Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.

Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.

Objective:To investigate subalar change after rhinoplasty with costal cartilage.Methods:A retrospective study was performed on patients who received cartilaginous rhinoplasty at the Rhinoplasty Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences from May 2019 to August 2020. The facial three-dimensional(3D) and CT scanning data of young female cases was analyzed. Pre-operative and more than 6 months follow-up data was matched. The 3D facial coordinate system was established. Preoperative and postoperative location of the subnasale and the lateral point of nasal-facial junction, the angle between endocanthion-alare and coronal plane and the nasolabial angle were analyzed with paired samples t-test. The volume of subalar area was analyzed with one-sample t-test. Results:Eighteen female cases aged (27.30±4.41) years were enrolled in the study with (10.61±3.53) months follow-up. One case (5.6%) suffered from nostril asymmetry one month after the surgery. The subnasale moved forward from (74.30±1.97) mm to (77.67±2.37) mm [average difference (3.36±0.96) mm]. The lateral point of nasal-facial junction moved forward from (65.51±2.45) mm to (68.05±2.52) mm [average difference (2.53±1.50) mm]. Nasolabial angle was (88.79±11.21) degree preoperatively and (101.37±5.53) degree postoperatively [average difference (12.57±7.57) degree]. Angle between endocanthion-alare and coronal plane increased from (9.01±3.24) degree to (12.73±3.27) degree [average difference (3.72±2.22) degree]. The differences between pre- and post-operative data were statistically significant ( P<0.01). The volume of subalar area increased by (282.59±103.22) mm 3. The difference was statistically significant ( P<0.01). Conclusions:Rhinoplasty with costal cartilage could make subalar area move forward.

Objective:To investigate subalar change after rhinoplasty with costal cartilage.Methods:A retrospective study was performed on patients who received cartilaginous rhinoplasty at the Rhinoplasty Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences from May 2019 to August 2020. The facial three-dimensional(3D) and CT scanning data of young female cases was analyzed. Pre-operative and more than 6 months follow-up data was matched. The 3D facial coordinate system was established. Preoperative and postoperative location of the subnasale and the lateral point of nasal-facial junction, the angle between endocanthion-alare and coronal plane and the nasolabial angle were analyzed with paired samples t-test. The volume of subalar area was analyzed with one-sample t-test. Results:Eighteen female cases aged (27.30±4.41) years were enrolled in the study with (10.61±3.53) months follow-up. One case (5.6%) suffered from nostril asymmetry one month after the surgery. The subnasale moved forward from (74.30±1.97) mm to (77.67±2.37) mm [average difference (3.36±0.96) mm]. The lateral point of nasal-facial junction moved forward from (65.51±2.45) mm to (68.05±2.52) mm [average difference (2.53±1.50) mm]. Nasolabial angle was (88.79±11.21) degree preoperatively and (101.37±5.53) degree postoperatively [average difference (12.57±7.57) degree]. Angle between endocanthion-alare and coronal plane increased from (9.01±3.24) degree to (12.73±3.27) degree [average difference (3.72±2.22) degree]. The differences between pre- and post-operative data were statistically significant ( P<0.01). The volume of subalar area increased by (282.59±103.22) mm 3. The difference was statistically significant ( P<0.01). Conclusions:Rhinoplasty with costal cartilage could make subalar area move forward.

Objective:To explore the clinical effect of digital technology and positioning technology with three-dimensional printing template which were applied systematically in the treatment of craniosynostosis secondary to orbital hypertelorism.Methods:There were 4 cases of congenital premature closure of unilateral coronal suture secondary to orbital hypertelorism treated in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from June 2015 to August 2019, including 1 male and 3 females, aged from 3 to 8 years. The operation of fronto-orbital advancement and inverted U-shaped osteotomy were used to correct skull malformation and orbital widening simultaneously. Before the operation, surgical plan was designed by digital technology and three-dimensional cranial model and surgical template were printed. During the operation, template was used to guide osteotomy. After the operation, the outcome was evaluated by digital technology. Anterior cranial vault asymmetry index (ACVAI) and inter-orbital distance were calculated by measuring preoperative and postoperative cranial three-dimensional data. The color gradient map was made by ProPlan CMF 3.0 to determine whether the postoperative cranial flap and orbital position were the same as the preoperative design.Results:The 4 patients were successfully received the operation according to the preoperative digital designed plan. The template was highly matched and it did not damage the surrounding tissues during the operation. The duration of osteotomy was shortened to 1-2 hours. There were no complications such as cerebrospinal fluid leakage, infection, intracranial hematoma and eyeball injury. Postoperative follow-up was conducted from 4 months to 3 years. The cranial and orbital appearances of the 4 patients were significantly improved, with ACVAI decreased to less than 3.5% (-1.5%-3.0%) and the postoperative inter-orbital distance was reduced to the normal range (22-28 mm). The color gradient diagram showed that the postoperative effect was highly consistent with the preoperative surgical design.Conclusions:The application of digital technology and positioning technology with three-dimensional printing template systematically used in the treatment of complicated congenital craniosynostosis secondary to orbital hypertelorism can significantly improve the accuracy of osteotomy, reduce the risk of surgery, shorten the operation time, and obtain a more satisfactory appearance.

