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Odedra A, Blumenow W, Dainty J, Dasgupta S, Dominguez-Gonzalez S, Gonzalez-Martin J, Hartley H, Kelly M, McKay VH, Sharma R, Spinty S, Fattah AY. Multidisciplinary Care for Moebius Syndrome and Related Disorders: Building a Management Protocol. J Clin Med 2024; 13:3309. [PMID: 38893020 PMCID: PMC11172851 DOI: 10.3390/jcm13113309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/18/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.
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Affiliation(s)
- Amar Odedra
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Wendy Blumenow
- Department of Speech and Language Therapy, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Jennifer Dainty
- Department of Psychology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Soumit Dasgupta
- Department of Audiology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Susana Dominguez-Gonzalez
- Department of Orthodontics and Paediatric Dentistry, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Jose Gonzalez-Martin
- Department of Ophthalmology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Helen Hartley
- Therapy Department, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Maria Kelly
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Victoria H. McKay
- Department of Genetics, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
| | - Ravi Sharma
- Ear Nose and Throat Department, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Adel Y. Fattah
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
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Alarcón-Sánchez MA, Romero-Servin S, Yessayan L, Mosaddad SA, Heboyan A. Oral findings and comprehensive dental management of Moebius syndrome: a systematic review. BMC Oral Health 2024; 24:192. [PMID: 38321523 PMCID: PMC10845393 DOI: 10.1186/s12903-024-03968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/01/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Moebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral and extraoral findings in MS patients and their comprehensive dental management. METHODS A digital search was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, restricted to articles in English from Jan 01, 2000, to Apr 02, 2023, following PRISMA guidelines. The methodological quality of the studies was evaluated following the JBI guidelines. Qualitative analysis was carried out on the overall result, extraoral and intraoral manifestations, considering dental management as appropriate. RESULTS Twenty-three studies were included, and a total of 124 cases of patients with MS were analyzed. The 82% of patients with MS were younger than 15 years of age. The most frequent extraoral manifestations were blinking and visual problems (78,22%), malformations of the upper and lower limbs (58,22%), bilateral facial paralysis (12,90%), lack of facial expression (12.09%), and unilateral facial paralysis (6,45%). On the other hand, the most frequent oral manifestations were tongue deformities (78,22%), micrognathia (37,90%), labial incompetence (36,29%), cleft palate (22,87%), gothic palate (16,12%), microstomia (15,32%), anterior open bite (15,32%), dental caries (8,87%), and periodontal disease (8,06%). The majority of MS patients were treated by pediatric dentistry (60,86%), using a surgical approach (56,52%), and orthodontic and orthopedic maxillary (43,47%) followed by restorative (39,13%), and periodontal treatments (21,73%). CONCLUSIONS This systematic review demonstrates that patients with MS present a wide variety of oral and extraoral manifestations, for which dental treatments are planned and tailored to each patient in accordance with oral manifestations. These treatments encompass problem resolution and oral health maintenance, incorporating recent techniques in managing and treating patients with MS.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Science, Autonomous University of Guerrero, Chilpancingo 39090, Guerrero, Mexico
| | - Selenne Romero-Servin
- Resident Student, Oral and Maxillofacial Pathology, National School of Higher Studies, Leon Unit of the National Autonomous University of Mexico, Leon 37684, Guanajuato, Mexico
| | - Lazar Yessayan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-e-Dasht Street, Shiraz, Iran.
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
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De Stefani E, Barbot A, Zannoni C, Belluardo M, Bertolini C, Cosoli R, Bianchi B, Ferri A, Zito F, Bergonzani M, Schiano Lomoriello A, Sessa P, Ferrari PF. Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis. Front Neurol 2022; 13:757523. [PMID: 35665048 PMCID: PMC9156860 DOI: 10.3389/fneur.2022.757523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Rehabilitation after free gracilis muscle transfer (smile surgery, SS) is crucial for a functional recovery of the smiling skill, mitigating social and psychological problems resulting from facial paralysis. We compared two post-SS rehabilitation treatments: the traditional based on teeth clenching exercises and the FIT-SAT (facial imitation and synergistic activity treatment). FIT-SAT, based on observation/imitation therapy and on hand-mouth motor synergies would facilitate neuronal activity in the facial motor cortex avoiding unwanted contractions of the jaw, implementing muscle control. We measured the smile symmetry on 30 patients, half of whom after SS underwent traditional treatment (control group, CG meanage = 20 ± 9) while the other half FIT-SAT (experimental group, EG meanage= 21 ± 14). We compared pictures of participants while holding two postures: maximum and gentle smile. The former corresponds to the maximal muscle contraction, whereas the latter is strongly linked to the control of muscle strength during voluntary movements. No differences were observed between the two groups in the maximum smile, whereas in the gentle smile the EG obtained a better symmetry than the CG. These results support the efficacy of FIT-SAT in modulating the smile allowing patients to adapt their smile to the various social contexts, aspect which is crucial during reciprocal interactions.
