Left hemisphere and male sex dominance of cerebral hemiatrophy (Dyke-Davidoff-Masson Syndrome)

Although radiological findings of cerebral hemiatrophy (Dyke-Davidoff-Masson Syndrome) are well known, there is no systematic study about the gender and the affected side in this syndrome. Brain images in 26 patients (mean aged 11) with cerebral hemiatrophy were retrospectively reviewed. Nineteen patients (73.5%) were male and seven patients (26.5%) were female. Left hemisphere involvement was seen in 18 patients (69.2%) and right hemisphere involvement was seen in eight patients (30.8%). We conclude that male gender and left side involvement are frequent in cerebral hemiatrophy disease.

Three-dimensional morphology of the palate in subjects with unilateral complete cleft lip and palate at the stage of permanent dentition

OBJECTIVE

Three-dimensional analysis of palate size and shape in patients with complete unilateral cleft lip and palate (UCLP) at the stage of permanent dentition.

SUBJECTS

Thirty randomly selected dental casts of boys approximately 15 years old with complete UCLP and 28 dental casts of normal boys of the same age.

INTERVENTIONS

All patients underwent lip repair according to Tennison with primary periosteoplasty (mean age 8.5 months) and palate repair by pushback and pharyngeal flap surgery (mean age 4.9 years).

MAIN OUTCOME MEASURES

Data on the palate height in 210 defined locations.

RESULTS

The palate in patients with UCLP was narrower throughout its whole extent, more anteriorly than posteriorly. From the canines posteriorly, it was also lower, and the difference as compared with controls increased in a posterior direction up to the level of second premolars (up to 30%) and then slightly diminished (to 21% between the first molars). The reduction of area of transverse sections reached 45% between premolars and 39% between first molars. The palate in the anterior portion was highest on the cleft side and in a posterior direction the maximum height of the palate shifted toward the midline and even beyond that line toward the noncleft side. Palatal height did not depend on dentoalveolar arch width.

CONCLUSION

The smaller width and height of the palate confirm the substantially reduced space for the tongue in patients with UCLP. The reduction is only slightly larger than in previously examined patients with isolated cleft palate. Palatal vault is asymmetrical, highest anteriorly on the cleft side and posteriorly on the noncleft side.

Condylar asymmetry measurements in patients with temporomandibular disorders

OBJECTIVES

The relationship between condylar asymmetry and handedness of the patients with temporomandibular disorders (TMD) and patients with no signs or symptoms of TMD was investigated. The experimental group consisted of 25 patients aged 15 to 52 years who were referred for treatment of TMD. The mean age of this group was 26.24 years. The control group consisted of 25 patients aged 14 to 52 years (mean age: 26.16 years).

METHODS

The formula by Habets et al.14 was used to express the symmetry between the condyles and the rami on the orthopantomogram (OPG) image. Differences between both groups and subgroups (condyle, ramus, condyle plus ramus) regarding symmetry were calculated with the Student's t-test.

RESULTS

The mean of condylar asymmetry was found to be 11.11 +/- 11.03% in the TMD group. However, in the control group, the mean of condylar asymmetry was found to be 8.36 +/- 6.27%. No statistically significant differences were found between condylar asymmetry in both groups (p>0.05).

CONCLUSIONS

No statistically significant differences were found between condylar asymmetry index in patients with TMD according to myogenous problems and in patients with no signs or symptoms of TMD.

Facial scoliosis due to sternocleidomastoid torticollis: a cephalometric analysis

Facial scoliosis can be caused by either the plagiocephaly which arises from unilateral coronal suture synostosis, or by the effects of sternocleidomastoid torticollis. Despite publications which have presented the key clinical and radiographic craniofacial differentiating features, confusion between the two still persists. This report presents the essential cephalometric features found in sternocleidomastoid torticollis, which may be applied to confirm the diagnosis in those cases which present late, and which do not exhibit the characteristic features of synostosis.

Evaluation of temporomandibular joint in patients with hemifacial microsomia

OBJECTIVE

The purpose of this study was to elucidate positional relationships between temporomandibular joint (TMJ) components, including the articular discs, using magnetic resonance imaging (MRI) in patients with hemifacial microsomia (HFM).