Objective:To explore the experience and clinical effect of endoscopic assisted resection of septal cartilage and ethmoid bone vertical plate in rhinoplasty.Methods:Twenty women with short noses underwent septal extension graft from February 2018 to September 2019. Endoscopic technique was utilized to harvest the septal cartilage and ethmoid vertical plate. During the operation, the average area of septal cartilage was 22 mm × 15 mm, the average area of ethmoid bone vertical plate was 26mm × 16mm, and the septum retained a 10 mm wide " L" sturt. The septal cartilage and the vertical plate of the ethmoid bone were used as the columella strut and the extension graft respectively to reconstruct the shape of the tip of the nose. Expanded polytetrafluoroethylene was implanted in the nasal dorsum to increase its height.Results:The patients were followed up for 3-12 months at an average of 9 months. 20 patients achieved straight back of nose, symmetrical arch of nose and no deviation of columella. The tip of nose is soft without rigidity. There was no exposure of prosthesis or perforation of nasal septum. There was significant differences in the distance between the root and tip of nose before and after operation ( P<0.05). 2 patients complained of olfactory hypoesthesia and recovered spontaneously after 4 months. 1 patient was not satisfied with the improvement of the nasal projection. There was no obstruction of nasal ventilation and other dysfunction after operation. Conclusions:Endoscopy can assist the operator to harvest the septal cartilage and ethmoid bone vertical plate safely and accurately. The extension of nasal septum prepared by the cartilage of nasal septum combined with the vertical plate of ethmoid bone can effectively increase the length of nose.

Objective:To explore the clinical effect of digital technology and positioning technology with three-dimensional printing template which were applied systematically in the treatment of craniosynostosis secondary to orbital hypertelorism.Methods:There were 4 cases of congenital premature closure of unilateral coronal suture secondary to orbital hypertelorism treated in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from June 2015 to August 2019, including 1 male and 3 females, aged from 3 to 8 years. The operation of fronto-orbital advancement and inverted U-shaped osteotomy were used to correct skull malformation and orbital widening simultaneously. Before the operation, surgical plan was designed by digital technology and three-dimensional cranial model and surgical template were printed. During the operation, template was used to guide osteotomy. After the operation, the outcome was evaluated by digital technology. Anterior cranial vault asymmetry index (ACVAI) and inter-orbital distance were calculated by measuring preoperative and postoperative cranial three-dimensional data. The color gradient map was made by ProPlan CMF 3.0 to determine whether the postoperative cranial flap and orbital position were the same as the preoperative design.Results:The 4 patients were successfully received the operation according to the preoperative digital designed plan. The template was highly matched and it did not damage the surrounding tissues during the operation. The duration of osteotomy was shortened to 1-2 hours. There were no complications such as cerebrospinal fluid leakage, infection, intracranial hematoma and eyeball injury. Postoperative follow-up was conducted from 4 months to 3 years. The cranial and orbital appearances of the 4 patients were significantly improved, with ACVAI decreased to less than 3.5% (-1.5%-3.0%) and the postoperative inter-orbital distance was reduced to the normal range (22-28 mm). The color gradient diagram showed that the postoperative effect was highly consistent with the preoperative surgical design.Conclusions:The application of digital technology and positioning technology with three-dimensional printing template systematically used in the treatment of complicated congenital craniosynostosis secondary to orbital hypertelorism can significantly improve the accuracy of osteotomy, reduce the risk of surgery, shorten the operation time, and obtain a more satisfactory appearance.