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Affiliation(s)
- Elisa De Stefani
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Child and Adolescent Neuropsychiatry–NPIA District of Scandiano, AUSL of Reggio Emilia, Reggio Emilia, Italy
- *Correspondence: Elisa De Stefani
| | - Anna Barbot
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Cecilia Zannoni
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Mauro Belluardo
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Chiara Bertolini
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Rita Cosoli
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Andrea Ferri
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Francesca Zito
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Michela Bergonzani
- Operative Unit of Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | | | - Paola Sessa
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
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Classification and Clinical Treatments for Unfavorable Fractures of the Proximal Segment in Sagittal Spilt Ramus Osteotomy: A Retrospective Study of 964 Cases. J Craniofac Surg 2021; 33:1445-1449. [PMID: 34629384 DOI: 10.1097/scs.0000000000008276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT Unfavorable fractures in sagittal split ramus osteotomy are hard to manage. The aim of this study is to develop a new classification method for unfavorable fractures of the proximal segment to guide clinical managements. After reviewing 964 cases of sagittal split ramus osteotomy, we found that the unfavorable fractures can be divided into 3 types: mandibular ramus transverse fractures (Type 1), bad fractures accompanied by free fragments (Type 2), and unexpected separation patterns without free fragments (Type 3). We calculated the incidence of each fracture type and provided instructions for their corresponding treatments. Thirty-six patients suffered from unfavorable fractures (7.4% of patients), among which 32 patients had unilateral fractures and 4 patients had bilateral fractures. There were 2 Type 1 fractures (0.2% of split sites), 8 Type 2 fractures (0.8% of split sites), and twenty-six Type 3 fractures (2.3% of split sites). Type 1 unfavorable fractures are difficult to deal with, but Types 2 and 3 are generally manageable and they have no significant impact on the final outcomes. The new classification can effectively guide treatment strategies for unfavorable fractures. Severe cases of unfavorable fractures are rare, and most unfavorable fracture cases have a positive prognosis if correctly treated in time.
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A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies. Neural Plast 2021; 2021:8890541. [PMID: 33833792 PMCID: PMC8016575 DOI: 10.1155/2021/8890541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.
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Cephalometric Analysis of the Craniofacial Morphology in Patients With Moebius Syndrome. J Craniofac Surg 2021; 32:2446-2448. [PMID: 33606435 DOI: 10.1097/scs.0000000000007559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with Moebius syndrome may present a wide range of associated orofacial malformations, however, their craniofacial morphology has not been established via controlled cephalometric studies. OBJECTIVE To present our institution's findings in the cephalometric evaluation in patients with Moebius syndrome. METHODS Retrospective, cross-sectional study that included patients with Moebius syndrome over 9 years of age who had lateral cephalometric radiographs. Cephalometric analysis measurements of Ricketts, Steiner, and McNamara were performed. Quantitative data are expressed as mean and standard deviation, and qualitative data are expressed in totals and percentages. Comparative statistics between classic and incomplete Moebius and between patients older and younger than 16 years of age were performed. RESULTS Twenty-four patients were included (54.2% females), mean age 17.46 ± 8.85 years. Fifteen patients (62.5%) had classic Moebius syndrome, and nine (37.5%) had incomplete Moebius. Sixty-six percent of the patients presented either micrognathia or retrognathia, 95% showed mandibular hypoplasia, and 75% had a skeletal class II. Maxillary height was increased resulting in a vertical growth pattern. Upper and lower incisors tended towards proclination, and upper and lower lips protruded over cephalometric markings, and a long upper lip was evidenced in 41% of the patients. No significant differences were noted when comparing classic and incomplete Moebius syndrome. Patients younger than 16 years of age had significantly larger sella-nasion-A point and sella-nasion-B point angles, and a higher proportion of skeletal class II cases. CONCLUSIONS Patients with Moebius syndrome have a vertical maxillary growth, micro or retrognathia, developing a skeletal class II and lip protrusion.
