbooks, and I would not like to think that the time will be forced upon us when we shall have no choice, then it looks as if we must be prepared to pay for the privilege. DOUG ADDY Consultant paediatrician

https://adc.bmj.com/content/archdischild/68/3/435.2.full.pdf

Syndromes of the Head and Neck

PURPOSE
This descriptive analytical study assesses the cause, type, incidence, demographic, and treatment data of maxillofacial fractures managed at our medical center during a 5-year period and compares them with the existing body of literature on the subject.


PATIENTS AND METHODS
A 5-year retrospective clinical and epidemiologic study evaluated 237 patients treated for maxillofacial fractures from 1996 to 2001 at one medical center. There were 211 male patients (89%) and 26 (11%) female patients. The patients ranged in age from 3 to 73 years, with 59.0% (140 patients) in the 20- to 29-year age group. A number of parameters, including age, gender, cause of injury, site of injury, type of injury, treatment modalities, and complications, were evaluated. All maxillofacial injuries were assessed and treated by a single oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by appropriate consultant specialists.


RESULTS
There were 173 (72.9%) mandibular, 33 (13.9%) maxillary, 32 (13.5%) zygomatic, 57 (24.0%) zygomatico-orbital, 5 (2.1%) cranial, 5 (2.1%) nasal, and 4 (1.6%) frontal injuries. Car accidents caused 73 (30.8%), motorcycle accidents caused 55 (23.2%), altercations 23 (9.7%), sports 15 (6.3%), and warfare caused 23 (9.7%) of the maxillofacial injuries. Regarding distribution of mandibular fractures, 32% were seen in the condylar region, 29.3% in the symphyseal-parasymphyseal region, 20% in the angle region, 12.5% in the body, 3.1% in the ramus, 1.9% in the dentoalveolar, and 1.2% in the coronoid region. The distribution of maxillary fractures was Le Fort II in 18 (54.6%), Le Fort I in 8 (24.2%), Le Fort III in 4 (12.1%), and alveolar in 3 (9.1%). Of the 173 mandibular fractures, 56.9% were treated by closed reduction, 39.8% by open reduction, and 3.5% by observation only. Of 33 maxillary fractures, 54.6% were treated using closed reduction, 40.9% using open reduction, and 4.5% with observation only. Approximately 52.1% of the patients were treated under general anesthesia, and 47.9% were treated under local anesthesia and sedation. Postsurgical complications were recorded in 5% of patients. These complications included infection, asymmetry, and malocclusion. Overall mortality in this series was 0.84% (2 patients); mortality was caused by pulmonary infection.


CONCLUSION
The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from 1 country to another.

An assessment of maxillofacial fractures: a 5-year study of 237 patients an assessment of maxillofacial fractures: a 5-year study of 237 patients an assessment of maxillofacial fractures: a 5-year study of 237 patients

Classification of teeth in cone-beam CT using deep convolutional neural network

Objectives: Analysis of dental radiographs is an important part of the diagnostic process in daily clinical practice. Interpretation by an expert includes teeth detection and numbering. In this pro...

/pdf/tooth-detection-and-numbering-in-panoramic-radiographs-using-i7o8kt3y6j.pdf

Tooth detection and numbering in panoramic radiographs using convolutional neural networks.

A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities

BACKGROUND: This multicenter study assessed the demographics, prevalence, causes, types, treatment, and complications of maxillofacial (MF) fractures managed by MF surgeons nationwide. METHODS: This 5-year retrospective descriptive analytical chart study evaluated 8,818 patients treated for MF fractures from 2007 to 2012 at 11 medical centers. Parameters, including age, sex, cause of injury, site of injury, type of injury, fracture patterns, treatment modalities, and complications, were evaluated from patient charts and radiographs. Collected data were analyzed via t test or χ test using SPSS 20 (Chicago, IL). A p value of less than 0.05 was considered statistically significant. This retrospective chart study was exempt from institutional review board approval. RESULTS: There were 7,369 male patients (83.6%), 1,376 female patients (15.7%), and 73 patients (0.8%) of unknown sex (aged 6 months to 112 years); 39.54% (3,457 patients) were in the 21-year to 30-year age group (mean, 28.18 years). We found 5,737 mandibular fractures (65.1%); mandible fracture was the most common (p CONCLUSION: On the basis of our study, mandibular fractures, in males and resulting from road traffic accidents in the third decade of life, were significant findings. Although the prevalence of MF fractures, demographics, and causes vary from one country to another and awareness of these patterns can provide insight to prevention protocols, this study shows that, despite better law enforcement of traffic regulations, better roads, better automobiles, and the like, the pattern of MF fractures in Iran has not changed significantly during the past 10 years. LEVEL OF EVIDENCE: Epidemiologic study, level IV. Language: en

Pattern of maxillofacial fractures: a 5-year analysis of 8,818 patients.

