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 Gwen R.J. Swennen
Editor

3D Virtual Treatment
Planning of
Orthognathic Surgery

A Step-by-Step Approach for

Orthodontists and Surgeons

123
3D Virtual Treatment Planning of Orthognathic Surgery
Gwen R.J. Swennen
Editor

3D Virtual
Treatment Planning
of Orthognathic
Surgery
A Step-by-Step Approach for Orthodontists
and Surgeons

With Contributions by Martin Gaboury

Editor
Gwen R.J. Swennen
Division of Maxillofacial Surgery and Facial Plastic Surgery
Department of Surgery, General Hospital St-Jan Bruges-Ostend, Belgium
Bruges Cleft and Craniofacial Centre, Bruges, Belgium
Private Practice in Facial Cosmetic Surgery, Clinic Tilleghem, Bruges, Belgium
Associate Professor, Department of Oral and Maxillofacial Surgery
Hannover Medical School, Hannover, Germany
Affiliate Professor, Department of Oral and Maxillofacial Surgery
University of Catalunya, Barcelona, Spain

ISBN 978-3-662-47388-7 ISBN 978-3-662-47389-4 (eBook)

DOI 10.1007/978-3-662-47389-4
Library of Congress Control Number: 2016957321

© Springer-Verlag Berlin Heidelberg 2017

This work is subject to copyright. All rights are reserved by the Publisher, whether the
whole or part of the material is concerned, specifically the rights of translation, reprinting,
reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other
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The use of general descriptive names, registered names, trademarks, service marks, etc. in
this publication does not imply, even in the absence of a specific statement, that such
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The publisher, the authors and the editors are safe to assume that the advice and
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Neither the publisher nor the authors or the editors give a warranty, express or implied,
with respect to the material contained herein or for any errors or omissions that may have
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Printed on acid-free paper

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The registered company is Springer-Verlag GmbH Berlin Heidelberg
First of all, I want to dedicate this book to my lovely wife Valérie and my sons Joaquin
and Cédrique.

I also want to dedicate this colour atlas and manual to my former chairman,
colleague and above all personal good friend, Professor Calix De Clercq.

Gwen R. J. Swennen
Foreword I
In the first half of the previous century,
radiographic cephalometry moved the
focus of orthodontists from malocclusions
towards underlying skeletal disharmonies.
Linear and angular measurements were not
only used to study the dento-alveolar
structures in relation to the jaws but also
the jaws in relation to the rest of the cranio-
facial complex. Data collected from longi-
tudinal growth studies were used to better
understand complex facial changes and
establish reference values for “normality”.
For many decades, these cephalometric
values and proportions were the bases for a
better diagnosis of cranio-facial malforma-
tions, the planning of orthognathic surgery
and the long-term evaluation of treatment
outcome. However, cephalometric analyses
are limited to 2 dimensions.
With the introduction of the cone-beam
CT, reduction of the costs for the hard-
ware and reduction of the radiation dose,
3D imaging became available for a grow-
ing group of clinicians and a standard
tool for diagnosis and treatment planning
in several disciplines. Colour maps gener-
ated after registration of 2 consecutive
CBCTs on stable structures in the ante-
rior cranial base give us new tools to
assess in detail hard and soft tissue
changes over time. This is a revolution for
future research to study growth modifica-
tions induced by dento-facial orthopae-
dic appliances, treatment outcome and
long-term stability after orthognathic
surgery. The correction of cranio-facial
malformations and asymmetries by sur-
gical repositioning of both jaws, and
complex rotations in 3 planes, can now
virtually be simulated with high accuracy.
Intermediate wafers made by CAD/CAM
or 3D printing are the link between the
virtual simulation and the surgeon in the
operating room.
Gwen Swennen has written a masterpiece
helping us to better explore all new
potentials of 3D imaging for the planning
of orthognathic surgery. With splendid
illustrations and step-by-step procedures,
this is the perfect guide for all clinicians,
young and old, to improve their skills in
extracting and implementing all these data
for further improvement of the quality of
patient care. This atlas and manual is the
result of many years of enthusiastic
research by the author. His input for the
development of adapted software makes
this technology available to all of us. We
are grateful to the author willing to share
his expertise with us.
Professor Hugo De Clerck, DDS, PhD
Orthodontic Private Practice,
Brussels, Belgium
Adjunct Professor, Department of
Orthodontics,
Chapel Hill NC, USA
August 2016

Foreword II
Foreword II
I first met Gwen Swennen in May 2009, at
the Spanish Association of Oral and Max-
illofacial Surgery meeting in Bilbao. At
that moment, I was still conventionally
planning my surgeries with good results
and was deeply convinced that computers
would just unnecessarily complicate my
routine work, besides being eventually
time consuming. It was in that precise
occasion that I had the opportunity to
attend Gwen’s lecture on 3D virtual plan-
ning which was utterly enlightening. The
speaker’s clear and rigorous demonstra-
tion of the concept’s sequence, the high
quality of the images proposed, and the
compelling logic of the processes forced
me to a critical revision of my own every-
day activities. That young and clever sur-
geon had literally enchanted me, thanks to
his technical knowledge and his passionate
application of 3D virtual planning of
orthognathic surgery.
We became good friends and, since then,
we have been taking advantage of con-
gresses and meetings around the world to
meet, to reinforce our mutual consider-
ation and respect, while sharing profes-
sional and private experiences with a touch
of irony and joie de vivre. All occasions
were perfect to spend some spare time
with Gwen and Valérie, his precious wife,
in Bruges or in Knokke.
It was in 2011 that, after passionately
devouring all Gwen Swennen’s articles and
publications, I finally decided to convert to
3D virtual planning. I attended one of his
courses in Bruges which definitely con-
vinced me, and from that moment I dived
into 3D virtual planning. I was helped by
two valid surgeons and friends in this quest:
Prof. Dr. Federico Hernandez Alfaro and,
above all, Dr. Simonas Gribauskas. More-
over, I witnessed Dr. Bill Arnett, to whom I
have tremendous respect, also making the
vii
same change. My personal shift to 3D vir-
tual planning happened, and today, after 3
years of its routine clinical application, I
have become absolutely convinced.
Anyway, after this personal digression, let
us focus on Gwen Swennen’s book. It was
in Melbourne, last October, during the
ICOMS 2015 congress that I assisted to the
first presentation of his “integrated” work.
Once more, Gwen surprised me with the
lucidity and clarity with which he system-
atized his pioneering work.
First, it is an atlas, a manual notwith-
standing its impressive dimension. The
author’s experience is so deep that the
manuscript focuses on all aspects of 3D
virtual planning of orthognathic surgery.
The division in thematic chapters is prone
to a rapid consultation on specific topics.
All subjects are exemplified with illustra-
tions and easily understandable to a gen-
eral public. Diagnosis, transition from
clinical practice to digital representation,
orthodontical and surgical planning, and
risk evaluation are clearly analyzed.
Moreover, tricks but also potential pit-
falls, risks, mistakes, and their prevention
are included in the treatise. Finally, a
great variety of cases are shown as exam-
ples in Chap. 6.
In short, all clinical relevant topics are
critically analyzed by the author, who has
been rationally applying his knowledge to
his everyday clinical routine practice,
going from first intuitions to actual sim-
plification and moreover evaluation of
potential future applications. Prof. Gwen
Swennen with his well-known and recog-
nized generosity is offering the reader his
fatigue, his knowledge, and his vast clini-
cal experience toward this subject. I am
definitely suggesting his book to anyone
who approaches 3D virtual planning in
viii Foreword II
orthognathic surgery, ensuring that he
will find in this work a theological
“summa” on the subject.
Moreover, even those surgeons who still
rely on conventional planning technique
are advised to read Gwen Swennen’s book
since they may find in these pages, that
sort of flash of inspiration which leads to
a substantial change, besides benefiting
from practical information to improve
their own clinical practice in maxillofacial
deformity surgery.
Professor Mirco Raffaini, MD
Maxillofacial Surgery, University of
Florence, Florence, Italy
Founder and Director, Face Surgery
Center, Parma, Italy
August 2016