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Bianchi B, Zito F, Perlangeli G, Pedrazzi G, Ferrari PF, De Stefani E, Sesenna E, Di Tano A, Ferri A. Long-term results of facial animation surgery in patients with Moebius syndrome. J Craniomaxillofac Surg 2020; 48:1132-1137. [PMID: 33191114 DOI: 10.1016/j.jcms.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/30/2020] [Accepted: 10/25/2020] [Indexed: 12/19/2022] Open
Abstract
Gracilis neuromuscular transplant is considered the gold standard for facial animation in Moebius syndrome patients. However, long-term evaluation of the results has not been critically examined in the international literature. Thus, it remains unknown how the transplanted flap changes with facial growth, and whether contraction (smiling) is maintained. Pediatric patients with Moebius syndrome who underwent facial animation surgery with at least 5 years of follow-up were retrospectively examined. Photographs taken at the 1-year and most recent follow-up visits were analyzed and compared using Emotrics software. Analyses focused on the rest position, and on gentle and maximum smiles. Eighteen patients were enrolled. Seven patients had bilateral and 11 unilateral Moebius syndrome; therefore, 25 gracilis transplants were analyzed. The latest follow-ups ranged from 5 to 13.2 years (mean 7.6 years). The three principal facial expressions that were examined did not differ significantly between 1 year and a mean of 7.6 years after surgery, but tended to improve in most patients. Commissure excursion and smile angle for the maximum smile did improve significantly (p = 0.002 and 0.029, respectively). The series examined in this study supports the limited literature regarding the long-term stability of gracilis transplantation to animate the faces of Moebius syndrome children.
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Affiliation(s)
- Bernardo Bianchi
- Maxillo-Facial Specialist in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Francesca Zito
- Resident in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Italy.
| | - Giuseppe Perlangeli
- Resident in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Italy.
| | | | | | | | - Enrico Sesenna
- Head of the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Italy.
| | | | - Andrea Ferri
- Maxillo-Facial Specialist in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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Changes of Occlusal Plane in Growing Patients With Increased Vertical Dimension During Class II Correction by Using Cervical Headgear. J Craniofac Surg 2020; 31:172-177. [DOI: 10.1097/scs.0000000000006197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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De Stefani E, Nicolini Y, Belluardo M, Ferrari PF. Congenital facial palsy and emotion processing: The case of Moebius syndrome. GENES BRAIN AND BEHAVIOR 2019; 18:e12548. [PMID: 30604920 DOI: 10.1111/gbb.12548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/16/2018] [Accepted: 12/15/2018] [Indexed: 12/13/2022]
Abstract
According to the Darwinian perspective, facial expressions of emotions evolved to quickly communicate emotional states and would serve adaptive functions that promote social interactions. Embodied cognition theories suggest that we understand others' emotions by reproducing the perceived expression in our own facial musculature (facial mimicry) and the mere observation of a facial expression can evoke the corresponding emotion in the perceivers. Consequently, the inability to form facial expressions would affect the experience of emotional understanding. In this review, we aimed at providing account on the link between the lack of emotion production and the mechanisms of emotion processing. We address this issue by taking into account Moebius syndrome, a rare neurological disorder that primarily affects the muscles controlling facial expressions. Individuals with Moebius syndrome are born with facial paralysis and inability to form facial expressions. This makes them the ideal population to study whether facial mimicry is necessary for emotion understanding. Here, we discuss behavioral ambiguous/mixed results on emotion recognition deficits in Moebius syndrome suggesting the need to investigate further aspects of emotional processing such as the physiological responses associated with the emotional experience during developmental age.