Quantification of teeth is of clinical importance for various computer assisted procedures such as dental implant, orthodontic planning, face, jaw and cosmetic surgeries. In this regard, segmentation is a major step. In this paper, we propose a method for segmentation of teeth in volumetric computed tomography (CT) data using panoramic re-sampling of the dataset in the coronal view and variational level set. The proposed method consists of five steps as follows: first, we extract a mask in a CT images using Otsu thresholding. Second, the teeth are segmented from other bony tissues by utilizing anatomical knowledge of teeth in the jaws. Third, the proposed method is followed by estimating the arc of the upper and lower jaws and panoramic re-sampling of the dataset. Separation of upper and lower jaws and initial segmentation of teeth are performed by employing the horizontal and vertical projections of the panoramic dataset, respectively. Based the above mentioned procedures an initial mask for each tooth is obtained. Finally, we utilize the initial mask of teeth and apply a Variational level set to refine initial teeth boundaries to final contours. The proposed algorithm was evaluated in the presence of 30 multi-slice CT datasets including 3,600 images. Experimental results reveal the effectiveness of the proposed method. In the proposed algorithm, the variational level set technique was utilized to trace the contour of the teeth. In view of the fact that, this technique is based on the characteristic of the overall region of the teeth image, it is possible to extract a very smooth and accurate tooth contour using this technique. In the presence of the available datasets, the proposed technique was successful in teeth segmentation compared to previous techniques.

Segmentation of teeth in CT volumetric dataset by panoramic projection and variational level set

Aim: This study was designed to assess the prevalence, distribution, and patterns of injury among athletes engaged in combat sports and compare the prevalence, pattern, and types of oral and maxillofacial trauma in these athletes. Materials and Methods: A total of 120 male athletes engaged in four combat sports (boxing, taekwondo, kickboxing, and Muay Thai) who had sustained bodily trauma were studied; 95 subjects with at least one traumatic injury to the face requiring treatment were referred to us by the physician team. The type of injury (facial laceration, facial fractures, jaw dislocation, etc.), site of facial injury (jaw, nose, malar bone, teeth, etc.), dental injuries (tooth fracture, displacement, luxation, and avulsion), causative sport (boxing, taekwondo, kickboxing, and Muay Thai) as well as demographic data were recorded. Injuries were examined clinically and radiographically, and treated accordingly by a specialist. Treatment data and demographics were recorded for each subject. Recorded data were assessed, and c2 , ANOVA, and Kruskal-Wallis tests were used to statistically analyze and compare the data. Results: Of 120 subjects, 95 male subjects (79.2%), aged 18-25 years (avg. 20 years), had at least one traumatic injury to the face requiring medical treatment. These injuries included facial laceration, bone fractures (nose, mandible, and zygoma), dental injuries (displacement, luxation, fracture, and avulsion), and mandibular dislocation which were recorded in 83 (69.2%), 55 (45.1%), 53 (44.2%), and 8 (6.7%) cases respectively. Statistically significant differences were encountered among various injuries and the sports; kickboxing caused the most maxillofacial injuries and was identified as more injurious. Tooth fractures (59.7%) were the most common dental injuries, and the nose (84.7%) was the most frequently fractured facial bone. Lacerations were more common in Thai-boxers (93.3%). Injuries were significantly greater in professional rather than amateur athletes. Conclusion: In this study, prevalence of facial injuries from combat sports professionals was significantly high (roughly 80%), especially in kickboxing (in part due to use of less protective gear). Because the nose and teeth sustained the most injuries, they require more attention with regard to prevention. Kickboxing was the most injurious of these combat sports and caused the most significant number of maxillofacial trauma. More safety apparel and protective guards seem warranted in athletes of combat sports if facial injury is to be prevented.

Prevalence and patterns of combat sport related maxillofacial injuries

Rapid Automatic Segmentation and Visualization of Teeth in CT-Scan Data

Teeth arrangement is essential in face ergonomics and healthiness. In addition, they play key roles in forensic medicine. Various computer-assisted procedures for medical application in quantitative dentistry require automatic classification and numbering of teeth in dental images. In this paper, we propose a multi-stage technique to classify teeth in multi-slice CT (MSCT) images. The proposed algorithm consists of the following three stages: segmentation, feature extraction and classification. We segment the teeth by employing several techniques including Otsu thresholding, morphological operations, panoramic re-sampling and variational level set. In the feature extraction stage, we follow a multi-resolution approach utilizing wavelet-Fourier descriptor (WFD) together with a centroid distance signature. We compute the feature vector of each tooth by employing the slice associated with largest tooth tissues. The feature vectors are employed for classification in the third stage. We perform teeth classification by a conventional supervised classifier. We employ a feed- forward neural network classifier to discriminate different teeth from each other. The performance of the proposed method was evaluated in the presence of 30 different MSCT data sets including 804 teeth. We compare classification results of the WFD technique with Fourier descriptor (FD) and wavelet descriptor (WD) techniques. We also investigate the invariance properties of the WFD technique. Experimental results reveal the effectiveness of the proposed method. We provided an integrated solution for teeth classification in multi-slice CT datasets. In this regard, suggested segmentation technique was successful to separate teeth from each other. The employed WFD approach was successful to discriminate and numbering of the teeth in the presence of missing teeth. The solution is independent of anatomical information such as knowing the sequence of teeth and the location of each tooth in the jaw.

Gholamreza Shirani

Papers

Pattern of maxillofacial fractures: a 5-year analysis of 8,818 patients.

Segmentation of teeth in CT volumetric dataset by panoramic projection and variational level set

Prevalence and patterns of combat sport related maxillofacial injuries

Rapid Automatic Segmentation and Visualization of Teeth in CT-Scan Data

Classification and numbering of teeth in multi-slice CT images using wavelet-Fourier descriptor.