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Pak S, Bous RM, Acosta Lenis C, Kumar AR, Valiathan M. A 3-Dimensional Evaluation of the Effects of Unilateral Vertical Mandibular Distraction Osteogenesis on Airway Volume Among Patients With Hemifacial Microsomia. Cleft Palate Craniofac J 2024; 61:1157-1163. [PMID: 36891580 DOI: 10.1177/10556656231158984] [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] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). DESIGN This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. RESULTS Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability (r > .86, P < .001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% (P = .043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 (P = .044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant (P > .05), but an increase in the mean values were observed. CONCLUSION Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD.
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Affiliation(s)
- Sarah Pak
- Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Rany M Bous
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Claudia Acosta Lenis
- Department of Craniofacial and Special Care Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Anand R Kumar
- Department of Plastic and Reconstructive Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Manish Valiathan
- Department of Craniofacial and Special Care Orthodontics, Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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Xing L, Liu Y, Wu J, Song C, Jiang B. Spatial and Temporal Expression of Ectodysplasin-A Signaling Pathway Members During Mandibular Condylar Development in Postnatal Mice. J Histochem Cytochem 2023; 71:631-642. [PMID: 37731334 PMCID: PMC10617443 DOI: 10.1369/00221554231201691] [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] [Indexed: 09/22/2023] Open
Abstract
A growing body of evidence emerging supported that ectodysplasin-A (EDA) signaling pathway contributed to craniofacial development. However, their expression in condyle has not been elucidated yet. This study investigated the expression patterns of EDA, EDA receptor (EDAR), and EDAR-associated death domain (EDARADD) in condyle of postnatal mice. Histological staining and micro-computed tomography (CT) scanning showed that as endochondral ossification proceeded, the thickness of chondrocyte layer decreased, and the volume of mandibular condyle increased. Osteoclasts remained active throughout the condylar development. Immunohistochemistry staining demonstrated that EDA was expressed in almost all layers during the first 2 weeks after birth. EDA shifted from the mature and hypertrophic layers to fibrous and proliferating layers at postnatal 3 weeks. As condyle matured, the distribution of EDA tended to be limited to hypertrophic layer. The distribution patterns of EDAR and EDARADD were consistent with EDA, while the level of EDAR expression was slightly lower. mRNA expression levels of EDA signaling pathway-related components increased after birth. Furthermore, we evaluated the expression of EDA using ATDC5 in vitro. EDA increased during the late stage of chondrogenesis. These findings proved that EDA signaling pathway was involved in condylar development and acted as a regulatory factor in condylar maturation and differentiation.
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Affiliation(s)
- Ludan Xing
- Department of Pediatric Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Yuan Liu
- Department of Pediatric Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Jiayan Wu
- Department of Pediatric Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Chenyu Song
- Department of Pediatric Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Beizhan Jiang
- Department of Pediatric Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
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Ma LK, Zhang ZY, Tang XJ, Xu X, Feng S, Zhao SB, Shu KY, Liu BY, Zang TY, Liu W. Respiratory outcome of mandibular distraction osteogenesis on obstructive sleep apnea in craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00079-3. [PMID: 37355371 DOI: 10.1016/j.jcms.2023.05.006] [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: 12/22/2022] [Revised: 02/09/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
This study aimed to evaluate the effect of mandibular distraction osteogenesis (MDO) on respiratory function in CFM patients with obstructive sleep apnea (OSA) according to polysomnography (PSG). This study retrospectively analyzed patients with CFM who underwent PSG before surgery and after completion of mandible distraction. Patients who met the inclusion criteria were selected. The Pediatric Sleep Questionnaire (PSQ) was used to assess patients' signs and symptoms related to OSA. The obstructive apnea-hypopnea index (OAHI) and lowest oxygen saturation (LSaO2) were imported into SPSS version 26.0. The Wilcoxon signed-rank test was used to assess the differences in PSG before and after MDO. Other data were described using descriptive statistics. A P-value less than 0.05 was considered statistically significant. A total of 25 unilateral CFM patients were included in this study. Most patients (72%) had mild OSA; moderate and severe OSA were 12% and 16%, respectively. Snoring (52%) was the most common symptom among these patients. After completion of mandibular distraction, snoring and other OSA-related symptoms were significantly improved. Twelve patients had normalized PSG and the severity of OSA improved significantly in 3 patients. The total effective rate of MDO for OSA was 60%. The statistical results showed that OAHI (P = 0.045) decreased and LSaO2 (P = 0.009) increased significantly compared to preoperative values. MDO can improve OSA-related symptoms in CFM patients. In addition, respiratory function was improved in most patients after MDO, based on PSG. CFM patients, especially those with OSA, can benefit from MDO.
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Affiliation(s)
- Lun-Kun Ma
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Zhi-Yong Zhang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Xiao-Jun Tang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Xi Xu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Shi Feng
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Shan-Baga Zhao
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Kai-Yi Shu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Bing-Yang Liu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Tian-Ying Zang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Wei Liu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China.
