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PubMed1997

Magnetic resonance renography: optimisation of pulse sequence parameters and Gd-DTPA dose, and comparison with radionuclide renography.

The aim of this study was to assess the feasibility of magnetic resonance renography (MRR) using gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) in comparison with conventional radionuclide renography (RR) using technetium-99m-DTPA (99mTc-DTPA). MRR has many advantages over RR, including lack of ionising radiation, increased spatial resolution, and visible background anatomy. By optimising the pulse sequence, we developed an MRR protocol in which signal intensity is linear with Gd-DTPA concentration over a clinically relevant range. Twenty-nine patients and a volunteer were studied using this protocol. Magnetic resonance renography was performed using three different doses of Gd-DTPA: 0.1 mmol kg-1 (n = 13), 0.05 mmol kg-1 (n = 7), and 0.025 mmol kg-1 (n = 9). Each patient was also assessed using radionuclide renography. The resulting renograms were assessed in terms of time to peak signal intensity, signal decrease after peak, and kidney function ratios calculated from both the areas underneath and the slopes of the uptake curves. We have shown that the MR renograms obtained using low dose Gd-DTPA correlate best with the radionuclide renograms. Remaining discrepancies may be explained by variations in the injection procedures (hence in arterial input functions) and the limited coverage of the three MRR slices compared to the whole body projection of RR. Furthermore, at high local concentrations, signal becomes independent of T1 and is dominated by T2.

Adult↗

PubMed2006

[Design of geometric models of the removable partial denture framework].

PURPOSE: The aim of this study was to introduce a method on computer aided design (CAD) of removable partial denture(RPD) framework based on domestic CAD/CAM software system, which contributes to the further research to develop the domestic software system applied in restorative dentistry. METHODS: Point cloud data of a partially edentulous cast, a mandibular Kennedy Class II modification 2 arch, was captured by an optical scanning system with projective grating and high-resolution digital camera. Using domestic CAD/CAM software system, the above point cloud data was reduced, digital surveying line and inserting path were determined. In terms of the principle of clinical design, the tissue surfaces and polishing surfaces of every component of RPD were built such as clasp, rest, lingual bar, and mesh construction, et al. As well as the characteristic structures of the framework, including the half-pear shaped cross section of lingual bar, the internal and external finish lines, the tissue stop at the tissue surface of mesh construction and so on, were fabricated on the base of reduced data model. 3-D surface model of the RPD framework was created. RESULTS: Geometric model of the RPD framework was fabricated successfully, which took on good fitting, high visibility and editing conveniently. And the data converted to STL file format that could be read by any other CAD/CAM software system and was in preparation for subsequent computer aided manufacture (CAM) of RPD framework. CONCLUSIONS: It is suggested that this method based on domestic software in CAD of RPD framework be feasible.

Computer-Aided Design↗

PubMed1987

Community involvement in health promotion: progress or panacea?

There are many arenas within which health promotion may be located. This paper addresses the issues involved in the development of health promotion in one such arena: the community health movement. This movement is complex and dynamic. When reference is made to non-statutory health action, or to community involvement in health, this complexity may not be fully appreciated. There is a tendency for the range of activity to be reduced to its most "visible" form: self-help activity. However, there is more to the community health movement than this. A typology is offered here in which three levels of community-based activity in Britain are identified. These are referred to as self-help groups, community health groups and community development health projects. The breadth and range of this activity reflects the inability of formalized health care to tackle many of the underlying causes of ill-health. Each type of community health activity exists as a declaration of this failure, but some forms of activity may be welcomed by the health professions whilst others may not. In particular the numerically small community development health projects offer a significant challenge to formal health care because they seek to encourage collective health activity by those who are least in control of their own health. It is within the context of developing strategies for health promotion that community health action is most relevant. National and local strategy documents suggest that community involvement is essential for the successful promotion of health. Fully comprehensive participation by community groups signifies a major shift in our perceptions of health and health care. An appreciation of the existing range of health action in communities is an important starting point for medical health professionals engaged in this task.

Community Health Services↗

PubMed2000

How constant anatomically is the tendon of Todaro as a marker for the triangle of Koch?