Preface
… Existing paradigms are held by a
scientific community. They explain
observations, are the basis for
communication and guide future
research …
… Observations that don’t fit the
paradigm are ignored, or are explained
in ways that fit the paradigm …
… A crisis occurs when the existing
paradigms no longer explains the
observations and new theories arise.
A revolution occurs and new
paradigms are accepted …
… Once a paradigm shift has occurred,
a veritable explosion of new ideas
and information leads to rapid
advances in the field …
Thomas S. Kuhn:
The Structure of Scientific Revolutions.
The University of Chicago Press. 1996
When I reflect on this new project, I realise
that I was already playing with the idea
and preliminary outline of this book in my
mind since 2009. This would definitely
have been too early, and the book would
most probably have been outdated already.
The idea of our “Colour Atlas and Manual
on Three-Dimensional Cephalometry
(2005)” was an attempt to bridge conven-
tional cephalometry with the 3D virtual
approach and 3D cephalometry. It is amaz-
ing that after more than 10 years the concept
of this latter atlas is currently more than
actual for both orthodontists and surgeons.
With this new book, I hope to offer a com-
prehensive, systematic, standardised and
above all individualised approach towards
3D virtual planning of orthognathic surgery
ix
in the daily clinical routine. This book is
based on my personal experience having
being involved in more than 2700 clinical
cases on virtual planning since almost 20
years. Moreover, I was fortunate to be
continuously triggered over all these years
by my colleagues, residents, fellows, sur-
geons and orthodontists all over the world
during scientific meetings, courses and
workshops.
The concept towards “step-by-step” indi-
vidualised and integrated 3D virtual
treatment planning of orthognathic sur-
gery outlined in this book aims to make
once again the bridge between conven-
tional and 3D virtual treatment plan-
ning:
1. (3D-VPS1) “3D Cephalometry of
the Patient’s Hard Tissues and Teeth
(Sect. 2.2.2)” can be compared to
conventional cephalometric tracing.
2. (3D-VPS2) “3D Cephalometry of the
Patient’s Soft Tissues (Sect. 2.2.3)“can be
compared with direct or indirect anthro-
pometric assessment of the patient.
3. (3D-VPS3) “3D Virtual Osteotomies
(Sect. 3.2)” can be compared to some
extent with conventional
“orthognathic model surgery”.
4. (3D-VPS4) “3D Virtual Occlusal
Definition (Sect. 3.3)” can be
compared with conventional occlusal
definition on plaster dental models.
5. (3D-VPS5) “10 Step-by-Step Individu-
alised 3D Virtual Treatment Planning
(Sect. 3.5)” finally attempts to provide
the clinician a manner to integrate 3D
virtual planning in daily clinical rou-
tine based on the concepts of conven-
tional treatment planning.
x Preface

The underlying philosophy of this colour Orthognathic and Orthofacial Surgery” to

atlas and manual is not to dogmatise but to further improve patient care.
push forward “the paradigm shift” that
truly occurred in treatment planning of Professor Gwen R.J. Swennen, MD, DMD,
orthognathic surgery and especially stim- PhD, MSc, FEBOMFS
ulate further development and innovation Bruges, Belgium
in “3D Virtual Treatment Planning of August 2016

Acknowledgements
I especially wish to thank my teachers and
mentors Professor Jarg-Erich Hausamen
(former chair, Department of OMF and
Plastic Surgery, Hannover Medical Univer-
sity, Hannover), Professor Henning Schlie-
phake (Department of OMF and Plastic
Surgery, Georg-August University, Göttin-
gen), Professor Albert De Mey (former
chair, Deparment of Plastic Surgery, Uni-
versity Hospital Brugmann and Queen
Fabiola Children’s University Hospital,
Brussels) and Professor Chantal Malevez
(former chair, Department of OMF Surgery,
Queen Fabiola Children’s University Hospi-
tal, Brussels) who taught me the importance
of working hard to try to become not only
an excellent surgeon and clinician but also a
good researcher. I am also very grateful to
Peter Brachvogel (former staff member,
Department of OMF and Plastic Surgery,
Hannover Medical University, Hannover)
and Hannes Berten (former staff member,
Department of Orthodontics, Hannover
Medical University, Hannover) for teaching
and sharing their clinical and scientific
knowledge on orthognathic surgery with
me during my training.
I want to thank my associate colleagues Pro-
fessor Calix De Clercq, Johan Abeloos,
Philippe Lamoral, Nathalie Neyt, Krisztian
Nagy, Joke De Ceulaer, all our residents,
international fellows and Professor Jan Cas-
selman (chair, Department of Radiology and
Medical Imaging, GH Hospital St-Jan
Bruges) and his team for their continuous
support. I am also very grateful to Bill Arnett
(Santa Barbara, USA) and Mirco Raffaini
(Florence, Italy) for sharing with me their
knowledge and for all the stimulating discus-
sions that we had together all over the world.
From all the fellows who have visited our
department over the last 10 years since I
have been in Bruges, I particularly want to
thank Raquel Guijarro Martinez (Barce-
lona, Spain) and Martin Gaboury (Quebec,
Canada). I am very proud that I had the
xi
opportunity to be together with my per-
sonal friend, Professor Federico-Hernandez
Alfaro (Barcelona, Spain), director of the
first Spanish OMF European PhD thesis
conducted by Raquel on “Cone-beam com-
puterized tomography evaluation of the
upper airway in the context of orthognathic
surgery”. Moreover I am very grateful to
Martin Gaboury for his critical reviewing of
this project; his contribution to Chaps. 1, 2
and 4; and his collaboration in the videos,
which are of major importance to the clini-
cal reader of this book and would otherwise
have never been realised without his help
and efforts. I wish to thank all my referring
orthodontists and colleagues for having
been working together so nicely for the last
10 years in Bruges, and I look forward to
close collaboration in the future.
I want to thank in particular S.O.R.G.
(Strasbourg Osteosynthesis Research
Group) and especially Professor Paul Stoe-
linga (former chair, Department of OMF
Surgery, Radboud University, Nijmegen,
and former chair, S.O.R.G. Orthognathic
Section), Oliver Scheunemann and all my
co-members of both the orthognathic and
cranio-facial section of S.O.R.G for the
excellent and stimulating collaboration
over the years. I would also like to express
my special thanks to Filip Schutyser, Wouter
Mollemans and their engineering team for
their invaluable support over almost 20
years. Finally, I wish to thank Christian
Leibinger for his belief in me and the oppor-
tunity as a clinician to develop IPS CaseDe-
signer, which I truly believe is the next level
of 3D virtual planning software.
Last but not least, I need to thank Springer
for their trust, boundless patience and col-
laboration in publishing this new project.
Professor Gwen R.J. Swennen, MD, DMD,
PhD, MSc, FEBOMFS
Bruges, Belgium
August 2016
Introduction
“3D Virtual Treatment Planning of
Orthognathic Surgery” offers a “step-by-
step” guide towards three-dimensional
(3D) diagnosis, treatment planning and
evaluation of maxillofacial deformity to
orthodontists and orthognathic and ortho-
facial surgeons. Vertical cone-beam CT
imaging has definitely revolutionised the
treatment planning of orthognathic sur-
gery. Moreover, it allows unprecedented
evaluation of treatment outcome in
patients with maxillofacial deformity. This
colour atlas and manual attempts to pro-
vide clinicians a comprehensive, system-
atic, standardised and above all
individualised “step-by-step” approach
towards 3D virtual diagnosis, treatment
planning and outcome assessment of
orthognathic surgery. In Chap. 1, the 3D
imaging workflow is explained along with
how it can be integrated in the daily clini-
cal routine. Systematic CBCT virtual diag-
nosis of the patient’s deformity, anatomy
and pathology (including 3D airway and
TMJ) is described in a comprehensive way
in Chap. 2. Moreover, 3D cephalometric
analysis of the patient’s soft and hard
tissues and teeth and the potential of 3D
List of Videos
Video N° 1: 3D-VPS1-2: Chapter 2
Video N° 2: NHP-PHP: Chapter 3
Video N° 3: 3D-VPS3: Chapter 3
Video N° 4: 3D-VPS4: Chapter 3
Video N° 5: 3D-VPS5: Chapter 3
Videos can be found in the electronic supplementary material in the online version of the book.
On http://springerlink.com enter the DOI number given on the bottom of the chapter opening page.
Scroll down to the Supplementary material tab and click on the respective videos link.
In addition, all videos to this book can be downloaded from http://extras.springer.com. Enter the
ISBN number and download all videos.
mirroring and colour distance maps for
enhanced patient diagnostics are elabo-
rated. Chapter 3 focuses on the “Virtual
Natural Head Position (v-NHP) and Plan-
ning Head Position (PHP)”; “3D Virtual
Osteotomies and 3D Virtual Occlusal Def-
inition”; “the Principles of ‘Roll’, ‘Yaw’ and
‘Pitch’ in the 3D Virtual Scene”; and finally
“10-Step-by-Step Individualised 3D Vir-
tual Treatment Planning”. In Chap. 4, the
transfer of the 3D virtual treatment plan
towards the patient in the operation the-
atre is explained. Chapter 5 shows the
unprecedented potential towards 3D vir-
tual evaluation of treatment outcome of
orthognathic surgery. Finally, after having
provided this essential background infor-
mation to the reader, Chap. 6 illustrates the
application of the 3D virtual approach in
different types of maxillofacial deformity.
Based on almost 20 years of personal expe-
rience, the author discusses and shares
with the reader the clinical relevant poten-
tial but also the current limits and actual
pitfalls of 3D virtual diagnosis, treatment
planning and evaluation of treatment out-
come of orthognathic surgery throughout
this book.
 xiii