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Ranjitkar S, Wong C, Edwards S, Anderson PJ. Computed tomography assessment of hypodontia and crown size in hemifacial microsomia. Arch Oral Biol 2023; 147:105633. [PMID: 36738488 DOI: 10.1016/j.archoralbio.2023.105633] [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: 07/01/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our aims were to assess the prevalence of hypodontia in unilateral hemifacial microsomia (HFM), and to compare tooth (crown) size between affected and unaffected sides. DESIGN In a retrospective cross-sectional study of South Australians, computed tomography (CT) scans were used to assess hypodontia and crown size (mesiodistal length, buccolingual width and crown height). The inclusion criteria were the absence of other congenital anomalies and the availability of CT scans. The exclusion criteria were the lack of extraction history or reproducible landmarks for morphometric assessment. The final sample comprised 41 participants in both dentitions, including 32 children and 9 adults (median age 13.9 years, range 0.4 - 47.6 years; 19 males and 22 females). Hypodontia was assessed in all participants, and the permanent crown size in 30 (73.2%) participants. Linear mixed-effects models were performed to determine if crown size was significantly different between the two sides, controlling for sex, HFM severity, and tooth and jaw type. RESULTS Hypodontia occurred in none of the participants in the primary dentition, but in 6/30 (20%) participants in the permanent dentition (3/30 each on the affected and unaffected sides). There was no significant difference in the mean crown dimensions between the two sides, but the crown size was larger in males (p < 0.05), except for mesiodistal length, and became progressively smaller with increased HFM severity (p < 0.05). CONCLUSIONS Hypodontia spared the primary dentition but featured prominently in the permanent dentition. The permanent crown dimensions were unaltered between the two sides.
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Affiliation(s)
- Sarbin Ranjitkar
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.
| | - Calvin Wong
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, Australia
| | - Peter J Anderson
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Mesenchymal Stem Cell Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia; Cleft and Craniofacial South Australia, Women's and Children's Hospital, Adelaide, SA, Australia
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Fitriasari S, Trainor PA. Gene-environment interactions in the pathogenesis of common craniofacial anomalies. Curr Top Dev Biol 2022; 152:139-168. [PMID: 36707210 DOI: 10.1016/bs.ctdb.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Craniofacial anomalies often exhibit phenotype variability and non-mendelian inheritance due to their multifactorial origin, involving both genetic and environmental factors. A combination of epidemiologic studies, genome-wide association, and analysis of animal models have provided insight into the effects of gene-environment interactions on craniofacial and brain development and the pathogenesis of congenital disorders. In this chapter, we briefly summarize the etiology and pathogenesis of common craniofacial anomalies, focusing on orofacial clefts, hemifacial microsomia, and microcephaly. We then discuss how environmental risk factors interact with genes to modulate the incidence and phenotype severity of craniofacial anomalies. Identifying environmental risk factors and dissecting their interaction with different genes and modifiers is central to improved strategies for preventing craniofacial anomalies.
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Affiliation(s)
| | - Paul A Trainor
- Stowers Institute for Medical Research, Kansas City, MO, United States; Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, United States.
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Ammoury MJ, Abou Chebel N, Macari AT. Three-dimensional surgical management of a patient with Pruzansky I hemifacial microsomia and severe facial asymmetry: A 4-year follow-up. Am J Orthod Dentofacial Orthop 2022; 161:708-726. [PMID: 35031193 DOI: 10.1016/j.ajodo.2020.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/01/2022]
Abstract
Treatment of hemifacial microsomia is challenging and often requires multiple interventions to restore function and facial esthetics. In this article, the combined orthodontic-surgical treatment of a young patient exhibiting Pruzansky I hemifacial microsomia is reported. The patient was aged 15 years, but his bone age was determined to be 18 years. His facial asymmetry was severe, with the nose and a retrusive chin deviated to the left side and a canted smile. The presurgical phase was aimed at centering the mandibular midline to the center of the chin through the distal movement of the mandibular left buccal dentition. The surgery was planned with 3-dimensional computer-aided surgical simulation and included a LeFort I and unilateral sagittal split osteotomies combined with a genioplasty. This report illustrates the therapeutic stages and a 4-year follow-up of a unique and complex orthognathic surgical approach, chosen among other alternatives and leading to improved function and appearance and stable results.
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Affiliation(s)
- Makram J Ammoury
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Naji Abou Chebel
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony T Macari
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon.
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Sharma AK, Kim DD, Fraser JA. Pearls & Oy-sters: Paradoxical Head Tilt in a Congenital Fourth Nerve Palsy. Neurology 2021; 97:e320-e323. [PMID: 33893197 DOI: 10.1212/wnl.0000000000012082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amit Kumar Sharma
- From the Department of Clinical Neurological Sciences (A.K.S., D.D.K., J.A.F.) and Department of Ophthalmology (J.A.F.), Western University, Canada.
| | - David Dongkyung Kim
- From the Department of Clinical Neurological Sciences (A.K.S., D.D.K., J.A.F.) and Department of Ophthalmology (J.A.F.), Western University, Canada
| | - John Alexander Fraser
- From the Department of Clinical Neurological Sciences (A.K.S., D.D.K., J.A.F.) and Department of Ophthalmology (J.A.F.), Western University, Canada
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Wang R, Xu S, Yang R. What is the impact of distraction osteogenesis on the upper airway of hemifacial microsomia patient with obstructive sleep apnea: a case report. Eur J Med Res 2021; 26:76. [PMID: 34256849 PMCID: PMC8278579 DOI: 10.1186/s40001-021-00547-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/07/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Current research about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes. This case report shows the outcome of DO on the upper airway of a HFM patient with obstructive sleep apnea (OSA) based on the use of computational fluid dynamics (CFD). CASE PRESENTATION An 11-year-old boy was diagnosed as HFM with OSA, and underwent unilateral DO. Polysomnography and CT scans were performed before and 6 months after treatment. After DO, lowest blood oxygen saturation increased from 81% to 95% and apnea and hypopnea index decreased from 6.4 events/hour to 1.2 events/hour. The oropharynx and nasopharynx were obviously expanded. We observed apparently increased average pressure, decreased average velocity and pressure drop in all cross-sections, and largely decreased airflow resistance and maximum velocity entirely in the airway. CONCLUSIONS The results suggest that DO might be effective for the treatment of OSA by expanding the upper airway and reducing the resistance of inspiration.