INTRODUCTION: Although well recognized by anatomists as a border of the triangle of Koch demarcating the location of the AV node, the tendon of Todaro is not visible in the operating room or in the catheterization laboratory. Instead, clinicians use as surrogate a projected line between the eustachian valve and the central fibrous body. The constancy of the tendon of Todaro within this border remains to be determined. MATERIALS AND RESULTS: We reexamined serial histologic sections from 25 adults and 50 infants and gross dissections in four normal hearts. The tendon of Todaro was identified in all cases and traced to the central fibrous body in all but one case. It tended to be thicker in the hearts of infants cases (0.2 to 0.8 mm vs 0.1 to 0.6 mm). The tendon and the hinge-line of the septal leaflet of the tricuspid valve were consistent as landmarks for location of the compact AV node in all the cases studied by histology. Gross dissections traced the tendon to the free edge of the eustachian valve. CONCLUSION: The tendon of Todaro is present in hearts obtained from both adults and infants. It, or its surrogate, is a reliable border for the triangle of Koch and serves as a landmark to location of the atrial components of the AV conduction axis.

Adolescent↗

PubMed1997

Visible and ultraviolet-B ocular-ambient exposure ratios for a general population. Salisbury Eye Evaluation Project Team.

PURPOSE: To estimate the numerical value of the ocular-ambient exposure ratio (OAER) (ratio of the facial exposure to that on a horizontal plane) as a function of wavelength band, season, and job category and to establish the effect of various modifiers, such as geography and the use of hats, for use in general population studies. METHODS: Two hundred sixty-four persons within several job categories representing the jobs in our Salisbury, Maryland, population were instrumented with ultraviolet-B (UVB) and visible band sensors for 1 complete day. Studies were done over all four seasons, both with and without hats. RESULTS: OAERs in the UVB wavelength band generally are higher than in the visible (13% versus 6%), display no significant variation with job category, show a seasonal effect (highest in the winter-spring [18%], lowest in the summer [10%], and intermediate in the fall [14%]), and are reduced 34% by the use of hats. In the visible wavelength band, OAERs are affected weakly by job function, although this variation is not significant, display a seasonal effect with three seasons as in the UVB, and are not affected significantly by the use of hats. In neither the UVB nor the visible portions of the spectrum did the authors find an effect on the OAER due to photophobia or eye color. CONCLUSIONS: With the authors' exposure model, the authors have at their disposal a valuable tool for exploring the relation between UVB, UVA, and visible radiation and a number of age-related eye diseases.

Environmental Exposure↗

PubMed2006

Patient safety in hospital acute care units.

The most visible threats to patient safety associated with nursing care occur on hospital inpatient units. Patient safety research is a new phenomenon, but it builds on the knowledge provided by quality-of-care research done previously. The purpose of this chapter is to describe the current state of the science in the area of nurse staffing and patient safety. The results of research studies published since the last round of reviews (1996-2005) are described by level of analysis, measures of nurse staffing and patient outcomes. Although research linking nurse staffing to the quality of patient care has increased markedly since 1996, the results of recent research projects do not yet provide a thorough and consistent foundation for producing solutions to the crisis in hospital nursing care. The inconsistencies are largely due to differing units of analysis (hospital, patient, care unit), variability in measures of nurse staffing, the variety of quality indicators chosen, the difficulty finding accurate measures of these indicators, and the difficulty creating risk-adjustment strategies for the indicators most sensitive to nursing care. Nursing administration and policy most urgently need research conducted with standardized data collected at the patient care unit level.

Accidental Falls↗

PubMed2002

The pursuit of Leonardo's constraint.

Leonardo da Vinci (1452-1519) identified two stimulus situations that cannot be painted faithfully on a canvas: (a) when two objects are located in the same direction with respect to the painter's head, and (b) when parts of a surface are visible to one eye, but occluded from the other eye. He analysed these situations in terms of rays being emitted from the two eyes and, aside from the origin of the rays, the projective geometry he used was correct. His analyses showed that what can be seen from two vantage points cannot be represented on a canvas, because a 'correct' painting must be created from a single 'station point'. He was struck by the consequence of this fact that the depth seen on a canvas cannot match that of viewing the scene with two eyes. Subsequent visual scientists focused on Leonardo's observation about the lack of vivid depth in a picture. We argue that a complete understanding of what we see in the two stimulus situations requires consideration of visual direction in addition to visual depth. More specifically, we argue that the visual directions of the two objects, (a) above, and the visual direction of the monocular areas, (b) above, are dependent upon the constraint that two opaque objects cannot be represented in the same direction. Demonstrations that readers can perform, and that support this argument, are provided on the Perception website at http://www.perceptionweb.com/perc0102/ono.html.