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Affiliation(s)
- Elisa De Stefani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ylenia Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mauro Belluardo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pier Francesco Ferrari
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Institut des Sciences Cognitives Marc Jeannerod, CNRS, Université de Lyon, Lyon, France
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Giuliani A, Mazzoni S, Mangano C, Zecca PA, Caprioglio A, Vercellini N, Raspanti M, Mangano F, Piattelli A, Iezzi G, Fastuca R. Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography. BMC Oral Health 2018; 18:125. [PMID: 30045728 PMCID: PMC6060467 DOI: 10.1186/s12903-018-0590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/12/2018] [Indexed: 11/11/2022] Open
Abstract
Background Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME. Methods Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy. Results In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture’s long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae. Conclusions The microCT imaging revealed, for the first time to the authors’ knowledge, the 3D bone regeneration in children submitted to RME. Electronic supplementary material The online version of this article (10.1186/s12903-018-0590-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra Giuliani
- Sezione di Biochimica, Biologia e Fisica Applicata, Department of Clinical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 1, 60131, Ancona, Italy.
| | - Serena Mazzoni
- Sezione di Biochimica, Biologia e Fisica Applicata, Department of Clinical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 1, 60131, Ancona, Italy
| | | | - Piero Antonio Zecca
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Nicolò Vercellini
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Mario Raspanti
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | | | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti Scalo, CH, Italy
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti Scalo, CH, Italy
| | - Rosamaria Fastuca
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
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Chardey EK, Fastuca R, Beretta M, Di Blasio A, Vercellini N, Caprioglio A, Zecca PA, Macchi A. Digital Dynamic 3D Monitoring of Lower Incisors Intrusion in Lingual Orthodontics. Open Dent J 2018; 12:104-117. [PMID: 29492176 PMCID: PMC5815052 DOI: 10.2174/1874210601812010104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the present study is to propose a 3-dimensional evaluation of lower intrusion obtained with lingual orthodontics considering not only the crowns but also dental roots. Methods 9 adult patients underwent fixed lingual orthodontic treatment with i-TTя lingual brackets system for the correction of crowding in the lower arch associated with a deep overbite. Initial records, consisting of photos, CBCTs and intraoral scans were collected. Threshold segmentation of the CBCT was performed to generate a three-dimensional virtual model of each the teeth of the lower arch, superimposed with the crown of the same teeth obtained by intraoral scan models to generate a complete set of digital composite lower arch The same procedure was performed to monitor one key step of the i-TTЯ technique consisting in lower incisors intrusion (T2). T1-T2 three-dimensional superimposition and color displacement maps were generated to measure and evaluate the movements obtained at the lower arch. Results The root displacement of the incisors during their intrusion in the early stage was totally "bone-safe" in the 88.9% (8 of 9) of the cases observed. No significant extrusion of the premolars used as anchorage unit was measured. Conclusion This method has proved to be an accurate and reliable approach to dynamically visualize the 3-dimensional positions of the teeth, including their roots, with no additional radiation for in-progress treatment monitoring. The 3-dimensional evaluation showed that the employed lingual appliance allowed to obtain significant lower incisors intrusion with negligible undesired extrusion of premolars employed as anchorage teeth.
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Affiliation(s)
- Elia Kodjo Chardey
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Rosamaria Fastuca
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Matteo Beretta
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Alberto Di Blasio
- Department of Biotechnological, Biomedical and Translational Sciences, Section of Orthodontics, University of Parma, Parma, Italy
| | - Nicolò Vercellini
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Piero Antonio Zecca
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Aldo Macchi
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Early Orthopaedic Treatment of Hemifacial Microsomia. Case Rep Dent 2018; 2017:7318715. [PMID: 29387494 PMCID: PMC5745710 DOI: 10.1155/2017/7318715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/01/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to report treatment effects of functional therapy in a growing patient affected by hemifacial microsomia (HM). According to Kaban's classification, the patient was classified as grade IIa as she presented all mandibular and temporomandibular joint components and a normal shaped, hypoplastic mandible. The therapeutic approach included the use of an asymmetrical functional activator (AFA) to stimulate the growth of the affected side and consequently to improve symmetry of the mandible and maxillary deficiency. Further effects were the lengthening of the mandibular ramus, restoration of occlusion, and expansion of soft tissues.
