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Lewyllie A, Cadenas De Llano-Pérula M, Verdonck A, Willems G. Three-dimensional imaging of soft and hard facial tissues in patients with craniofacial syndromes: a systematic review of methodological quality. Dentomaxillofac Radiol 2017; 47:20170154. [PMID: 29168926 DOI: 10.1259/dmfr.20170154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To systematically review the methodological quality of three-dimensional imaging studies of patients with craniofacial syndromes and to propose recommendations for future research. METHODS PubMed, Embase and Cochrane databases as well as Grey literature were electronically searched. Inclusion criteria were patients with genetic syndromes with craniofacial manifestations and three-dimensional imaging of facial soft and/or hard tissues. Exclusion criteria consisted of non-syndromic conditions or conditions owing to environmental causes, injury or trauma, facial soft and hard tissues not included in the image analysis, case reports, reviews, opinion articles. No restrictions were made for patients' ethnicity nor age, publication language or publication date. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS The search yielded 2228 citations of which 116 were assessed in detail and 60 were eventually included in this review. Studies showed a large heterogeneity in study design, sample size and patient age. An increase was observed in the amount of studies with time, and the imaging method most often used was CT. The most studied craniofacial syndromes were Treacher Collins, Crouzon and Apert syndrome. The articles could be divided into three main groups: diagnostic studies (34/60, 57%), evaluation of surgical outcomes (21/60, 35%) and evaluation of imaging techniques (5/60, 8%). For comparative studies, the median MINORS score was 13 (12-15, 25-75th percentile), and for non-comparative studies, the median MINORS score was 8 (7-9, 25-75th percentile). CONCLUSIONS The median MINORS scores were only 50 and 54% of the maximum scores and there was a lack of prospective, controlled trials with sufficiently large study groups. To improve the quality of future studies in this domain and given the low incidence of craniofacial syndromes, more prospective multicentre controlled trials should be set up.
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Affiliation(s)
- Arianne Lewyllie
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Maria Cadenas De Llano-Pérula
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Anna Verdonck
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Guy Willems
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
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Suzuki N, Miyazaki A, Igarashi T, Dehari H, Kobayashi JI, Miki Y, Ogi K, Nagai I, Sonoda T, Yotsuyanagi T, Hiratsuka H. Relationship between Mandibular Ramus Height and Masticatory Muscle Function in Patients with Unilateral Hemifacial Microsomia. Cleft Palate Craniofac J 2017; 54:43-52. [DOI: 10.1597/14-329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To clarify the relationship between mandibular ramus height and function of masticatory muscles in patients with hemifacial microsomia. Design Retrospective study of imaging and physiological data. Setting Images and physiological data were obtained from the records of Sapporo Medical University Hospital. Patients A total of 29 patients with hemifacial microsomia who showed Pruzansky grades I, II deformity. Main Outcome Measures Mandibular ramus height and masticatory muscle volume were evaluated with multi-detector row computed tomography. The electromyographic value was measured by the K7 Evaluation System. The hemifacial microsomia patients were classified into three groups based on the mandibular ramus height ratio of the affected and unaffected sides: group 0, > 1.00; group 1, 1.00 to 0.85; group 2, < 0.85. The Tukey-Kramer method and Games-Howell method were used to determine correlations between parameters. Results Decreased mandibular ramus height was significantly correlated with both reduced electromyographic values of the masseter muscle (P < .05) and the amount of mandibular lateral deviation at the time of maximum opening (P < .05) on the affected side. These differences were prominent in unilateral hemifacial microsomia patients classified as group 2. Conclusions Decreased mandibular ramus height may cause dysfunction of the masseter muscles but not the temporal muscle on the affected side in patients with hemifacial microsomia.
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Affiliation(s)
- Naohiro Suzuki
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akihiro Miyazaki
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomohiro Igarashi
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hironari Dehari
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jun-Ichi Kobayashi
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiki Miki
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuhiro Ogi
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Itaru Nagai
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoko Sonoda
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takatoshi Yotsuyanagi
- Department of Plastic and Reconstructive Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyoshi Hiratsuka
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Abstract
Goldenhar Syndrome or oculoauriculovertebral spectrum is a complex syndrome characterized by an association of maxillomandibular hypoplasia, deformity of the ear, ocular dermoid and vertebral anomalies and the most severe form of hemifacial microsomia. Here, we describe a 26-year-old male patient with unilateral hemifacial microsomia, preauricular ear tags, macrosomia on the right side of the face.
