Orthodontic-Orthopedic-Surgical Treatment of Syndromic Third Class: Proposal of a New Craniofacial Cephalometric Method

Craniofacial syndromes and class III phenotype: common genotype fingerprints? A scoping review and meta-analysis

Skeletal Class III (SCIII) is among the most challenging craniofacial dysmorphologies to treat. There is, however, a knowledge gap regarding which syndromes share this clinical phenotype. The aims of this study were to: (i) identify the syndromes affected by the SCIII phenotype; (ii) clarify the involvement of maxillary and/or mandibular structures; (iii) explore shared genetic/molecular mechanisms. A two-step strategy was designed: [Step#1] OMIM, MHDD, HPO, GeneReviews and MedGen databases were explored; [Step#2]: Syndromic conditions indexed in [Step#1] were explored in Medline, Pubmed, Scopus, Cochrane Library, WOS and OpenGrey. Eligibility criteria were defined. Individual studies were assessed for risk of bias using the New Ottawa Scale. For quantitative analysis, a meta-analysis was conducted. This scoping review is a hypothesis-generating research. Twenty-two studies met the eligibility criteria. Eight syndromes affected by the SCIII were targeted: Apert syndrome, Crouzon syndrome, achondroplasia, X-linked hypohidrotic ectodermal dysplasia (XLED), tricho-dento-osseous syndrome, cleidocranial dysplasia, Klinefelter and Down syndromes. Despite heterogeneity between studies [p < 0.05], overall effects showed that midface components were affected in Apert and Down Syndromes, lower face in Klinefelter Syndrome and midface and lower face components in XLED. Our review provides new evidence on the craniofacial characteristics of genetically confirmed syndromes exhibiting the SCIII phenotype. Four major regulatory pathways might have a modulatory effect on this phenotype. IMPACT: What does this review add to the existing literature? To date, there is no literature exploring which particular syndromes exhibit mandibular prognathism as a common trait. Through this research, it was possibly to identify the particular syndromes that share the skeletal Class III phenotype (mandibular prognathism) as a common trait highlighting the common genetic and molecular pathways between different syndromes acknowledging their impact in craniofacial development.

Orthognathic Surgery and Relapse: A Systematic Review

BACKGROUND

This review aimed to analyze the relapse in orthognathic surgery.

METHODS

PubMed, Scopus, and Web of Science databases were used to find papers that matched our topic dating from 1 January 2012 up to November 2022. Inclusion criteria were (1) human studies, (2) open access studies, (3) studies concerning the correlation between orthognathic surgery and relapse. Exclusion criteria were: (1) in vitro or animal studies, (2) off-topic studies, (3) reviews, (4) other languages than English.

RESULTS

A total of 482 results were obtained resulting in 323 publications after duplicate removal (158). After screening and eligibility phases 247 records were excluded: 47 reviews, 5 in animals, 35 in vitro, 180 off-topic. The authors successfully retrieved the remaining 78 papers and evaluated their eligibility. A total of 14 studies from these were ultimately included in the review.

CONCLUSION

Using cephalometric examinations and digital study models, these studies reveal that the relapse after orthognathic surgery is an event that occurs in most of the cases. The limitation of our research is that most of the studies are retrospective and use small sample sizes. A future research goal should be to conduct long-term clinical trials with larger numbers of samples.

Cephalometric analyses for cleft patients: a statistical approach to compare the variables of Delaire's craniofacial analysis to Bergen analysis

Objectives

Cephalometric analyses using lateral craniofacial radiographs are common diagnostic procedures for evaluating skeletal patterns. However, in patients with pronounced abnormalities like cleft lip and palate, standard cephalometric analyses and landmarks may not be suitable. This study aims to clarify whether the inclusion of landmarks less compromised by the cleft defect or located outside the cleft area results in a different cephalometric assessment of the viscerocranium. Delaire’s whole-skull analysis and Bergen analysis were examined for similarities and underlying common observations.

Materials/methods

Based on the cephalometric evaluation of 217 patients with different types of non-syndromal cleft formation, Delaire and Bergen analysis were compared using three statistical methods: correlation analysis, factor analysis, and cluster analysis. Reproducibility was assessed by Bland–Altman plots, intraclass correlation coefficients, mean absolute differences, and coefficients of variability.

Results

Although Delaire analysis and Bergen analysis are based on different concepts and landmarks, a majority of corresponding variables was found. Certain aspects of craniofacial base relation and craniospinal articulation are only assessed by Delaire analysis. All but one variable showed very good reproducibility.

Conclusions

The inclusion of landmarks less compromised by or located outside the cleft area does not result in variables that provide a different assessment of the viscerocranial area.

Clinical Relevance

The findings contradict the concept of invalidity of landmarks compromised by the cleft defect or located within the affected cleft area. Within the scope of its viscerocranial field of view, Bergen analysis appears to be on a par with Delaire analysis in the diagnosis of cleft patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04006-3.