SUBJECTS AND METHODS

Twenty TMJs in 10 patients with HFM were examined at closed- and open-mouth positions using an MRI scanner. The condyle-fossa and disc-condyle relationships, disc configuration at the closed-mouth position, and the reduction of the disc at the open-mouth position were evaluated.

RESULTS

On the unaffected side, the condyle-fossa and disc-condyle relationships appeared fairly normal at the closed mouth position. The disc-condyle relationship at the open-mouth position was also normal. The TMJ disc showed normal biconcave configurations at both closed- and open-mouth positions. On the affected side, there was considerable variation in the state of the TMJ. At the closed-mouth position, 5 of the 10 patients revealed fairly normal disc-condyle relationships, one patient showed anterior displacement of the disc, and four patients had no disc. Two patients appeared biconcave, three patients appeared biplanar, and one patient was hemiconvex. At the open-mouth position, the condyle and disc moved in harmony in five patients with normal disc-condyle relationships, but the disc was reduced in a patients with anterior disc displacement. The degree of the TMJ disc dysplasia did not necessarily correspond with the degree of mandibular dysplasia.

CONCLUSIONS

The present study contributes to an improved understanding of TMJ pathology in patients with HFM. The results suggest that, in HFM patients, the examination of the TMJ using MRI is helpful for determining treatment procedures in mandibular distraction osteogenesis.

3D morphometrics of craniofacial dysmorphology reveals sex-specific asymmetries in schizophrenia

Over early fetal life cerebral and craniofacial morphogenesis proceed in embryological intimacy. Therefore, craniofacial shape differences between schizophrenia patients and controls are informative of developmental disturbance(s) in cerebral-craniofacial morphogenesis. 3D craniofacial coordinates were calculated from interlandmark distances for 169 patients with DSM-III-R schizophrenia and 78 matched normal controls. These were analysed using geometric morphometrics with visualisation of the resultant statistical models. Patients of both sexes were characterised by an intricate topography of 3D shape change involving lengthened lower mid-facial height, shortened upper mid-facial height, nasion located posteriorly and a wider face posteriorly; there was sex-specific rotation of the midface such that the base of the nose is more anterior in female patients but more posterior in male patients. Importantly, there were sex-specific asymmetries: in males, controls evidenced marked directional asymmetry while patients showed reduced directional asymmetry; conversely, in females controls evidenced little directional asymmetry while patients showed marked directional asymmetry. In schizophrenia, the topography of craniofacial dysmorphology appears to reflect subtle disruption to a critical 3D trajectory of embryonic-fetal craniofacial growth, particularly along the midline, with disturbance to the establishment of normal asymmetries in a sex-related manner.

Open reduction of pediatric atlantoaxial rotatory fixation: long-term outcome study with functional measurements

OBJECT

Atlantoaxial rotatory fixation (AARF) is an uncommon disorder of childhood in which resolution usually occurs spontaneously or after traction therapy. In a minority of children irreducible or chronic fixation develop, and the natural history then usually involves restriction of head on neck movement, abnormal head position, and progressive facial asymmetry. The conventional management in these cases has been a posterior fusion.

METHODS

The authors performed an open reduction via the extreme-lateral approach without adjunctive fixation surgery in 13 children who ranged in age from 4 to 11 years. Postoperatively, halo jacket therapy was undertaken for 8 to 12 weeks. There were no neurological complications despite damage to one vertebral artery and one wound infection. Functional outcome was assessed after a minimum of 24 months (range 29-72 months). Facial asymmetry markedly improved. Sagittal movements were similar to those observed in control individuals. Axial rotation, although reduced compared with that in controls, was present but usually asymmetrical.

CONCLUSIONS

In the authors' opinion, open reduction provides the best possibility of normal facial development and return of axial movement in cases of AARF.