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Affiliation(s)
- Ruchi Bhuyan
- Department of Oral Pathology and Microbiology, Siksha O Anusandhan University, Khandagiri, Bhubaneswar, Odisha, India
| | - Abhishek Ranjan Pati
- Department of Oral Medicine and Radiology, Siksha O Anusandhan University, Khandagiri, Bhubaneswar, Odisha, India
| | - Sanat Kumar Bhuyan
- Department of Oral Medicine and Radiology, Siksha O Anusandhan University, Khandagiri, Bhubaneswar, Odisha, India
| | - Bikash Bishwadarshee Nayak
- Department of Oral Medicine and Radiology, Siksha O Anusandhan University, Khandagiri, Bhubaneswar, Odisha, India
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Surgical Classification of the Mandibular Deformity in Craniofacial Microsomia Using 3-Dimensional Computed Tomography. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e598. [PMID: 27104097 PMCID: PMC4801100 DOI: 10.1097/gox.0000000000000582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022]
Abstract
Background: Grading systems of the mandibular deformity in craniofacial microsomia (CFM) based on conventional radiographs have shown low interrater reproducibility among craniofacial surgeons. We sought to design and validate a classification based on 3-dimensional CT (3dCT) that correlates features of the deformity with surgical treatment. Methods: CFM mandibular deformities were classified as normal (T0), mild (hypoplastic, likely treated with orthodontics or orthognathic surgery; T1), moderate (vertically deficient ramus, likely treated with distraction osteogenesis; T2), or severe (ramus rudimentary or absent, with either adequate or inadequate mandibular body bone stock; T3 and T4, likely treated with costochondral graft or free fibular flap, respectively). The 3dCT face scans of CFM patients were randomized and then classified by craniofacial surgeons. Pairwise agreement and Fleiss' κ were used to assess interrater reliability. Results: The 3dCT images of 43 patients with CFM (aged 0.1–15.8 years) were reviewed by 15 craniofacial surgeons, representing an average 15.2 years of experience. Reviewers demonstrated fair interrater reliability with average pairwise agreement of 50.4 ± 9.9% (Fleiss' κ = 0.34). This represents significant improvement over the Pruzansky–Kaban classification (pairwise agreement, 39.2%; P = 0.0033.) Reviewers demonstrated substantial interrater reliability with average pairwise agreement of 83.0 ± 7.6% (κ = 0.64) distinguishing deformities requiring graft or flap reconstruction (T3 and T4) from others. Conclusion: The proposed classification, designed for the era of 3dCT, shows improved consensus with respect to stratifying the severity of mandibular deformity and type of operative management.
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Abstract
There is a wide variety of developmental maxillofacial anomalies secondary to defective transformation of the first pair of pharyngeal arches into adult structures. Computed tomography and magnetic resonance imaging are essential to precisely define aberrant maxillofacial anatomy and guide appropriate management. This review article provides an overview of maxillofacial embryogenesis, clinical symptoms, and characteristic imaging features of several anomalies, including choanal atresia, congenital nasal piriform aperture stenosis, dacryocystoceles, nasolacrimal duct stenosis, cleft lip and palate, micrognathia, and midline nasal masses. Finally the major features of common first pharyngeal arch syndromes are discussed.
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Affiliation(s)
- Daniel J G Baxter
- Department of Diagnostic Imaging, Neuroradiology Division, The Hospital for Sick Children, Toronto, Canada
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Albuquerque M, Gaia B, Cavalcanti M. Oral cleft volumetric assessment by 3D multislice computed tomographic images. Int J Oral Maxillofac Surg 2011; 40:1280-8. [DOI: 10.1016/j.ijom.2011.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 04/08/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
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Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate. ACTA ACUST UNITED AC 2011; 112:249-57. [DOI: 10.1016/j.tripleo.2011.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/03/2011] [Accepted: 03/04/2011] [Indexed: 11/21/2022]
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Radiological evidence of Goldenhar syndrome in a paleopathological case from a South German ossuary. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2008; 59:453-61. [PMID: 18996519 DOI: 10.1016/j.jchb.2008.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 02/11/2008] [Indexed: 11/21/2022]
Abstract
We investigated the skull of a juvenile living in Southern Germany between 1400 and 1800 A.D. A remarkable hemifacial microsomia led to further detailed computed tomographic examination especially of the petrous bone revealing a total bony atresia of the external auditory canal as well as distinct anomalies of the middle ear on the same side. The combination of these findings strongly suggests the diagnosis of Goldenhar syndrome. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development, whereby the constellation of anomalies indicate their origin at approximately 30-45 days of gestation, caused by genetic or intrauterine factors. Despite the lack of clinical information and the absence of soft tissue it was possible to perform a differential diagnosis in this palaeopathological case. Thereby, the use of modern modalities of image reconstructions in this computed tomographic clearly enhanced the supposed diagnosis.
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Santos KCP, Dutra MEP, Costa C, Lascala CA, Lascala CE, de Oliveira JX. Aplasia of the mandibular condyle. Dentomaxillofac Radiol 2007; 36:420-2. [PMID: 17881603 DOI: 10.1259/dmfr/23852698] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A rare case of aplasia of the mandibular condyle is presented along with the tomographic findings. A 31-year-old Caucasian woman presented with a main complaint of facial asymmetry. No family history or any trauma was found. A CT study was performed and the sagittal CT view demonstrated a complete absence of the left condyle. This case of unknown aetiology was thoroughly examined and, based on clinical findings, we suggest that it could be of developmental origin.