Depth Perception↗

PubMed1995

Ultrasonographic examination of wound tracts.

OBJECTIVE: To determine if ultrasonography is useful in evaluating penetrating injuries of the trunk to assess whether violation of the peritoneum or pleura has occurred. METHODS: The study group was 29 patients who suffered gunshot (n = 17), stab (n = 10), or shotgun (n = 2) wounds. The abdomen was at risk in 21 injuries, the thorax in eight. The results of physical examination and plain x-rays suggested the pleura and or peritoneum might be intact in all patients. Using a 7-MHz transducer, wound tract(s) were images, looking for the presence of soft-tissue air and/or echolucent areas consistent with soft-tissue blood. Injuries were deemed extraperitoneal or extrapleural if (1) the entire tract was visualized; (2) it appeared superficial to the deepest fascial structure in that area; and (3) in shotgun injuries, all visible pellets on x-ray films were identified by ultrasound in the abdominal wall. RESULTS: Evidence of penetration occurred in four abdominal wounds and one thoracic wound. These were confirmed by operation in the abdominal cases and by subsequent chest x-ray examination in the one thoracic wound. The diagnosis of nonpenetration was confirmed in all the remainder by serial benign abdominal examination (n = 15), chest x-ray examination (n = 8), and laparoscopy (n = 1). Positive and negative predictive accuracy were thus 100% in this pilot series. CONCLUSIONS: Ultrasonographic exploration of penetrating truncal injuries is feasible and accurate. Ultrasonographic wound exploration may serve as a noninvasive and safe replacement for diagnostic laparoscopy, conventional local wound exploration, peritoneal lavage, and 6-hour chest x-rays (repeated chest x-rays taken 6 hours after initial chest x-ray examination). If used as part of the initial physical examination, cost-effectiveness can also be realized.

Humans↗

PubMed2000

Asthma and the home environment of low-income urban children: preliminary findings from the Seattle-King County healthy homes project.

OBJECTIVES: Childhood asthma is a growing public health concern in low-income urban communities. Indoor exposure to asthma triggers has emerged as an important cause of asthma exacerbations. We describe indoor environmental conditions related to asthma triggers among a low-income urban population in Seattle/King County, Washington, as well as caregiver knowledge and resources related to control of these triggers. METHODS: Data are obtained from in-person, structured, closed-end interviews with the caretakers of children aged 4-12 years with persistent asthma living in households with incomes less than 200% of poverty. Additional information is collected during a home inspection. The children and their caregivers are participants in the ongoing Seattle-King County Healthy Homes Project, a randomized controlled trial of an intervention to empower low-income families to reduce exposure to indoor asthma triggers. We report findings on the conditions of the homes prior to this intervention among the first 112 enrolled households. RESULTS: A smoker was present in 37.5% of homes. Mold was visible in 26.8% of homes, water damage was present in 18.6% of homes, and damp conditions occurred in 64.8% of households, while 39.6% of caregivers were aware that excessive moisture can increase exposures to allergens. Dust-trapping reservoirs were common; 76.8% of children's bedrooms had carpeting. Cockroach infestation in the past 3 months was reported by 23.4% of caregivers, while 57.1% were unaware of the association of roaches and asthma. Only 19.8% of the children had allergy-control mattress covers. CONCLUSIONS: Many low-income urban children with asthma in King County live in indoor environments that place them at substantial risk of ongoing exposure to asthma triggers. Substandard housing and lack of resources often underlie these exposures. Initiatives involving health educators, outreach workers, medical providers, health care insurers, housing agencies, and elected officials are needed to reduce these exposures.

Asthma↗

PubMed2006

Deep-inspiration breath-hold kilovoltage cone-beam CT for setup of stereotactic body radiation therapy for lung tumors: initial experience.