Morphologic characteristics of the dentition and palate in cases of skeletal asymmetry

The purpose of this study was to clarify the three-dimensional morphological characteristics of the dentition and palate in skeletal asymmetry in patients with skeletal Class III malocclusion using a newly defined palatal reference plane in a dental cast. Twenty patients (5 males and 15 females) who had skeletal Class III malocclusion with facial asymmetry were selected. Pretreatment posteroanterior cephalometric radiographs and maxillary dental casts were used. The lateral deviation of Me was measured as the distance from a line perpendicular to Lo-Lo' that passed through CG. The angle between the Lo-Lo' plane and the J-J' plane was measured. Each maxillary dental cast was measured using a three-dimensional surface-scanning system, and the newly defined palatal reference plane was calculated. The right/left difference in the radius of curvature of the palate and right/left differences in the vertical and mesiodistal positions of the first molars were analyzed. Linear correlation and regression techniques were used. Our findings demonstrate that the lateral deviation of the mandible is closely related to the morphology of the alveolar process and to the vertical height of the dentition. In this study, the three-dimensional application of a new palatal reference plane is very useful in morphological research, and the results provide detailed information on the characteristics of facial asymmetry.

Masticatory muscle right-left differences in controls and hemifacial microsomia patients

One aim of this study was to assess right-left differences in the volume of masticatory muscles in controls so as to be able to distinguish between normal variations and pathological differences. The other aim was to compare the masticatory muscle volume of the nonaffected side of hemifacial microsomia patients with the smaller side of controls so as to test the compensation hypothesis. The study group consisted of 39 children with hemifacial microsomia and the control group of 52 children. Computed tomography scans were made using a Philips Tomoscan 350 and a Pro Speed S Fast Spiral General Electric scanner. The normal right-left differences in volume of the masticatory muscle of the controls, calculated as a percentage of the total, demonstrated small mean differences of 2.57% to 2.88% (SD:1.98-2.74). For hemifacial microsomia patients, the relative difference was about 10 times the difference for controls. For controls, the averages of the right-left differences (%) were all below the generally accepted SEM of 4%. Testing the compensation hypothesis of all effects, only the age effect was multivariately significant (P < 0.001). No overcompensation of the masticatory muscles of the nonaffected side of hemifacial microsomia patients could be demonstrated.

Unilateral Angle II in functional lateralities

The aim of this study was to explore unilateral Angle II-type malocclusion prevalences in functionally true right-sided (TRS) and non-right-sided (NRS) children having one or more left-sided functions (eye, hand, foot). A half cusp sagittal relationship of the upper and lower M1 and Dm2 was determined on dental casts of 1423 young American black and white children in a cross-sectional sample with the mean age of 8.5 years (range 6-12 years). Hand, foot and eye preferences were recorded at the age of 4 years during the Collaborative Perinatal Study. The prevalences of symmetric bilateral Angle I and II and asymmetric unilateral Angle II right and Angle II left cases were compared between TRS and NRS children using Chi-square analysis. In general, unilateral Angle II right occurred in 9 per cent of the population and Angle II left in 6.5 per cent. In moderate non-right sideness (two-thirds of left dominant functions), these proportions were 17 and 3 per cent, respectively, and in true right sidedness 8 and 6 per cent, respectively. TRS subjects were more symmetric (bilateral Angle I or II in 85 per cent of cases) than NRS children (80 per cent), and the differences were statistically significant (P < 0.02). These results highlight the anatomical relationships of structures supporting the occlusion and the symmetry/asymmetry of the neurocranium, cranial base, masticatory apparatus, and probably also the sidedness and the growth-stimulating effect of lateralized jaw function. Based on the results and considering earlier observations on brain asymmetry in functional lateralities, it can be hypothesized that a normal symmetric sagittal occlusal relationship is based on unilateral sagittal compensatory growth to maintain optimal bite, challenging early preventive orthodontic treatment in suspect unilateral Angle II cases.

Axial mesodermal dysplasia sequence: autopsy findings

We describe an infant with the phenotype of the "axial mesodermal dysplasia spectrum" who had the oculo-auriculo-vertebral sequence and caudal dysgenesis. Postmortem studies identified anomalies of the middle ear ossicles, and muscles, in association with microtia and atresia of the external auditory canals, but no cerebral abnormalities.