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Affiliation(s)
- Rongyang Wang
- Department of Stomatology, Qilu Children's Hospital of Shandong University, No 23976, Jingshi Rd, Jinan, 250022, Shandong, China
| | - Shixing Xu
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ruimei Yang
- Department of Stomatology, Qilu Children's Hospital of Shandong University, No 23976, Jingshi Rd, Jinan, 250022, Shandong, China.
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Kamran R, Longmire NM, Rae C, Riff KWYW, Forrest CR, O’Hara J, Bulstrode N, Klassen AF. Concepts Important to Patients With Facial Differences: A Qualitative Study Informing a New Module of the FACE-Q for Children and Young Adults. Cleft Palate Craniofac J 2020; 58:1020-1031. [DOI: 10.1177/1055665620969589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient’s perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Justine O’Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Morphologic and Aerodynamic Changes of Upper Airway in Pediatric Hemifacial Microsomia Patients Undergoing Distraction Osteogenesis. J Craniofac Surg 2020; 31:2132-2135. [PMID: 33136841 DOI: 10.1097/scs.0000000000006899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Current studies on hemifacial microsomia (HFM) patients undergoing unilateral distraction osteogenesis (DO) mainly confined to description of facial morphology. This study was to investigate the effect of unilateral DO on upper airway in pediatric HFM patients using computational fluid dynamics. The investigators implemented the present retrospective study composed of 20 patients (age 9.5 ± 2.5 years, 11 males, 9 females) with moderate HFM performed unilateral DO on the ramus of mandible. Computational fluid dynamics models of the upper airway were obtained based on the computed tomography data sets which were taken before and 6 months after distraction. Morphologic and aerodynamic parameters were respectively computed and compared at peak inspiration. Paired t-tests were used to compare the differences between the before and after parameters with the significance set at P < 0.05. The authors observed that after DO, oropharynx and nasopharynx were the major expanded regions, average pressure increased in all cross-sections, average velocity decreased significantly except in the superior border of the epiglottis plane, and the airflow resistance significantly reduced in the whole upper airway (P < 0.05). The results indicate that unilateral DO may expand the constricted oropharynx and nasopharynx, obtain a relatively symmetrical airway shape and decrease the airflow resistance which consequently reduce the workload necessary for breathing and facilitate inspiration.
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Applications of Computer-Aided Design/Manufacturing Technology in Treatment of Hemifacial Microsomia. J Craniofac Surg 2020; 31:1133-1136. [DOI: 10.1097/scs.0000000000006335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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One-Year Relapse of Mandibular Distraction for Hemifacial Microsomia Using Masseteric Botulinum Toxin Type A Injections. J Craniofac Surg 2018; 29:1737-1741. [PMID: 29894467 DOI: 10.1097/scs.0000000000004687] [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 The relapse of hemifacial microsomia was thought to be highly related to the soft tissue envelope around the mandible angle mainly composed by masseter and medial pterygoid. According to the reason, we tried to apply masseter injection of type A botulinum toxin to weaken the soft envelope tension on the early stage post mandible distraction in adult HFM patients. METHODS Eight patients diagnosed with HFM were studied and randomly assigned to an experimental or control group. Patients in the experimental group were treated with DO, orthognathic surgeries, autologous fat grafting, and bilateral masseter muscle injection with type A botulinum toxin. The patients in control group were treated with the same procedures as the patients in experimental group except for masseter muscle injection with type A botulinum toxin. The recurrence rates of both groups were evaluated and analyzed after nearly 1 year of follow-up. RESULTS The mean recurrence rate was 26.30% ± 11.84% (range 7.62%-37.27%) in the 8 patients after 1-year follow-up. The relapse rate was 16.32% ± 7.78% (7.62%-26.22%) in the experimental group and 36.28% ± 1.03% (34.84%-37.27%) in the control group. There was a significant difference (P = 0.002) between the experimental group and the control group. CONCLUSIONS The combination of DO, orthognathic surgeries, autologous fat particle transplantation, and masseter muscle type A botulinum toxin injection technique could be a comprehensive treatment plan for adult patients of HFM. Furthermore, masseter injection of type A botulinum toxin might be an alternative method to reduce the early recurrence rate of postoperative adult patients of HFM.
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Wang P, Wang Y, Zhang Z, Li X, Ye B, Li J. Comprehensive consideration and design with the virtual surgical planning-assisted treatment for hemifacial microsomia in adult patients. J Craniomaxillofac Surg 2018; 46:1268-1274. [PMID: 29887198 DOI: 10.1016/j.jcms.2018.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Hemifacial microsomia (HFM) is a frequently encountered congenital malformation syndrome involving both hard and soft tissue. Various surgical methods have been described to correct the deformities of HFM in the literature. This study aims to evaluate the therapeutic efficacy for HFM with the assistance of virtual surgical planning (VSP) and 3-dimensionally printed surgical templates. MATERIALS AND METHODS From January 2010 to January 2016, a total of 46 patients were referred to the study. Different surgical procedures under the guidance of VSP and 3-dimensionally printed surgical templates combined with orthodontic treatment were used to correct the deformities. Clinical outcomes were evaluated by comparing the differences of affected-side ramus height, occlusal cant degrees and chin point deviation between the preoperative VSP and postoperative surgical results. RESULTS Satisfactory facial contour and occlusion were achieved with the combination of orthognathic and orthodontic treatment. Postoperative examination results showed that VSP was accurately transferred into actual surgery. The difference between the preoperative design and the postoperative outcome was not statistically significant. CONCLUSION VSP and 3-dimensionally printed surgical templates serve as a reliable method and show great value in improving the accuracy and efficacy of surgical treatment of HFM.