Contents

1 Imaging Workflow for 3D Virtual Treatment Planning

of Orthognathic Surgery ........................................................................................................... 1
Gwen R.J. Swennen and Martin Gaboury

2 3D Virtual Diagnosis of the Orthognathic Patient ................................................... 53

Gwen R.J. Swennen and Martin Gaboury

3 3D Virtual Treatment Planning of Orthognathic Surgery ................................... 217

Gwen R.J. Swennen

4 3D Virtual Treatment Planning Transfer in the Operation Theatre ............... 279

Gwen R.J. Swennen and Martin Gaboury

5 3D Virtual Evaluation of Treatment Outcome

of Orthognathic Surgery ........................................................................................................... 329
Gwen R.J. Swennen

6 Clinical Applications of 3D Virtual Treatment Planning

of Orthognathic Surgery ........................................................................................................... 367
Gwen R.J. Swennen

Addendum Templates
Definitions ............................................................................................................................................... 564
Index ......................................................................................................................................................... 565
Abbreviations

AM Additive manufacturing MSCT Multi-slice computed tomography

AUM Augmented model
NHP Natural head position
CAD/CAM Computer-aided design/computer- c-NHP Clinical natural head position
aided manufacturing v-NHP Virtual natural head position
CBCT Cone-beam computed tomography
CCW Counterclockwise PACS Picture archiving and communica-
tion system
CR Centric relation
PHP Planning head position
CW Clockwise
PSI Patient-specific implant
DICOM Digital imaging and communica-
tions in medicine RPT Rapid prototyping technology

FOV Field of view STI Surface to image

STL Standard tessellation language
ICP Iterative closest point
IO-CBCT Intra-operative cone-beam computed VOI Volume of interest
tomography VOXEL Volumetric pixel
IO-MSCT Intra-operative multi-slice computed VPS Virtual planning step
tomography
 xv

Contributor

Martin Gaboury, DMD, MSc, FRCDc

Private Practice in Maxillofacial and Facial Cosmetic Surgery,
OroSphère, Quebec, Canada
Division of Oral and Maxillofacial Surgery, Department of Surgery,
Hôtel-Dieu de Lévis, Lévis, Canada
Clinical Fellow, Division of Maxillofacial and Facial Plastic Surgery,
Department of Surgery, General Hospital St-Jan Bruges-Ostend, Belgium
 1 1

Imaging Workflow for

3D Virtual Treatment
Planning of Orthognathic
Surgery
Gwen R.J. Swennen and Martin Gaboury

1.1 Image Acquisition for 3D Virtual Treatment

Planning of Orthognathic Surgery – 2
1.1.1 Image Acquisition and Virtual Rendering of the
Patient’s Head – 2
1.1.2 Additional Image Acquisition of the Patient’s
Dentition and Occlusion – 12
1.1.3 Additional Image Acquisition of the Texture of the
Patient’s Head – 17

1.2 Processing of Acquired Image Data Towards

a 3D Virtual Augmented Model of the
Patient’s Head – 20
1.2.1 Principles of Rigid Registration – 20
1.2.2 Without the Use of Plaster Dental Models – 21
1.2.3 With the Use of Plaster Dental Models – 26

1.3 Virtual Mandibular Autorotation – 46

Additional Recommended Reading – 52

© Springer-Verlag Berlin Heidelberg 2017

G.R.J. Swennen (ed.), 3D Virtual Treatment Planning of Orthognathic Surgery,
DOI 10.1007/978-3-662-47389-4_1
 2 G.R.J. Swennen and M. Gaboury
1.1 Image Acquisition for 3D
1 Virtual Treatment Planning
of Orthognathic Surgery
1.1.1 Image Acquisition and Virtual
Rendering of the
Patient’s Head
For proper orthognathic and orthofacial surgery
planning, the patient’s head needs to be scanned
without deformation of the facial soft tissue mask,
with the mandible in “centric relation (CR)” and ide-
ally in its individual “natural head position (NHP)”:
1. “Without deformation of the facial soft tissue
mask” implements that the patient is scanned in a
vertical seated or standing position, without
distortion of the facial mask especially lip
morphology and posture. With the advent of
“cone-beam CT imaging (CBCT)” in a seated or
standing position, this has become feasible.
Multi-slice CT (MSCT) scanning, which is
performed in a horizontal position and also
CBCT apparatus that scan the patient in a supine
position, inherently falsify the 3D facial soft tissue
mask of the patient due to the effects of gravity.
On the other hand, careful attention should be
paid that wax-bite wafers or registration devices
do not disturb lip position neither lip morphology
(. Figs. 1.1 and 1.2).
2. To ensure that the patient is scanned with the
mandible “in CR”, the patient needs to be
scanned with a wax-bite wafer. This wax-bite
wafer is not different than the one used in
conventional orthognathic surgery planning.
It is, however, important that this wax-bite
wafer is meticulously trimmed in order to
avoid deformation of the facial soft tissue
mask by interference with the cheeks or lips
(. Fig. 1.3). A CBCT scout view is made
prior to scanning of the patient to assure that
the wax-bite wafer is adequately in place and
that the patient’s mandible is in CR
(. Fig. 1.4).
3. Based on the author’s personal experience, the
patient’s head position during image acquisi-
tion never corresponds to its true clinical
“NHP”. Therefore, a “step-by-step” approach is
described to virtually modify the patient’s
head position towards its individual clinical
NHP (7 see also Sect. 3.1), prior to start 3D
virtual treatment planning.
Accurate “3D virtual treatment planning of
orthognathic surgery” starts with proper
image acquisition.
Chapter 1 · Imaging Workflow for 3D Virtual Treatment Planning of Orthognathic Surgery
3 1
z Image Acquisition and Virtual Rendering of the Patient’s Head