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Bartzela TN, Carels C, Maltha JC. Update on 13 Syndromes Affecting Craniofacial and Dental Structures. Front Physiol 2017; 8:1038. [PMID: 29311971 PMCID: PMC5735950 DOI: 10.3389/fphys.2017.01038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
Care of individuals with syndromes affecting craniofacial and dental structures are mostly treated by an interdisciplinary team from early childhood on. In addition to medical and dental specialists that have a vivid interest in these syndromes and for whom these syndromes are of evident interest, experts of scientific background-like molecular and developmental geneticists, but also computational biologists and bioinformaticians-, become more frequently involved in the refined diagnostic and etiological processes of these patients. Early diagnosis is often crucial for the effective treatment of functional and developmental aspects. However, not all syndromes can be clinically identified early, especially in cases of absence of known family history. Moreover, the treatment of these patients is often complicated because of insufficient medical knowledge, and because of the dental and craniofacial developmental variations. The role of the team is crucial for the prevention, proper function, and craniofacial development which is often combined with orthognathic surgery. Although the existing literature does not provide considerable insight into this topic, this descriptive review aims to provide tools for the interdisciplinary team by giving an update on the genetics and general features, and the oral and craniofacial manifestations for early diagnosis. Clinical phenotyping together with genetic data and pathway information will ultimately pave the way for preventive strategies and therapeutic options in the future. This will improve the prognosis for better functional and aesthetic outcome for these patients and lead to a better quality of life, not only for the patients themselves but also for their families. The aim of this review is to promote interdisciplinary interaction and mutual understanding among all specialists involved in the diagnosis and therapeutic guidance of patients with these syndromal conditions in order to provide optimal personalized care in an integrated approach.
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Affiliation(s)
- Theodosia N Bartzela
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Berlin, Germany.,Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carine Carels
- Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Jaap C Maltha
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
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Brevi B, Di Blasio A, Di Blasio C, Piazza F, D'Ascanio L, Sesenna E. Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome? ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 35:332-7. [PMID: 26824915 PMCID: PMC4720930 DOI: 10.14639/0392-100x-415] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperatively by both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner's SNA angle increased from 78.18° to 85.58° (p < 0.001), while mean Delaire's C3/FM-CPA angle increased from 81.19° to 89.71° (p < 0.001). The mean value of Steiner's SNB angle increased from 74.33° to 80.73° (p < 0.001), while Delaire's C3/FM-Me angle increased from 80.10° to 87.29° (p < 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p < 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA.
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Affiliation(s)
- B Brevi
- Department of Maxillo-Facial Surgery, University Hospital of Parma, Italy
| | - A Di Blasio
- Department of Dentistry, University Hospital of Parma, Italy
| | - C Di Blasio
- Department of Maxillo-Facial Surgery, University Hospital of Parma, Italy
| | - F Piazza
- Department of Otolaryngology-Head & Neck Surgery, "Carlo Poma" Civil Hospital of Mantova, Italy
| | - L D'Ascanio
- Department of Otolaryngology-Head & Neck Surgery, "Carlo Poma" Civil Hospital of Mantova, Italy
| | - E Sesenna
- Department of Maxillo-Facial Surgery, University Hospital of Parma, Italy
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15
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Fastuca R, Lorusso P, Lagravère MO, Michelotti A, Portelli M, Zecca PA, D’ Antò V, Militi A, Nucera R, Caprioglio A. Digital evaluation of nasal changes induced by rapid maxillary expansion with different anchorage and appliance design. BMC Oral Health 2017; 17:113. [PMID: 28705206 PMCID: PMC5513127 DOI: 10.1186/s12903-017-0404-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/04/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Scientific evidence showed that rapid maxillary expansion (RME) affects naso-maxillary complex, increasing nasal width and volume. This study aimed to evaluate nasal changes induced by rapid maxillary expansion with different anchorage and appliance design by using low dose and cone beam computed tomography. METHODS A total of 44 patients (20 males, mean age 8y 8 m ± 1y 2 m; 24 females mean age 8y 2 m ± 1y 4 m) were included in the investigation and divided into three groups according to the appliance: Hyrax-type expander anchored to permanent teeth, modified Hyrax-type expander anchored to deciduous teeth, modified Haas-type expander anchored to deciduous teeth. Maxillary expansion was performed until overcorrection and the expander was passively kept in situ for 7 months at least. All patients had three-dimensional imaging before expansion (T0) and after the retention period (T1). Nasal floor width, nasal wall width, maxillary inter-molar width were measured by means of Mimics software. The paired sample t-test was employed to assess the significance of the differences between the time points; the analysis of variance test (ANOVA) was used to compare differences between groups. RESULTS The statistical analysis revealed significant differences between T0 and T1 for each recorded measurement in each group; no significant differences were found by comparing groups. CONCLUSIONS Rapid maxillary expansion produces a significant skeletal transverse expansion of nasal region in growing patients. No significant differences in nasal effects are expected when the appliance is anchored onto deciduous teeth, with or without the palatal acrylic coverage.