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Affiliation(s)
- Peng Wang
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Yu Wang
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Zhen Zhang
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Xiang Li
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Bin Ye
- Center of Orthognathic and TMJ Surgery, West China Stomatology, Sichuan University, Chengdu, China
| | - Jihua Li
- State Key Laboratory of Oral Diseases and Center of Orthognathic & TMJ Surgery, West China Stomatology, Sichuan University, Chengdu, China.
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Ziermann JM, Diogo R, Noden DM. Neural crest and the patterning of vertebrate craniofacial muscles. Genesis 2018; 56:e23097. [PMID: 29659153 DOI: 10.1002/dvg.23097] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 12/17/2022]
Abstract
Patterning of craniofacial muscles overtly begins with the activation of lineage-specific markers at precise, evolutionarily conserved locations within prechordal, lateral, and both unsegmented and somitic paraxial mesoderm populations. Although these initial programming events occur without influence of neural crest cells, the subsequent movements and differentiation stages of most head muscles are neural crest-dependent. Incorporating both descriptive and experimental studies, this review examines each stage of myogenesis up through the formation of attachments to their skeletal partners. We present the similarities among developing muscle groups, including comparisons with trunk myogenesis, but emphasize the morphogenetic processes that are unique to each group and sometimes subsets of muscles within a group. These groups include branchial (pharyngeal) arches, which encompass both those with clear homologues in all vertebrate classes and those unique to one, for example, mammalian facial muscles, and also extraocular, laryngeal, tongue, and neck muscles. The presence of several distinct processes underlying neural crest:myoblast/myocyte interactions and behaviors is not surprising, given the wide range of both quantitative and qualitative variations in craniofacial muscle organization achieved during vertebrate evolution.
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Affiliation(s)
- Janine M Ziermann
- Department of Anatomy, Howard University College of Medicine, Washington, DC
| | - Rui Diogo
- Department of Anatomy, Howard University College of Medicine, Washington, DC
| | - Drew M Noden
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Wickert NM, Wong Riff KW, Mansour M, Forrest CR, Goodacre TE, Pusic AL, Klassen AF. Content Validity of Patient-Reported Outcome Instruments used with Pediatric Patients with Facial Differences. Cleft Palate Craniofac J 2018; 55:989-998. [DOI: 10.1597/16-148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this systematic review was to identify patient-reported outcome (PRO) instruments used in research with children/youth with conditions associated with facial differences to identify the health concepts measured. Design: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from 2004 to 2016 to identify PRO instruments used in acne vulgaris, birthmarks, burns, ear anomalies, facial asymmetries, and facial paralysis patients. We performed a content analysis whereby the items were coded to identify concepts and categorized as positive or negative content or phrasing. Results: A total of 7,835 articles were screened; 6 generic and 11 condition-specific PRO instruments were used in 96 publications. Condition-specific instruments were for acne (four), oral health (two), dermatology (one), facial asymmetries (two), microtia (one), and burns (one). The PRO instruments provided 554 items (295 generic; 259 condition specific) that were sorted into 4 domains, 11 subdomains, and 91 health concepts. The most common domain was psychological (n = 224 items). Of the identified items, 76% had negative content or phrasing (e.g., “Because of the way my face looks I wish I had never been born”). Given the small number of items measuring facial appearance (n = 19) and function (n = 22), the PRO instruments reviewed lacked content validity for patients whose condition impacted facial function and/or appearance. Conclusions: Treatments can change facial appearance and function. This review draws attention to a problem with content validity in existing PRO instruments. Our team is now developing a new PRO instrument called FACE-Q Kids to address this problem.
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Song RB, Kent M, Glass EN, Davis GJ, Castro FA, de Lahunta A. Hemifacial Microsomia in a Cat. Anat Histol Embryol 2017; 46:497-501. [PMID: 28718994 DOI: 10.1111/ahe.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/12/2017] [Indexed: 11/27/2022]
Abstract
A 7-month-old domestic medium hair cat presented with facial asymmetry affecting the bony and soft tissue structures of the right side of the head including the maxilla, nose, eye and pinna of the ear. Additionally, neurological dysfunction of the facial and vestibulocochlear nerves on the affected side was present. A congenital malformation affecting the first and second embryologic pharyngeal arches was suspected. This is the first case of hemifacial microsomia of likely congenital origin reported in a cat.
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Affiliation(s)
- R B Song
- Department of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Compassion First Pet Hospitals, Tinton Falls, NJ, USA
| | - M Kent
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - E N Glass
- Department of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Compassion First Pet Hospitals, Tinton Falls, NJ, USA
| | - G J Davis
- Department of Surgery, Red Bank Veterinary Hospital, Compassion First Pet Hospitals, Tinton Falls, NJ, USA
| | - F A Castro
- Department of Radiology, Red Bank Veterinary Hospital, Compassion First Pet Hospitals, Tinton Falls, NJ, USA
| | - A de Lahunta
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Al-Mahdi AH, Al-Hasnawi SN, Al-Jumaily HA. Changes in Soft Tissue Measurements After Mandibular Distraction Osteogenesis. J Craniofac Surg 2016; 27:e702-e707. [DOI: 10.1097/scs.0000000000003029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ongkosuwito E, van der Vlies L, Kraaij V, Garnefski N, van Neck H, Kuijpers-Jagtman AM, Hovius S. Stress in Parents of a Child with Hemifacial Microsomia: The Role of Child Characteristics and Parental Coping Strategies. Cleft Palate Craniofac J 2016; 55:959-965. [PMID: 27632763 DOI: 10.1597/15-229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Examine stress levels of parents of children with hemifacial microsomia (HFM) and the relationship of parental stress to child characteristics and cognitive coping strategies. DESIGN Prospective cross-sectional study. PARTICIPANTS AND SETTING Parents with a child (age 3-19 years) with HFM (N = 31) were recruited through the Department of Orthodontics and the Craniofacial Center, Sophia-Erasmus Medical Center, Rotterdam, The Netherlands. Intervention and Outcome Measures: The adapted and shortened Dutch version of the parental stress index (NOSI-K) was used to measure parental stress, and the cognitive emotion-regulation questionnaire was used to measure cognitive coping strategies. Pearson correlations and a multiple regression analysis were performed. RESULTS The hierarchical multiple regression analysis showed associations between increased parental stress and learning difficulties and use of acceptance as a coping strategy. This suggests that problems other than the characteristic visual appearance of the child's face in HFM have a greater influence on parental stress. CONCLUSIONS Learning difficulties of the child with HFM and parental acceptance affect stress in parents with a child with HFM the most and are important in the search for a targeted tailoring of intervention for parents with high levels of parental stress.