To illustrate the workflow towards (1) image
acquisition of the patient’s head, (2) additional
image acquisition of the patient’s dentition and
occlusion and finally (3) additional image acquisi-
tion of the texture of the patient’s head, volunteer
M.G. will be used throughout this chapter.
On the other hand, the routine clinical
imaging workflow for 3D virtual treatment
planning of orthognathic surgery will be dem-
onstrated on Case 1 (Patient V.E.W.) which will
be used throughout this book (7 Chaps. 2, 3, 4, 5
and 6).

Stabilisation of the patient’s head is crucial

during CBCT scanning.
Do not use chin supports neither frontal
bands that cover the forehead.

. Fig. 1.1 Full face CBCT scanning of the patient, with a

wax-bite wafer in CR, needs to be performed in a vertical
position (seated or standing) without distortion of the
facial soft tissue mask. To avoid movement artefacts, it is
crucial that the patient is stabilised by a headrest in the
back and a frontal headband. Note that although
attempted to scan volunteer M.G. is its individual NHP, in a
seated position with the use of laser lines, the shoulders
were still distorted which caused a small “Yaw” rotation
(7 see also Sect. 3.4) to the left (i-CAT, Imaging Sciences
International Inc., volunteer M.G.)
 4 G.R.J. Swennen and M. Gaboury

Image Acquisition and Virtual Rendering of the Patient’s Head

1
a b c

. Fig. 1.2 A wax-bite wafer (Delar Corp., Lake Oswego, USA) was taken in CR as in conventional treatment planning
to ensure adequate CR during CBCT scanning (b). Note the significant distortion of the lips and the cheeks when the
wax-bite wafer is not trimmed (a, c) (volunteer M.G.)

a b c

. Fig. 1.3 A wax-bite wafer (Delar Corp., Lake Oswego, USA) was taken in CR as in conventional treatment planning
to ensure adequate CR during CBCT scanning. The wax-bite wafer was meticulously trimmed to remove all parts that
could interfere with the lips and cheeks during CBCT scanning (b). Note that there is no distortion of the lips neither of
the cheeks (a, c) (7 see also Sect. 1.1.3) (volunteer M.G.)
Chapter 1 · Imaging Workflow for 3D Virtual Treatment Planning of Orthognathic Surgery
Image Acquisition and Virtual Rendering of the Patient’s Head
. Fig. 1.4 CBCT profile scout view, to ensure that the
wax-bite wafer is adequately in place and that the patient’s
mandible is in CR prior to CBCT scanning (i-CAT, Imaging
Sciences International Inc., volunteer M.G.)
Always
Take a scout view prior to CBCT scanning
of the patient to verify:
1. Adequate CR
2. Adequate positioning of the wax-bite
wafer
z Virtual Rendering of the Patient’s Head in a
“3D Virtual Scene Approach”
An appropriate “3D virtual visualisation paradigm”
(Swennen and Schutyser 2007) is needed to visual-
ise the DICOM CBCT data, but also additional
5 1
image data (7 see also Sects. 1.1.2. and 1.1.3) that
can be acquired from other 3D imaging sources.
A ”3D Virtual Scene Approach“ is therefore
adopted in which the “3D virtual space” is consid-
ered as a “3D virtual scene” with “medical image
data” as “actors” (Schutyser 2005). This “3D virtual
scene” is viewed with a virtual camera and the
resulting views are shown on the computer screen.
The virtual camera can be moved around in the “3D
virtual scene” to image and inspect the structures of
interest from various angles and positions.
Besides visualising the patient’s image data
with the virtual camera, the “3D virtual visualisa-
tion paradigm” and the “3D Virtual Scene
Approach“ allow other actions and interactions in
the “3D virtual scene” such as indicating 3D
cephalometric landmarks of the patient’s hard tis-
sues and teeth (3D-VPS1) (7 see also Sect. 2.2.2),
indicating 3D cephalometric landmarks of the
patient’s soft tissues (3D-VPS2) (7 see also Sect.
2.2.3), performing 3D virtual osteotomies (3D-
VPS3) (7 see also Sect. 3.2), indicating 3D virtual
occlusal definition (3D-VPS4) (7 see also Sect.
3.3) and moving bone fragments with additional
soft tissue simulation, towards the “step-by-step”
individualised 3D virtual treatment planning
(3D-VPS5) of orthognathic surgery
(7 see also Sect. 3.5).
After proper image acquisition of the patient’s
head, CBCT imaging results in a 3D volume of
DICOM (Digital Imaging and Communications
in Medicine) data, consisting of a collection of
“cube-like blocks” called “voxels”. Each voxel has a
certain height, width and depth. A typical voxel
size of a CBCT scan of the patient’s head is [vx, vy,
vz] = [0.4 mm, 0.4 mm, 0.4 mm].
 6 G.R.J. Swennen and M. Gaboury

Virtual Rendering of the Patient’s Head
1 The CBCT DICOM data can be “rendered” to gen-
erate a 3D virtual image of the patient’s head by (1)
“surface rendering” or (2) “volume rendering”.
1. “Surface rendering” is an indirect way for
reconstruction of 3D structures by segmen-
tation (. Figs. 1.5 and 1.6) based on the
grayscales of the image data towards sur-
faces that are drawn on the computer screen
given a viewing direction of the virtual cam-
era (. Fig. 1.7). “Surface rendering” has the
advantage that it allows additional actions
and interactions in the “3D virtual scene”
such as indicating 3D cephalometric land-
marks, performing 3D virtual osteotomies,
3D virtual occlusal definition, moving bone
fragments with additional soft tissue simu-
lation and 3D superimposition of datasets.
Moreover, axial, coronal, sagittal and multi-
planar reslices can be calculated and added
to the “3D virtual scene”. Finally, “surface
rendering” allows to integrate the results
from surface scanning hardware for addi-
tional image acquisition of the patient’s den-
tition and occlusion (7 see also Sect. 1.1.2)
or texture of the patient’s head (7 see also
Sect. 1.1.3) in a straightforward way.
2. “Volume rendering” is a more direct way for
reconstruction of 3D structures by rendering a
volume of voxels. Towards each voxel, a colour
and opacity is assigned based on shading algo-
rithms. According to the viewing direction of
the virtual camera in the “3D virtual scene”, a
projection image is computed and presented on
the computer screen. Compared to “surface
rendering”, “volume rendering” has the advan-
tage that the transitions between several tissues
(e.g. teeth and bone) are smooth which results
in more detailed anatomy of the teeth and
interdental spaces (. Figs. 1.8 and 1.9). It how-
ever does not allow actions and interactions
such as indicating 3D cephalometric land-
marks, performing 3D virtual osteotomies, 3D
virtual occlusal definition, moving bone frag-
ments with additional soft tissue simulation
and 3D superimposition of datasets.
For optimal 3D virtual treatment planning of
orthognathic surgery, both “surface rendering”
and “volume rendering” are combined.