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Affiliation(s)
- Rosamaria Fastuca
- Department of Surgical and Morphological Sciences, University of Messina, Via Consolare Valeria 1, Messina, Italy
- C/O Dental School, Via G. Piatti, 10, 21100 Velate, VA Italy
| | - Paola Lorusso
- Private Practice in Orthodontics, Bari, Italy
- Research Fellow, University of insubria, Via G. Piatti, 10 Varese, Italy
| | - Manuel O Lagravère
- Department of Dentistry, University of Alberta, 11400 University Avenue, Edmonton, AB Canada
| | - Ambra Michelotti
- Section of Orthodontics, Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, Naples, Italy
| | - Marco Portelli
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Via G. Piatti, 10 Varese, Italy
| | | | - Angela Militi
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Riccardo Nucera
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Alberto Caprioglio
- Department of Surgical and Morphological Sciences, University of Insubria, Via G. Piatti, 10 Varese, Italy
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16
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Cephalometric changes in growing patients with increased vertical dimension treated with cervical headgear. J Orofac Orthop 2017; 78:312-320. [DOI: 10.1007/s00056-017-0087-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/04/2017] [Indexed: 10/19/2022]
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Caprioglio A, Bergamini C, Franchi L, Vercellini N, Zecca PA, Nucera R, Fastuca R. Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition. Prog Orthod 2017; 18:9. [PMID: 28367605 PMCID: PMC5376539 DOI: 10.1186/s40510-017-0163-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to identify cephalometric pretreatment parameters for prediction of Class II improvement induced by rapid maxillary expansion. METHODS Lateral cephalograms of 30 patients (mean age 8.3 ± 1.6 years old) showing Class II molar relationship and undergone to rapid maxillary expansion on the upper deciduous molars were traced before treatment, and molar relation changes were evaluated on dental casts before and after treatment. Overall treatment time lasted 10.2 ± 2 months. Good responders (18 subjects, 10 females and 8 males) showed improvement of at least 2.50 mm, and bad responders (12 subjects, 7 females and 5 males) showed no improvement, improvement less than 2.50 mm, or worsening of molar relationship after treatment. Student's t test was used to assess significance of differences between groups, and discriminant analysis allowed identification of predictive pretreatment variables. RESULTS Articular angle, superior gonial angle, and mandibular dimensions (Co-Gn, S-Ar, Ar-Go, Go-Me) showed significant differences in the comparison between groups. Mandibular length Co-Gn and superior gonial angle were selected as significant predictive variable for discrimination. CONCLUSIONS Patients with smaller mandibular length and more acute superior gonial angle are expected to have more chances to improve molar Class II after rapid maxillary expansion.
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Affiliation(s)
- Alberto Caprioglio
- Division of Orthodontics, Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Chiara Bergamini
- Division of Orthodontics, Department of Surgical and Morphological Sciences, Orthodontic Programme, School of Medicine, University of Insubria, Varese, Italy
| | - Lorenzo Franchi
- Division of Dentistry, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Nicolò Vercellini
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Riccardo Nucera
- Division of Orthodontics, Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy. .,C/O Dental School, Via G. Piatti, 10, Velate, 21100, Varese, Italy.