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Luo E, Yang S, Du W, Chen Q, Liao C, Fei W, Hu J. Bimaxillary Orthognathic Approach to Correct Skeletal Facial Asymmetry of Hemifacial Microsomia in Adults. Aesthetic Plast Surg 2016; 40:400-9. [PMID: 26908014 DOI: 10.1007/s00266-015-0590-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 11/13/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hemifacial microsomia (HFM) is the second most common congenital craniofacial deformity after cleft lip and palate. Distraction osteogenesis (DO) is regarded as an alternative and efficient treatment option for patients with HFM. However, DO was not proven effective for all cases, and the results of long-term follow-up were not satisfactory as expected. Compared with DO, the orthognathic surgery approach may offer more stable clinical outcomes for this kind of disease. The purpose of this study is to evaluate the long-term clinical and radiographic outcome of bimaxillary orthognathic surgery in the treatment of adult HFM. METHODS Eight patients with HFM who had undergone bimaxillary orthognathic surgery between 2008 and 2012 were included in the study. The surgical procedures included Le Fort I osteotomy, inverted-L osteotomy, sagittal split ramus osteotomy, genioplasty, and iliac bone grafting. Pre- and postoperative orthodontic treatments were performed, respectively. Clinical and radiographic examinations were carried out to assess postoperative outcomes. RESULTS No obvious complications appeared postoperatively and no recurrences occurred during follow-up. All patients obtained satisfactory aesthetic results. Marked improvement in facial contour and occlusion were observed. Plain radiographs showed that the height ratios between the affected and unaffected ramus were ameliorated significantly. CONCLUSION The bimaxillary orthognathic approach to correct the deformity of adult HFM can obtain stable results in the long-term follow-up, and should be considered as a priority method for the treatment of adult patients with dentofacial deformity. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- En Luo
- West China Hospital of Stomatology, State Key Laboratory of Oral Disease, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Shimao Yang
- West China Hospital of Stomatology, State Key Laboratory of Oral Disease, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wen Du
- West China Hospital of Stomatology, State Key Laboratory of Oral Disease, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qianming Chen
- West China Hospital of Stomatology, State Key Laboratory of Oral Disease, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Chuhang Liao
- Department of Stomotology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China
| | - Wei Fei
- Department of Stomotology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China.
| | - Jing Hu
- West China Hospital of Stomatology, State Key Laboratory of Oral Disease, Sichuan University, Chengdu, 610041, People's Republic of China.
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Abstract
Teeth are housed in mandible and maxilla and are known to undergo variations in clinical presentation depending on the degree of abnormality during growth and development. It is essential to identify these variations in normal anatomy so that appropriate treatment can be initiated to address the anomaly. Some normal anatomic variations are harmless and best left alone, whereas others require intervention. Radiology plays a vital role in identification of such anomalies. This article focuses on the diagnostic radiographic interpretation and strategies to include pertinent differential diagnosis. Also discussed is the importance of advanced imaging and its appropriateness in the diagnosis and interpretation.
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Parker SE, Starr JR, Collett BR, Speltz ML, Werler MM. Nausea and vomiting during pregnancy and neurodevelopmental outcomes in offspring. Paediatr Perinat Epidemiol 2014; 28:527-35. [PMID: 25327160 PMCID: PMC4232991 DOI: 10.1111/ppe.12151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nausea and vomiting during pregnancy (NVP) is the most common complication of pregnancy. NVP has been associated with improved fetal outcomes, but its association with childhood neurodevelopmental outcomes has rarely been studied. METHODS Subjects were children aged 5-12 years (n = 560) who were controls in a previously conducted case-control study of prenatal risk factors for craniofacial malformations. Information on NVP, including trimester, duration, and treatment, was collected through a maternal interview conducted within 3 years of delivery. Neurocognition was assessed using the Peabody Picture Vocabulary Test (PPVT-III) and the Beery-Buktenica Test of Visual Motor Integration-Fifth Edition (VMI-5). Psychosocial outcomes, including internalising and externalising behaviour problems, were measured by maternal report, using the Child Behavior Checklist (CBCL), and teacher report, using the Teacher Report Form. Linear regression models were used to calculate adjusted mean (adjMD -3.04, 95% confidence interval (CI) -5.02, -1.06) differences (adjMD) and 95% confidence intervals [CI] on test scores for children exposed and unexposed to NVP in utero. Differences based on trimester, duration, and treatment were assessed. RESULTS NVP was reported among 63% of women and was most common in early pregnancy. Children exposed to NVP performed worse on the VMI-5 [-3.04, 95% CI: -5.02, -1.06] but exhibited few other differences from unexposed children. Durations of NVP ≥4 months were associated with poorer scores on PPVT-III (adjMD -2.52), VMI-5 (adjMD -5.41), and CBCL [adjMD 3.38 (internalising) and adjMD 4.19 (externalising)]. CONCLUSIONS Overall, there were few differences between children exposed and unexposed to NVP. NVP was associated with slightly worse visual motor performance, and prolonged NVP and NVP extending late into pregnancy were associated with poorer scores on several neurodevelopmental measures.