Objective:To explore the experience and clinical effect of endoscopic assisted resection of septal cartilage and ethmoid bone vertical plate in rhinoplasty.Methods:Twenty women with short noses underwent septal extension graft from February 2018 to September 2019. Endoscopic technique was utilized to harvest the septal cartilage and ethmoid vertical plate. During the operation, the average area of septal cartilage was 22 mm × 15 mm, the average area of ethmoid bone vertical plate was 26mm × 16mm, and the septum retained a 10 mm wide " L" sturt. The septal cartilage and the vertical plate of the ethmoid bone were used as the columella strut and the extension graft respectively to reconstruct the shape of the tip of the nose. Expanded polytetrafluoroethylene was implanted in the nasal dorsum to increase its height.Results:The patients were followed up for 3-12 months at an average of 9 months. 20 patients achieved straight back of nose, symmetrical arch of nose and no deviation of columella. The tip of nose is soft without rigidity. There was no exposure of prosthesis or perforation of nasal septum. There was significant differences in the distance between the root and tip of nose before and after operation ( P<0.05). 2 patients complained of olfactory hypoesthesia and recovered spontaneously after 4 months. 1 patient was not satisfied with the improvement of the nasal projection. There was no obstruction of nasal ventilation and other dysfunction after operation. Conclusions:Endoscopy can assist the operator to harvest the septal cartilage and ethmoid bone vertical plate safely and accurately. The extension of nasal septum prepared by the cartilage of nasal septum combined with the vertical plate of ethmoid bone can effectively increase the length of nose.

Objective To measure the change of facial volume maintenance rate after autologous fat grafted for repaired progressive facial hemiatrophy by using three-dimensional digital technology.Methods 3D scanner was used to acquire facial data in 10 patients with progressive facial hemiatrophy before operation;Mimics 17.0 software was used to reconstruce patients' facial 3D model and to calculate the volume of facial tissue defect;autologous fat was grafted to repair facial deformity.The facial volume maintenance rate was calculated in all the patients 3 months and 6 months after operation.Results We had performed facial 3D data acquisition and facial repaired with autologus fat grafted in 10 patients;patients' facial morphology was improved.The mean facial volume maintenance rate was (35.80±3.44)％ in 3 months and (27.82±3.80)％ 6 months after surgery.Conclusions The mean facial volume maintenance rate in postoperative 3 months is inferior to that in 6 months in single autologous fat grafted for repairing progressive facial hemiatrophy.

Objective: To establish finite element models of skull, fronto-orbital advancement and fronto-orbital distraction osteogenesis of craniosynostosis, to analyze the mechanical characteristics of skull base and fronto-orbital operation area, so as to guide the later application of tractors. Methods: One 6-year-old male patient with unilateral coronal synostosis was enrolled in October 2015. Three-dimensional (3D) computed tomography (CT) scan of skull was performed. DICOM data was imported into Mimics 17.0 for contour extraction and cranial 3D reconstruction. The skull model was processed by Mimics, Geomagic Studio 12.0, Hypermesh 12.0 and other software to establish a three-dimensional finite element model. The unilateral and bilateral fronto-orbital anterior osteotomy models were simulated respectively. The mechanical analysis was performed at point A in forehead area and point B in temporal area. Three different groups of traction forces were loaded: (1) 50 Newton for point A, 50 Newton for point B; (2) 80 Newton for point A and 50 Newton for point B; (3) 100 Newton for point A and 50 Newton for point B, to obtain the optimized traction force. Results: Stress analysis was performed on established cranial finite element model, as well as unilateral and bilateral fronto-orbital advancement procedures. The stress distribution of the anterior and middle cranial fossae was found to be concentrated. After unilateral fronto-orbital advancement, the stress of anterior cranial fossa, especially the affected side, was decreased. The stress on both side in anterior cranial fossa was decreased after bilateral fronto-orbital advancement. After force was applied to point A and point B, the optimum deviation result at supraorbital notch point, midpoint of supraorbital margin, frontal temporal point and frontal zygomatic suture point in 3D (Deviation result of X value: -29.4%, -20.5%, -8.6%, -9.3%; Deviation result of Y value: 20.9%, 31.5%, 73.0%, 539.4%; Deviation result of Z value: 4.4%, 1.9%, 0.1%, 11.8%) demonstrated the application of traction force can inwardly, downwardly and forwardly move the bone flap. The optimized traction was 80 Newton at point A and 50 Newton at point B by preliminary assessment. Conclusions The finite element analysis of the fronto-orbital advancement can be used for more accurate preoperative simulation, to clarify the influence of fronto-orbital advancement on craniofacial morphology and development, as well as skull base. It also facilitates surgical decision and predicts the postoperative distraction vectors.