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18
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Di Blasio A, Di Blasio C, Pedrazzi G, Cassi D, Magnifico M, Manfredi E, Gandolfini M. Combined photographic and ultrasonographic measurement of the ANB angle: a pilot study. Oral Radiol 2017; 33:212-218. [PMID: 28890606 PMCID: PMC5570769 DOI: 10.1007/s11282-017-0275-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/23/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study was performed to evaluate the feasibility of noninvasive measurement of the ANB angle using photographic and ultrasonographic methods. METHODS Twenty consecutive orthodontic patients were evaluated. The ANB angle and soft tissue thickness covering the N, A, and B cephalometric points were measured by lateral teleradiography; these measurements were made by two expert operators. The soft tissue thickness covering the N, A, and B cephalometric points was measured by ultrasonography; these measurements were also made by two expert operators. On a 1:1 photographic profile print on which the ultrasonographic points were marked, the ANB ultrasonographic angle was measured. The following comparisons were considered: averaged and single measurements of N, A, and B points by first versus second ultrasonographer; averaged and single ultrasonographic versus radiographic soft tissue thickness covering the N, A, B points; and averaged and single ultrasonographic versus radiographic measurements of ANB angle. RESULTS High correlation and concordance of the averaged and single measurements, but no significant difference, was found between the two ultrasonographers. No statistically significant difference was found between the two methods for measuring averaged soft tissue thickness, but a 20% difference was found for the single measurements. High correlation and concordance between the ultrasonographic and radiographic measurements, but no significant difference, was found between the single and averaged ANB angle measurements. CONCLUSION Ultrasonography seems to be a noninvasive and reliable technique for measurement of the ANB angle and may replace radiographic measurement in some cases.
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Affiliation(s)
- Alberto Di Blasio
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Di Blasio
- Head and Neck Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Giuseppe Pedrazzi
- Neuroscience Department, University of Parma (Italy), Via Volturno 39, 43125 Parma, Italy
| | - Diana Cassi
- Doctoral School in Life and Health Science, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Marisabel Magnifico
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Edoardo Manfredi
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Mauro Gandolfini
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
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Pre- and Postsurgical Orthodontics in Patients with Moebius Syndrome. Case Rep Dent 2017; 2017:1484065. [PMID: 28409036 PMCID: PMC5376922 DOI: 10.1155/2017/1484065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/09/2017] [Indexed: 02/04/2023] Open
Abstract
The authors report a combined orthodontic-surgical correction of an adult patient's malocclusion affected by Moebius Syndrome (MS). The treatment was conducted at the Dentistry Unit and the Maxillofacial Surgery Unit of the University Hospital of Parma. Treatment of malocclusion was performed after the correction of facial mimic mobility with smile surgery. The postoperative stability and orthodontic results were good and the correction of the morphological problems related to the syndrome was very satisfactory.
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20
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Ghosh R, Shetty V, Hegde S, Babu GS, Ajila V, Kishore P N, Nair M. Rare features associated with Mobius syndrome: Report of two cases. J Dent Res Dent Clin Dent Prospects 2017; 11:60-65. [PMID: 28413599 PMCID: PMC5390129 DOI: 10.15171/joddd.2017.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/01/2017] [Indexed: 01/30/2023] Open
Abstract
Mobius syndrome is a rare congenital disorder with the preliminary diagnostic criteria of congenital facial and abducent nerve palsy. Involvement of other cranial nerves, too, is common. Prevalence rate of this syndrome is approximately 1 in 100,000 neonates. It is of unknown etiology with sporadic occurrence. However, data regarding the occurrence rate in India is limited. Features such as orofacial malformations, limb defects, and musculoskeletal, behavioral, and cognitive abnormalities might be associated. A thorough evaluation to identify the condition and establishing an adequate treatment plan is of utmost important in this condition. We are reporting clinical and radiographic features of Mobius syndrome in two cases along with unusual findings of limb and neck deformity.