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Affiliation(s)
| | | | - Brent R. Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matthew L. Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Shibazaki-Yorozuya R, Yamada A, Nagata S, Ueda K, Miller AJ, Maki K. Three-dimensional longitudinal changes in craniofacial growth in untreated hemifacial microsomia patients with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2014; 145:579-94. [PMID: 24785922 DOI: 10.1016/j.ajodo.2013.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 09/01/2013] [Accepted: 09/01/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the concept that the affected and contralateral sides do not grow at the same rate in patients with hemifacial microsomia. Changes in the cranial base, maxilla, mandible, and occlusal plane were evaluated on 3-dimensional images from cone-beam computed tomography data in untreated patients. METHODS Six patients were classified as having mandibular Pruzansky/Kaban type I, IIA, or IIB hemifacial microsomia. Cone-beam computed tomography (MercuRay; Hitachi, Tokyo, Japan) scans were taken before orthodontic treatment during both growth and postpuberty periods. RESULTS The cranial base as defined by the position of the mastoid process was in a different position between the affected and contralateral control sides. The nasomaxillary length or height was shorter on the affected side for all 6 patients with hemifacial microsomia regardless of its severity, and it grew less than on the contralateral control side in 5 of the 6 patients. The occlusal plane angle became more inclined in 4 of the 6 patients. The mandibular ramus was shorter on the affected side in all patients and grew less on the affected side in 5 of the 6 patients. The mandibular body grew slower, the same, or faster than on the control side. CONCLUSIONS The cranial base, position of the condyle, lengths of the condyle and ramus, and positions of the gonial angle and condyle can vary between the affected and contralateral control sides of patients with hemifacial microsomia, with the ramus and nasomaxillary length usually growing slower than they grow on the control side. These results suggest that many factors affect the growth rate of the craniofacial region and, specifically, the mandible in patients with hemifacial microsomia.
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Affiliation(s)
- Reiko Shibazaki-Yorozuya
- Assistant professor, Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan.
| | - Akira Yamada
- Lecturer, Department of Plastic and Reconstructive Surgery, Osaka Medical School, Osaka, Japan; visiting professor, World Craniofacial Foundation, Dallas, Tex
| | - Satoru Nagata
- Director, Nagata Microtia and Reconstructive Plastic Surgery Clinic, Saitama, Japan; visiting professor, Department of Plastic and Reconstructive Surgery, University of California Irvine School of Medicine, Irvine, Calif
| | - Kouichi Ueda
- Professor and chair, Department of Plastic and Reconstructive Surgery, Osaka Medical School, Osaka, Japan
| | - Arthur J Miller
- Professor, Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, Calif
| | - Koutaro Maki
- Professor and chair, Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
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Choi SH, Kang DY, Hwang CJ. Adult patient with hemifacial microsomia treated with combined orthodontics and distraction osteogenesis. Am J Orthod Dentofacial Orthop 2014; 145:72-84. [DOI: 10.1016/j.ajodo.2013.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 10/25/2022]
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Murdoch-Kinch CA. Craniofacial Anomalies. Oral Radiol 2014. [DOI: 10.1016/b978-0-323-09633-1.00032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Heike CL, Hing AV, Aspinall CA, Bartlett SP, Birgfeld CB, Drake AF, Pimenta LA, Sie KC, Urata MM, Vivaldi D, Luquetti DV. Clinical care in craniofacial microsomia: a review of current management recommendations and opportunities to advance research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2013; 163C:271-82. [PMID: 24132932 DOI: 10.1002/ajmg.c.31373] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Craniofacial microsomia (CFM) is a complex condition associated with microtia, mandibular hypoplasia, and preauricular tags. It is the second most common congenital facial condition treated in many craniofacial centers and requires longitudinal multidisciplinary patient care. The purpose of this article is to summarize current recommendations for clinical management and discuss opportunities to advance clinical research in CFM.
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Luquetti DV, Saltzman BS, Vivaldi D, Pimenta LA, Hing AV, Cassell CH, Starr JR, Heike CL. Evaluation of ICD-9-CM codes for craniofacial microsomia. ACTA ACUST UNITED AC 2012; 94:990-5. [PMID: 22903955 DOI: 10.1002/bdra.23059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/21/2012] [Accepted: 07/01/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Craniofacial microsomia (CFM) is a congenital condition characterized by microtia and mandibular underdevelopment. Healthcare databases and birth defects surveillance programs could be used to improve knowledge of CFM. However, no specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code exists for this condition, which makes standardized data collection challenging. Our aim was to evaluate the validity of existing ICD-9-CM codes to identify individuals with CFM. METHODS Study sample eligibility criteria were developed by an expert panel and matched to 11 ICD-9-CM codes. We queried hospital discharge data from two craniofacial centers and identified a total of 12,254 individuals who had ≥1 potentially CFM-related code(s). We reviewed all (n = 799) medical records identified at the University of North Carolina (UNC) and 500 randomly selected records at Seattle Children's Hospital (SCH). Individuals were classified as a CFM case or non-case. RESULTS Thirty-two individuals (6%) at SCH and 93 (12%) at UNC met the CFM eligibility criteria. At both centers, 59% of cases and 95% of non-cases had only one code assigned. At both centers, the most frequent codes were 744.23 (microtia), 754.0 and 756.0 (nonspecific codes), and the code 744.23 had a positive predictive value (PPV) >80% and sensitivity >70%. The code 754.0 had a sensitivity of 3% (PPV <1%) at SCH and 36% (PPV = 5%) at UNC, whereas 756.0 had a sensitivity of 38% (PPV = 5%) at SCH and 18% (PPV = 26%) at UNC. CONCLUSIONS These findings suggest the need for a specific CFM code to facilitate CFM surveillance and research.