a b

. Fig. 1.5 “Surface rendering” (Maxilim v. 2.3.0.3) of the hard (a, b) and soft (c, d) tissues of the head of volunteer M.G.
after CBCT image acquisition. For the hard tissue rendering, the isovalue was set at 412, while for soft tissue rendering, it
was set at -560 (i-CATTM, Imaging Sciences International, Inc., Hatfield, USA, “extended field” modus; FOV, 17 cm
diameter – 22 cm height; scan time 2 × 20 s; voxel size 0.4 mm at 120 kV according to DICOM field, 0018,0060 KVP, and
48 mA according to DICOM field, 0018,1151 XRayTubeCurrent) (volunteer M.G.)
Chapter 1 · Imaging Workflow for 3D Virtual Treatment Planning of Orthognathic Surgery
7 1
Virtual Rendering of the Patient’s Head

c d

. Fig. 1.5 (continued)

During the “surface rendering” process, the
“threshold” is adjusted to optimise the visualisa-
tion of the 3D hard (. Fig. 1.5a and 1.6) and soft
tissue (. Fig. 1.5c) surface representations of the
patient’s head.
“Thresholding” is the process of creating a
“black-and-white image” out of a “grayscale
image” consisting of setting exactly those pixels to
white whose value is above a given threshold
while setting the other pixels to black. Finally, a
colour can be assigned to the reconstructed 3D
hard (. Figs. 1.5b, 1.6 and 1.7) and soft tissue
(. Figs. 1.5d and 1.7) surface representations.
 8 G.R.J. Swennen and M. Gaboury

Virtual Rendering of the Patient’s Head

1

. Fig. 1.6 “Surface rendering” (IPS CaseDesigner ALPHA version) of the hard tissues of the head of volunteer M.G.
after CBCT image acquisition. The threshold is adjusted to optimise the visualisation of the hard tissues (i-CATTM,
Imaging Sciences International, Inc., Hatfield, USA, “extended field” modus; FOV, 17 cm diameter – 22 cm height; scan
time 2 × 20 s; voxel size 0.4 mm at 120 kV according to DICOM field, 0018,0060 KVP, and 48 mA according to DICOM field,
0018,1151 XRayTubeCurrent) (volunteer M.G.)
Chapter 1 · Imaging Workflow for 3D Virtual Treatment Planning of Orthognathic Surgery
9 1

Virtual Rendering of the Patient’s Head

a b c

d e f

g h i

. Fig. 1.7 3D “surface-rendered” (Maxilim v. 2.3.0.3) soft and hard tissues representations of the head of volunteer
M.G., as acquired during CBCT image acquisition (i-CATTM, Imaging Sciences International, Inc., Hatfield, USA). Volunteer
M.G. was vertically scanned with a wax-bite wafer in place in a natural seated position using a standardised CBCT
scanning protocol (“extended field” modus; FOV, 17 cm diameter – 22 cm height; scan time 2 × 20 s; voxel size 0.4 mm at
120 kV according to DICOM field, 0018,0060 KVP, and 48 mA according to DICOM field, 0018,1151 XRayTubeCurrent)
(volunteer M.G.). Right profile (a, d, g), frontal (b, e, h) and left profile (c, f, i) views. Note the incorrect position and
orientation of the head (“Yaw” rotation to the left, 7 see also Sects. 3.1 and 3.4) although it was attempted to scan
volunteer M.G. in his correct NHP. Also note the presence of artefacts at the dentition level although volunteer M.G.
does not have orthodontic brackets neither dental reconstitution materials
 10 G.R.J. Swennen and M. Gaboury

Virtual Rendering of the Patient’s Head

1 During the “volume rendering” process, a colour and opacity are assigned towards each voxel
(. Figs. 1.8 and 1.9) based on shading algorithms.

a b c

d e f

g h i

. Fig. 1.8 3D “volume-rendered” (IPS CaseDesigner ALPHA version) soft and hard tissues representations of the head
of volunteer M.G., as acquired during CBCT image acquisition (i-CATTM, Imaging Sciences International, Inc., Hatfield,
USA). Volunteer M.G. was vertically scanned with a wax-bite wafer in place in a natural seated position using a
standardised CBCT scanning protocol (“extended field” modus; FOV, 17 cm diameter – 22 cm height; scan time 2 × 20 s;
voxel size 0.4 mm at 120 kV according to DICOM field, 0018,0060 KVP, and 48 mA according to DICOM field, 0018,1151
XRayTubeCurrent) (volunteer M.G.). Right profile (a, d, g), frontal (b, e, h) and left profile (c, f, i) views. Note that “volume
rendering” produces less artefacts at the dentition level
Chapter 1 · Imaging Workflow for 3D Virtual Treatment Planning of Orthognathic Surgery
11 1
Virtual Rendering of the Patient’s Head

a
Attention
Towards 3D virtual diagnosis, 3D virtual
treatment planning and 3D outcome
evaluation, both “surface rendering” and
“volume rendering” are necessary and need
to be combined.

b c

. Fig. 1.9 3D “volume-rendered” (IPS CaseDesigner ALPHA version) hard tissue representations of the head of
volunteer M.G., as acquired during CBCT image acquisition (i-CAT TM, Imaging Sciences International, Inc., Hatfield,
USA). Volunteer M.G. was vertically scanned with a wax-bite wafer in place in a natural seated position using a
standardised CBCT scanning protocol (“extended field” modus; FOV, 17 cm diameter – 22 cm height; scan time
2 × 20 s; voxel size 0.4 mm at 120 kV according to DICOM field, 0018,0060 KVP, and 48 mA according to DICOM
field, 0018,1151 XRayTubeCurrent) (volunteer M.G.). Frontal (a ), right profile (b) and left (c) views. Note that
“volume rendering” produces less artefacts and gives more detailed information towards the roots of the teeth
and interdental space
 12 G.R.J. Swennen and M. Gaboury
1.1.2 Additional Image Acquisition
1 of the Patient’s Dentition
and Occlusion
For proper “3D virtual treatment planning of orthog-
nathic surgery”, additional image acquisition of the
patient’s dentition is necessary, since isolated CBCT
scanning of the patient’s head (7 see Sect. 1.1.1)
does not provide accurate occlusal and intercuspi-
dation data, necessary for 3D virtual occlusal defini-
tion (7 see also Sect. 3.3) and 3D CAD/CAM splint
manufacturing (7 see also Sect. 4.1.1).
Additional image acquisition of the patient’s
dentition in order to obtain accurate occlusal and
intercuspidation data can be performed by:
1. Direct scanning of the impressions of the patient’s
dental arches
2. Indirect scanning of the plaster dental models
of the patient
3. Intra-oral scanning of the patient’s dentition
“Single CBCT scanning of the patient’s
head” does not provide accurate occlusal
and intercuspidation data which are man-
datory for proper 3D virtual orthognathic
surgery planning.
Chapter 1 · Imaging Workflow for 3D Virtual Treatment Planning of Orthognathic Surgery
1. Direct scanning of the impressions of the
patient’s dental arches
Direct scanning of the impression(s) of the
patient’s dental arches can be performed with the
same CBCT apparatus that is used for scanning of
the patient’s head. Either an “all-in-one” impres-
sion or separate impressions of the upper and
lower dental arches can be CBCT scanned. Laser
13 1
surface scanning is not recommended for scan-
ning of impressions since undercuts are not
imaged correctly due to the fact that the laser light
is following a straight path.
Direct CBCT scanning of the impression(s) of
the patient’s dental arches provides additional
accurate occlusal and intercuspidation data data
(. Figs. 1.10 and 1.11).