We report our initial experience with deep-inspiration breath-hold (DIBH) cone-beam CT (CBCT) on the treatment table, using the kilovoltage imager integrated into our linear accelerator, for setting up patients for DIBH stereotactic body radiation therapy (SBRT) for lung tumors. Nine patients with non-small cell lung cancer (seven stage I), were given 60Gy in three fractions. All nine patients could perform a DIBH for 35s. For each patient we used a diagnostic reference CT volume image acquired during a DIBH to design an SBRT plan consisting of 7-10 noncoplanar conformal beams. Four patients were setup by registering DIBH kilovoltage projection radiographs or megavoltage portal images on the treatment table to digitally reconstructed radiographs from the reference CT. Each of the last 14 fractions out of a total of 27 was setup by acquiring a CBCT volume image on the treatment table in three breath-holds. The CBCT and reference CT volume images were directly registered and the shift was calculated from the registration. The CBCT volume images contained excellent detail on soft tissue and bony anatomy for matching to the reference CT. Most importantly, the tumor was always clearly visible in the CBCT images, even when it was difficult or impossible to see in the radiographs or portal images. The accuracy of the CBCT method was confirmed by DIBH megavoltage portal imaging and each treatment beam was delivered during a DIBH. CBCT acquisition typically required five more minutes than radiograph acquisition but the overall setup time was often shorter using CBCT because repeat imaging was minimized. We conclude that for setting up SBRT treatments of lung tumors, DIBH CBCT is feasible, fast and may result in less variation among observers than using bony anatomy in orthogonal radiographs.

Aged↗

PubMed2005

Current and emerging concepts in muscle tension dysphonia: a 30-month review.

UNLABELLED: The modern theory of hoarseness is that there are multifactorial etiologies contributing to the voice problem. The hypothesis of this study is that muscle tension dysphonia is multifactorial with various contributing etiologies. METHODS: This project is a retrospective chart review of all patients seen in the Voice Speech and Language Service and Swallowing Center at our institution with a diagnosis of muscle tension (functional hypertensive) dysphonia over a 30-month period. A literature search and review is also performed regarding current and emerging concepts of muscle tension dysphonia. RESULTS: One hundred fifty subjects were identified (60% female, 40% male, with a mean age of 42.3 years). Significant factors in patient history believed to contribute to abnormal voice production were gastroesophageal reflux in 49%, high stress levels in 18%, excessive amounts of voice use in 63%, and excessive loudness demands on voice use in 23%. Otolaryngologic evaluation was performed in 82% of patients, in whom lesions, significant vocal fold edema, or paralysis/paresis was identified in 52.3%. Speech pathology assessment revealed poor breath support, inappropriately low pitch, and visible cervical neck tension in the majority of patients. Inappropriate intensity was observed in 23.3% of patients. This set of multiple contributing factors is discussed in the context of current and emerging understanding of muscle tension dysphonia. CONCLUSIONS: Results confirm multifactorial etiologies contributing to hoarseness in the patients identified with muscle tension dysphonia. An interdisciplinary approach to treating all contributing factors portends the best prognosis.

Adult↗

PubMed1996

[MR-Cholangiopancreatography as a single-shot projection: techniques and results of 200 examinations].

PURPOSE: Evaluation of utility and value of a selective projection technique for bile and pancreatic ducts in MRI. MATERIAL AND METHODS: 200 patient examinations of the pancreaticobiliary duct system using a turbo-SE pulse sequence in "single-shot" technique were evaluated in retrospect concerning anatomic display and diagnostic accuracy compared to surgery, ERCP, i.v. cholangiography, ultrasound and clinical course. RESULTS: Non-dilated ducts allowed visualisation of gallbladders in 78%, common bile ducts in 97%, cystic ducts in 80%, intrahepatic main ducts in 71% and pancreatic main ducts in 69%. When dilatation was present, all common bile, intrahepatic main and pancreatic ducts were visible. Display of cystic ducts and gallbladders with a detection rate of 69 and 85%, respectively, did not improve. Sensitivities for diagnosing papillary stenoses (n = 6), pancreatic ductal stenoses and dilatation (n = 13), compressions and dilatations of the biliary tree (n = 33) as well as for one choledochal cyst were 100%. Choledocholithiasis could correctly be predicted in 11/15 cases (73%), cholecystolithiasis in 71/120 cases (59%). CONCLUSION: "Single-shot" MR-cholangiopancreatography is a fast and non-invasive modality which can replace i.v. cholangiography and restrict the indication for ERCP to therapeutic indications and problem cases.

Adult↗

PubMed1989

[Value of cine magnetic resonance imaging in the diagnosis and quantification of valvular regurgitation. Comparison with angiography and Doppler echocardiography].