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Affiliation(s)
- Daniela V Luquetti
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington 98101, USA.
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Manni A, Cozzani M, De Rinaldis C, Menini A. Functional and fixed orthodontics-induced growth of an aplastic condyle in a young patient: A case report. Int Orthod 2011. [DOI: 10.1016/j.ortho.2010.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Change of lip and occlusal cant after simultaneous maxillary and mandibular distraction osteogenesis in hemifacial microsomia. J Maxillofac Oral Surg 2011; 9:344-9. [PMID: 22190822 DOI: 10.1007/s12663-010-0157-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the lip and occlusal cant changes in hemifacial microsomia (HFM) cases after simultaneous maxilla and mandibular distraction osteogenesis (DO) of the mandible. PATIENTS AND METHODS Retrospective analysis of all HFM cases at Balaji Dental and Craniofacial Hospital were performed. Patient of either gender with all medical imaging records and pre and post-operative (6 months) facial photographs in natural head position were included in the study. The lip cant change was assessed by the angle of each labial commissure and the bi-pupillary reference line. The line joining the frontozygomatic unions and a parallel line is drawn at the level of anterior nasal spine. The occlusal plane is then traced. A vertical line is traced perpendicular to the frontozygomatic union. The deviation of the occlusal plane from the horizontal is measured as the occlusal cant and a change, between pre and post-operative records was considered as the angle and linear measurements. RESULT With the linear measurement, the mean change in occlusal cant was 7.18 ± 1.47 mm while for the mean change in lip cant was 3.31 ± 0.52 mm (P = 0.120). For the angular measurement, the mean angle change in occlusal cant was 13.86 ± 2.69° and mean change in angle of lip cant was 8.54 ± 0.7° (P = 0.01). DISCUSSION AND CONCLUSION For type1HFM, DO corrects the occlusal and lip cant. In present study, the lip cant change relative to occlusal cant change was 47.54 ± 10.71% in linear measurements while for angular measurements it was 63.19 ± 10.07% (P = 0.476; Pearson's correlation coefficient = -0.241).
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Dhillon M, Mohan RPS, Suma GN, Raju SM, Tomar D. Hemifacial microsomia: a clinicoradiological report of three cases. J Oral Sci 2010; 52:319-24. [PMID: 20587959 DOI: 10.2334/josnusd.52.319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Hemifacial microsomia is a congenital malformation in which there is deficiency in the amount of hard and soft tissues on one side of the face. It is primarily a syndrome of first and second branchial arches involving underdevelopment of the temporomandibular joint, mandibular ramus, masticatory muscles, ears and occasionally defects in facial nerve and muscles. Here, we report three cases of hemifacial microsomia diagnosed based on clinical and radiographic findings. All three cases had variable presentations ranging from the mildest form that included facial asymmetry and ear deformity to the most severe and unusual form with facial nerve paralysis and spine deformity.
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Affiliation(s)
- Manu Dhillon
- Department of Oral Medicine and Radiology, Kothiwal Dental College and Research Centre, Moradabad, India.
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A new hypothesis of mechanisms of traumatic ankylosis of temporomandibular joint. Med Hypotheses 2009; 73:92-3. [PMID: 19261390 DOI: 10.1016/j.mehy.2009.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 01/13/2009] [Accepted: 01/15/2009] [Indexed: 11/20/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is a disease that severely affects the human health. Although it is well known that trauma is the most common cause of TMJ ankylosis, the mechanisms by which the traumatic TMJ ankylosis develops are unclear. The existing hypothesis is not convincing in explaining the genesis of traumatic TMJ ankylosis. We make a hypothesis that the distraction osteogenesis (DO) of the lateral pterygoid muscle combining with the dislocated and damaged disc is an important factor in genesis of traumatic TMJ ankylosis. If this hypothesis is verified, it will be helpful for the prevention of traumatic TMJ ankylosis and change the principle of management of sagittal fracture of mandibular condyle (SFMC).
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Abstract
Hemifacial microsomia (HFM) is a craniofacial disorder characterized by a wide spectrum of anomalies, including conductive hearing loss due to external and middle ear deformities [1]. Hemifacial microsomia is the second most common developmental craniofacial anomaly after cleft lip and palate. Diagnostic imaging is important for presurgical evaluation of patients with this anomaly; however the broad spectrum of abnormalies encountered in patients with hemifacial microsomia can be confusing [2]. We present a case of a hemifacial microsomia in 12 year old male.