Biometric and magnetic resonance imaging assessment of dentofacial abnormalities in a case of Klippel-Trénaunay-Weber syndrome

Klippel-Trénaunay-Weber syndrome is characterized by cutaneous hemangioma, arteriovenous fistulas or varicosities (or both), and unilateral hypertrophy of hard and soft tissues with different localization. Klippel-Trénaunay-Weber syndrome represents a syndrome of interest for those in the fields of oral and maxillofacial radiology and pathology because of the high incidence of compromise of the orofacial area in affected patients. The patient reported here presents with all of the 3 characteristic signs of the syndrome. The somatic and facial hypertrophy is contralateral to angiomata. As revealed through the use of magnetic resonance imaging, the primary component of facial hypertrophy is adipic subcutaneous tissue. Statistical analysis of the dental dimensions revealed that teeth on the hypertrophic side are significantly larger than normal.

Features and treatment of skeletal class III malocclusion with severe lateral mandibular shift and asymmetric vertical dimension

AIM

To highlight the effectiveness of orthodontic treatment and bilateral equalization of the vertical occlusal dimension, along with the correction of asymmetric cervical and masticatory muscle activities in patients with Class III malocclusion with lateral deviation of the mandible and severely asymmetric condyle and ramus.

METHODS

Two normally growing and one nongrowing Japanese patients with severe lateral deviation of the mandible, asymmetric vertical occlusal dimension, and severely asymmetric temporomandibular joints are discussed. In addition to orthodontic treatment, all patients received physiotherapy of the cervical muscles and gum-chewing training for elimination of the masticatory muscular imbalance. Patients also had postural training during treatment. All patients were treated with a bite plate to equalize the bilateral posterior vertical dimension, followed by full multi-bracketed treatment to establish a stable form of occlusion and to improve facial esthetics.

RESULTS

This interdisciplinary treatment approach resulted in normalization of stomatognathic function, elimination of temporomandibular joint dysfunction symptoms, and improvement of facial appearance and posture. In growing patients, the significant response of the fossa, condyle, and ramus on the affected side during and after occlusal correction contributed to the improvement of cervical muscle activity. In contrast, less improvement was observed in the growing patient who did not receive physiotherapy of the neck muscles, postural training, or masticatory habit training during the posttreatment period. The nongrowing patient showed little morphologic improvement of the cervical spine, condyle, and fossa during treatment and after retention, even with physiotherapy of the neck muscles and attention to posture and masticatory habits.

CONCLUSION

Based on these results, early occlusal improvement, combined with physiotherapy to achieve muscular balance of the neck and masticatory muscles, was found to be effective. It is important to assess the morphology and function of the neck muscles and cervical spine prior to occlusal therapy in patients with an asymmetric vertical dimension, lateral deviation of the mandible, and asymmetric temporomandibular joint structures. Therapy should correlate orthopedic and surgical patient management as needed.

Longitudinal Results of Mandibular Distraction Osteogenesis in Hemifacial Microsomia

The aim of this study was to evaluate mandibular distraction therapy by three-dimensional (3-D) computed tomography (CT) imaging so as to be able to improve the treatment results. The study group consisted of eight children (3 male and 5 female) with hemifacial microsomia. For each child, CT scans of the head were available (Pro Speed S Fast Spiral scanner; General Electric). Longitudinal measurements of the mandible, bony and soft tissue 3-D reconstructions, and masticatory muscles were demonstrated. Three-dimensional CT scans provide important data concerning the results of mandibular distraction therapy and should be used in treatment evaluation. In some patients and for some muscles only, a small increase in the volume of the affected side of the masticatory muscles in comparison to the normal side was found 3 years after mandibular distraction. In around 50% of the cases, there seems to be a relapse occurring 1 year after distraction osteogenesis, and this relapse has a progressive character when seen 3 years after distraction osteogenesis in comparison to 15 weeks after distraction osteogenesis.

Facial asymmetry--3D assessment of infants with cleft lip & palate

OBJECTIVES

To determine the degree of facial asymmetry in infants with unilateral cleft lip and/or palate, and quantify improvements following primary surgery, in three dimensions.

DESIGN

The faces of 20 infants with unilateral clefts (10 UCL; 10 UCLP), and 20 age-matched, non-cleft controls, were captured using the C3D stereophotogrammetry system prior to primary lip/nose repair (at 3 months), at 6 months and at age 1 year.