a b

c d

. Fig. 1.10 Clinical photographs of the “all-in-one” impression of the upper and lower dental arches (a, c, e) and
3D “surface-rendered” representations (b, d, f). The Triple Tray® AlgiNotTM impression (7 see also Sect. 1.2.2) was
scanned using a high-resolution standardised CBCT scanning protocol (i-CATTM, Imaging Sciences International, Inc.,
Hatfield, USA, “high-resolution” modus; FOV, 17 cm diameter – 6 cm height; scan time 40 s; voxel size 0.2 mm, at
120 kV according to DICOM field, 0018,0060 KVP, and 47 mA according to DICOM field, 0018,1151 XRayTubeCurrent)
(Maxilim v. 2.3.0.3., volunteer M.G.). Note that the plastic Triple Tray® is no longer visible on the 3D surface
representations because of its radiolucent nature
 14 G.R.J. Swennen and M. Gaboury

Direct Scanning of the Impressions of the Patient’s Dental Arches

1
e f

. Fig. 1.10 (continued)

a b

. Fig. 1.11 To scan the Triple Tray® AlgiNotTM impression, it was put on a commercially available sponge (a) to
avoid segmentation problems with the CBCT apparatus table. The Triple Tray® AlgiNotTM impression was scanned
using a high-resolution standardised CBCT scanning protocol (i-CATTM, Imaging Sciences International, Inc., Hatfield,
USA, “high-resolution” modus; FOV, 17 cm diameter – 6 cm height; scan time 40 s; voxel size 0.2 mm, at 120 kV
according to DICOM field, 0018,0060 KVP, and 47 mA according to DICOM field, 0018,1151 XRayTubeCurrent). 3D
“surface-rendered” representation (b) (Maxilim v. 2.3.0.3.) (volunteer M.G.)
Another random document with
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dorsal line—the dorsal fin; one in the ventral line behind the anus—
the anal fin; and one confined to the extremity of the tail—the caudal
fin.

Fig. 3.

1. Simple ray.
2. Spine.
3. Simple articulated ray (soft).
4. Branched ray (soft).]

The caudal fin is rarely symmetrical, so that its upper half would
be equal to its lower; the greatest degree of asymmetry obtains in
fishes with heterocercal termination of the vertebral column (see
subsequently, Figs. 31, 41). In fishes in which it is nearly symmetrical
it is frequently prolonged into an upper and lower lobe, its hind
margin being concave or more or less deeply excised; in others the
hind margin is rounded, and when the middle rays greatly exceed in
length the outer ones the fin assumes a pointed form.
 Fig. 4.—Labrax lupus (Bass), an Acanthopterygian with anterior spinous, and
posterior soft dorsal fin.
Many and systematically important differences are observed in
the dorsal fin, which is either spiny-rayed (spinous)
(Acanthopterygian), or soft-rayed (Malacopterygian). In the former, a
smaller or greater number of the rays are simple and without
transverse joints; they may be flexible, or so much osseous matter is
deposited in them that they appear hard and truly spinous (Fig. 3);
these spines form always the anterior portion of the fin, which is
detached from, or continuous with, the remaining jointed rays. The
spines can be erected or depressed at the will of the fish; if in the
depressed position the spines cover one another completely, their
points lying in the same line, the fish is called homacanth; but if the
spines are asymmetrical, alternately broader on one side than on the
other, the fish is called heteracanth. The spinous division, as well as
the one consisting of jointed rays, may again be subdivided. In the
Malacopterygian type all the rays remain jointed; indeed, sometimes
the foremost ray, with its preceding short supports, is likewise
ossified, and a hard spine, but the articulations can nearly always be
distinctly traced. Sometimes the dorsal fin of Malacopterygian fishes
is very long, extending from the head to the end of the tail,
sometimes it is reduced to a few rays only, and in a few cases it is
entirely absent. In addition to the rayed dorsal fin, many
Malacopterygian fishes (as the Salmonoids, many Siluroids,
Scopeloids, etc.) have another of greater or lesser extent, without
any rays; and as always fat is deposited within this fold, it is called a
fatty fin (pinna adiposa).

Fig. 5.—Saurus undosquamis, a Malacopterygian with anterior soft dorsal, and

additional adipose fin.

The anal fin is built on the same plan as the dorsal, and may be
single or plural, long or short, or entirely absent; in
Acanthopterygians its foremost rays are frequently simple and
spinous.
The horizontal or paired fins consist of two pairs: the pectorals
and ventrals.
The pectoral fins (with their osseous supports) are the
homologues of the anterior limbs of the higher Vertebrata. They are
always inserted immediately behind the gill-opening; either
symmetrical with a rounded posterior margin, or asymmetrical, with
the upper rays longest and strongest; in Malacopterygians with a
dorsal spine the upper pectoral ray is frequently developed into a
similar defensive weapon.
The ventral fins are the homologues of the hind-limbs, and
inserted on the abdominal surface, either behind the pectorals
(Pisces s. Pinnæ abdominales), or below them (Pisces s. Pinnæ
thoracicæ), or in advance of them (Pisces s. Pinnæ jugulares). They
are generally narrow, composed of a small number of rays, the outer
of which is frequently osseous. In some small groups of fishes, like
the Gobies, the fins coalesce and form a suctorial disk.

Fig. 6.—Salmo salar (Salmon), with abdominal ventral fins.

Fig. 7.—Mullus barbatus (Red Mullet), with thoracic ventral fins.

 Fig. 8.—Burbot (Lota vulgaris), with jugular ventral fins.

For the definition of the smaller systematic groups, and the

determination of species, the numbers of the spines and rays are
generally of the greatest importance. This holds good, especially for
the ventral rays, by the number of which the Acanthopterygian
affinities of a fish can nearly always be determined. The numbers of
the dorsal and anal rays generally correspond to the number of
vertebræ in a certain portion of the spine, and are therefore constant
specific, generic, or even family characters; but when their number is
very great, a proportionally wide margin must be allowed for
variation, and the taxinomic value of this character becomes
uncertain. The numbers of the pectoral and caudal rays are rarely of
any account.
The fins are organs of motion; but it is chiefly the tail
Function of the and the caudal fin by which the fish impels itself
Fins. forward. To execute energetic locomotion the tail and
caudal fin are strongly bent, with rapidity, alternately
towards the right and left; whilst a gentle motion forwards is effected
by a simple undulating action of the caudal fin, the lobes of which act
like the blades of a screw. Retrograde motions can be made by fish
in an imperfect manner only, by forward-strokes of the pectoral fins.
When the fish wants to turn towards the left, he gives a stroke of the
tail towards the right, the right pectoral acting simultaneously, whilst
the left remains ad-pressed to the body. Thus the pectoral fins assist
in the progressive motions of the fish, but rather directing its course
than acting as powerful propellers. The chief function of the paired
fins is to maintain the balance of the fish in the water, which is
always the most unsteady where there is no weight to sink it: when
the pectoral of one side, or the pectoral and ventral of the same side
are removed, the fish loses its balance and falls on the side
opposite; when both pectorals are removed, the fish’s head sinks; on
removal of the dorsal and anal fins the motion of the fish assumes a
zig-zag course. A fish deprived of all fins, as well as a dead fish,
floats with the belly upwards, the back being the heavier part of the
body.
In numerous groups of fishes which live in mud, or are enabled to
pass a longer or shorter time in soil periodically dried and hardened
during the hot season, forms occur entirely devoid of, or with only
rudimentary, ventral fins (Cyprinodon, Ophiocephalidæ, Galaxiidæ,
Siluridæ). The chief function of these fins being to balance the body
of the fish whilst swimming, it is evident that in fishes moving during
a great part of their life over swampy ground, or through more or less
consistent mud, this function of the ventral fins ceases, and that
nature can readily dispense with these organs altogether.