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Affiliation(s)
- Sonali Ullal
- Department of Radiodiagnosis, Kasturba Medical College Hospital, Attawar, Mangalore 575 001 India
| | - Ajit Mahale
- Department of Radiodiagnosis, Kasturba Medical College Hospital, Attawar, Mangalore 575 001 India
| | - Kalyan Paudel
- Department of Radiodiagnosis, Kasturba Medical College Hospital, Attawar, Mangalore 575 001 India
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Kaneyama K, Segami N, Hatta T. Congenital deformities and developmental abnormalities of the mandibular condyle in the temporomandibular joint. Congenit Anom (Kyoto) 2008; 48:118-25. [PMID: 18778456 DOI: 10.1111/j.1741-4520.2008.00191.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The temporomandibular joint (TMJ) consists of the mandibular condyle and the articular eminence of the temporal bone. The morphological development of the TMJ during prenatal life lags behind other joints in terms of both the timing of its appearance and its progress. At birth, the joint is still largely underdeveloped. There are many causes of the various growth disturbances and abnormalities of the mandibular condyle and related structures. Growth disturbances in the development of the mandibular condyle may occur in utero late in the first trimester and may result in disorders such as aplasia or hypoplasia of the mandibular condyle. Meanwhile, hyperplasia of the mandibular condyle is not visible at birth and seems to be gradually acquired during growth. In the present review article, the congenital abnormalities of the mandibular condyle are classified morphologically into three major groups and two subgroups from a clinical standpoint: (1) hypoplasia or aplasia of the mandibular condyle, including (i) primary condylar aplasia and hypoplasia, (ii) secondary condylar hypoplasia; (2) hyperplasia; and (3) bifidity. In addition, the molecular-based etiology of anomalies of the mandibular condyle is also discussed.
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Affiliation(s)
- Keiseki Kaneyama
- Department of Oral and Maxillofacial Surgery, School of Medicine, Kanazawa Medical University, Ishikawa, Japan.
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Abstract
Facial asymmetry is a common finding in infants and can be the result of a number of distinctive conditions such as hemifacial microsomia, overgrowth syndromes, a soft tissue tumor, and a vascular malformation. However, overgrowth syndromes such as Beckwith-Wiedemann syndrome (BWS) typically manifest more extensive involvement; it rarely presents as isolated facial overgrowth.Here, we present a 7-year-old boy who presented with facial asymmetry. He was found to have isolated facial hemihyperplasia, involving his right cheek and teeth. No abnormalities were seen in the rest of his examination. The diagnosis of BWS was considered and was confirmed by detection of a methylation abnormality in H19 (DMR1). This case demonstrates that BWS should be considered, even with isolated facial involvement. This is important, as affected patients are predisposed to certain malignancies, especially in the first 5 to 8 years of life. Therefore, specialized surveillance is recommended as the part of management.
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Stosich MS, Bastian B, Marion NW, Clark PA, Reilly G, Mao JJ. Vascularized adipose tissue grafts from human mesenchymal stem cells with bioactive cues and microchannel conduits. TISSUE ENGINEERING 2007; 13:2881-90. [PMID: 17824832 PMCID: PMC4035031 DOI: 10.1089/ten.2007.0078] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vascularization is critical to the survival of engineered tissues. This study combined biophysical and bioactive approaches to induce neovascularization in vivo. Further, we tested the effects of engineered vascularization on adipose tissue grafts. Hydrogel cylinders were fabricated from poly(ethylene glycol) diacrylate (PEG) in four configurations: PEG alone, PEG with basic fibroblast growth factor (bFGF), microchanneled PEG, or both bFGF-adsorbed and microchanneled PEG. In vivo implantation revealed no neovascularization in PEG, but substantial angiogenesis in bFGF-adsorbed and/or microchanneled PEG. The infiltrating host tissue consisted of erythrocyte-filled blood vessels lined by endothelial cells, and immunolocalized to vascular endothelial growth factor (VEGF). Human mesenchymal stem cells were differentiated into adipogenic cells, and encapsulated in PEG with both microchanneled and adsorbed bFGF. Upon in vivo implantation subcutaneously in immunodeficient mice, oil red O positive adipose tissue was present and interspersed with interstitial fibrous (IF) capsules. VEGF was immunolocalized in the IF capsules surrounding the engineered adipose tissue. These findings suggest that bioactive cues and/or microchannels promote the genesis of vascularized tissue phenotypes such as the tested adipose tissue grafts. Especially, engineered microchannels may provide a generic approach for modifying existing biomaterials by providing conduits for vascularization and/or diffusion.
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Affiliation(s)
- Michael S Stosich
- Tissue Engineering and Regenerative Medicine Laboratory, College of Dental Medicine, Columbia University, New York, New York 10032, USA
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Santos DT, Miyazaki O, Cavalcanti MGP. Clinical-embryological and radiological correlations of oculo-auriculo-vertebral spectrum using 3D-CT. Dentomaxillofac Radiol 2003; 32:8-14. [PMID: 12820847 DOI: 10.1259/dmfr/36409607] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this paper is to present a variety of imaging findings of oculo-auriculo-vertebral spectrum (Goldenhar syndrome) using three-dimensional reconstructed images from computed tomography (3D-CT), associating clinical and embryological patterns of the syndrome. METHODS The study population consisted of 10 patients with oculo-auriculo-vertebral spectrum with clinically identified hemifacial microsomia. The patients were examined using spiral CT, and abnormal imaging features were grouped under facial, ear and temporal bone, vertebral, and skull base anomalies. The original CT data were transferred to a networked computer workstation with a computer graphics system to generate 3D-CT volume rendered images of the skull and vertebra. Two observers analysed the bone and muscular setting protocols to assess the relationship between bone and muscular structures. RESULTS Asymmetric underdevelopment was a characteristic pattern of this syndrome resulting from hypoplasia of the mandibular ramus and condyle, the zygomatic, sphenoid and auricular conduct bones, and the temporal and masseter muscles. The syndrome was associated with local atrophy seen on 3D-CT images using specific bone and muscles protocols in all cases. CONCLUSIONS Understanding the aetiology, embryology and wide imaging spectrum of this syndrome is essential to make a correct diagnosis, for treatment planning, and for evaluation when associated with a 3D-CT computer graphics system.
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Affiliation(s)
- D T Santos
- Department of Radiology, College of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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