Thirty-three patients presenting with regurgitation of the mitral valve (19 cases), tricuspid valve (14 cases) or aortic valve (11 cases) documented by angiography (n = 20) and/or doppler-echocardiography (n = 28) were examined by cine-MRI in order to test this method in valvular regurgitation. Sixteen ECG-synchronized cine-MRI images were acquired by the GRASS technique every 40 ms on appropriate projections, with a resistive 0.28 Tesla Bruker magnet. The semiology of normal and pathological blood flow images at cine-MRI is described. Valvular regurgitations present as "signal void" jets the chronology and spatial extension of which depend on the severity of the lesion. The differential diagnosis with physiological flows is discussed. The diagnostic sensitivity of the method was 29/29 when compared with angiography and 29/33 when compared with doppler-echocardiography (2 cases of 1/4 mitral regurgitation and 2 cases 1/4 tricuspid regurgitation were not visible at cine-MRI). The specificity of this method, as can be judged from 104 patients explored, also seems to be satisfactory. The severity of regurgitation was graded from 1 to 4 with the three methods, on the basis of strict criteria. The differences in grade evaluation exceeded +/- 1 point in only one case of mitral regurgitation which was greatly underestimated by the doppler method as compared with angiography and cine-MRI. Thus, cine-MRI is a reliable method to evaluate valvular regurgitations and their severity. It solves the practical problem raised by non-echogenic patients when catheterization is to be postponed or avoided.

Adult↗

PubMedDate not supplied

Rejuvenation of the aging lip with an injectable acellular dermal graft (Cymetra).

OBJECTIVE: To evaluate the effects of Cymetra (micronized AlloDerm tissue) in rejuvenating the aging and atrophic lip. PATIENTS: Forty-four patients aged 32 to 80 years who reported age-related changes in the size and contour of the upper lip. METHODS: Patients were randomized to treatment with either Cymetra or glutaraldehyde cross-linked bovine collagen (Zyplast). Standardized photographs of each subject were taken before and after treatment initially and 3, 6, 9, and 12 months after initial treatment. Patients were monitored for signs of hypersensitivity, infection, and inflammation. MAIN OUTCOME MEASURES: Digital photographs were analyzed for changes in the nasolabial angle, percentage of the total lip accounted for by the exposed red lip in the midline and on the lateral view, the visible red upper and lower lip surface areas, and the anterior projection of the upper and lower lips. RESULTS: All patients tolerated treatment well without any significant local or systemic complications. Nineteen patients were treated with Cymetra and 25 with Zyplast. Cymetra-treated patients were more likely than Zyplast-treated patients at 12 months (3 months after the previous treatment) to have increased the percentage of red lip in the midline (84.6% vs 38.9%; P =.01), the vermilion height in the upper lip midline (84.6% vs 38.9%; P =.01), and the exposed red lower lip on the lateral view (69.2% vs 33.3%; P =.048) by at least 20%; increased the lower lip projection by 0.5 mm or more (69.2% vs 27.8%; P =.02); and decreased the nasolabial angle by at least 10 degrees (46.2% vs 16.7%; P =.07). CONCLUSIONS: Cymetra is a suspension of particulate dermal matrix that seems to increase the upper lip bulk, vermilion, and lower lip projection after a threshold of Cymetra has been administered. There are few differences in any measured long-term (3 months after treatment) variables until the 12-month visit, when there were statistically significantly more Cymetra-treated patients with improved lip aesthetics than those treated with Zyplast. With repeated treatments, Cymetra seems to accumulate, producing a long-term effect superior to Zyplast in many patients.

Adult↗

PubMed1981

[Institutional care of severely handicapped - how does it happen? - or: can the patient's career be influenced?].

The project "Analysis of the placement of handicapped in institutions from a social point of view (example: multiple sclerosis); has the objectives to improve knowledge about the situation of institutionalized MS-patients and to analyse the patient's way towards institutionalization. As far as this way is concerned, numerous examples show that the evolution of social factors in a wider sense is at least as important as the evolution of the medical factors. With regard to these social factors, the problem solving processes both of the patients and of their aides, professionals or not, are of primary importance together with the problem of being in control of the situation. Repression of the illness and uncertainty about the future are both barriers towards the search for new aims of life. Often, help is asked for in a moment when a great number of possible solutions for the problem are not anymore feasible. Furthermore, the "unique" patient is confronted with the well-tested problem solving process of the aide and thus, his own initiative is reduced and his dependency increased. These mechanisms do also exist within an institution where they have a major impact upon quality of life and influence it much more than the visible structure of the institution, e.g. buildings and equipments.