Fig. 9.—Ventrals of Gobius.

 In certain fishes the shape and function of the fins are
considerably modified: thus, in the Rays, locomotion is almost
entirely effected and regulated by the broad and expanded pectoral
fins acting with an undulatory motion of their margins, similar to the
undulations of the long vertical fins of the Flat-fishes; in many
Blennies the ventral fins are adapted for walking on the sea-bottom;
in some Gobioids (Periophthalmus), Trigloids, Scorpænioids, and
Pediculati, the pectoral fins are perfect organs of walking; in the
Gobies, Cyclopteri, and Discoboli the ventral fins are transformed
into an adhesive disk, and finally in the Flying-fish, in which the
pectorals act as a parachute. In the Eels and other snake-like fishes,
the swimming as well as the gliding motions are effected by several
curvatures of the body, alternate towards the right and left,
resembling the locomotion of Snakes. In the Syngnathi (Pipe-fishes)
and Hippocampi, whose body admits of but a slight degree of lateral
curvature, and whose caudal fin is generally small, if present at all,
locomotion is very limited, and almost wholly dependent on the
action of the dorsal fin, which consists of a rapid undulating
movement.

Fig. 10.—Cycloid scale of Gadopsis

marmoratus (magn.)
 Fig. 11.—Cycloid scale of Scopelus
resplendens (magn.)
The skin of fishes is either covered with scales, or
Skin and naked, or provided with more or less numerous
Scales. scutes of various forms and sizes. Some parts, like
the head and fins, are more frequently naked than
scaly. All fishes provided with electric organs, the majority of Eels,
and the Lampreys, are naked. Scales of fishes are very different
from those of Reptiles; the latter being merely folds of the cutis,
whilst the scales of fishes are distinct horny elements, developed in
grooves or pockets of the skin, like hairs, nails, or feathers. Very
small or rudimentary scales are extremely thin, homogeneous in
structure, and more or less imbedded in the skin, and do not cover
each other. When more developed, they are imbricated (arranged in
the manner of tiles), with the posterior part extruded and free, the
surface of the anterior portion being usually covered by the skin to a
greater or less extent. On their surface (Figs. 10 and 11) may be
observed a very fine striation concentric and parallel to the margin,
and coarser striæ radiating from a central point towards the hind
margin. Scales without a covering of enamel, with an entire (not
denticulated) posterior margin, and with a concentric striation, are
called Cycloid scales. Ctenoid scales (Figs. 12–15) are generally
thicker, and provided with spinous teeth on the posterior edges of the
layers of which the scale consists. In some species only the layer
nearest to the margin is provided with denticulations (Fig. 14).
Scales, the free surface of which is spiny, and which have no
denticulation on the margin, have been termed Sparoid scales; but
their distinction from ctenoid scales is by no means sharp, and there
are even intermediate forms between the cycloid and ctenoid types.
Both kinds of scales may occur not only in species of the same
genus of fishes, but in the same fish.

Fig. 12.—Ctenoid scale of

Scatophagus multifasciatus (magn.)
Fig. 13.—Ctenoid scale of Platycephalus
cirrhonasus (magn.)

Fig. 14.—Ctenoid scale of Gobius

ommaturus (magn.)
Fig. 15.—Ctenoid scale of Lethrinus
(magn.)

Fig. 16. Ganoid

Scales.
 Ganoid scales are hard and bony, covered with a layer of
enamel; they are generally rhombic or quadrangular, rarely rounded
and imbricate; and arranged in oblique rows, those of one row being
linked together by an articulary process. This type of scales,
common in fossil Ganoid fishes, occurs among recent fishes in
Lepidosteus and Polypterus only.
Finally, in Sharks, the Balistidæ, and others, true scales are
absent and replaced by the ossified papillæ of the cutis, which give
the surface the appearance of fine-grained chagreen. These
generally small bodies, as well as the large osseous scutes of the
Rays, Sturgeons, etc., have been comprised under the common
name Placoid scales; a term which deservedly is being abandoned.

Fig. 17.—Dermal papillæ of Monacanthus trossulus.

Fig. 18.—Dermal papillæ of Monacanthus hippocrepis (magn.)

 Fig. 19.—Cycloid scale from the lateral line of Odax lineatus
(magn.)
Along the side of the body of osseous fishes runs a series of
perforated scales, which is called the lateral line (Fig. 21). The
perforating duct is simple at its base, and may be also simple at its
outer opening (Fig. 19), or (and this is frequently the case) the
portion on the free surface of the scale is ramified (Fig. 20). The
lateral line runs from the head to the tail, sometimes reaching the
caudal fin, sometimes stopping in front of it, sometimes advancing
over its rays. It is nearer to the dorsal profile in some fishes than in
others. Some species have several lateral lines, the upper one
coasting the dorsal, the lower the abdominal outline, one running
along the middle as usual. The scales of the lateral line are
sometimes larger than the others, sometimes smaller, sometimes
modified into scutes, sometimes there are no other scales beside
them, the rest of the body being naked. The foramina of the lateral
line are the outlets of a muciferous duct which is continued on to the
head, running along the infraorbital bones, and sending off a branch
into the præopercular margin and mandible. In many fishes, as in
many Sciænoids, Gadoids, and in numerous deep-sea fishes, the
ducts of this muciferous system are extraordinarily wide, and
generally filled with mucus, which is congealed or contracted in
specimens preserved in spirits, but swells again when the specimens
are immersed in water. This system is abundantly provided with
nerves, and, therefore, has been considered to be the seat of a
sense peculiar to fishes, but there cannot be any doubt that its
function is the excretion of mucus, although probably mucus is
excreted also from the entire surface of the fish.

Fig. 20.—Cycloid scale from the lateral line of Labrichthys

laticlavius (magn.)
The scales, their structure, number and arrangement, are an
important character for the determination of fishes; in most scaly
fishes they are arranged in oblique transverse series; and as the
number of scales in the lateral line generally corresponds to the
number of transverse series, it is usual to count the scales in that
line. To ascertain the number of longitudinal series of scales, the
scales are counted in one of the transverse series, generally in that
running from the commencement of the dorsal fin, or the middle of
the back to the lateral line, and from the lateral line down to the vent
or ventral fin, or middle of the abdomen.[4]
Fig. 21.—Arrangement of scales in the Roach (Leuciscus ratilus): Ll = Lateral line;
tr = Transverse line. a, Transverse line from lateral line to ventral fin.

The scales of many fishes are modified for special purposes,

especially to form weapons of defence or a protective armour, but
the details of such modifications are better mentioned under the
several families in which they occur. All scales are continually
growing and wasting away on the surface, and it seems that some
fish, at least,—for instance, Salmonoids—“shed” them periodically;
during the progress of this shedding the outlines of the scales are
singularly irregular.
 CHAPTER III.

TERMINOLOGY AND TOPOGRAPHY OF THE SKELETON.