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Affiliation(s)
- K C P Santos
- Department of Oral Radiology, School of Dentistry, University of Sao Paulo, Brazil
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Khadir K, Habibeddine S, Bouanane N, Lakhdar H. [Multiple accessory tragi and Goldenhar's syndrome]. Arch Pediatr 2006; 13:1557-8. [PMID: 17064884 DOI: 10.1016/j.arcped.2006.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 08/10/2006] [Indexed: 11/28/2022]
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Clinical and imaging correlations of Treacher Collins syndrome: report of two cases. ACTA ACUST UNITED AC 2006; 103:836-42. [PMID: 17531943 DOI: 10.1016/j.tripleo.2006.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 03/09/2006] [Accepted: 04/22/2006] [Indexed: 11/25/2022]
Abstract
Mandibulofacial dysostosis (Treacher Collins Syndrome) is an autosomal dominant genetic disorder that probably derives from inhibition of the facial structures from the first and second branchial arches. The facial pattern of the syndrome is a convex facial profile with a prominent nose above a retruded chin. The eyes are deformed by antimongoloid slant of the palpebral fissures and facial bones are hypoplastic. The alterations are caused by mutation in gene 5q32-33.1, which encodes the nucleolar phosphoprotein treacle. Computed tomography images are able to demonstrate craniofacial bones, allowing the morphological analysis of these bones in individuals with complex deformities. The purpose of this paper is to present the results of a clinical and computed tomography investigation of two patients with Treacher Collins syndrome.
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Woodworth BA, Meetze K, Schlosser RJ. Chronic rhinosinusitis in congenital craniofacial malformations. Int J Pediatr Otorhinolaryngol 2006; 70:247-52. [PMID: 16085320 DOI: 10.1016/j.ijporl.2005.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 06/06/2005] [Accepted: 06/06/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To review developmental abnormalities and iatrogenic alterations in sinus anatomy that may predispose patients with congenital craniofacial malformations to chronic rhinosinusitis. STUDY DESIGN Retrospective study. METHODS Seven patients with craniofacial malformations who were surgically treated by the senior author were included in the study. All were diagnosed with chronic rhinosinusitis refractory to medical management. Four patients had undergone previous corrective craniofacial surgery, and three of these patients developed iatrogenic sinus disease. Demographic data, diagnoses and anatomical abnormalities were included. RESULTS Abnormal sinus anatomy was present in all patients, most commonly skull base abnormalities and dehiscent lamina papyracea. All patients underwent successful endoscopic surgical management (n = 7) for their chronic rhinosinusitis. Two patients had adjuvant external procedures. There were no complications and no recurrences after a mean follow up time of 15 months. CONCLUSIONS Otolaryngologists should be aware of the possibility of chronic rhinosinusitis in patients with craniofacial malformations. Careful preoperative evaluation of radiographic studies should be performed as most of these patients will have abnormal sinus anatomy. In addition, patients who undergo surgery to correct their craniofacial malformations are susceptible to altered sinus anatomy that may predispose them to the development of iatrogenic chronic rhinosinusitis.
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Affiliation(s)
- Bradford A Woodworth
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, 29425, USA
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Gaia BF, Perella A, de Cara ACB, Antunes JLF, Cavalcanti MGP. CT interpretation of craniofacial anomalies: a comparative analysis by undergraduate dental students. Braz Oral Res 2005; 19:58-62. [PMID: 16229358 DOI: 10.1590/s1806-83242005000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the accuracy and reproducibility of computed tomography (CT) image interpretation made in axial slices (2D-CT) and 3D reconstructed images (3D-CT) of patients with craniofacial anomalies. The analyses were made by undergraduate dental students, and compared with the diagnoses considered upon surgical intervention. Computed tomography of 43 patients were analyzed independently by three calibrated examiners (undergraduate students) with, respectively, one, two, and three semesters of experience in craniofacial CT training and interpretation. The analysis of 2D-CT and 3D-CT images were performed at distinct times using an independent workstation associated with a specific computer graphics software for volumetric images. The analysis of inter-examiner agreement and of the agreement between observers and the gold standard was performed using the Kappa test. The accuracy evaluation presented a progressively higher value for examiners with progressively broader experience in 2D-CT and 3D-CT image interpretation. 3D-CT analyses allowed a higher inter-examiner agreement (1 - 0.896) than 2D-CT analyses (1 - 0.614). 3D-CT was considered more precise and accurate than 2D-CT for all students' evaluations. The reproducibility and accuracy varied according to the experience in CT interpretation, and the most experienced student achieved results closer to the gold standard.
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Affiliation(s)
- Bruno Felipe Gaia
- Department of Social Dentistry, School of Dentistry, University of São Paulo
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