Community Health Services↗

PubMed2001

Oral health of patients with hepatitis C virus infection: a pilot study.

OBJECTIVES: This study examined the oral health of a cohort of hepatitis C virus (HCV) patients. In particular, the prevalence of lichen planus and xerostomia were determined. Experiences of discrimination against HCV-infected patients by their dentists were also recorded. METHODS: Forty patients infected with HCV, who were not undergoing anti-viral treatment, were examined. Patient information collected included demographic details together with patients' perception of their oral health and access to dental care since being diagnosed with hepatitis C. Both extra-oral and intra-oral examinations were conducted. Teeth present and visible caries were recorded, periodontal condition was measured using a Community Periodontal Index of Treatment Need (CPITN) probe and denture fit and hygiene were assessed where appropriate. The soft tissues were examined and lichen planus diagnosed clinically. Salivary flow rates were estimated by the Salivette system. RESULTS: The oral health of this cohort was poor. Eight patients had clinical evidence of oral lichen planus (OLP), although this was not confirmed histologically. The salivary flow rates were significantly lower (P < 0.001) than in previously reported healthy controls. Of the 15 (37.5%) regular dental attenders, two had encountered problems accessing dental care. CONCLUSIONS: Chronic hepatitis C patients have significant oral health needs. More effective oral health education is required for both HCV-infected patients and their carers, including dental practitioners.

Adult↗

PubMedDate not supplied

Polypoidal choroidal vasculopathy.

Polypoidal choroidal vasculopathy was first described as a peculiar hemorrhagic disorder of the macula, characterized by recurrent sub-retinal and sub-retinal pigment epithelium bleeding in middle aged black women. The use of indocyanine green angiography and subsequently of optical coherent tomography has widened our ability to study and understand the pathophysiology of this disorder. The primary abnormality involves the choroidal circulation, and the characteristic lesion is an inner choroidal vascular network of vessels ending in an aneurysmal bulge or outward projection, visible clinically as a reddish orange, spheroid, polyp-like structure. We have also recognized that individuals of African-American and Asian descents are more at risk for developing polypoidal choroidal vasculopathy as the disorder seems to preferentially affect pigmented individuals. However, it has been shown that while that still holds true, patients of other racial backgrounds may be afflicted. Particularly, polypoidal choroidal vasculopathy has been found to be present in about 8-13% of white patients with clinical appearance of exudative age-related macular degeneration. Polypoidal choroidal vasculopathy has also been reported in Irish, French, German, and Italian patients. The natural course of the disease often follows a remitting-relapsing course, and clinically, it is associated with chronic, multiple, recurrent serosanguineous detachments of the retinal pigment epithelium and neurosensory retina with long-term preservation of good vision. Photodynamic treatment appears to be a promising alternative to conventional laser therapy, for the treatment of polypoidal choroidal vasculopathy. In conclusion, polypoidal choroidal vasculopathy seems to be a distinct clinical entity that should be differentiated from other types of choroidal neovascularization associated with age-related macular degeneration and other known choroidal degenerative, inflammatory, and ischemic disorders.

Choroid↗

PubMed1984

Diagnosis and treatment planning of skeletal asymmetry with the submental-vertical radiograph.

The purpose of this study was to assess the reproducibility of landmarks visible in the submental-vertical radiographic projection. Ten subjects with at least a 2 mm apical base discrepancy as diagnosed by means of a posteroanterior headfilm were selected. Mean tracing and measurement error was found to be less than 1 mm for all landmarks. A system of patient orientation and radiographic technique is presented. The radiographs were made at 90 kVp, 15 mA, 1 second exposure, using Kodak Lanex X-D film with a speed of 600. A system of cephalometric analysis is presented for the assessment of skeletal asymmetry in the horizontal plane. This system of analysis uses landmarks within the cranial base, maxilla, and mandible to construct reference lines with which to assess asymmetry. These reference systems allow the assessment of asymmetry within each component part of the craniofacial complex as well as the relative relationship of these parts to one another. Examples are presented to demonstrate the use of this system in assessing skeletal asymmetry. These examples show how this system of analysis can be incorporated into the data base for a particular patient and how it can be useful in making treatment decisions for patients with skeletal asymmetries. This method lends itself to future incorporation into a three-dimensional computerized cephalometric analysis.

Adult↗