METHODS

Procrustes techniques were applied to 3D landmark configurations to its mirror image. Mean squared distances between landmarks and their antimeres were calculated and expressed as asymmetry scores for each 3D configuration. Full-face, nose and lip median scores were compared and changes with time evaluated (P < 0.01).

RESULTS

There were no significant changes in asymmetry scores in the control group from 3 months to 1 year. The UCLP group was more asymmetric than the UCL group, displaying greatest improvement in nasal symmetry following primary repair. The lips continued to improve over time. The UCL group had significant nasal asymmetry, which did not appear to improve with primary surgery.

CONCLUSIONS

Immediate improvement in asymmetry scores in children with UCLP is related to the production of a more symmetrical nasal form after primary surgery. In contrast, the nasal asymmetry seen in children with UCL is unchanged despite surgery. Full face asymmetry scores may mask subtle changes over time. Nasal and lip asymmetry should be considered individually.

Thyroid dysfunction in a patient with aglossia

We report a Thai girl who had aglossia, micrognathia, microsomia, collapse of mandibular arch, persistence of buccopharyngeal membrane, microcephaly, and mild developmental delay. Thyroid function tests indicated that she had subclinical hypothyroidism. Thyroid scan revealed normal uptake of the whole thyroid gland. Tongue morphogenesis is integrally linked to the normal development of thyroid gland, and abnormal tongue morphogenesis could potentially result in a functional thyroid disorder. We propose that micrognathia, microsomia, congenital absence of mandibular incisors, and collapse of the mandibular arch are the result of abnormal tongue development.

Quantitative evaluation of lip symmetry in functional asymmetry

The objectives of this study were to quantitate lip symmetry/asymmetry from clinical photographs; to demonstrate that asymmetry due to functional side shifts (functional asymmetry) leading to unilateral crossbites including the canines, results from measurable thinning of the upper lip and thickening of the lower lip on the side of the crossbite when viewed in the intercuspal contact position; and to show that orthodontic treatment aimed at eliminating the functional shift and crossbite would achieve lip symmetry, both visually and quantitatively. The study consisted of 26 patients, who were divided into two groups: a study group of 13 patients (eight females, five males, aged 8-17 years) with a functional asymmetry, and a control group of 13 age- and gender-matched subjects with other forms of malocclusion without functional asymmetry. All patients in the study group exhibited unilateral crossbites including the canines in intercuspal contact position. Digitized images of frontal facial photographs were analysed for upper and lower lip symmetry pre- and post-orthodontic treatment. The upper and lower lips were subdivided into four quadrants and the surface area and length of each quadrant were measured and expressed as a percentage of the total surface area/length of the relevant lip. The degree of asymmetry was obtained by calculating the difference in percentage area or length between the two quadrants of each lip. In the study group, the lower lip quadrant on the shift side was enlarged while the contralateral side was reduced (mean area ratio 59.9 to 40.1 per cent, mean length ratio 53.0 to 47.0 per cent). The upper lip demonstrated differences that were smaller and inverse. The controls showed a small difference between the right and left sides (less than 1 per cent). After treatment, both groups displayed visual and quantitative lower and upper lip symmetry, i.e. an area or length of approximately 50 per cent of each quadrant. In absolute values, the control patients had up to 3 per cent asymmetry in area regardless of treatment. The patients in the study group exhibited mean absolute asymmetry of 9.2 per cent in the upper lip and 19.8 per cent in the lower lip. Asymmetry values in the study group were reduced to approximately 3 per cent post-treatment. The absolute values of asymmetry in length of all patients were up to 2 per cent in the control group regardless of treatment. The subjects in the study group exhibited mean absolute asymmetry of 6.3 per cent in the upper lip and 8.6 per cent in the lower lip. Asymmetry values in the study group were reduced post-treatment to approximately 2 per cent. Although asymmetry in the study group could be quantitated using both parameters (lip surface area and lip length), the surface area parameter proved to be a more sensitive tool for measuring lip asymmetry.