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Affiliation(s)
- Rumela Ghosh
- Department of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, India
| | - Vikram Shetty
- Nitte Meenakshi Institute of Craniofacial Surgery, K.S.Hegde Medical College and Hospital, Nitte University, Mangalore, India
| | - Shruthi Hegde
- Department of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, India
| | - G Subhas Babu
- Nitte Meenakshi Institute of Craniofacial Surgery, K.S.Hegde Medical College and Hospital, Nitte University, Mangalore, India
| | - Vidya Ajila
- Department of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, India
| | - Nanda Kishore P
- Department of Orthodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, India
| | - Mithula Nair
- Department of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, India
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Caprioglio A, Fastuca R, Zecca PA, Beretta M, Mangano C, Piattelli A, Macchi A, Iezzi G. Cellular Midpalatal Suture Changes after Rapid Maxillary Expansion in Growing Subjects: A Case Report. Int J Mol Sci 2017; 18:ijms18030615. [PMID: 28287481 PMCID: PMC5372631 DOI: 10.3390/ijms18030615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/25/2022] Open
Abstract
The present case report aimed to investigate immediate histologic changes in midpalatal suture in humans following rapid maxillary expansion compared to control. Three patients (mean age 8.3 ± 0.9 years) were enrolled in the case report and underwent midpalatal suture biopsy. Two patients underwent treatment before biopsy. The third patient did not show transversal maxillary deficiency and was enrolled as a control. Biopsy samples of midpalatal suture at 7 (subject 1) and 30 days (subject 2) after maxillary expansion as well as of one control (subject 3) were collected and processed for histology. In the control (subject 3) inter-digitations at the palatal suture gap were observed. At 7 days (subject 1) mature bone with small marrow spaces and trabecular bone with the peculiar storiform appearance inside the soft tissue and collagen fibers running parallel only in the central part were present. At 30 days (subject 2), a greater number of newly-formed bone trabeculae with a perpendicular orientation to the long axis of the suture could be seen. At 30 days the fibrous component of bone tissue was less represented compared to the sample at 7 days. Data from the preliminary histological results showed that bone formation was observed in the gap after rapid maxillary expansion, although the healing process was still ongoing.
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Affiliation(s)
- Alberto Caprioglio
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, 98100 Messina, Italy.
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Matteo Beretta
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Carlo Mangano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Aldo Macchi
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
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Fairgray E, Miles A. Enhancing surgical outcomes: The effects of speech therapy on a school-aged girl with Moebius Syndrome. Int J Pediatr Otorhinolaryngol 2016; 90:58-62. [PMID: 27729154 DOI: 10.1016/j.ijporl.2016.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Moebius Syndrome is a rare congenital neurological condition often characterized by multiple cranial nerve involvement. This case study presents an eight-year old girl with Moebius Syndrome (MC) who received 30 sessions of speech therapy. This occurred after presenting to clinic 11 months after left facial reanimation with gracilis thigh muscle transfer surgery. On examination, only flickers of left facial movement were observed. There was no movement on the right side of the face. As a consequence of the minimal movement, MC presented with drooling and unintelligible speech. The purpose of speech therapy was three fold: minimise the pooling of saliva, improve the placement of the articulators so that articulation of speech sounds would be more accurate, and gain advances in overall intelligibility. METHODS Therapy focussed on speech, facial movement and saliva management using a combination of speech drills, evidence-based articulation therapies, facial exercises with surface electromyography biofeedback, self-awareness training and compensatory saliva management strategies. RESULTS After a course of 30 one-hour speech therapy sessions, substantial improvements were seen in speech sound accuracy, overall intelligibility, facial movement and saliva control. CONCLUSIONS The combination of surgery and speech therapy led to functional gains that surgery alone did not achieve. The impact of speech therapy on surgical outcomes in individuals with Moebius syndrome deserves further investigation.
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Affiliation(s)
| | - Anna Miles
- Speech Science, The University of Auckland, New Zealand.
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Bianchi B, Ferri A, Ferrari S, Leporati M, Ferri T, Sesenna E. Ancillary Procedures in Facial Animation Surgery. J Oral Maxillofac Surg 2014; 72:2582-90. [DOI: 10.1016/j.joms.2014.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/18/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
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Affiliation(s)
- David Alfi
- Department of Oral & Maxillofacial Surgery, Houston Methodist Specialty Physician Group, Weill Medical College Cornell University, New York, 6560 Fannin Suite 1280, Houston, TX 77030, USA.
| | - Din Lam
- Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaime Gateno
- Department of Oral & Maxillofacial Surgery, Houston Methodist Specialty Physician Group, Weill Medical College Cornell University, New York, 6560 Fannin Suite 1280, Houston, TX 77030, USA
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Kim JY, Jung HD, Jung YS, Hwang CJ, Park HS. A simple classification of facial asymmetry by TML system. J Craniomaxillofac Surg 2014; 42:313-20. [DOI: 10.1016/j.jcms.2013.05.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 05/26/2013] [Accepted: 05/27/2013] [Indexed: 01/04/2023] Open
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