In order to readily comprehend the subsequent account of the modifications of

the skeleton in the various sub-classes and groups of Fishes, the student has to
acquaint himself with the terms used for the numerous bones of the fish skeleton,
as well as with their relative position. The skeleton of any of the more common
kinds of osseous fish may serve for this purpose; that of the Perch is chosen
here.
The series of bones constituting the axis of the body, and destined to protect
the spinal chord and some large longitudinal blood-vessels, is called the vertebral
or spinal column; the single bones are the vertebræ. The skull consists of the
bones surrounding the brain and organs of sense, and of a number of arches
suspended from it, to support the commencement of the alimentary canal and the
respiratory organs.
The vertebra (Fig. 22) consists of a body or centrum (c), with a concave
anterior and posterior surface, and generally of several processes or apophyses,
as—1. Two neurapophyses (na), which, on the dorsal side, rising upwards, form
the neural arch over the canal, in which the spinal chord is lodged. 2. Two
parapophyses (pa) usually projecting from the lower part of the sides of the body,
or two hæmapophyses (ha) which actually coalesce to form on the ventral side
the hæmal canal for a large trunk of the vascular system. 3. A neural spine (ns),
which crowns the neurapophyses, or is interposed between their tips. 4. A hæmal
spine (hs), having the same relation to the hæmapophyses. 5. Two
pleurapophyses or floating ribs, suspended from, or from the base of, the
parapophyses. 6. In most fishes the neural arches are connected together by
articular or oblique processes, zygapophyses (za), which are developed from the
base of each neurapophysis.
 Fig. 22.—Side and Front view of Fish-vertebra.
The vertebræ are either abdominal or caudal vertebræ, the coalescence of the
parapophyses into a complete hæmal ring, and the suspension of the anal fin
generally forming a sufficiently well-marked boundary between abdominal and
caudal regions (Fig. 23). In the Perch there are twenty-one abdominal and as
many caudal vertebræ. The centrum of the first vertebra or atlas is very short,
with the apophyses scarcely indicated, and lacking ribs like the succeeding
vertebra. All the other abdominal vertebræ, with the exception of the last or two
last, are provided with ribs, many of which are bifid (72). A series of flat spines
(74), called interneurals, to which the spines and rays of the dorsal fins are
articulated, are supported by the neural spines, the strength of the neurals and
interneurals corresponding to that of the dermal spines (75). The caudal vertebræ
differ from the abdominal in having the hæmapophyseal elements converted into
spines similar to the neurals, the anterior being likewise destined to support a
series of interhæmals (79), to which the anal rays are articulated. The last and
smallest caudal vertebra articulates with the hypural (70), a fan-like bone, which,
together with the dilated hindmost neural and hæmal elements, supports the
caudal rays.
Looking at a perch’s skull from the side (Fig. 24), the most superficial bones
will be found to be those of the jaws, a chain of thin bones round the lower half of
the eye, and the opercles.
The anterior margin of the upper jaw is formed by the intermaxillary or
premaxillary (17) which bears teeth, terminates in a pedicle above, to allow of a
forward sliding motion of the jaw, and is dilated into a flat triangular process
behind, on which leans the second bone of the upper jaw, the maxillary (18). This
bone is toothless, articulates with the vomer and palatine bone, and is greatly
dilated towards its distal extremity. Both the maxillary and intermaxillary lie and
move parallel to each other, being connected by a narrow membrane; in many
other fishes their relative position is very different.
The mandible or lower jaw consists of a right and left ramus; their union by a
ligament in front is called symphysis. Each ramus is formed of several pieces;
that which, by a sigmoid concavity articulates with the quadrate, is the articulary
bone (35); it sends upwards a coronoid process, to which a ligament from the
maxillary and the masticatory muscles are attached; and forwards a long-pointed
process, to be sheathed in the deep notch of the anterior piece. A small separate
piece (36) at the lower posterior angle of the mandible is termed angular. The
largest piece (34) is tooth-bearing, and hence termed dentary; at its inner surface
it is always deeply excavated, to receive a cylindrical cartilage, called Meckel’s
cartilage, the remains of an embryonic condition of the jaw, the articulary and
angular being but ossified parts of it. In other Teleostei this number is still more
increased by a splenial and other bones.
The infraorbital ring of bones (Fig. 23, 19) consists of several (four) pieces, of
which the anterior is the largest, and distinguished as præorbital.
The so-called præoperculum (30) belongs rather to the bones of the
suspensorium of the mandible, presently to be described, than to the opercles
proper. It is narrow, strong, angularly bent, so as to consist of a vertical and
horizontal limb, with an incompletely closed canal running along both limbs. As it
is quite a superficial bone, and frequently armed with various spines, its form and
configuration form an important item in the descriptive details of many fishes.
The principal piece of the gill-cover is the operculum (28), triangular in shape,
situated behind, and movably united with, the vertical limb of the præoperculum.
There is an articulary cavity at its upper anterior angle for its junction with the
hyomandibular. The oblong lamella below the operculum is the sub-operculum
(32), and the one in front of this latter, below the horizontal limb of the
præoperculum, is the interoperculum (33), which is connected by ligament with
the angular piece of the lower jaw, and is also attached to the outer face of the
hyoid, so that the gill-covers cannot open or shut without the hyoid apparatus
executing a corresponding movement.
The chain of flat bones which, after the removal of the temporal muscles,
appear arranged within the inner concavity of the præoperculum (Fig. 24), are
comprised with the latter under the common name of mandibulary suspensorium.
They connect the mandible with the cranium. The uppermost, the epitympanic or
hyomandibular (23), is articulated by a double articulary head with the mastoid
and posterior frontal. Another articulary head is destined for the opercular joint.
The mesotympanic or symplectic (31) appears as a styliform prolongation of the
lower part of the hyomandibular; is entirely cartilaginous in the young, but nearly
entirely ossified in the adult. The position of this bone is noteworthy, because,
directly inwards of its cartilaginous junction with the hyomandibular, there is
situated the uppermost piece of the hyoid arch, the stylohyal. The next bone of
the series is the pretympanic or metapterygoid (27), a flat bone forming a bridge
towards the pterygoid, and not rarely absent in the teleosteous sub-class. Finally,
the large triangular hypo-tympanic or quadrate (26) has a large condyle for the
mandibulary joint.
The palatine arch (Fig. 26) connects the suspensorium with the anterior
extremity of the skull, and is formed by three bones: the entopterygoid (25), an
oblong and thin bone attached to the inner border of the palatine and pterygoid,
and increasing the surface of the bony roof of the mouth towards the median line;
it constitutes also the floor of the orbit. The pterygoid (24) (or os transversum)
starts from the quadrate, and is joined by suture to the palatine, which is toothed,
and reaches to the vomer and anterior frontal.
In the occipital region there are distinguished the basi-occipital (5), readily
recognised by the conical excavation corresponding and similar to that of the
atlas, with which it is articulated through the intervention of a capsule filled with a
gelatinous substance (the remains of the notochord); the exoccipitals (10),
articulated, one on each side, to the basi-occipital, and expanding on the upper
surface of that bone, so as to meet and support the spinal column; a superficial
thin lamella (13), suturally connected with the exoccipitals, not constant in fishes,
and erroneously believed by Cuvier to be the petrosal (os petrosum) of higher
animals; further, the paroccipitals (9), which are wedged in between the
exoccipitals and supraoccipital. This last bone (8) forms the key of the arch over
the occipital foramen, and raises a strong high crest from the whole length of its
mesial line; a transverse supraoccipital ridge, coming from each side of the base
of this spine runs outwards laterally to the external angles of the bone. The
supraoccipital separates the parietals, and forms a suture with the frontals.
In front of the basi-occipital the base of the skull is formed by the
basisphenoid (parasphenoid of Huxley) (6). This very long and narrow bone
extends from the basi-occipital beyond the brain-capsule to between the orbits,
where it forms the support of the fibro-membranous interorbital septum. Anteriorly
it is connate with another long hammer-shaped bone (16), the vomer, the head of
which marks the anterior end of the palate, and is beset with teeth. The
alisphenoids (11) are short broad bones, rising from the basisphenoid; their
posterior margins are suturally connected with the anterior of the basi- and
exoccipitals.