Overlap between VACTERL and hemifacial microsomia illustrating a spectrum of malformations seen in axial mesodermal dysplasia complex (AMDC)

We describe a male infant born to consanguineous healthy parents with multiple congenital anomalies of the skeleton and internal organs. His phenotype displays an overlap between VACTERL and hemifacial microsomia (oculo-auriculo-vertebral spectrum/OAV). In addition, striking asymmetry of the malformations further supports the classification as part of the "axial mesodermal dysplasia complex" (AMDC) which is supposed to arise from disturbed mesodermal cell migration during early blastogenesis. The present case was instructive to review the continuous spectrum of AMDC related anomalies.

Craniofacial asymmetry in development: an anatomical study

The purpose of this study was to evaluate the occurrence of craniofacial asymmetries in four areas of human skulls of various age groups to test the hypothesis that there is craniofacial symmetry before the chewing habit is established. The data were obtained from 95 skulls of fetuses, infants, children, and adults, from the collection of Federal University of São Paulo. The following measurements were taken on each skull with a digital caliper: from the infraorbital foramen to the anterior nasal spine (IOF); from the greater palatine foramen to the posterior nasal spine (GPF); from the spinous foramen to the basion (SF); and from the spinous foramen to the zygomatic arch (ZA). On different occasions, each measurement was taken three times on both sides of the skull in random order. The mean of the right-side measurements were subtracted from the mean of the left-side measurements, and the differences were transformed into percentages. Comparisons were made by analysis of variance. The presence of cranial asymmetry was statistically significant throughout the whole sample. The minimum value found was 2.8% and the maximum 6.5%. All age groups presented the same degree of asymmetry of distances IOF, GPF, and SF. The group of infants presented a higher degree of asymmetry on distance ZA, followed by the groups of fetuses, children, and adults. This study confirmed statistically significant craniofacial asymmetry in fetuses and infants (before dentition). Therefore, the hypothesis that craniofacial asymmetry only appears after establishment of the chewing habit was not supported.

Facio-auriculo-vertebral sequence in association with DiGeorge sequence, Rokitansky sequence, and Dandy-Walker malformation: case report

Extreme variability of expression is characteristic of the facio-auriculo-vertebral sequence. Sporadic and familial cases have been reported with obvious etiologic heterogeneity. Most reports in the literature are of clinical cases. The purpose of this paper is to present a fetal autopsy case report of the facio-auriculo-vertebral sequence in association with DiGeorge sequence, Rokitansky sequence, and Dandy-Walker malformation. A standard neonatal autopsy was performed on a macerated female fetus, gestational age 29 wk. External examination of the fetus revealed hypoplastic right face, low-set microtic right ear, and macrostomia. Internal examination showed hypoplastic thymus and lungs, a type I truncus arteriosus, and ventricular septal defect. Both kidneys showed evidence of pelvi-ureteric junction obstruction. The ovaries and fallopian tubes were present with an absent uterus and vagina (Rokitansky sequence). In addition, Dandy-Walker malformation was identified. Microscopically, a single hypoplastic parathyroid gland was noted and there was cystic renal dysplasia. We report the sixth case of the facio-auriculo-vertebral sequence in association with Rokitansky sequence and the first case of this sequence in association with Dandy-Walker malformation. In addition, features of DiGeorge sequence were present.

Goldenhar's syndrome--case report

Goldenhar's syndrome is a rare condition described initially in the early 1950's. It is characterized by a combination of anomalies: dermal epibulbar cysts, auricular appendices and malformation of the ears. In 1963, Gorlin suggested the name oculo-auriculo-vertebral (OAV) dysplasia for this condition and also included vertebral anomalies as signs of the syndrome. The etiology of this rare disease is not fully understood, as it has shown itself variable genetically and of unclear causes. This work reports a case of Goldenhar's syndrome in an 11-year-old female, who presented all classical signs of this rare condition

Brachmann-de Lange syndrome (BDLS) with asymmetry and skin pigmentary anomalies: a result of mosaicism for a putative bdls gene mutation?

Brachmann-de Lange syndrome (BDLS, OMIM 122470) is a rare malformation syndrome characterized by mental retardation, short stature, limb abnormalities, and a distinctive craniofacial appearance. There is wide clinical variability and mildly affected patients are common. The genetic basis of BDLS and the reasons for its phenotypical variability are still unknown. We report on a patient with mild BDLS and the unusual findings of asymmetric growth of one body half and irregularly shaped pigmentary anomalies of the skin. These two traits have not been previously described in BDLS but have been associated with phenomena of genetic mosaicism in other conditions. We suggest that this patient's phenotype could be the result of mosaicism for a mutation or submicroscopic deletion affecting one or several genes responsible for BDLS.

Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with unilateral disk displacement without reduction

The purpose of this study was to evaluate the effect of unilateral disk displacement without reduction (UDDN) on the skeletal and dental pattern of affected individuals. There were 12 symptomatic female patients and 46 asymptomatic normal female volunteers. All study participants had bilateral high-resolution magnetic resonance scans in the sagittal (closed and open) and coronal (closed) planes to evaluate the temporomandibular joints. Linear and angular cephalometric measurements were taken to evaluate the skeletal, denture base, and dental characteristics of the two groups. ANOVA was used to compare the symptomatic subjects with the control subjects. A few skeletal differences were found. There was an overall reduction in length of the anterior (S-Na) and total (S-Ba) cranial base measurements in the UDDN group. The mandibular plane angle was steeper and the posterior ramal height (Ar-Go) was shorter in the symptomatic group. The only dental difference found was a relative infraeruption of the lower first molar. This study suggests that subjects with UDDN may manifest altered craniofacial morphology. Although the cephalometric measurements used did not account for any asymmetry, previous studies have shown that UDD may cause mandibular asymmetry. Presence of asymmetry and altered craniofacial morphology should alert the clinician especially while orthodontically treating children and surgical patients.

Asymmetric crying facies associated with hemihypertrophy: report of one case

An infant whose face appears symmetrical at rest yet whose mouth is pulled downward to one side when crying is said to have an "asymmetric crying facies". The cause of the facial asymmetry in this disorder is congenital absence or hypoplasia of the depressor anguli oris muscle at the corner of the mouth. Associations of this minor facial defect with major congenital anomalies have been reported, most commonly in the cardiovascular system and less frequently involving the genitourinary, musculoskeletal, cervicofacial, respiratory, and, rarely, the central nervous system. In this article, a 40-day-old boy with asymmetric crying facies associated with malformed right ear, patent foramen ovale, hemivertebrae, thoracic scoliosis, and hemihypertrophy is presented. The last anomaly has not previously been published in association with asymmetric crying facies in the literature according to our knowledge.

Craniofacial morphology and dental age in children with Silver-Russell syndrome

OBJECTIVES

This investigation is a part of a multidisciplinary descriptive evaluation of the Silver-Russell syndrome (SRS). The aim of this study was to describe the craniofacial morphology, occlusion and dental age in children with the SRS.

DESIGN

A descriptive literature-controlled study.

SETTING AND SAMPLE POPULATION

Sixteen children diagnosed as having SRS, 10 boys and six girls, aged 4.4-14.5 years, were referred from different parts of Sweden to the Queen Silvia Children's Hospital, Göteborg University.

EXPERIMENTAL VARIABLE

Facial morphology was measured on lateral and postero-anterior radiographs. Occlusion, tooth eruption and palatal height were measured on casts, and dental maturity was evaluated on orthopantomograms.

OUTCOME MEASURE

Linear and angular measurements were obtained from lateral radiographs and the ratios of the linear measurements from the postero-anterior radiographs. The degree of tooth calcification shown on orthopantomograms was taken as a measure of dental maturity. Biometric measurements were taken and the degree of tooth eruption was recorded from the dental casts. The SRS children were compared with reference groups with t-test and z-scores.

RESULTS

Overall, SRS children were found to have smaller linear facial dimensions and deviations in the facial proportions, such as a small retropositioned, and steeply inclined maxilla and mandible, and a proportionally larger anterior facial height in relation to the posterior facial height. In 40% of them a smaller facial height or length on one side (facial asymmetry) was correlated to the smaller side of the body. The frequency of malocclusions was higher, and the palatal height showed a tendency towards an increase. Dental maturity was within normal limits, while the time of tooth eruption was slightly delayed.

CONCLUSIONS

The deviating facial morphology described above is a part of the syndrome, which is characterized by short stature, growth hormone deficiency and asymmetries of the body. The higher percentage of malocclusions in the SRS children might lead to a greater need of orthodontic treatment.